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Abstract
Background
This Delphi study aimed to assess current perspectives on hormone receptor-positive/human epidermal growth factor receptor 2-negative(HR+/HER2−) advanced breast cancer (aBC) treatment strategies across the Nordics, and to establish where consensus exists across the Nordics on HR+/HER2− aBC treatment.
Material and methods
A modified, three-round Delphi method was followed. A steering committee was appointed for study coordination, panellist selection, and questionnaire development. The questionnaires covered relevant topics on HR+/HER2− aBC treatment: treatment patterns in different lines of therapy (first [1L], second [2L], and third [3L]), oligometastatic disease, de novo aBC, brain metastases, age as influential factor, visceral crisis, radiotherapy, diagnostics, and clinical guidelines. Both open and closed-ended questions were included. Consensus was defined as at least 70% agreement.
Results
In total, 28 experienced BC oncologists participated in the study from all five Nordic countries. Overall, topics reaching consensus included: preferred treatment approach in 1L and 2L therapy, treatment of oligometastatic disease, visceral crisis, brain metastases, and age-related treatment considerations. No consensus was reached for 3L therapy and local treatment for primary tumour in de novo aBC. Endocrine therapy (ET) combined with a cyclin-dependent kinase (CDK)4/6 inhibitor was the treatment of choice for 1L and 2L therapy. Treatment patterns in clinical practice did not always follow recommendations in current Nordic guidelines, as seen in the case of recently approved treatments.
Discussion
ET in combination with a CDK4/6 inhibitor is the preferred frontline treatment for HR+/HER2− aBC in the Nordics. The observed discrepancy between current guidelines and clinical practice could be due to differences in the reimbursement of novel treatments in the Nordics. Collaborative research efforts are warranted for topics that lack consensus.
Acknowledgements
The authors would like to acknowledge Catarina Vitor and Inola Subban from Nordic Market Access for editorial support. The authors would also like to acknowledge the Novartis medical team for its support throughout the study.
Disclosure statement
J. Geisler: financial interests, personal and institutional, advisory board, research collaboration through NEOLETRIB study – Novartis; financial interests, personal and institutional, advisory board – Pfizer, AstraZeneca, BMS, Roche, Pierre Fabre, and Lilly.
P. Karihtala: financial interests, personal, advisory board – Pfizer, Pierre Fabre, Lilly, and Novartis; financial interests, personal, expert testimony – Pfizer and Novartis; financial interests, personal, advisory board – MSD and Roche; financial interests, personal, invited speaker – Pfizer, Lilly, and Amgen; financial interests, institutional, invited speaker – Lilly, Novartis, and Sanofi.
M. Tuxen: financial interests, personal, advisory board/consultant tasks – MSD, Pfizer, Novartis, AstraZeneca, Gilead, Pfizer, and Lilly.
A. Valachis: financial interests, institutional, research grant, research grant for a research project on molecular profiling of triple-negative breast cancer – Roche; financial interests, institutional, invited speaker, PRODAT trial – Novartis; financial interests, institutional, invited speaker, CHECKMATE-401 trial – Bristol Myers Squibb; financial interests, institutional, invited speaker, CHECKMATE-76K trial – Bristol Myers Squibb; financial interests, institutional, invited speaker, TELEPIK trial – Novartis; financial interests, institutional, invited speaker, DESTINY-Breast09 trial – AstraZeneca.
C. Ahlin: Novartis, Oxica Pharmaceuticals, and FARON Pharmaceuticals.
C. Bergquist Fosskaug: nothing to declare.
J. Bergqvist: the author has a research grant from AstraZeneca and is cooperating in a research project funded by Novartis in which Novartis takes place on the steering committee.
A. Bosch Campos: the author has received institutional honoraria from Pfizer, Roche, and Lilly for consultation and lectures; participated in advisory board meetings for Pfizer and Novartis and is the co-founder and chair of the board for SACRA Therapeutics.
E. Harder Brix: nothing to declare.
E. Hugger Jakobsen: advisory board with – Pfizer, AstraZeneca, Novartis, and Daichii Sankyo.
A. Bonde Jensen: consulting fee – AstraZeneca; lecture honoraria – Pfizer, Eli Lilly, Seagen Nordic, and Daichii Sankyo.
O. Johannsson: to be added.
M. Jääskeläinen: consulting fees – Amgen, AstraZeneca, BMS, Ipsen, Merck, MSD, Novartis, Pfizer, Roche, Sanofi, Sobi; congress participations – AbbVie, Amgen, MSD, Pfizer, Pierre Fabre, and Roche.
T. Kursetgjerde: nothing to declare.
B. Linderholm: consulting or advisory role – AstraZeneca, Pfizer, Merck, Eli Lilly, and Daiichi Sankyo/UCB Japan.
H. Lindman: research grants – Roche; Lectures – Lilly, AstraZeneca, Daiichi Sankyo, Pierre Fabre; advisory board – Lilly, MSD, Daiichi Sankyo, Novartis, Seattle Genetics, Gilead, and AstraZeneca.
B. Mannsåker: nothing to declare.
U. Narbe: consulting and/or advisory work for Novartis, Lilly, and Exact Sciences.
A. Carmen Porojnicu: honorarium for lecture from BMS and Novartis.
K. Selander: nothing to declare.
S. Songe-Møller: advisory boards, interviews and lectures held for Pfizer, AstraZeneca, Novartis, Eli Lilly, Roche, and Daiichi Sankyo.
E. Støre Blix: consulting or advisory role – AstraZeneca, Daiichi Sankyo, Eli Lilly, Gilead, MSD, and Novartis.
A. Søegaard Knop: to be added.
A. Thulin: honorarium for study participation.
L. Tiainen: consulting or advisory honoraria from Amgen, Bristol Myers Squibb, Merck, Novartis, Pierre Fabre, Pfizer, Roche, and Sanofi.
A. Weder: nothing to declare.
S. Yammeni: to be added.
B. Holm: employee at Novartis, shares in Novartis.
Data availability statement
The data that support the findings of this study are available on request from the corresponding author (P.K.). The data are not publicly available due to restrictions, e.g., their containing information that could compromise the privacy of research participants.