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PO58 CURRENT AND FUTURE MANAGEMENT OF PATIENTS WITH ADVANCED HR+ HER2- ABC WITH PIK3CA MUTATIONS IN THE UK: THE PIK PATHWAY UK PROJECT
Breast ; 59:S47, 2021.
Article in English | EMBASE | ID: covidwho-1599256
ABSTRACT

Background:

This survey aimed to expand understanding of the current and future UK management of patients with HR+ HER2-advanced/metastatic BC with PIK3CA mutations.

Methods:

Surveys were completed at one-to-one meetings with UK oncologists involved in HR+ HER2- aBC management, either in person or by video conference between February and October 2020. Questions (multi-option and open questions and Likert scales) were designed to understand the unmet need for HR+ HER2- aBC patients, current and future PIK3CA testing and treatment sequencing (pre/post-introduction of PI3Ki) and perceptions around managing adverse events. Responses were entered into a digital survey platform.

Results:

264 oncologists were contacted to participate in the survey. Unprecedented pressures on NHS clinicians due to the COVID-19 pandemic limited availability to participate in the survey. As such, 36 oncologists working at 31 geographically-dispersed UK hospitals completed interviews. For HR+ HER2- aBC, 92% oncologists agreed/strongly agreed that the PIK3CA mutation was prognostically significant and 92% agreed/strongly agreed that a PIK3CA mutation was predictive of a response with PI3Ki. 58% oncologists had previously tested for PIK3CA mutations and 33% had clinical experience with PI3Ki. 53% oncologists are currently testing for PIK3CA, 79% of which are testing in the research setting only. Of those currently testing for PIK3CA mutations, 21% test at diagnosis of metastatic disease and the remainder at first- or second-line disease progression. The median (IQR) percentage of patients estimated to have available archival tissue for PIK3CA testing was 80% (33%-95%) including metastatic tissue in 50% (28%-73%). OS followed by PFS and then HRQoL were the priority primary treatment goals. Efficacy was the most important factor driving a decision to use a particular treatment. In the setting of PI3Ki becoming routinely available, the majority of clinicians would use a PI3Ki + fulvestrant as next line therapy following progression on CDK4/6i + AI in patients with a PIK3CA mutation (89% for patients progressing with primary endocrine resistance and 97% for patients progressing with secondary endocrine resistance (ABC guidelines). The PI3Ki-related Grade 1/2 toxicities of most concern to oncologists were diarrhoea and hyperglycaemia (40% and 35% concerned/strongly concerned, respectively). The AE of most concern to patients was thought to be diarrhoea (49% rated diarrhoea as the most concerning AE, 92% placed diarrhoea in the top 3 most concerning AEs). Opinion was that introduction of PI3Ki into UK clinical practice would result in increased utilisation of endocrinology support, increased consultation, clinic and clinician admin time, and more clinical assessments.

Conclusions:

The survey provides contemporary insights into UK aBC treatment pathways, suggesting how PI3Ki may be integrated following progression on first line CDK4/6i, and the potential impact of the general introduction of PI3Ki.

Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Breast Year: 2021 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Breast Year: 2021 Document Type: Article