Real world patterns of care in HER2-overexpressing breast cancer: Results of a survey of TEACH clinical trial investigators in 2011

The Global Need for a Trastuzumab Biosimilar for Patients With HER2-Positive Breast Cancer

“…21 In an international survey of physicians (N ¼ 151) conducted in 2011, 27% of respondents who reported at least 1 instance within the previous year in which adjuvant trastuzumab was recommended to a patient who ultimately did not receive it cited cost as the reason for withholding treatment. 19 Furthermore, cost was more often cited by physicians in low-and middle-income countries (73%) than in high-income countries (7%; P < .0001) as a reason for withholding adjuvant trastuzumab. 19 Biosimilars 56 Biologics such as trastuzumab are high molecular-weight proteins, often containing post-translational modifications, with complex 3-dimensional structures that are difficult to fully characterize.…”

“…In a 2011 international physician survey, 92% of respondents (N ¼ 151) indicated that they routinely recommend 1 year of adjuvant trastuzumab; however, 47% reported having at least 1 case within the previous year in which trastuzumab was recommended but treatment could not be started. 19 Failure to start recommended trastuzumab was more commonly reported by physicians from lowand middle-income countries (75%) than high-income countries (40%; P ¼ .005) and most often cited by respondents from Africa (100%), Asia (89%), and Latin America (80%). 19 Observational studies on real-world treatment patterns in patients diagnosed with and/or treated for HER2 þ EBC between 2005 and 2015 suggest that 19.1% to 59.5% in the United States, Canada, Australia, New Zealand, United Kingdom, The Netherlands, Germany, and China did not receive neoadjuvant or adjuvant trastuzumab (Table 1).…”

“…19 Failure to start recommended trastuzumab was more commonly reported by physicians from lowand middle-income countries (75%) than high-income countries (40%; P ¼ .005) and most often cited by respondents from Africa (100%), Asia (89%), and Latin America (80%). 19 Observational studies on real-world treatment patterns in patients diagnosed with and/or treated for HER2 þ EBC between 2005 and 2015 suggest that 19.1% to 59.5% in the United States, Canada, Australia, New Zealand, United Kingdom, The Netherlands, Germany, and China did not receive neoadjuvant or adjuvant trastuzumab (Table 1). [23][24][25][30][31][32][34][35][36][37][39][40][41]44,45 Use of trastuzumab was somewhat less in patients with small ( 1 cm) and/or node-negative HER2 þ tumors, 28,30,40,41,44 in whom the benefits of adjuvant trastuzumab therapy are somewhat controversial.…”

“…3,4,7,9,10 As a result of reimbursement strategies, some patients might face greater economic burden, which might create a barrier to accessing treatment. [19][20][21] Among surveyed oncologists in the United States and emerging markets who reported that they "not so often," "rarely," or "never" use trastuzumab, 34% (of 137 respondents) and 42% (of 41 respondents) cited "high out-of-pocket treatment cost for patient" as a barrier to use in the neoadjuvant and adjuvant settings, respectively. 21 In an international survey of physicians (N ¼ 151) conducted in 2011, 27% of respondents who reported at least 1 instance within the previous year in which adjuvant trastuzumab was recommended to a patient who ultimately did not receive it cited cost as the reason for withholding treatment.…”

“…For example, a study calculated that the potential cost savings generated by switching 100,000 patients in Germany, France, Italy, Spain, and the United Kingdom from originator epoetin to biosimilar epoetin could support an additional 9770 to 12,913 rituximab, 3912 to 5171 bevacizumab, or 3713 to 4908 trastuzumab treatments. 18 Access to trastuzumab might be limited for various reasons such as lack of drug funding or because of treatment costs, [19][20][21] and real-world data show that not all patients with HER2 þ breast cancer receive trastuzumab. This review discusses the use of, and barriers to, treatment with trastuzumab in patients with HER2 þ breast cancer, and how the introduction of trastuzumab biosimilars might address the needs of patients and the wider health care system.…”