Lapatinib and trastuzumab in combination with an aromatase inhibitor for the first-line treatment of metastatic hormone receptor-positive breast cancer which over-expresses human epidermal growth factor 2 (HER2): a systematic review and economic analysis

Abstract

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Cost-Effectiveness of Lapatinib plus Letrozole in Post-Menopausal Women with Hormone Receptor- and HER2-Positive Metastatic Breast Cancer

“…The methods and results of the study by McNamara et al are similar to those employed in the Roche manufacturer's submission to NICE as reported by the AG [22]. Estimates of the cost-effectiveness of LAP + LET and TZ + ANA versus LET and ANA were similar to those reported here.…”

“…As part of the NICE assessment of LAP and TZ plus AI therapy, the assessment group (AG) conducted separate analyses of the cost-effectiveness of LAP + LET versus LET, and of TZ + ANA versus ANA, arguing that trial data were not sufficiently similar to support an adjusted indirect comparison [22]. For the LAP + LET versus LET comparison, the AG developed a de novo model using data from EGF30008 and other published sources.…”

“…While eLEcTRA, TAnDEM and EGF30008 provide evidence of the clinical benefits of HER2-targeted therapy plus an AI in patients with HR+/HER2+ MBC, these studies did not assess cost-effectiveness. The analysis reported herein was the basis of an economic evaluation included in the manufacturer's submission to the UK's National Institute for Health and Clinical Excellence (NICE) in response to a multiple technology assessment (MTA) of LAP and TZ in combination with an AI for the first-line treatment of postmenopausal women with HR+/HER2+ MBC [22]. …”

Disease management patterns for postmenopausal women in Europe with hormone-receptor-positive, human epidermal growth factor receptor-2 negative advanced breast cancer

“…In this study, targeted therapies were used more with chemotherapy than with HT. However, recent evidence suggests that multiple lines of HT with different endocrine agents and combinations with newer targeted agents provide clinical benefit in appropriate patients 14,19 . In the current guidelines, anti-HER2 agents and the antiangiogenic agent bevacizumab are generally considered targeted therapies; the newer targeted agents are considered additional therapies to overcome endocrine resistance 1,3 .…”

Adaptation to AI Therapy in Breast Cancer Can Induce Dynamic Alterations in ER Activity Resulting in Estrogen-Independent Metastatic Tumors

“…ER/growth factor cross-talk and in particular amplification of the growth factor receptor HER2 has been associated with resistance to endocrine therapy in both preclinical and clinical studies (4)(5)(6). Recently, clinical and proteomic work has implicated PI3K as a central node in AI-resistant second messenger signaling networks (2,(7)(8)(9).…”