The enclosed audio program provides highlights of a daylong roundtable meeting with a dozen prominent breast cancer clinical investigators examining a number of the most challenging and controversial questions in current breast cancer management.

During the event, we asked the faculty to discuss four major treatment areas:

1. Adjuvant therapy for patients with HER2-positive tumors
2. Adjuvant chemotherapy
3. Adjuvant endocrine therapy for patients with ER-positive tumors
4. Systemic management of metastatic disease

Considering the crucial practical issues that these topics represent, it is noteworthy that these investigators generally disagreed with each other on many important facets of these topics, specifically related to what constitutes a reasonable approach to clinical care.

We were actually able to quantify the disparity in the perceptions of these mavens because immediately prior to the think tank, we asked each roundtable participant to complete a survey asking whether he or she “agreed,” “disagreed” or was “in between” with regard to a series of 27 clinical practice questions. The results of this fascinating exercise are reproduced in the accompanying monograph. What is particularly interesting is that in only about one third of these cases did the participants reach a consensus. My favorite questions were the ones that split the faculty in neat thirds, four for each answer.

The disagreement we observed is relevant to one of the most common comments we receive about our audio programs, namely that doctors in practice feel a sense of reassurance when they hear the “experts” struggle with the interpretation of research data and treatment decision-making.

An example of how this controversy plays out in clinical decision-making is the choice of chemotherapy regimen in a patient with ER-positive, HER2- negative, node-positive disease. During the Think Tank, Chuck Vogel identified four anthracycline/taxane regimens with “Level 1” supportive evidence on this question (Figure 1). However, our CME group’s national Patterns of Care surveys of US-based medical oncologists and breast cancer clinical investigators demonstrates that, although about two thirds of these docs usually turn to dose-dense AC paclitaxel or TAC, a substantial minority rely on other regimens.

Clearly, the available research evidence on this question and many others in contemporary oncology leaves a great deal of room for research to practice applications, as demonstrated by the furious debate of these elite investigators on a variety of topics.

Our CME group found this day of repartee highly informative and entertaining, and to further explore the debate, we will assemble a similar group for another Think Tank event early this summer. Given the timing (soon after ASCO), this meeting will undoubtedly shed more light on the important research to practice issues that are vexing to us all.

— Neil Love, MD
NLove@ResearchToPractice.net

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