41 Provider Preferences and Practices in Testing and Reporting HER2 Immunohistochemistry in Patients With Breast Cancer: A Survey and Interview Study Among US Pathologists and Oncologists

Publication
Article
Miami Breast Cancer Conference® Abstracts Supplement42nd Annual Miami Breast Cancer Conference® - Abstracts
Volume 39
Issue 4
Pages: 79-80

41 Provider Preferences and Practices in Testing and Reporting HER2 Immunohistochemistry in Patients With Breast Cancer: A Survey and Interview Study Among US Pathologists and Oncologists

41 Provider Preferences and Practices in Testing and Reporting HER2 Immunohistochemistry in Patients With Breast Cancer: A Survey and Interview Study Among US Pathologists and Oncologists

Background/Significance

The 2023 ASCO-CAP guideline update emphasized accurate HER2 testing and reporting for HER2-low metastatic breast cancer. This study seeks to better understand providers’ (oncologists’ and pathologists’) perceptions and practices for HER2 testing in the community setting and characterize facilitators and barriers to HER2 testing, documentation, and treatment.

Materials and Methods

A web-based survey was developed using Qualtrics software with inputs from subject matter experts; the survey was piloted and deployed (February 26, 2024, to May 8, 2024) to US community-based pathologists and oncologists who test or treat patients with breast cancer within the Guardian Research Network or IQVIA’s health care professionals panel to assess preferences and practices for HER2 testing. A self-selected subset of respondents participated in semistructured 1:1 virtual interviews to contextualize their survey responses. Providers were compensated for their time. Responses were analyzed using MAXQDA.

Results

There were 63 survey responses (to 100+ invitations) and 27 interviews among US community-based pathologists (31 surveys, 14 interviews) and oncologists (32 surveys, 13 interviews). While most pathologists (93%) report discrete immunohistochemistry (IHC) scoring on pathology reports, 20% do not distinguish IHC 0 and IHC 1+, and 32% do not report percentage staining. Barriers to discrete IHC reporting were background staining, poor interpretation standards, and staining variability. Increased interpretation time and workflow disruptions were barriers to reporting percentage staining, and pathologists were awaiting further evidence of clinical utility. Both pathologists and oncologists agreed that oncologists’ requests drive testing changes. Oncologists report lack of reimbursement of tests and treatment as major barriers to treatment decision-making for HER2-directed therapies. Digital pathology (digital imaging/scanning, scoring algorithms, and other tools) was viewed favorably by oncologists (92%) and by pathologists (50%), with improved accuracy, efficiency, and reduced subjectivity as advantages, and high costs and lack of practice standards as barriers to adoption.

Conclusion

These findings characterize community providers’ preferences and practices for HER2 IHC testing results and treatment for metastatic breast cancer patients. While innovative testing tools are viewed favorably, cost and need for additional training are barriers to broader adoption.

Articles in this issue

40 Frequency of Documented IHC Score in Patients With HER2-Negative Breast Cancer in the US: An Observational Study Using Guardian Research Network Data
40 Frequency of Documented IHC Score in Patients With HER2-Negative Breast Cancer in the US: An Observational Study Using Guardian Research Network Data
41 Provider Preferences and Practices in Testing and Reporting HER2 Immunohistochemistry in Patients With Breast Cancer: A Survey and Interview Study Among US Pathologists and Oncologists
41 Provider Preferences and Practices in Testing and Reporting HER2 Immunohistochemistry in Patients With Breast Cancer: A Survey and Interview Study Among US Pathologists and Oncologists
42 Exploring the Treatment Gap in High-Risk HR+, HER2– Early Breast Cancer: Eligible Patients Not Receiving Abemaciclib in the US
42 Exploring the Treatment Gap in High-Risk HR+, HER2– Early Breast Cancer: Eligible Patients Not Receiving Abemaciclib in the US
TPS 43 ADELA: A Double-Blind, Placebo-Controlled, Randomized Phase 3 Trial of Elacestrant + Everolimus vs Elacestrant + Placebo in ER+/HER2– Advanced Breast Cancer Patients With ESR1-Mutated Tumors Progressing on Endocrine Therapy
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45 A Phase 3 Randomized Study of Adjuvant Sacituzumab Tirumotecan Plus Pembrolizumab vs Treatment of Physician’s Choice in Patients With Triple-Negative Breast Cancer Who Received Neoadjuvant Therapy and Did Not Achieve a Pathological Complete Response at Surgery
46 Neoadjuvant Pembrolizumab or Placebo Plus Chemotherapy Followed by Adjuvant Pembrolizumab or Placebo for High-Risk, Early-Stage Triple-Negative Breast Cancer: Overall Survival and Subgroup Results From the Phase 3 KEYNOTE-522 Study
46 Neoadjuvant Pembrolizumab or Placebo Plus Chemotherapy Followed by Adjuvant Pembrolizumab or Placebo for High-Risk, Early-Stage Triple-Negative Breast Cancer: Overall Survival and Subgroup Results From the Phase 3 KEYNOTE-522 Study
48 Prevalence of “HER2 Ultra-Low” Among Advanced Breast Cancer Patients With Historical IHC0 Status
48 Prevalence of “HER2 Ultra-Low” Among Advanced Breast Cancer Patients With Historical IHC0 Status
49 Clinical Characteristics and Treatment Persistence in US Patients With HR+/HER2–, Node-Positive Early Breast Cancer Treated With Abemaciclib: Real-World Study From First Year After Approval
49 Clinical Characteristics and Treatment Persistence in US Patients With HR+/HER2–, Node-Positive Early Breast Cancer Treated With Abemaciclib: Real-World Study From First Year After Approval
52 Correlation and Prediction of Complete Pathologic Response Rates and Ki-67 in Patients Receiving Neoadjuvant Immunotherapy for Triple-Negative Breast Cancer
52 Correlation and Prediction of Complete Pathologic Response Rates and Ki-67 in Patients Receiving Neoadjuvant Immunotherapy for Triple-Negative Breast Cancer
53 Comparison of Surgical Complications With Direct-to-Implant vs Tissue Expander Reconstruction After Wise Pattern Skin-Sparing Mastectomy
53 Comparison of Surgical Complications With Direct-to-Implant vs Tissue Expander Reconstruction After Wise Pattern Skin-Sparing Mastectomy
54 The Treatment of Breast Cancer With Percutaneous Thermal Ablation: Results of the THERMAC Trial
54 The Treatment of Breast Cancer With Percutaneous Thermal Ablation: Results of the THERMAC Trial
55 Do Genetic Counseling and Testing Affect Rates of Contralateral Prophylactic Mastectomy in Patients Without Clinically Actionable Mutations?
55 Do Genetic Counseling and Testing Affect Rates of Contralateral Prophylactic Mastectomy in Patients Without Clinically Actionable Mutations?
56 Paternal vs Maternal Inheritance of a BRCA Mutation: Is There a Difference in Presentation and Stage of Breast Cancer at Diagnosis?
56 Paternal vs Maternal Inheritance of a BRCA Mutation: Is There a Difference in Presentation and Stage of Breast Cancer at Diagnosis?
57 Tumor Morphology Concordance in Multifocal/Multicentric Triple- Negative and HER2+ Breast Cancers
57 Tumor Morphology Concordance in Multifocal/Multicentric Triple- Negative and HER2+ Breast Cancers
59 Are Choosing Wisely Guidelines Applicable to Patients With a High Ki-67 Proliferation Index and Magee Equation Score?
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