ArticleOncology and therapy2025
The Management of ER-Low, HER2-Negative Breast Cancer in the United Kingdom: A Survey of Current Clinical Practice.
Article in Oncology and therapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThe optimal management of oestrogen receptor (ER)-low HER2-negative breast cancer (BC) is unclear. We surveyed current approaches of UK clinicians in ER-low BC, and also present outcomes of ER-low early BC at single centre.
methodsSurvey: We conducted an anonymised online survey of clinicians treating BC in the UK between 6 May and 5 June 2024. Participants were presented with clinical scenarios of ER-low (Allred ER3/ER4) BC with multiple-choice and free-text questions. Clinical audit: Patients diagnosed with stage I-III, ER2-4 HER2-negative BC undergoing neoadjuvant treatment (chemotherapy vs. chemo-immunotherapy) from 1 January 2017 to 31 December 2023 were included. Clinical data was collected retrospectively at Barts Health NHS Trust, London, UK. The primary endpoint was pathological complete response (pCR).
resultsSurvey: Of 72 survey respondents, 40% recommended neoadjuvant chemo-immunotherapy for ER3 disease vs. 10% for ER4 disease; 57% recommended adjuvant endocrine therapy for ER3 disease, and 90% for ER4 disease. In the advanced setting 75% recommended chemo-immunotherapy for PD-L1-positive ER3 disease with 7% recommending CDK4/6 inhibitors. For PDL1-positive ER4 disease, these percentages were 32% and 51% respectively. In PDL1-negative disease, chemotherapy rates were 81% for ER3 and 36% for ER4 disease. Clinical audit: Sixty-six patients receiving neoadjuvant treatment were included, with 29 belonging to the ER2, 30 belonging to the ER3 and 7 belonging to the ER4 groups respectively; 33% received neoadjuvant chemo-immunotherapy. pCR rate was 61%, with no association with ER score for chemotherapy (p = 0.319) and chemo-immunotherapy (p = 0.603).
conclusionsThere is marked variation in approach to ER-low in the UK. The audit data suggests treating ER-low BC as triple-negative BC.
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