Multidisciplinary discussion on phenotypical characterization of metastatic breast cancer and patient pathway optimization from an expert panel across South Italian regions

Abstract

Breast cancer (BC) might change its receptor status during malignant progression, resulting in challenging clinical care. The project, developed during two residential meetings by expert Italian oncologists and pathologists, was aimed at optimizing metastatic BC management. A 17-point survey was administered to healthcare workers in centers of three regions, essentially to assess the perception of metastasis biopsy on treatment choice in different BC molecular subtypes, the appropriate timing for performing tissue and liquid biopsy in metastatic BC, the selection of target genes and the use of multidisciplinary approaches in tumour management. Nineteen centers participated in the survey. The first important finding was that most centers manage more than 150 patients yearly, and 95% have a pathology department. Some questions received a substantial agreement: tissue biopsy of metastatic BC was largely considered as mandatory, generally performed at onset of metastatic disease. Liquid biopsy is not used by all centers, confirming its strict dependency on the available technologies. The answers on the therapeutic line change in case of HER2 + disease becoming triple negative confirmed an attitude consistent with clinical practice. The survey also revealed that half of the interviewed oncologists discuss with multidisciplinary team only for selected cases. The survey revealed that while a shared consensus exists on the importance of metastasis biopsy, some areas still deserve attention to achieve standardized approaches: interdisciplinary collaboration and more effective communication between specialists and patients are necessary to optimize the diagnostic and therapeutic journey of women with metastatic BC.

Keywords: Breast cancer molecular subtype; Intratumoral heterogeneity; Liquid biopsy; Metastasis biopsy; Metastatic breast cancer; Tumour phenotypical characterization.