Management of Early and Metastatic Breast Cancer: A Consensus Statement from Oncologists in Saudi Arabia

In the Kingdom of Saudi Arabia, there is a lack of up-to-date clinical guidelines on the treatment of early-stage or metastatic breast cancer (BC) that are relevant to local resource and financial constraints. Therefore, we aimed to develop consensus statements to provide practical guidance for general oncologists on BC management in the Kingdom that support fair and rational decision-making across institutions.

A panel of medical oncologist experts from the Kingdom of Saudi Arabia was convened. Based on a pragmatic literature review, 35 statements were drafted by two of the participating oncologist experts (S. Alaklabi and M. Alzahrani) that focused on clinical scenarios with lacking/contradictory data while taking into account healthcare resource availability. A modified Delphi process was used (consensus threshold was ≥ 70%); the first round of voting was online and second-round voting was conducted in-person.

Twenty-six panelists voted on each statement in Round 1 and 19 to 23 panelists (not all voted on every statement) voted in Round 2. Consensus was reached on 13 of 20 statements for early BC and on seven of 15 statements for metastatic BC (MBC). Statements on early BC defined the use of adjuvant cyclin-dependent kinase-4/6 inhibitors, neoadjuvant hormonal therapy duration (statements S6-7), and the management of triple-negative BC, where there is residual disease or pathologic complete response is not achieved after neoadjuvant chemoimmunotherapy. Statements on MBC defined the use of trastuzumab deruxtecan in patients with hormone receptor-positive human epidermal growth factor receptor 2 (HER2)-low disease or in patients with HER2+ MBC and brain metastases/leptomeningeal disease, and the use of sacituzumab govitecan in hormone receptor-positive/negative HER2-low MBC. Antibody-drug conjugate sequencing and oligoprogression were also covered.

The consensus statements provide expert guidance for medical oncologists, and it is hoped these statements will help unify clinical practice across the Kingdom.