Curigliano Giuseppe, Cardoso Fatima, Gnant Michael, Harbeck Nadia, King Judy, Laenkholm Anne-Vibeke, Penault-Llorca Frédérique, Prat Aleix
European Institute of Oncology, IRCCS, Milan, Italy.
Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy.
NPJ Breast Cancer. 2023 Feb 24;9(1):8. doi: 10.1038/s41523-023-00510-9.
Breast cancer multigene signatures (BCMS) have changed how patients with early-stage breast cancer (eBC) are managed, as they provide prognostic information and can be used to select patients who may avoid adjuvant chemotherapy. Clinical guidelines make recommendations on the use of BCMS; however, little is known on the current use of BCMS in clinical practice. We conduct a two-round Delphi survey to enquire about current use and perceived utility for specific patient profiles, and unmet needs of BCMS. Overall, 133 panellists experienced in breast cancer across 11 European countries have participated, most using BCMS either routinely (66.2%) or in selected cases (27.1%). Our results show that BCMS are mainly used to assess the risk of recurrence and to select patients for adjuvant chemotherapy; notably, no consensus has been reached on the lack of utility of BCMS for selecting the type of chemotherapy to administer. Also, there are discrepancies between the recommended and current use of BCMS in clinical practice, with use in certain patient profiles for which there is no supporting evidence. Our study suggests that physician education initiatives are needed to ensure the correct use and interpretation of BCMS to, ultimately, improve management of patients with eBC.
乳腺癌多基因检测（Breast cancer multigene signatures，BCMS）改变了早期乳腺癌（early-stage breast cancer，eBC）患者的管理方式，因为它们能提供预后信息，并可用于选择可能避免辅助化疗的患者。临床指南对BCMS的使用提出了建议；然而，目前BCMS在临床实践中的使用情况却鲜为人知。我们开展了两轮德尔菲调查，以了解BCMS在特定患者群体中的当前使用情况、感知效用以及未满足的需求。总体而言，来自11个欧洲国家的133名乳腺癌领域经验丰富的专家参与了调查，其中大多数专家常规使用BCMS（66.2%）或在特定病例中使用（27.1%）。我们的研究结果表明，BCMS主要用于评估复发风险和选择辅助化疗患者；值得注意的是，对于BCMS在选择化疗类型方面缺乏效用这一点，尚未达成共识。此外，BCMS在临床实践中的推荐使用与当前使用情况存在差异，在某些患者群体中使用时缺乏支持证据。我们的研究表明，需要开展医生教育活动，以确保正确使用和解读BCMS，最终改善eBC患者的管理。
