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Is steroid receptor data useful in patients with metastatic breast cancer?
1Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
Abstract:
Optimal therapy for patients with metastatic breast cancer is unknown. For those with rapidly progressive disease or liver metastases, combination chemotherapy is believed to be the treatment of choice. However, most patients do not fall into that category. For them, two treatment approaches can be considered: (1) ignore estrogen receptor/progesterone receptor (ER/PR) data and treat all patients with hormonal therapy or (2) use ER/PR data and treat patients with ER-/PR- tumors with combination chemotherapy and treat all other patients with hormonal therapy. This report presents a decision analysis for assessing the usefulness of ER/PR data in this situation. The probabilities of response to hormonal therapy were obtained from literature reviews. Patients' utilities or preferences for the various outcomes were estimated by using physicians as patient surrogates. The baseline analysis favored ignoring ER/PR data and treating all patients with hormonal therapy. Extensive sensitivity analyses showed that the decision was most affected by patients' utilities for the various outcomes. The conclusion is that patients' utilities are most important in deciding the usefulness of ER/PR data in metastatic breast cancer.
Insights
For metastatic breast cancer, patient preferences are key to deciding between hormonal therapy and combination chemotherapy. Ignoring estrogen and progesterone receptor (ER/PR) data may be optimal, depending on patient utilities.
Area of Science:
- Oncology
- Medical Decision Making
Background:
- Optimal therapy for metastatic breast cancer remains unclear.
- Standard practice often involves chemotherapy for rapidly progressing disease or liver metastases, but most patients do not fit this profile.
- Two approaches exist: ignoring or utilizing estrogen receptor/progesterone receptor (ER/PR) data to guide treatment selection.
Purpose of the Study:
- To conduct a decision analysis evaluating the utility of ER/PR data in treatment selection for metastatic breast cancer.
- To compare outcomes of ignoring ER/PR data versus using it for treatment decisions.
Main Methods:
- Literature review to determine probabilities of response to hormonal therapy.
- Physician surrogates used to estimate patient utilities for various treatment outcomes.
- Decision analysis model to assess the value of ER/PR information.
Main Results:
- Baseline analysis indicated that ignoring ER/PR data and opting for hormonal therapy was the preferred strategy.
- Sensitivity analyses revealed that patient utilities significantly influenced the decision-making process.
- The choice between treatment strategies is highly dependent on patient preferences.
Conclusions:
- Patient utilities are the most critical factor in determining the usefulness of ER/PR data for metastatic breast cancer treatment.
- The decision to use ER/PR data should be individualized based on patient preferences and potential outcomes.
