Management of early‑stage HER2‑positive breast cancer and attitudes towards HER2DX test in Spain: insights from a nationwide survey

• Olga Martínez Sáez ^[1] ; Aleix Prat ^[1] ; Javier Cortés ^[2] ; Eva Ciruelos ^[3] ; Mercedes Marín Aguilera ^[4] ; Gloria González ^[5] ; Laia Paré ^[4] ; Adriana Herrera ^[4] ; Patricia Villagrasa González ^[4] ; Miguel Martín ^[6]
  1. [1] Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
  2. [2] International Breast Cancer Center, Pangaea Oncology Quironsalud Group, Barcelona, Spain
  3. [3] Department of Medical Oncology, Hospital Universitario, 12 de Octubre, Madrid, Spain
  4. [4] Reveal Genomics, Barcelona, Spain
  5. [5] Adelphi Targis, Barcelona, Spain
  6. [6] Department of Medical Oncology, Hospital Gregorio Marañón, Madrid, Spain

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 26, Nº. 8, 2024, págs. 2060-2069
• Idioma: inglés
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• Resumen

  • Purpose This study aimed to investigate the current therapeutic management of patients with early-stage HER2-positive (HER2+) breast cancer in Spain, while also exploring the perceptions surrounding HER2DX in terms of its credibility, clinical relevance, and impact on therapeutic decision-making. Understanding these aspects is crucial for optimizing treatment strategies and enhancing patient outcomes in the context of HER2+ breast cancer.

    Methods An online questionnaire was conducted by an independent third-party between April and May 2022 across 70 medical oncologists highly specialized in breast cancer management in Spain. The survey included 37 questions regarding treatment decision making in HER2+ early breast cancer.

    Results The management of patients with HER2+ early breast cancer exhibited a high degree of heterogeneity. Among the interviewed oncologists, 53% would recommend upfront surgery for node negative tumors measuring 1 cm or less. Interestingly, 69% and 56% of interviewers were open to deescalate the duration of adjuvant trastuzumab in pT1a and pT1b N0 tumors, respectively. Certain clinicopathological characteristics, such as high grade, high Ki-67, and young age, influenced the decision to prescribe neoadjuvant treatment for patients with clinical stage 1 disease. In cases where neoadjuvant treatment was prescribed for cT1-2 N0 tumors, there was a wide variation in the choice of chemotherapeutic and anti-HER2 regimens. Regarding the use of adjuvant trastuzumab emtansine (T-DM1) in patients with residual disease after neoadjuvant therapy, there was diversity in practice, and a common concern emerged that T-DM1 might be overtreating some patients. HER2DX, as a diagnostic tool, was deemed trustworthy, and the reported scores were considered clinically useful. However, 86% of interviewees believed that a prospective trial was necessary before fully integrating the test into routine clinical practice.

    Conclusion In the context of early-stage HER2+ breast cancer in Spain, a notable diversity in therapeutic approaches was observed. The majority of interviewed medical oncologists acknowledged HER2DX as a clinically valuable test for specific patients, in line with the 2022 SEOM-GEICAM-SOLTI clinical guidelines for early-stage breast cancer. To facilitate the full integration of HER2DX into clinical guidelines, conducting prospective studies to further validate its efficacy and utility was recommended.