Cost-effectiveness in managing skeletal related events in breast cancer: a strategy of less-intense dosing schedule of bone modifying agents

Tella, Sri Harsha; Kommalapati, Anuhya; Singhi, Ryan

doi:10.21037/tcr.2018.01.07

Cited by 5 publications

(4 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, this may be offset by longer time to SRE and ease of access with subcutaneous delivery. Likewise, there are marked variables on the financial burden of SRE, include the location of bone metastases, type of SRE, hospitalisation costs and need for surgery or radiation therapy 35 . Further research is required to help delineate the cost‐effectiveness of BMA in an Australian setting, coupled with ongoing research identifying a subset of patients that would benefit from de‐escalation of dosing intervals and early BMA cessation.…”

Section: Discussionmentioning

confidence: 99%

Uptake of bone‐modifying agents in patients with HER2+ metastatic breast cancer with bone metastases – prospective data from a multi‐site Australian registry

Wong

Boer

Dunn

et al. 2022

Internal Medicine Journal

View full text Add to dashboard Cite

Background International practice guidelines recommend administration of bone‐modifying agents (BMA) in metastatic breast cancer (MBC) patients with bone metastases to reduce skeletal‐related events (SRE). Optimal delivery of BMA in routine clinical practice, including agent selection and prescribing intervals, remains unclear. Aim To describe real‐world practice of Australian breast oncologists. Methods Prospective data from February 2015 to July 2020 on BMA delivery to MBC patients with bone metastases was analysed from Treatment of Advanced Breast Cancer in the Human Epidermal Growth Factor Receptor 2 (HER2)‐Positive Australian Patient (TABITHA), a multi‐site Australian HER2+ MBC registry. Results Of 333 HER2+ MBC patients, 171 (51%) had bone metastases at diagnosis, with a mean age of 58.1 years (range, 32–87). One hundred and thirty (76%) patients received a BMA, with 90 (69%) receiving denosumab and 40 (31%) receiving a bisphosphonate. Patients who received a BMA were more likely to have received concurrent first‐line systemic anti‐HER2 therapy (95% vs 83%; P = 0.04), to present with bone‐only metastases at diagnosis (24% vs 7%; P = 0.02) and less likely to have visceral metastases (51% vs 71%; P = 0.03). Ten of 40 (25%) bisphosphonate patients and 45 of 90 (50%) denosumab patients received their BMA at the recommended 4‐weekly interval. Prescribing intervals varied over time. Adverse events reported were consistent with clinical trial data. Conclusion Three‐quarters of Australian HER2+ MBC patients with bone metastases receive a BMA, often at different schedules than guidelines recommend. Further studies, including all MBC subtypes, are warranted to better understand clinicians' prescribing rationale and potential consequences of current prescribing practice on SRE incidence.

show abstract

Section: Discussionmentioning

confidence: 99%

Uptake of bone‐modifying agents in patients with HER2+ metastatic breast cancer with bone metastases – prospective data from a multi‐site Australian registry

Wong

Boer

Dunn

et al. 2022

Internal Medicine Journal

View full text Add to dashboard Cite

show abstract

“…Cost-effectiveness analyses have been completed comparing these medications but have yielded inconsistent conclusions, potentially due to different study designs, cost estimation from multiple published sources, and study sponsors. [14][15][16][17] Our medication use evaluation of denosumab for the prevention of SREs found 22 (7%) patients who did not meet formulary criteria, these patients received a total of 110 doses over the investigational period, equating to approximately $310,000 in direct drug costs ($2822 [AWP price for denosumab] × 110 doses of denosumab = $310,420). Of those 22 patients, 20 had a primary oncology diagnosis of MM and use was categorized as inappropriate as these patients did not have a CrCl < 30 mL/min at time of first administration or a documented intolerance to bisphosphonates.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of denosumab in adult oncology patients for the prevention of skeletal related events across a large academic health system

