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. 2024 Jan 5;29(1):e38-e46.
doi: 10.1093/oncolo/oyad198.

Physicians' Hierarchy of Tumor Biomarkers for Optimizing Chemotherapy in Breast Cancer Care

Halle H Thannickal  1 , Noon Eltoum  2 , Nicole L Henderson  2 , Lauren P Wallner  3 , Lynne I Wagner  4 , Antonio C Wolff  5 , Gabrielle B Rocque  2   6   7
Affiliations

Physicians' Hierarchy of Tumor Biomarkers for Optimizing Chemotherapy in Breast Cancer Care

Halle H Thannickal et al. Oncologist. .

Abstract

Background: Tumor biomarkers are regularly used to guide breast cancer treatment and clinical trial enrollment. However, there remains a lack of knowledge regarding physicians' perspectives towards biomarkers and their role in treatment optimization, where treatment intensity is reduced to minimize toxicity.

Methods: Thirty-nine academic and community oncologists participated in semi-structured qualitative interviews, providing perspectives on optimization approaches to chemotherapy treatment. Interviews were audio-recorded, transcribed, and analyzed by 2 independent coders utilizing a constant comparative method in NVivo. Major themes and exemplary quotes were extracted. A framework outlining physicians' conception of biomarkers, and their comfortability with their use in treatment optimization, was developed.

Results: In the hierarchal model of biomarkers, level 1 is comprised of standard-of-care (SoC) biomarkers, defined by a strong level of evidence, alignment with national guidelines, and widespread utilization. Level 2 includes SoC biomarkers used in alternative contexts, in which physicians expressed confidence, yet less certainty, due to a lack of data in certain subgroups. Level 3, or experimental, biomarkers created the most diverse concerns related to quality and quantity of evidence, with several additional modulators.

Conclusion: This study demonstrates that physicians conceptualize the use of biomarkers for treatment optimization in successive levels. This hierarchy can be used to guide trialists in the development of novel biomarkers and design of future trials.

Keywords: biomarkers; breast neoplasm; chemotherapy; clinical trials; overtreatment; qualitative research; quality of life.

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Conflict of interest statement

Lauren Wallner reported consulting for Gilead Sciences, patient-centered decision making consortium. Lynne I. Wagner reported consulting for Celgene/Bristol Myers Squibb, and Connect Multiple Myeloma registry, Scientific Steering Committee member. Gabrielle B. Rocque reported consulting for Pfizer and Gilead, research funding from Daiichi Sankyo, Pfizer, and Genentech, and travel expenses from Gilead. The other authors indicated no financial relationships.

Figures

Figure 1.
Figure 1.
A hierarchal model of biomarkers that guides oncologists’ treatment decisions.
Figure 2.
Figure 2.
Modulators of comfort with biomarker-guided chemotherapy optimization.
See this image and copyright information in PMC

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