Perspectives on Balancing Toxicity and Efficacy When Managing Advanced HER2-Negative Breast Cancer with First-Line Treatment

Patients and oncologists are prepared to make trade-offs between efficacy and toxicities, but patients appreciate toxicities impacting quality of life while endeavoring to increase survival.

With the approval of new therapeutic options in the first-line setting, such as CDK4/6 inhibitors, poly (ADP-ribose) polymerase (PARP) inhibitors, and atezolizumab, the treatment armamentarium for HER2-negative metastatic breast cancer has expanded widely. Patients and oncologists must consistently balance trade-offs of efficacy and toxicity. Therefore, this study focused on whether there is agreement or discrepancy between these 2 perspectives, specifically focusing on priorities in cases of triple-negative and hormone-ineligible hormone receptor–positive, HER2-negative metastatic breast cancer.

An online cross-sectional study was conducted recruiting patients with HER2-negative metastatic breast cancer. Advocacy groups and a healthcare research panel were utilized to help with recruitment. The assessment of preferences was conducted by discrete choice experiments in which hypothetical treatment profiles were selected by participants with different attribute levels associated with first-line therapy for metastatic breast cancer treatment, and characteristics were established by using previous qualitative research with oncologists and patients.

Suvina Amin, MPH, FRSPH, Associate Director, Global Real-World Evidence Strategy Tumor Lead, Oncology, AstraZeneca, Gaithersburg, MD, and colleagues’ analysis included 169 patients: 69% with triple-negative disease; 30% with hormone receptor–positive disease with an average age of 54 years; 92% had received chemotherapy; 35% had received hormone therapy; 24% had received CDK4/6 inhibitor or mammalian target of rapamycin inhibitor; and 2% had received immunotherapy. The analysis also included 117 oncologists who had been practicing for an average of 16 years, with 78% working in a community setting.

Patients and oncologists agreed that improving overall survival (OS) by 15 months was most important, and this was at least twice as important as the other characteristics explored in the study. Oncologists regarded all-grade neuropathy as more important than patients did. On the other hand, patients regarded all-grade nausea, alopecia, and grade 3/4 immune-related adverse events more important than oncologists did. While approximately 51% of patients reported a preference of oral therapy (vs intravenous administration) and 25% showed no clear preference, the majority (81%) of oncologists felt that their patients preferred oral therapy. Most importantly, while two-thirds of oncologists felt that patients were more concerned with efficacy of treatment than quality of life, only a third of patients agreed with this assessment. Consideration should be given that patients place higher value on specific toxicities that affect quality of life, despite both clinicians and patients wanting to improve OS.

Source: Amin S, Tolaney SM, Cambron-Mellot MJ, et al. Will oncologists and patients make trade-offs between efficacy and toxicities in first-line treatment of advanced HER2 negative breast cancer? J Clin Oncol. 2020;38(15_suppl). Abstract e19228.