Effectiveness of Trastuzumab for Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer in a Real-Life Setting: One Decade of Experience Under National Treatment Coverage Regulations

Abstract

PURPOSE Trastuzumab has shown an overall survival (OS) benefit in patients with human epidermal growth factor receptor 2 (HER2)–positive breast cancer (BC), in both the adjuvant and the metastatic setting. We assessed the effectiveness of trastuzumab in patients treated in daily practice according to national treatment coverage protocols and compared our results with those reported by randomized clinical trials. These coverage protocols included patient selection criteria similar to those of those clinical trials and were developed by the Uruguayan National Resource Fund (FNR), the agency that has funded these prescriptions for more than a decade. PATIENTS AND METHODS We included all patients with HER2-positive BC treated with trastuzumab under FNR coverage approved between January 1, 2006, and December 31, 2016. The source of data was the FNR database, and primary outcome was OS, analyzed through Cox proportional hazards regression analysis. RESULTS A total of 1,944 women were included: 1,085 women (55.8%) were postmenopausal and 1,240 (63.7%) had HER2 and hormone receptor–positive BC. Trastuzumab was administered as adjuvant therapy to 1,233 patients (63.5%), of whom 154 also received it as a neoadjuvant treatment. Three hundred nineteen patients (16.4%) received trastuzumab for advanced disease. Five-year OS in the adjuvant setting was 86.4% (95% CI, 84.0% to 88.7%). The median survival of patients with advanced BC was 25.1 months (95% CI, 10.1 to 42.5 months). CONCLUSION Our survival results are not inferior to those reported in clinical trials, in both adjuvant and advanced settings. Importantly, these results support the relevance and the feasibility of treating patients in routine practice, following coverage protocols based on patient selection criteria and methods supported by positive clinical trials. In addition, these results favor quality and appropriate access to BC treatment in our country.

Cardiotoxic adverse effects of trastuzumab in breast cancer outpatients in Sunpasitthiprasong Hospital, Ubonratchathani: A retrospective cohort study

“…Five-year OS in the adjuvant setting was 86.4% (95% CI, 84.0% to 88.7%). The median survival of patients with advanced BC was 25.1 months (95% CI, 10.1 to 42.5 months) 4 .…”

Third- and Late Line Treatments of Metastatic Gastric Cancer: Still More to Be Done

“…In the case of epidermal growth factor receptor 2 (HER-2) positivity, the association of trastuzumab to CT has improved therapeutic efficacy [ 14 , 15 ].…”

Trastuzumab-induced cardiotoxicity in early breast cancer over a 10-year period in Uruguay

“…The patients included in the coverage regulations for adjuvant/neoadjuvant treatment are those with a diagnosis of node-positive or node-negative operable HER2 + BC with a primary tumor, with an invasive component of ≥1 cm; in our study, the overall survival rate at 5 years for patients with operable BC (stages I–IIIA) who received the adjuvant (with or without neoadjuvant) trastuzumab (n = 1233) was 86.4% (95% confidence interval, 84.0%–88.7%). [ 12 ]…”

“…The patients included in the coverage regulations for adjuvant/neoadjuvant treatment are those with a diagnosis of node-positive or node-negative operable HER2 + BC with a primary tumor, with an invasive component of ≥1 cm; in our study, the overall survival rate at 5 years for patients with operable BC (stages I-IIIA) who received the adjuvant (with or without neoadjuvant) trastuzumab (n = 1233) was 86.4% (95% confidence interval, 84.0%-88.7%). [12] Trastuzumab is used as a monotherapy and in combination with various drugs. The most commonly used combinations in adjuvant systemic treatment are those combining trastuzumab and taxanes concurrently after treatment with anthracyclines or those combining trastuzumab, docetaxel, and carboplatin.…”