Abstract
Purpose
Although metastatic breast cancer (MBC) is treatable, it is not curable and most patients remain on treatment indefinitely. While oncologists commonly prescribe the recommended starting dose (RSD) from the FDA-approved label, patient tolerance may differ from that seen in clinical trials. We report on a survey of medical oncologists’ perspectives about treatment-related toxicity and willingness to discuss flexible dosing with patients.
Methods
We disseminated a confidential survey via social media/email in Spring 2021. Eligible respondents needed to be US-based medical oncologists with experience treating patients with MBC.
Results
Of 131 responses, 119 were eligible. Physicians estimated that 47% of their patients reported distressing treatment-related side effects; of these, 15% visited the Emergency Room/hospital and 37% missed treatment. 74% (n = 87) of doctors reported improvement of patient symptoms after dose reduction. 87% (n = 104) indicated that they had ever, if appropriate, initiated treatment at lower doses. Most (85%, n = 101) respondents did not believe that the RSD is always more effective than a lower dose and 97% (n = 115) were willing to discuss individualized dosing with patients.
Conclusion
Treatment-related side effects are prevalent among patients with MBC, resulting in missed treatments and acute care visits. To help patients tolerate treatment, oncologists may decrease initial and/or subsequent doses. The majority of oncologists reject the premise that a higher dose is always superior and are willing to discuss individualized dosing with patients. Given potential improvements regarding quality of life and clinical care, dose modifications should be part of routine shared decision-making between patients and oncologists.
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Data availability
The dataset used in this study may be available from the corresponding author upon reasonable request.
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by ALL in coordination with PCDI patient advocates and Advisory Board members. The first draft of the manuscript was written by LG and ALL, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Lucy Gao: Affiliation with Massachusetts General Hospital. Aditya Bardia is a consultant/member of advisory board for Pfizer, Novartis, Genentech, Merck, Radius Health, Immunomedics/Gilead, Sanofi, Daiichi Pharma/Astra Zeneca, Phillips, Eli Lilly, and Foundation Medicine and receives contracted Research/Grant (to institution) from Genentech, Novartis, Pfizer, Merck, Sanofi, Radius Health, Immunomedics/Gilead, Daiichi Pharma/Astra Zeneca, and Eli Lilly. Mark E. Burkard is a member of Medical advisory board of Strata Oncology and receives research funding from Abbvie, Arcus, Apollomics, Elevation Oncology, Genentech, Loxo Oncology/Lilly, Puma, and Seagen. Kevin M. Kalinsky reports grants/contracts to his institution from Incyte, Novartis, Genentch, Eli Lilly, Pfizer, Calithera, Immunomedics, Acetylon, Seattle Genetics, Amgen, Zentalis, and CytomX Therapeutics; consulting fees/consultant honorarium from Daiichi Sankyo, Eli Lilly, Pfizer, Novartis, Eisai, AstraZeneca, Immunomedics, Merck, Seattle Genetics, Cyclocel, Oncosec, and 4D Pharma; speakers bureau: Eli Lilly; support for attending meetings and/or travel from Eli Lilly, AstraZeneca, and Pfizer; participation on advisory board (steering committee): Immunomedics, AstraZeneca, Ambryx, and Genentech; and stock options/employment: Grail (spouse), Array BioPharma (spouse), and Pfizer (spouse). Jeffrey Peppercorn reports spouse employment: GSK, Research funding Outcomes4me Inc—to institution, consulting Abbott Labs. Hope S. Rugo receives research support for clinical trials through the University of California: Pfizer, Merck, Novartis, Lilly, Roche, Daiichi, Seattle Genetics, Macrogenics, Sermonix, Boehringer Ingelheim, Polyphor, AstraZeneca, Ayala, Astellas, and Gilead; Honoraria from: Puma, Samsung, Mylan, Chugai, Blueprint, and NAPO; and Travel: GE Healthcare. Martha Carlson receives grant funding from Pfizer/NCCN and serves on a patient panel review for AstraZeneca. Maryam Lustberg is a consultant/member of advisory board for Pfizer, Lily, Astra Zeneca, Sanofi, and Novartis.
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This is an observational study. An Institutional Review Board exemption was obtained from Solutions IRB.
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Loeser, A.L., Gao, L., Bardia, A. et al. Patient-centered dosing: oncologists’ perspectives about treatment-related side effects and individualized dosing for patients with metastatic breast cancer (MBC). Breast Cancer Res Treat 196, 549–563 (2022). https://doi.org/10.1007/s10549-022-06755-5
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DOI: https://doi.org/10.1007/s10549-022-06755-5