Fabi Alessandra, Buono Giuseppe, Bria Emilio, Bianchini Giampaolo, Curigliano Giuseppe, De Laurentiis Michelino, De Placido Sabino, Del Mastro Lucia, Guarneri Valentina, Generali Daniele, Livi Lorenzo, Lorusso Vito, Montemurro Filippo, Puglisi Fabio, Vigneri Paolo, Zambelli Alberto, Arpino Grazia
Precision Medicine in Breast Cancer Unit, Scientific Directorate, Department of Woman and Child Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Department of Breast and Thoracic Oncology, National Cancer Institute, IRCCS Fondazione G Pascale, Naples, Italy.
Front Oncol. 2022 Sep 9;12:950861. doi: 10.3389/fonc.2022.950861. eCollection 2022.
The treatment of HR+/HER2- metastatic breast cancer with cyclin-dependent kinases 4 and 6 inhibitors combined with endocrine therapy has recently emerged as the most relevant therapeutic strategy. However, in routine clinical practice, the best therapeutic approach in patients with comorbidities at early relapsing or metastatic disease, mutation, is still debated among oncologists. Given these areas of uncertainty, we conducted a Delphi survey to describe and confront the level of agreement or disagreement between clinicians working in referral vs local spoke oncological hospitals and summarize a consensus on these debated topics. In total, 56 items were drafted using the Nominal Group Technique and used for the Delphi Survey. A total of 46 clinicians participated in the survey. Overall, the consensus threshold among all participants was reached in 46/56 items (82%), and Delphi Survey results showed a high level of consensus. For the 10 items (18%) that did not reach the consensus threshold, possible explanations considering differences in clinical practice and recent findings from literature are provided in the Discussion. Outcomes from the present survey may help guide treatment in multiple comorbidities, early recurring and metastatic disease, and mutation, where evidence from randomized trials and level 1 evidence is currently missing.
细胞周期蛋白依赖性激酶4和6抑制剂联合内分泌治疗HR+/HER2-转移性乳腺癌最近已成为最相关的治疗策略。然而，在常规临床实践中，对于早期复发或转移性疾病、合并症患者以及存在突变的患者，最佳治疗方法在肿瘤学家之间仍存在争议。鉴于这些不确定领域，我们进行了一项德尔菲调查，以描述和对比在转诊肿瘤医院与地方肿瘤专科医院工作的临床医生之间的一致或分歧程度，并就这些有争议的话题总结出共识。总共使用名义小组技术起草了56个项目，并用于德尔菲调查。共有46名临床医生参与了调查。总体而言，所有参与者中有46/56个项目（82%）达到了共识阈值，德尔菲调查结果显示出高度的共识。对于未达到共识阈值的10个项目（18%），在讨论中提供了考虑临床实践差异和近期文献研究结果的可能解释。本次调查的结果可能有助于指导在多种合并症、早期复发和转移性疾病以及存在突变的情况下的治疗，而目前缺乏来自随机试验的证据和一级证据。
