There is substantial heterogeneity in the adoption of multi-gene assays in Europe. In a survey among physicians with at least 5 years of experience in treatment of breast cancer, a majority of respondents indicated that would use multi-gene assays in clinical practice in a subset of patients with hormone receptor (HR)-positive, HER2-negative disease, but the main perceived barriers for usage are reimbursement, price, and lack of availability, according to the survey’s results presented in a poster session on Genomics and proteomic analysis of breast cancer by Dr Matti Aapro of the Multidisciplinary Oncology Institute, Geneva, Switzerland at the IMPAKT 2014 Breast Cancer Conference (8-10 May 2014, Brussels, Belgium).
Multidisciplinary application of genomics in clinical practice
It has been demonstrated that multi-gene assays provide prognostic and predictive information beyond traditional parameters. Despite inclusion of some assays in the ESMO, ASCO, NCCN and St. Gallen guidelines for treatment of breast cancer, the access and use of multigene assays internationally is modest. The current use of different assays, the interest from physicians in using these assays, and the main reasons for not using the assays are poorly characterised
The multidisciplinary application of genomics in clinical practice (MAGIC) survey aimed to identify criteria used regarding need of adjuvant chemotherapy for breast cancer and to characterise patients for whom available data are sufficient for a decision and those for whom more data are required for informed decision-making. The survey also assessed adoption of multi-gene assays, usage in practice, and reasons behind non-using them.
The questions in the MAGIC survey questionnaire have been developed by international breast cancer experts and the SKIM group based in Rotterdam, The Netherlands developed the Web online module.
From August 2013 to January 2014 an online survey was distributed among physicians with at least 5 years of experience in breast cancer treatment. Specific trends were evaluated; for smaller countries with population less than 25 million inhabitants, it was required to obtain 25 responses and for countries with more than 25 million inhabitants, at least 50 responses were needed.
Among eligible respondents, 643 physicians from 34 European countries completed the survey. Approximately 75% had more than 10 years of experience in diagnosis and treatment of breast cancer. Eleven countries had a sufficient number of responses to evaluate country specific trends (Belgium, Switzerland, France, Germany, Greece, Hungary, Italy, The Netherlands, Spain, Sweden, Switzerland, and UK).
Results from the survey
MAGIC Survey results: Reasons for non-using multi-gene assays. © Matti Aapro
The results show that 51% of respondents use multi-gene assays in their clinical practice. A trend was observed that respondents who used multigene assays were more likely to request more information for a breast cancer patient profile than those who do not use multigene assays. The usage of multigene assays was higher among respondents who used tools or nomograms to estimate patient prognosis and respondents who did not consider Ki67% along with other existing pathology markers. Of those who had access to multigene assays, 38% indicated that they use them for more than 20% of their ER-positive, HER2-negative, node-negative patients and 22% used them for more than 20% of ER-positive, HER2-negative, node-positive patients.
Among respondents, there is a wide range of usage from less than 20% in Italy and Sweden to more than 80% in Germany, Greece and Netherlands.
Of those who use multi-gene assays, 68% reported to use it in less than 20% of their patients with HR-positive, HER2–negative and lymph nodes negative breast cancer.
The specific multi-gene assays used are Prosigna™ by 1% of respondents, FEMTELLE® by 2%, EndoPredict® by 5%, MammaPrint® by 15%, Oncotype DX® Breast Cancer Assay by 39% and other by 5%.
MammaPrint® is used most in Netherlands and Spain. Oncotype DX is used most elsewhere. In Sweden no multi-gene assays are used.
Of those who do not use multi-gene assays, 85% would like to incorporate them in their practice. They reported lack of reimbursement (51%), price (41%), no availability (35%), no recommended in relevant guidelines (20%), and lack of evidence (19%) as reasons for no use.
Although the survey covered a small portion of breast cancer physicians in Europe, the findings reflects substantial heterogeneity in the adoption of multi-gene assays and in most cases under-usage with underlining problems in reimbursement, cost, and lack of availability, as main barriers for usage.
Reference
Abstract 14P: M.S. Aapro, M. De Laurentiis, E. Mamounas, et al. Adoption of multi-gene assays in HR+, HER2- breast cancer (BC) patients in Europe: Results of the multidisciplinary application of genomics in clinical practice (MAGIC) survey. Annals of Oncology (2014) 25 (suppl_1): i5-i7. 10.1093/annonc/mdu065.
The survey was supported by an unrestricted grant from Genomic Health Inc.
Among the study authors, Dr Aapro reported that serves as an advisory board member for Genomic Health Inc., receives corporate-sponsored research from CarisLifeSciences and Champions, and has other substantive relationships with NGS Agora. Dr De Laurentiis serves as an advisory board member for Genomic Health Inc. Dr Mamounas serves as an advisory board for Genomic Health Inc. and GE Healthcare, and is in speakers’ bureau for Genomic Health Inc. Dr Martin receives speakers’ honoraria from Genomic Health Inc. Dr Rea serves as an advisory board member for Genomic Health Inc. Dr Rouzier serves as an advisory board for Genomic Health Inc., Roche and GSK, and receives corporate-sponsored research funding from Roche and GSK. Dr Smit serves as an advisory board member for Genomic Health Inc. Dr Thomssen serves as an advisory board member for Genomic Health Inc. and receives research support from American Diagnostica.
IMPAKT is an annual conference that was launched in 2009 by the Breast International Group (BIG) and the European Society for Medical Oncology (ESMO), in collaboration with a multidisciplinary alliance of European breast cancer organisations and patient groups - referred to as partners. Partners include the Foundation St. Gallen Oncology Conferences and the EBC Council. It is designed for breast cancer researchers and clinicians who have a specific interest in translational research, new agents, molecular and functional diagnostics, biomarkers and cutting-edge research applications in the clinical setting. The theme of IMPAKT 2014 was 'Anticipating the future of personalised medicine in breast cancer'.