Patterns and barriers of second-line therapy selection in HR+/HER2- metastatic breast cancer among medical oncologists in a developing country (Georgia).

Abstract

e13067 Background: Hormone receptor-positive, HER2-negative (HR+/HER2-) metastatic breast cancer (MBC) represents a complex therapeutic challenge, particularly in resource-constrained countries like Georgia. Limited access to therapies, economic constraints, and clinical decision variability impact treatment outcomes. This study examines the preferences and barriers influencing second-line treatment selection for HR+/HER2- MBC among medical oncologists in Georgia. Methods: A cross-sectional survey was conducted among oncologists practicing in Georgia. The survey assessed demographic data, clinical experience, patient volumes, preferred treatment regimens, and factors influencing therapy selection. Barriers to adopting advanced treatments such as antibody-drug conjugates (ADCs) and molecular-based therapies were also evaluated. The survey was designed electronically and distributed to medical oncologists for participation. Results: A total of 47 medical oncologists from differented regions of Georgia participated in the survey conducted during December 2024. The majority of respondents (87%) were female, with 30% having 5-10 years of experience. Everolimus plus exemestane was the most preferred second-line therapy (57%), followed by chemotherapy (49%). Everolimus plus exemestane was frequently chosen for patients with late progression (> 12 months) on CDK4/6 inhibitors (62%) and due to the availability of the combination treatment (47%). Among chemotherapy options, paclitaxel (51%) and capecitabine (40%) were most commonly used and were primarily selected for patients requiring a rapid treatment response. CDK4/6 inhibitors after progression were rarely continued (17%), with 69% favoring continuation for patients with a low disease burden and only following progression on Palbocilib (54%). The selection of hormone monotherapy was also infrequent (19%), with 25% of respondents indicating, that they had never used this approach. Barriers to ADC usage included drug unavailability (81%) and financial constraints (70%). For molecular-based treatments, the high cost of molecular testing (94%) and limited availability of targeted drugs (45%) were the primary obstacles. Conclusions: This study highlights significant barriers in adopting advanced therapies, such as ADCs and molecular-based treatments, among oncologists in Georgia. Accessibility and financial constraints remain primary challenges, with reliance on chemotherapy and everolimus-based regimens for second-line treatment. Improving access to targeted therapies and molecular diagnostics could optimize patient outcomes in this setting.