Efficacy and Economics of Hormonal Therapies for Advanced Breast Cancer

Abstract

Breast cancer is a leading cause of cancer-related mortality among postmenopausal women in the US, and the economic burden of breast cancer care comprises a large percentage of the healthcare budget. Hormonal therapies have a proven place in the management of advanced breast cancer. This type of therapy is more likely to be used in older, compared with younger, women, because tumours in older women are more likely to express estrogen and progesterone receptors. While it is difficult to measure the costs of cancer care because of variation in extent and duration of treatment, treatment-related costs including costs of hormonal agents used for advanced disease account for a relatively small component of the overall costs. Newer hormonal regimens such as the new third generation nonsteroidal (letrozole, anastrozole) and steroidal (exemestane) aromatase inhibitors have shown improved clinical efficacy compared with standard regimens such as megestrol and tamoxifen in the metastatic setting in terms of objective responses or time to tumour progression. In addition the newer agents have improved toxicity profiles. Cost analyses of the newer aromatase inhibitors (anastrozole and letrozole), compared with megestrol, show an optimistic outlook for these agents. Additional work needs to be done looking at a comparison of the efficacy and costs of the aromatase inhibitors relative to the currently recommended hormonal treatments used for women with metastatic breast cancer.

ONC201 activates ER stress to inhibit the growth of triple-negative breast cancer cells

“…TNBC lacks expression of the estrogen receptor, progesterone receptor, and HER2 [2, 3]. Consequently, this aggressive disease does not respond to widely used targeted therapies, such as trastuzumab, or endocrine therapies, such as tamoxifen or aromatase inhibitors [4, 5]. Conventional chemotherapeutic agents, including taxanes and anthracyclines, are standard-of-care treatment for TNBC [2].…”

Aromatase Inhibitors: Current Indications and Future Prospects for Treatment of Postmenopausal Breast Cancer

“…A cost‐effectiveness analysis of AIs favors these agents over megestrol acetate for the treatment of metastatic BC. Letrozole, although more expensive than megestrol acetate, is better tolerated and more effective 30 . The incremental cost‐effectiveness ratio (defined as difference in the cost of each agent divided by the difference in duration of survival) favors anastrozole 30 and letrozole 31 over megestrol acetate.…”

Targeting PP2A inhibits the growth of triple-negative breast cancer cells

“…One of these subtypes is triple-negative breast cancer (TNBC). Patients with TNBC do not benefit from widely used targeted therapies [3,4] because TNBC lacks the expression of estrogen receptor (ER), progesterone receptor (PR) and HER2 amplification [5,6]. TNBC makes up approximately 15-20% of all breast cancer cases [3,4].…”