Physician experiences and preferences in the treatment of HR+/HER2− metastatic breast cancer in the United States: a physician survey

摘要

Sequential endocrine therapy (ET) is recommended for postmenopausal women with hormone receptor‐positive (HR+)/human epidermal growth factor receptor 2‐negative (HER2−) metastatic breast cancer (mBC) and without visceral symptoms. Chemotherapy (CT) can be considered after sequential ETs, but is associated with adverse side effects. We assessed physicians' preferences and self‐reported prescribing patterns for ET and CT in the treatment of HR+/HER2− mBC at community practices in the United States. Community‐based oncologists/hematologists from a nationwide online panel who treated postmenopausal women with HR+/HER2− mBC were invited to complete a survey, blinded to the identity of study sponsor. Treatment preferences were collected by treatment class of ET‐based regimens versus CT and by agent for postmenopausal style="fixed-case">HR+/ style="fixed-case">HER2− style="fixed-case">mBC patients after prior nonsteroidal aromatase inhibitor use in the adjuvant or style="fixed-case">mBC setting. Among 213 physicians who completed the survey, 78% were male, 71% were based in small/intermediate practices (2–9 oncologists/subspecialists), 55% had >10 years of experience, and 58% referred to the National Comprehensive Cancer Network Guidelines when treating style="fixed-case">mBC. Among first‐line style="fixed-case">ETs, anastrozole was the most frequently used treatment (35%), followed by everolimus‐based ( style="fixed-case">EVE, 34%) and fulvestrant‐based ( style="fixed-case">FUL, 15%) therapy. After first‐line style="fixed-case">ET, the most preferred second‐ and third‐line treatments were style="fixed-case">ET monotherapy (48% and 39%), style="fixed-case">ET combination therapy (31% and 19%), and style="fixed-case">CT monotherapy (13% and 30%). Comparing style="fixed-case">EVE versus style="fixed-case">FUL, physicians preferred style="fixed-case">EVE in all lines but first line. Efficacy was the most important consideration for treatment choice. Physicians prescribed style="fixed-case">CT in early lines mainly because of visceral symptoms. This survey of treatment patterns for style="fixed-case">HR+/ style="fixed-case">HER2− style="fixed-case">mBC in community practice suggested that after first‐line style="fixed-case">ET, style="fixed-case"> ET mono‐ or combination therapy was commonly used for the second‐ and third‐line treatments and style="fixed-case">CT monotherapy for third‐ or later line treatments. style="fixed-case">CTs were used in early lines for patients with visceral symptoms.