Around the Practice: Updates in HER2+ Breast Cancer - Episode 6

HER2+ Breast Cancer: Optimizing Quality of Life

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Breast cancer experts discuss the importance of patient quality of life when considering treatment recommendations for HER2+ breast cancer.

Vijayakrishna Gadi, MD, PhD: Let’s go on to the next polling question. We’re going to transition to more quality-of-life types of things. How important do you think patient quality of life [QoL] is, compared with other considerations when selecting therapy for your patients with metastatic breast cancer? Not important, somewhat important, moderately important, very important? We should have the answers here soon. It looks like it’s very important for most of you and moderately important. Certainly no one should pick not important or somewhat important. It’s front and center on most of our minds. Dr Kaklamani, it’s routine and in vogue certainly to have quality-of-life data associated with your large clinical trials. How do you critically look at those data? Is it important that it comes from a phase 3 study? Is there value and stuff we learned from a phase 1 or 2 trial in terms of quality of life? How do you weigh the importance of the quality-of-life data?

Virginia Kaklamani, MD: There’s value in anything, but obviously these data can be a subject of bias more than the data on response and PFS [progression-free survival]. Phase 3 trial data are extremely important. But honestly, it’s my experience when I treat 3, 4 patients with a specific medication. If I see bad toxicities regardless of everything I do, that probably taints my perception of that medication. People do get biased with their experience on medications, more about quality-of-life and toxicity than response rates.

Vijayakrishna Gadi, MD, PhD: I totally agree with you: the more you use the drug, the better you get at handling it. The trial population is different from the patients we might take care of, different ECOG performance status, and so forth. Dr Iyengar, are there specific QoL data that patients bring up—not what you see but what they bring up—that comes up frequently, especially with some of the agents we’ve talked about tonight?

Neil Iyengar, MD: There are toxicities that contribute to patient-reported outcomes and quality of life, like diarrhea, that we’re familiar dealing with, in terms of neratinib or tucatinib. Where you get into things like fatigue or general deconditioning, that can be a little more gray. We each have our own perspective or experiences with the various agents in terms of overall functioning of a patient. Some of the EORTC instruments that are reported in some of these trials—with regard to time to deterioration, for example—can be useful when interpreting the data and the maintenance of those functioning supports, perhaps with better patient-reported outcomes for an agent. It goes back to this practice and feel that folks get with a drug as Dr Kaklamani mentioned. Specific toxicity certainly contribute, but we have to listen to our patients.

Transcript edited for clarity.