Sproat

Burton

Burdalski

et al. 2021

J Oncol Pharm Pract

View full text Add to dashboard Cite

Introduction Denosumab (Xgeva®) and zoledronic acid (Zometa®) are widely utilized for prevention of skeletal related events (SREs) in oncology patients. Drug costs, renal function, ease and logistics of administration, and adverse effect profile are factors frequently considered by patients and/or providers when selecting an optimal agent. Given the significantly higher drug cost of denosumab compared to zoledronic acid, an evaluation of our institution's denosumab use and investigation into opportunities to shift denosumab administrations to zoledronic acid and/or to lower cost sites-of-care was warranted. Methods A single-center, multi-site, retrospective, observational analysis of the electronic medical record (EMR) was conducted for adult oncology patients who received denosumab 120 mg for prevention of SREs from October 1st, 2018 to September 30th, 2019 at three institutions within our health system. Additional information was collected to characterize the patient population based on cancer diagnosis, renal function, and concomitant calcium and vitamin D supplementation. Our primary objective was to evaluate if the use of denosumab met current formulary restrictions of the health system. Results In total, 304 adult oncology patients received 1411 doses of denosumab for the prevention of SREs. The majority of reviewed patients had a primary oncology diagnosis of breast (35%) or lung (24%) cancer. Of the patients who received denosumab, 278 (93%) met the health system's current formulary restrictions. The majority of patients who did not meet formulary restrictions were those with multiple myeloma (MM) (20/22; 91%). Of the 304 patients reviewed, 70 had the appropriate parameters in the EMR to calculate creatinine clearance (CrCl) using Cockcroft-Gault Equation. Of those 70 patients, 59 (84%) would have been eligible to receive zoledronic acid instead of denosumab given that their CrCl >30 mL/min with no documented intolerance to bisphosphonates. Concurrent use of calcium and vitamin D is recommended when using denosumab. Based on the most recent prior to admission (PTA) medication list obtained from the 304 patients evaluated, 222 (73%) had both calcium and vitamin D listed as “taking”. Conclusions Within our health system, denosumab is restricted to those who meet formulary restrictions. Additional education is recommended to help limit the use of denosumab, specifically in MM, to reduce drug costs when zoledronic acid is also an appropriate first-line agent.

show abstract

“…Breast cancer as the most common malignant tumor is the primary cause of cancer-related death among women worldwide. Breast cancer is a multifaceted and heterogeneous disease with different molecular subtypes ( 1 ). Base on the 2013 St Gallen classification of intrinsic breast cancer subtypes, breast cancer is classified into luminal A, luminal B, Her-2 enrich and triple negative breast cancer, according to estrogen receptor (ER), progesterone receptor (PR) and Her-2 status ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Construction of differentially expressed Her-2 related lncRNA-mRNA-miRNA ceRNA network in Her-2 positive breast cancer

Xing¹,

Wang²,

Zhang³

et al. 2020

Transl Cancer Res TCR

View full text Add to dashboard Cite

Background Her-2 positive subtype breast cancer is characterized as Her-2 gene amplification with poor survival and increased invasiveness accounting for 20–30% of invasive infiltrated breast cancer. A lncRNA-miRNA-mRNA competing endogenous RNA (ceRNA) network is constructed to detect Her-2 specific RNAs in the development and progression of HER-2 positive breast cancer which may overcoming the anti-HER-2 therapy resistance of breast cancer cells. Methods One thousand one hundred and nine breast cancer samples obtained from The Cancer Genome Atlas (TCGA) database were classified into two cohorts including ER+/PR+ (n=461) and ER-/PR- breast cancer (n=152). Differently expressed mRNAs, lncRNAs and miRNAs were screened in ER+/PR+ and ER-/PR- breast cancer cohorts, respectively. lncRNA-miRNA interactions were preformed to predicted and verified by miRcode. miRNA-mRNA interactions were selected to predict targeted mRNAs of miRNAs by miRanda, Targetscan and miRTarBase. Results lncRNA-miRNA-mRNA ceRNA network was constructed by retained lncRNAs, miRNAs and mRNAs. Fifteen DEmiRNAs, 129 DElncRNAs and 269 DEmRNAs were retained in ER+/PR+ cohort after intersection with DEmiRNAs, DElncRNAs and DEmRNAs between breast cancer and normal tissues. Six hundred and ninety-three DEmRNAs, 25 DEmiRNAs and 364 DElncRNAs were retained in ER-/PR- cohort. ceRNA network in ER+/PR+ breast cancer cohort was constructed of the interactions of 4 DElncRNA–DEmiRNA pairs and 2 DEmiRNA–DEmRNA pairs included 4 DElncRNAs, 1 DEmiRNAs, and 2 DEmRNAs. ceRNA network in ER-/PR- breast cancer cohort was constructed of the interactions of 24 DElncRNA–DEmiRNA pairs and 1 DEmiRNA–DEmRNA pairs included 19 DElncRNAs, 4 DEmiRNAs, and 1 DEmRNA. MIR7-3HG- hsa-mir-204-NTRK2 axis was identified in both ER+/PR+ and ER-/PR- cohort in our study. Conclusions Based on the ceRNA hypothesis, a potential Her-2 related regulatory ceRNA networks are constructed which may provide novel insights into the mechanism underlying the biological processes of Her-2 positive breast cancer.

show abstract

Cost-effectiveness in managing skeletal related events in breast cancer: a strategy of less-intense dosing schedule of bone modifying agents

Cited by 5 publications

References 17 publications

Uptake of bone‐modifying agents in patients with HER2+ metastatic breast cancer with bone metastases – prospective data from a multi‐site Australian registry

Uptake of bone‐modifying agents in patients with HER2+ metastatic breast cancer with bone metastases – prospective data from a multi‐site Australian registry

Evaluation of denosumab in adult oncology patients for the prevention of skeletal related events across a large academic health system

Construction of differentially expressed Her-2 related lncRNA-mRNA-miRNA ceRNA network in Her-2 positive breast cancer

Contact Info

Product

Resources

About