Popović Lazar, Borštnar Simona, Božović-Spasojević Ivana, Cvetanović Ana, Dedić Plavetić Natalija, Kaneva Radka, Konsoulova Assia, Matos Erika, Tomić Snježana, Vrdoljak Eduard
Oncology Institute of Vojvodina, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia.
Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia.
Cancers (Basel). 2025 Apr 23;17(9):1412. doi: 10.3390/cancers17091412.
: The treatment landscape in HR+/HER2- metastatic breast cancer (mBC) is continuously evolving, with evidence on new agents and combinations published almost every year. Despite updated therapeutic guidelines, second-line (2L) selection may be challenging due to clinical factors, biomarker status, and available agents. : A two-round Delphi consensus was organized in July 2024, gathering input from 10 experts in research, diagnosis, and treatment of HR+/HER2- mBC on optimal 2L and beyond choice, considering the available biomarkers and results from published clinical trials. Consensus was defined as 70% agreement or disagreement. : The experts considered initially a list of 39 statements, structured into the following four sections: biomarker testing; selection of 2L treatment at progression of disease on first line endocrine therapy (ET) + CDK4/6i at ≥6 months after initiation of ET for mBC; selection of 2L treatment at disease progression on ET + CDK4/6i, at <6 months after initiation of ET for mBC, whilst on ET; and selection of post-2L treatment options. After a discussion, the experts decided to remove four statements, refine ten, and include three new ones. The final list consisted of 38 statements, and consensus was achieved in 37. : The panel recommends next-generation sequencing as the method of choice for genomic characterization at disease progression on first line. The optimal agent or treatment class is indicated depending on the presence of specific mutations; however, the panel admits that the strategy is different in clinical practice, where novel therapies might not be available or reimbursed.
激素受体阳性/人表皮生长因子受体2阴性转移性乳腺癌（mBC）的治疗格局在不断演变，几乎每年都有关于新药物和联合治疗的证据发表。尽管有更新的治疗指南，但由于临床因素、生物标志物状态和可用药物，二线（2L）治疗的选择可能具有挑战性。
2024年7月组织了两轮德尔菲共识会议，收集了10位HR+/HER2- mBC研究、诊断和治疗专家关于最佳2L及后续治疗选择的意见，同时考虑了可用的生物标志物和已发表临床试验的结果。共识定义为70%的同意或不同意。
专家们最初考虑了39条陈述清单，分为以下四个部分：生物标志物检测；一线内分泌治疗（ET）+ CDK4/6抑制剂治疗mBC，在ET开始≥6个月后疾病进展时的2L治疗选择；ET + CDK4/6抑制剂治疗mBC，在ET开始<6个月且仍在接受ET治疗时疾病进展时的2L治疗选择；以及2L后治疗方案的选择。经过讨论，专家们决定删除4条陈述，完善10条，并新增3条。最终清单包含38条陈述，其中37条达成了共识。
专家组建议将下一代测序作为一线疾病进展时基因组特征分析的首选方法。根据特定突变的存在情况指明最佳药物或治疗类别；然而，专家组承认在临床实践中策略有所不同，因为新疗法可能无法获得或无法报销。
