The MAGIC survey in hormone receptor positive (HR+), HER2-negative (HER2−) breast cancer:: When might multigene assays be of value?

Matti Aapro; Michelino De Laurentiis; Daniel Rea; Juan Enrique Bargallo Rocha; Roberto Elizalde; László Landherr; Barbro Linderholm; Eleftherios Mamounas; Christos Markopoulos; Patrick Neven; Alexander Petrovsky; Roman Rouzier; Vincent Smit; Christer Svedman; Daniel Schneider; Christoph Thomssen; Miguel Martin

doi:10.1016/j.breast.2017.01.012

The MAGIC survey in hormone receptor positive (HR+), HER2-negative (HER2−) breast cancer: When might multigene assays be of value?

Matti Aapro^*
, Michelino De Laurentiis
, Daniel Rea
, Juan Enrique Bargallo Rocha
, Roberto Elizalde
, László Landherr
, Barbro Linderholm
, Eleftherios Mamounas
, Christos Markopoulos
, Patrick Neven
, Alexander Petrovsky
, Roman Rouzier
, Vincent Smit
, Christer Svedman
, Daniel Schneider
, Christoph Thomssen
, Miguel Martin

^*Corresponding author for this work

Cancer Research UK Clinical Trials Unit

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

401 Downloads (Pure)

Abstract

Background

A modest proportion of patients with early stage hormone receptor-positive (HR+), HER2-negative (HER2−) breast cancer benefit from adjuvant chemotherapy. Traditionally, treatment recommendations are based on clinical/pathologic criteria that are not predictive of chemotherapy benefit. Multigene assays provide prognostic and predictive information that can help to make more informed treatment decisions. The MAGIC survey evaluated international differences in treatment recommendations, how traditional parameters are used for making treatment choices, and for which patients treating physicians feel most uncertain about their decisions.

Methods

The MAGIC survey captured respondents' demographics, practice patterns, relevance of traditional parameters for treatment decisions, and use of or interest in using multigene assays. Using this information, a predictive model was created to simulate treatment recommendations for 672 patient profiles.

Results

The survey was completed by 911 respondents (879 clinicians, 32 pathologists) from 52 countries. Chemo-endocrine therapy was recommended more often than endocrine therapy alone, but there was substantial heterogeneity in treatment recommendations in 52% of the patient profiles; approximately every fourth physician provided a different treatment recommendation. The majority of physicians indicated they wanted to use multigene assays clinically. Lack of reimbursement/availability were the main reasons for non-usage.

Conclusions

The survey reveals substantial heterogeneity in treatment recommendations. Physicians have uncertainty in treatment recommendations in a high proportion of patients with intermediate risk features using traditional parameters. In HR+, HER2− patients with early disease the findings highlight the need for additional markers that are both prognostic and predictive of chemotherapy benefit that may support more-informed treatment decisions.

Original language	English
Pages (from-to)	191-199
Number of pages	9
Journal	The Breast
Volume	33
Early online date	22 Apr 2017
DOIs	https://doi.org/10.1016/j.breast.2017.01.012
Publication status	Published - 1 Jun 2017

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Adjuvant chemotherapy
HER2-negative early breast cancer
Hormone receptor-positive
Multigene assay
Treatment decision

ASJC Scopus subject areas

Surgery

Access to Document

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Cite this

Aapro, M., De Laurentiis, M., Rea, D., Bargallo Rocha, J. E., Elizalde, R., Landherr, L., Linderholm, B., Mamounas, E., Markopoulos, C., Neven, P., Petrovsky, A., Rouzier, R., Smit, V., Svedman, C., Schneider, D., Thomssen, C., & Martin, M. (2017). The MAGIC survey in hormone receptor positive (HR+), HER2-negative (HER2−) breast cancer: When might multigene assays be of value? The Breast, 33, 191-199. https://doi.org/10.1016/j.breast.2017.01.012

@article{515ac29a8b71446ea6f71ac34c9e9155,

title = "The MAGIC survey in hormone receptor positive (HR+), HER2-negative (HER2−) breast cancer:: When might multigene assays be of value?",

abstract = "BackgroundA modest proportion of patients with early stage hormone receptor-positive (HR+), HER2-negative (HER2−) breast cancer benefit from adjuvant chemotherapy. Traditionally, treatment recommendations are based on clinical/pathologic criteria that are not predictive of chemotherapy benefit. Multigene assays provide prognostic and predictive information that can help to make more informed treatment decisions. The MAGIC survey evaluated international differences in treatment recommendations, how traditional parameters are used for making treatment choices, and for which patients treating physicians feel most uncertain about their decisions.MethodsThe MAGIC survey captured respondents' demographics, practice patterns, relevance of traditional parameters for treatment decisions, and use of or interest in using multigene assays. Using this information, a predictive model was created to simulate treatment recommendations for 672 patient profiles.ResultsThe survey was completed by 911 respondents (879 clinicians, 32 pathologists) from 52 countries. Chemo-endocrine therapy was recommended more often than endocrine therapy alone, but there was substantial heterogeneity in treatment recommendations in 52\% of the patient profiles; approximately every fourth physician provided a different treatment recommendation. The majority of physicians indicated they wanted to use multigene assays clinically. Lack of reimbursement/availability were the main reasons for non-usage.ConclusionsThe survey reveals substantial heterogeneity in treatment recommendations. Physicians have uncertainty in treatment recommendations in a high proportion of patients with intermediate risk features using traditional parameters. In HR+, HER2− patients with early disease the findings highlight the need for additional markers that are both prognostic and predictive of chemotherapy benefit that may support more-informed treatment decisions.",

keywords = "Adjuvant chemotherapy, HER2-negative early breast cancer, Hormone receptor-positive, Multigene assay, Treatment decision",

