Arpino Grazia, De Angelis Carmine, Gerratana Lorenzo, Lambertini Matteo, Igidbashian Sarah, Gramigna Rosanna, Guillaume Xavier
Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
Clinical and Translational Oncology, Scuola Superiore Meridionale, Naples, Italy.
BMC Cancer. 2025 May 22;25(1):920. doi: 10.1186/s12885-025-14308-4.
Hormone receptor (HR) positive (HR +) and human epidermal growth factor receptor 2 (HER2) negative (aka HER2 -) breast cancer (BC) is the most frequently diagnosed subtype. Recent development of next-generation endocrine therapies (e.g. selective estrogen receptor degraders (SERDs); third-generation aromatase inhibitors (AI) and targeted therapies (e.g., CDK4/6, PI3K, and mTOR inhibitors)) as well as antibody drugs conjugates (ADC, eg. T-DXd and SG) showed promising results with meaningful improvements in survival for patients with metastatic HR + HER2 - BC. Therapy selection is mainly based on clinical, tumor pathological and molecular characteristics as well as on efficacy based on trial data, nevertheless, side effect profiles are key differentiators of treatments in the metastatic setting. Therefore, understanding how patients evaluate various treatment attributes and how these change in different clinical situations is fundamental toward the choice of optimal therapeutic strategies for treating metastatic HR + HER2 - Stage IV patients. Here, we investigated treatment preferences of a total of 102 stage IV HR + HER2 - breast cancer patients in Italy by developing and applying a survey instrument based on discrete choice experiment (DCE). Treatment efficacy was the top valued attribute across all patient segments and the second most important attribute was the risk of grade ≥ 3 adverse events (AE). Overall, therapies with better outcomes of PFS or AE grade 3 or higher would have a higher impact on the preference to choose a treatment from a patient perspective.
激素受体（HR）阳性（HR +）且人表皮生长因子受体2（HER2）阴性（即HER2 -）乳腺癌（BC）是最常被诊断出的亚型。新一代内分泌疗法（如选择性雌激素受体降解剂（SERDs）、第三代芳香化酶抑制剂（AI））以及靶向疗法（如细胞周期蛋白依赖性激酶4/6（CDK4/6）、磷脂酰肌醇-3-激酶（PI3K）和哺乳动物雷帕霉素靶蛋白（mTOR）抑制剂）的最新进展，以及抗体药物偶联物（ADC，如曲妥珠单抗德瓦鲁单抗（T-DXd）和戈沙妥珠单抗（SG）），在转移性HR + HER2 - BC患者的生存方面取得了有意义的改善，显示出了有前景的结果。治疗选择主要基于临床、肿瘤病理和分子特征以及基于试验数据的疗效，然而，副作用情况是转移性环境中治疗的关键区分因素。因此，了解患者如何评估各种治疗属性以及这些属性在不同临床情况下如何变化，对于选择治疗转移性HR + HER2 - IV期患者的最佳治疗策略至关重要。在此，我们通过开发和应用基于离散选择实验（DCE）的调查工具，对意大利总共102例IV期HR + HER2 - 乳腺癌患者的治疗偏好进行了调查。治疗效果是所有患者群体中最受重视的属性，第二重要的属性是≥3级不良事件（AE）的风险。总体而言，从患者角度来看，无进展生存期（PFS）或3级或更高AE结果更好的疗法对选择治疗的偏好影响更大。
