Table I.
Expert's opinion on use of docetaxel, paclitaxel and doxorubicin formulations in MBC.
| Dosing schedule of docetaxel | Experts' opinion (% of responding experts) |
|---|---|
| Q 1. What is your preferred dose of docetaxel as a single agent in MBC? | 75 mg/m2 (100) |
| a) 60 mg/m2 | |
| b) 75 mg/m2 | |
| c) 100 mg/m2 | |
| Challenges with conventional docetaxel formulations | |
| Q 2. In your clinical practice, which are the most common limitations of conventional docetaxel that limit its use? | Neutropenia, use of steroids as premedication, and edema |
| Q 3. If toxicity was manageable, would you use 100 mg/m2 dose in MBC? | No (100) |
| a) Yes | |
| b) No | |
| Use of granulocyte colony stimulating factor | |
| Q 4. Do you use primary prophylaxis with GCSF irrespective of the dose? | Yes (100) |
| a) Yes | |
| b) No | |
| Duration of taxane therapy | |
| Q 5. From toxicity point of view, which is the preferred taxane and schedule? | Paclitaxel weekly (100) |
| a) Paclitaxel 3 weekly | |
| b) Paclitaxel weekly | |
| c) Docetaxel 3 weekly | |
| d) Docetaxel weekly | |
| Q 6. What is your taxane of choice in patients who can not come to the hospital weekly for logistic reasons? | Paclitaxel 3 weekly (100) |
| a) Paclitaxel 3 weekly | |
| b) Paclitaxel weekly | |
| c) Docetaxel 3 weekly | |
| d) Docetaxel weekly | |
| Corticosteroid premedication | |
| Q 7. Are we strict with steroid prophylaxis? | Yes (100) |
| a) Yes | |
| b) No | |
| Q 8. Is use of steroid premedication a major worry with respect to infections and hyperglycemia? | Yes (100) |
| a) Yes | |
| b) No | |
| Q 9. Which of following is the most important reason to choose the novel formulation of docetaxel over the conventional one? | No need of corticosteroid premedication (100) |
| a) Efficacy | |
| b) Toxicity | |
| c) No need of corticosteroid premedication | |
| d) Better QOL for patients | |
| Q 10. Do you feel that using a novel formulation of docetaxel would add value to current management of breast cancer in a metastatic setting? | Yes (85) |
| a) Yes | |
| b) No | |
| Novel formulations of docetaxel | |
| Q 11. Is the data of NDLS convincing with regards to? | Safety (85) |
| a) Efficacy | Not sure (15) |
| b) Safety | More data on efficacy is needed (100) |
| Q 12. In what fraction of patients who are eligible for docetaxel, you use a novel formulation in your clinical practice currently? | In 10–30% of patients (62) |
| In <10% of patients (15) | |
| No response (23) | |
| Q 13. In your opinion, using a novel formulation of docetaxel would add value in which setting of breast cancer? | Metastatic setting (85) |
| Not sure (15) | |
| a) Metastatic setting | |
| b) Neoadjuvant setting | |
| c) Adjuvant setting | |
| Q 14. If cost of novel formulations is not a constraint, I will prescribe novel formulation of docetaxel for: | Some of my patients in special circumstances (100) |
| a) All my patients who are candidates for docetaxel | |
| b) Some of my patients in special circumstances | |
| c) None of my patients | |
| Q 15. In which sub-group of patients would you strongly prefer novel formulation of docetaxel over conventional formulation? | Diabetics and patients in whom to avoid steroids in a metastatic setting (100) |
| Dosing schedule of paclitaxel | |
| Q 16. What is your preferred regimen for paclitaxel in the management of metastatic breast cancer? | Weekly (80 to 100 mg/m2) (100) |
| a) Weekly (80 to 100 mg/m2) | |
| b) Every three weeks (175 mg/m2) | |
| c) Other specify–––– | |
| Challenges with conventional paclitaxel formulations | |
| Q 17. Which are the most troublesome problems with conventional paclitaxel? | Hypersensitivity reactions, neuropathy, need for special IV infusion set, and longer infusion time (100) |
| Novel formulations of paclitaxel | |
| Q 18. What is the most feasible dose of weekly nab-paclitaxel in MBC in our country? | 100 mg/m2 (100) |
| a) 100 mg/m2 | |
| b) 125 mg/m2 | |
| c) 150 mg/m2 | |
| d) Other specify______________ | |
| Q 19. Do you feel that prescribing novel formulation of paclitaxel would add value to the current management of metastatic breast cancer? | Yes (100) |
| a) Yes | |
| b) No | |
| c) Not sure | |