author = "Matti Aapro and \{De Laurentiis\}, Michelino and Daniel Rea and \{Bargallo Rocha\}, \{Juan Enrique\} and Roberto Elizalde and L{\'a}szl{\'o} Landherr and Barbro Linderholm and Eleftherios Mamounas and Christos Markopoulos and Patrick Neven and Alexander Petrovsky and Roman Rouzier and Vincent Smit and Christer Svedman and Daniel Schneider and Christoph Thomssen and Miguel Martin",

year = "2017",

month = jun,

day = "1",

doi = "10.1016/j.breast.2017.01.012",

language = "English",

volume = "33",

pages = "191--199",

journal = "The Breast",

issn = "0960-9776",

publisher = "Elsevier",

}

Aapro, M, De Laurentiis, M, Rea, D, Bargallo Rocha, JE, Elizalde, R, Landherr, L, Linderholm, B, Mamounas, E, Markopoulos, C, Neven, P, Petrovsky, A, Rouzier, R, Smit, V, Svedman, C, Schneider, D, Thomssen, C & Martin, M 2017, 'The MAGIC survey in hormone receptor positive (HR+), HER2-negative (HER2−) breast cancer: When might multigene assays be of value?', The Breast, vol. 33, pp. 191-199. https://doi.org/10.1016/j.breast.2017.01.012

TY - JOUR

T1 - The MAGIC survey in hormone receptor positive (HR+), HER2-negative (HER2−) breast cancer:

T2 - When might multigene assays be of value?

AU - Aapro, Matti

AU - De Laurentiis, Michelino

AU - Rea, Daniel

AU - Bargallo Rocha, Juan Enrique

AU - Elizalde, Roberto

AU - Landherr, László

AU - Linderholm, Barbro

AU - Mamounas, Eleftherios

AU - Markopoulos, Christos

AU - Neven, Patrick

AU - Petrovsky, Alexander

AU - Rouzier, Roman

AU - Smit, Vincent

AU - Svedman, Christer

AU - Schneider, Daniel

AU - Thomssen, Christoph

AU - Martin, Miguel

PY - 2017/6/1

Y1 - 2017/6/1

N2 - BackgroundA modest proportion of patients with early stage hormone receptor-positive (HR+), HER2-negative (HER2−) breast cancer benefit from adjuvant chemotherapy. Traditionally, treatment recommendations are based on clinical/pathologic criteria that are not predictive of chemotherapy benefit. Multigene assays provide prognostic and predictive information that can help to make more informed treatment decisions. The MAGIC survey evaluated international differences in treatment recommendations, how traditional parameters are used for making treatment choices, and for which patients treating physicians feel most uncertain about their decisions.MethodsThe MAGIC survey captured respondents' demographics, practice patterns, relevance of traditional parameters for treatment decisions, and use of or interest in using multigene assays. Using this information, a predictive model was created to simulate treatment recommendations for 672 patient profiles.ResultsThe survey was completed by 911 respondents (879 clinicians, 32 pathologists) from 52 countries. Chemo-endocrine therapy was recommended more often than endocrine therapy alone, but there was substantial heterogeneity in treatment recommendations in 52% of the patient profiles; approximately every fourth physician provided a different treatment recommendation. The majority of physicians indicated they wanted to use multigene assays clinically. Lack of reimbursement/availability were the main reasons for non-usage.ConclusionsThe survey reveals substantial heterogeneity in treatment recommendations. Physicians have uncertainty in treatment recommendations in a high proportion of patients with intermediate risk features using traditional parameters. In HR+, HER2− patients with early disease the findings highlight the need for additional markers that are both prognostic and predictive of chemotherapy benefit that may support more-informed treatment decisions.

AB - BackgroundA modest proportion of patients with early stage hormone receptor-positive (HR+), HER2-negative (HER2−) breast cancer benefit from adjuvant chemotherapy. Traditionally, treatment recommendations are based on clinical/pathologic criteria that are not predictive of chemotherapy benefit. Multigene assays provide prognostic and predictive information that can help to make more informed treatment decisions. The MAGIC survey evaluated international differences in treatment recommendations, how traditional parameters are used for making treatment choices, and for which patients treating physicians feel most uncertain about their decisions.MethodsThe MAGIC survey captured respondents' demographics, practice patterns, relevance of traditional parameters for treatment decisions, and use of or interest in using multigene assays. Using this information, a predictive model was created to simulate treatment recommendations for 672 patient profiles.ResultsThe survey was completed by 911 respondents (879 clinicians, 32 pathologists) from 52 countries. Chemo-endocrine therapy was recommended more often than endocrine therapy alone, but there was substantial heterogeneity in treatment recommendations in 52% of the patient profiles; approximately every fourth physician provided a different treatment recommendation. The majority of physicians indicated they wanted to use multigene assays clinically. Lack of reimbursement/availability were the main reasons for non-usage.ConclusionsThe survey reveals substantial heterogeneity in treatment recommendations. Physicians have uncertainty in treatment recommendations in a high proportion of patients with intermediate risk features using traditional parameters. In HR+, HER2− patients with early disease the findings highlight the need for additional markers that are both prognostic and predictive of chemotherapy benefit that may support more-informed treatment decisions.

KW - Adjuvant chemotherapy

KW - HER2-negative early breast cancer

KW - Hormone receptor-positive

KW - Multigene assay

KW - Treatment decision

UR - https://www.scopus.com/pages/publications/85018528007

U2 - 10.1016/j.breast.2017.01.012

DO - 10.1016/j.breast.2017.01.012

M3 - Article

SN - 0960-9776

VL - 33

SP - 191

EP - 199

JO - The Breast

JF - The Breast

ER -