Association of Adherence to Endocrine Therapy Among Patients With Breast Cancer and Potential Drug-Drug Interactions

Abstract

ImportanceSuboptimal adherence to endocrine therapy (ET) among patients with hormone-receptor–positive breast cancer significantly affects survival outcomes and is associated with higher hospitalization rates and health care costs. Weak adherence to long-term treatments has multiple determinants, including disease characteristics, treatment adverse effects, and patients’ attributes, such as age and comorbidities.ObjectiveTo examine whether potential drug-drug interactions (PDDI) with tamoxifen or aromatase inhibitor were associated with adherence to ET in patients with early and advanced breast cancer.Design, Setting, and ParticipantsThis cohort study used anonymized health record data of women with breast cancer who received ET in a private observational primary care database. Patients eligible for analysis included women aged 18 years or older who had a reported diagnosis of breast cancer and received ET with tamoxifen or aromatase inhibitor between 1994 and 2021. Data were analyzed 2021.ExposuresAdherence to ET during a given year was defined by a medication possession ratio of 80% or greater over 1-year prescription periods. PDDI were categorized into absent, minor (a combination to take into account), moderate (combination requiring precautions for use), major (combination not recommended), and contraindicated according to guidelines in the Claude Bernard Drug Database.Main Outcomes and MeasuresWe used regression models to estimate odds ratios (ORs) and 95% CIs for the associations between adherence and age, baseline comorbidities, PDDI, and adherence to ET during the previous year.ResultsA total of 10 863 patients who were prescribed ET for breast cancer were eligible for the analysis (age 70 years or older, 3509 patients [32.3%]). In the tamoxifen cohort (3564 patients), PDDI were reported in 497 of 3670 patients (13.5%) at baseline (moderate, 254 patients [51.1%]; major, 227 patients [45.7%]), 2047 of 4831 patients (42.4%) at year 1, 1127 of 2751 patients (41.0%) at year 2, 761 of 1861 patients (40.9%) at year 3, 376 of 1058 patients (35.5%) at year 4, and 201 of 593 patients (33.9%) at year 5. In the aromatase inhibitor cohort (7299 patients), PDDI were reported in 592 of 7437 patients (8.0%) at baseline (moderate in 588 of 592 patients [99.3%]), which reached 2875 of 9031 patients (31.8%) at year 1 and ranged between 31.4% (1802 of 5730 patients in year 2) and 32.8% (791 of 2411 in year 4) throughout the study period. No association between adherence and PDDI was found in the tamoxifen (OR, 0.99; 95% CI, 0.91-1.08) or aromatase inhibitor (OR, 1.05; 95% CI, 0.95-1.15) cohort.Conclusions and RelevanceIn this cohort of patients with hormone-receptor–positive breast cancer, PDDI with tamoxifen and aromatase inhibitors were not associated with adherence to ET.

Breast cancer survivors’ opinion on personalizing endocrine therapy and developing informative tools

“…Additionally, the low representation of young and old patients (patients < 30 years n = 7 [0.8%] and those >70 years n = 57 [6.1%]) limits the generalizability of our findings to these demographic groups and points out the need for tailored strategies to address them. Participants who discontinued treatment early for tolerance/personal reasons could be less likely inclined to answer the survey, explaining the low rate of nonadherence and early discontinuation of ET in our cohort ( n = 88; 9.4%) in comparison to the published literature 9 , 35 . The survey did not assess subjective (patient-reported) or biologic (hormonal levels) measures of adherence to the prescribed therapy, nor did it evaluate compliance with the prolonged use of the application.…”

Association between endocrine adjuvant therapy intake timing and disease-free survival in patients with high-risk early breast cancer: results of a sub-study of the UCBG- UNIRAD trial

“…Compliance to ET is known to be suboptimal, since rates reportedly range between 50% and 89% of the patients. 10 , 11 , 12 Studies have shown that the survival of patients with HR-positive BC is strongly linked to adherence to ET, particularly in the adjuvant setting. In the French CANTO cohort, serum assessment of tamoxifen identified 16.0% of patients (n = 188) below the set adherence threshold.…”