| Q 20. Which of the following is the greatest advantage offered by a cremaphor free paclitaxel formulation? | Avoiding steroid premedication (100) |
| a) Efficacy | |
| b) Safety | |
| c) Avoiding steroid premedication | |
| d) Short infusion time | |
| e) Better QOL for patients | |
| f) Other, specify____________ | |
| Q 21. With lower doses of dexamethasone 4 mg being adequate for prophylaxis, would you still want to avoid conventional paclitaxel? | Yes (46) |
| No (54) | |
| a) Yes | |
| b) No | |
| c) Not sure | |
| Q 22. In your opinion, using novel formulation of paclitaxel adds value in which setting for breast cancer? | Metastatic setting (100) |
| a) Neoadjuvant setting | |
| b) Adjuvant setting | |
| c) Metastatic setting | |
| Q 23. What fraction of patients who are eligible for paclitaxel, do you use novel formulation in your clinical practice? | <10% of patients (92); |
| 10–20% (8) | |
| Q 24. If cost of novel formulation is not a constraint, I will prescribe novel formulation of paclitaxel for … | Some of my patients in special circumstances (100) |
| a) All of my patients who are candidates for paclitaxel | |
| b) Some of my patients in special circumstances | |
| c) None of my patients | |
| Q 25. In which sub-group of patients (any specific clinical settings or sub types of breast cancer) do you strongly prefer novel formulation of paclitaxel over conventional formulation? | Diabetics, patients who had hypersensitivity reactions to convent ional paclitaxel formulation and in whom steroid needs to be avoided (100) |
| Pegylated liposomal doxorubicin | |
| Q 26. What is the most common dose of PLD in clinical practice? | 40–50 mg/m2 (100) |
| a) 30 mg/m2 | |
| b) 40 mg/m2 | |
| c) 50 mg/m2 | |
| PLD vs. conventional doxorubicin | |
| Q 27. In which setting do you prefer PLD over conventional doxorubicin? | Metastatic (100) |
| a) Adjuvant | |
| b) Neoadjuvant | |
| c) Metastatic | |
| d) All | |
| e) None | |
| Q 28. Do you think that PLD is less cardiotoxic? | Yes (77) |
| a) Yes | Not sure (23) |
| b) No | |
| c) Not sure | |
| Q 29. Do you feel that there is enough evidence to prove that PLD is more effective than conventional doxorubicin in MBC? | Not sure (100) |
| a) Yes | |
| b) No | |
| c) Not sure | |
| Cumulative dose of PLD | |
| Q 30. Do you feel that there should be any limit for the cumulative dose of PLD? | Not sure (100) |
| a) Yes | |
| b) No | |
| c) Not sure | |
| Palmar-plantar erythrodysesthesia (PPE) with PLD | |
| Q 31. Do you feel that PPE is more common with PLD than with conventional doxorubicin? | Yes (73) |
| a) Yes | Not sure (27) |
| b) No | |
| c) Not sure | |
| Q 32. What do you feel about PPE? | Manageable (100) |
| a) Troublesome | |
| b) Manageable | |
| Q 33. Which are the other toxicities of concern with PLD? | Myelotoxicity, neutropenia, hypersensitivity and infusion site reactions (100) |
| PLD in anthracycline rechallenge | |
| Q 34. In patients exposed to doxorubicin in the adjuvant setting, how frequently do you need to rechallenge patients with PLD? | Rare (100) |
| a) Rare | |
| b) Frequent | |
| c) Not sure | |
| Q 35. Do you feel that it is safe to rechallenge patients with PLD in MBC setting (those exposed to doxorubicin in adjuvant setting)? | Yes (46) |
| No (23) | |
| a) Yes | Not sure (31) |
| b) No | |
| c) Not sure | |
| PLD in the elderly with MBC | |
| Q 36. Would PLD be preferred in elderly and in those with borderline cardiac function, in whom doxorubicin is planned to be administered? | Yes (100) |
| a) Yes | |
| b) No | |
| c) Not sure | |
| Combination of PLD with trastuzumab | |
| Q 37. Can trastuzumab be used concurrently with PLD? | No (77) |
| a) Yes | Not sure (23) |
| b) No | |
| c) Not sure | |
| Generic PLD formulations | |
| Q 38. Is the data available on generic PLD satisfactory? | Not sure (100) |
| a) Yes | |
| b) No | |
| c) Not sure | |
| Q 39. Any preferences among generic PLD? | None (100) |
| a) None | |
| b) I do not use PLD | |
| c) I prefer one over the other. Reason? | |
MBC, metastatic breast cancer; NDLS, nanosomal docetaxel lipid suspension; GCSF, granulocyte colony stimulating factor; PLD, pegylated-liposome encapsulated doxorubicin; PPE, palmar-plantar erythrodysesthesia.