Real-World Clinical and Economic Outcomes Associated with Palbociclib for HR-Positive/HER2 Negative Metastatic Breast Cancer: A Commentary

Abstract

Breast cancer is the second leading cause of cancer-related death among American women. 1 Breast cancer is a heterogeneous disease composed of distinct molecular subtypes that include luminal A and B, human epidermal growth factor receptor 2 (HER2) type, and triple-negative/basal-like. 2 As of 2020, the average risk for a woman to develop breast cancer in her life is 13% in the United States, with an estimated 276,480 new cases of invasive breast cancer and 48,530 new cases of noninvasive breast cancer expected to be diagnosed in 2020. 1 Breast cancer accounts for approximately 25% of all cancer cases and 15% of all deaths among women and constitutes one of the most expensive malignancies to treat. 1,3 As such, breast cancer puts a heavy burden on patients and their families, as well as health care systems across the world. 4 Strategies to fight breast cancer are geared toward prevention, early detection, and treatment. 5 Multiple subtypes and stages of breast cancer have been defined, which has led to the development of multiple, targeted strategies to treat the disease. 2 Hormone receptor-positive (HR+) and HER2 negative (HER2-) metastatic breast cancer (mBC), together, is the most common

Real-world effectiveness of palbociclib plus fulvestrant in advanced breast cancer: Results from a population-based cohort study

“…While the recommended starting dose is 125mg, a more careful approach is given to more fragile patients and/or with relevant comorbidities. With respect to dose reduction, 43.24% of patients in our study had the initial dose reduced, in line with previous real-world studies (ranging from 31% to 50%), which could suggest that this is the prevalence of palbociclib dose reduction in real-life context in this indication [10,22,25,26].…”

Treatment Experiences with CDK4&6 Inhibitors Among Women with Metastatic Breast Cancer: A Qualitative Study

“…Cost is often associated with decreased adherence/ persistence, 12,14,17,30 but despite the cost of CDK4&6i's, 31 most patients in this sample paid either very little or nothing due to a combination of insurance and co-payment assistance. Most participants knew very little about co-payment assistance as these details were handled by oncology support staff.…”

Cost-effectiveness of ribociclib plus endocrine therapy versus placebo plus endocrine therapy in HR-positive, HER2-negative breast cancer

“…38 Thus, medication management is highly important for patients on OAMs due to narrow therapeutic ranges and safety margins associated with these drugs. 37 Given of the cost-effectiveness of ribociclib within our WTP, demonstrating it was cost-effective 71.7% of the time.…”

“…However, a study on real-world clinical and economic outcomes of palbociclib indicated growing evidence of suboptimal effectiveness of oral anticancer medications (OAMs) due to significant low patient adherence, adverse effect profiles, and sociodemographic factors. 37 Although the study evaluated palbociclib, these findings can be applied equally to other CKD4/6 inhibitors. Adherence issues due to toxicity or other factors can lead to lower survival rates, increased risk of recurrence, and higher health care costs.…”