Using Probability for Pathological Complete Response (pCR) as a Decision Support Marker for Neoadjuvant Chemotherapy in HER2 Negative Breast Cancer Patients – a Survey Among Physicians

Abstract

Background In women with early breast cancer, a pathological complete response (pCR) after neoadjuvant chemotherapy is reported to be associated with an improvement of the survival. The aim of this survey among physicians was to investigate whether the probability of achieving pCR in patients with a hormone receptor-positive, HER2-negative disease encourages physicians to recommend neoadjuvant chemotherapy.

Methods The study was conducted via an online survey that was sent to 493 physicians, who were either known as members of national guideline committees, heads of breast cancer centers, being high recruiters in clinical trials or leading a private practice. Participants were asked about a specific case that should resemble patients for whom it is unclear, whether they should be treated with chemotherapy.

Results 113 (24.5%) physicians participated at the survey, out of which 96.5% had a work experience of more than 10 years and 94.7% were board certified in their specialty. A total of 84.1% would consider pCR for a decision concerning neoadjuvant chemotherapy. With regard to the pCR probability, 2.7 and 10.6% of the participants demanded at least a pCR rate of 5 and 10%, respectively, while 25.7% were satisfied with 20% probability, and another 25.7% with a pCR rate of 30%.

Conclusions The vast majority of the long-term experienced physicians would embrace the implementation of a further method such as the prediction of pCR probability in clinical routine to support decision making regarding the necessity of neoadjuvant chemotherapy. The cut-off of around 30% pCR probability seems to be a realizable rate to distinguish patient groups.

Zusammenfassung

Hintergrund Die pathologische Komplettremission (pCR) nach neoadjuvanter Chemotherapie bei Frauen mit Brustkrebs im Frühstadium weist auf eine verbesserte Überlebenswahrscheinlichkeit hin. Ziel dieser Umfrage unter Ärzten war es, zu untersuchen, ob die Wahrscheinlichkeit, dass eine Komplettremission bei Patientinnen mit hormonrezeptorpositivem/HER2-negativem Brustkrebs erreicht wird, Ärzte ermutigen würde, eine neoadjuvante Chemotherapie zu empfehlen.

Methoden Die Studie beruht auf eine Online-Umfrage, die an 493 Ärzte und Ärztinnen geschickt wurde. Alle angeschriebenen Ärzte und Ärztinnen waren entweder Mitglieder nationaler Richtlinien-Kommissionen bzw. Leiter von Brustkrebszentren, hatten bereits viele Patientinnen in klinische Studien rekrutiert oder waren niedergelassene Ärzte bzw. Ärztinnen. Die Teilnehmer wurden nach ihrer Einschätzung eines spezifischen Falles gefragt, wobei der Fall so dargestellt wurde, dass er Ähnlichkeit mit Patientinnen hatte, bei denen die Indikationsstellung für oder gegen Chemotherapie unklar ist.

Ergebnisse Insgesamt nahmen 113 (24,5%) der angeschriebenen Ärzte an der Umfrage teil. Davon hatten 96,5% mehr als 10 Jahre Berufserfahrung, und 94,7% waren Fachärzte. Von den Studienteilnehmern gaben 84,1% an, dass sie die pathologische Komplettremission bei der Entscheidungsfindung für oder gegen neoadjuvante Chemotherapie heranziehen würden. Was die Wahrscheinlichkeit eines pCR betrifft, gaben 2,7 bzw. 10,6% der Teilnehmer an, dass sie eine pCR-Rate von mindestens 5 bzw. 10% erwarteten, wohingegen 25,7% mit einer 20%iger Wahrscheinlichkeit und weitere 25,7% mit einer pCR-Rate von 30% zufrieden wären.

Schlussfolgerungen Die überwiegende Mehrzahl der Ärzte mit langjähriger Erfahrung würden die Einführung einer weiteren Methode als Unterstützungshilfe bei der Entscheidungsfindung, beispielsweise die Voraussage der pCR-Wahrscheinlichkeit, in der klinischen Praxis begrüßen. Ein Schwellenwert von rund 30% für die Wahrscheinlichkeit eines pCR scheint ein geeigneter Wert zu sein, um eine Unterscheidung zwischen verschiedenen Patientinnengruppen vorzunehmen.

Key words

breast cancer - pathological complete response (pCR) - neoadjuvant - chemotherapy

Schlüsselwörter

Brustkrebs - pathologische Komplettremission (pCR) - neoadjuvant - Chemotherapie

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