Considerations for payers in managing hormone receptor-positive advanced breast cancer

Abstract

Breast cancer (BC) is the second most common cause of death in women. In 2010, the direct cost associated with BC care in the US was $16.5 billion, the highest among all cancers. By the year 2020, at the current rates of incidence and survival, the cost is projected to increase to approximately $20 billion. Although endocrine therapies to manage hormone receptor-positive (HR+) BC are highly effective, endocrine resistance results in disease progression. Increased understanding of endocrine resistance and the mechanisms of disease progression has led to development and subsequent approval of novel targeted treatments, resulting in the expansion of the therapeutic armamentarium to combat HR+ BC. Clear guidelines based on the safety and efficacy of treatment options exist; however, the optimal sequence of therapy is unknown, and providers, payers, and other key players in the health care system are tasked with identifying cost-effective and evidence-based treatment strategies that will improve patient outcomes and, in time, help curb the staggering increase in cost associated with BC care. Safety and efficacy are key considerations, but there is also a need to consider the impact of a given therapy on patient quality of life, treatment adherence, and productivity. To minimize cost associated with overall management, cost-effectiveness, and financial burden that the therapy can impose on patients, caregivers and managed care plans are also important considerations. To help evaluate and identify the optimal choice of therapy for patients with HR+ advanced BC, the available data on endocrine therapies and novel agents are discussed, specifically with respect to the safety, efficacy, financial impact on patients and the managed care plan, impact on quality of life and productivity of patients, and improvement in patient medication adherence.

Acquisition of estrogen independence induces TOB1-related mechanisms supporting breast cancer cell proliferation

“…Numerous resistance mechanisms have been identified, including epigenetic changes affecting the ERα promoter [5], mutations activating the ERα protein to ligand independence [6, 7], altered expression or activation of cellular signaling proteins that generally promote survival such as epithelial growth factor receptor (EGFR) [8], insulin-like growth factor receptor (IGFR) [9], PI3K/AKT [10], mTOR signaling [11] and NFκB [12], and altered expression of specific miRNAs [13]. However, in hormone therapy-resistant breast cancer, chemotherapy remains the primary treatment modality [14], and the prognosis of such patients is poor.…”