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Metastatic triple-negative breast cancer - current treatment strategies in the Nordics: a modified Delphi study
Antonis Valachis1, Peeter Karihtala2, Jürgen Geisler3
1Department of Oncology, Faculty of Medicine and Health, Örebro University, Örebro, Örebro, Sweden. antonios.valachis@oru.se.
Background And Purpose:
This study aimed to assess current treatment strategies for metastatic triple-negative breast cancer (mTNBC) and the perceptions of clinical experts in Sweden, Denmark, Norway, Finland, and Iceland, comparing them to international guidelines to provide insights into how these therapies are implemented and adapted to national Nordic guidelines.
Methods:
A three-round modified Delphi method was followed with consensus defined as 70% agreement. A steering committee selected 20 experienced oncologists as panellists and developed the questionnaires. Questions included items related to treatment preferences in different treatment lines with different clinical scenarios in mTNBC patients.
Results:
In the first round, eight out of 33 questions on clinical treatment reached consensus with 14 out of 27 in the second round reaching consensus. In round three, eight out of eight questions reached consensus. The preferred treatment for mTNBC patients with PD-L1 positive was checkpoint inhibitors (CPI) in combination with chemotherapy. For patients with germline BRCA mutation and PD-L1 negative disease, PARP-inhibitors were preferred as 1L and sacituzumab govitecan (SG) in both 2L and later lines. Disagreement was observed for chemotherapy in later lines where evidence is sparse or lacking.
Interpretation:
The high level of consensus for new treatment strategies, such as CPI and PARP-inhibitors in 1L and SG in 2L or later lines, in comparison with the limited consensus for older treatments, such as chemotherapy, may reflect the growing academic evidence for different treatment strategies. Understanding the treatment patterns across different countries contributes to gaining consensus on the upcoming therapeutic advances.
Insights
Nordic experts reached high consensus on new treatments for metastatic triple-negative breast cancer (mTNBC), favoring checkpoint inhibitors (CPI) and PARP-inhibitors over traditional chemotherapy where evidence is limited.
Area of Science:
- Oncology
- Clinical Research
- Medical Guidelines
Background:
- Assessing current treatment strategies for metastatic triple-negative breast cancer (mTNBC) in Nordic countries.
- Comparing expert perceptions with international and national guidelines.
Observation:
- A modified Delphi method with 20 oncologists across Sweden, Denmark, Norway, Finland, and Iceland was employed.
- Three rounds of questionnaires were used to achieve consensus (defined as 70% agreement).
Findings:
- High consensus was reached on newer therapies: checkpoint inhibitors (CPI) plus chemotherapy for PD-L1 positive mTNBC.
- PARP-inhibitors preferred for 1L treatment in BRCA-mutated, PD-L1 negative mTNBC; sacituzumab govitecan (SG) for 2L+.
- Limited consensus observed for chemotherapy in later treatment lines due to sparse evidence.
Implications:
- Growing evidence for novel therapies (CPI, PARP-inhibitors, SG) drives expert consensus.
- Understanding regional treatment patterns is crucial for adopting future therapeutic advances in mTNBC care.
