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Area of Science:

  • Oncology
  • Clinical Trials
  • Medical Practice

Background:

  • Treatment of metastatic cancer aims to prolong and maintain patient quality of life.
  • Current systemic therapy dosing strategies are being questioned by patients and oncologists.
  • Limited data exists on oncologists' dose selection strategies and beliefs in metastatic cancer care.

Purpose of the Study:

  • To investigate oncologists' experiences with and attitudes toward dose reduction at initiation (DRI) for systemic therapy in metastatic cancer.
  • To understand current practices and beliefs regarding initial dose selection for metastatic cancer treatment.

Main Methods:

  • An international electronic survey was distributed to medical oncologists treating breast and/or gastrointestinal cancers.
  • Survey questions focused on the use of and attitudes toward dose reduction at initiation (DRI).
  • Data was collected from 367 responding oncologists out of 3,099 eligible participants.

Main Results:

  • 52% of oncologists reported using DRI at least 10% of the time to minimize toxicities.
  • Gastrointestinal specialists were more likely to use DRI compared to generalists and breast specialists.
  • 89% of those using DRI discussed efficacy-toxicity tradeoffs with patients; 65% agreed lowering doses for fewer side effects is acceptable, even if it compromises efficacy.
  • 89% supported trials for optimal effective dose determination.

Conclusions:

  • Oncology practice varies in discussing and individualizing starting doses for metastatic cancer.
  • Shared decision-making regarding initial dose selection is needed.
  • Oncologists strongly support clinical studies to define optimal dosing and best practices for individualized care.