Management of primary and metastatic triple negative breast cancer: Perceptions of oncologists from India

Parikh, PM; Gupta, Sudeep; Parikh, Biren; Smruti, B K; Issrani, J; Topiwala, Shehzad; Goswami, Chirayu; Bhattacharya, GS; Sen, Triparna; Sekhon, JS; Malhotra, Hemant; Nag, Shona; Chacko, RT; Govind, Kanakasetty Babu; Raja, T; Vaid, AK; Doval, DC; Das, PK

doi:10.4103/0019-509x.82874

Cited by 4 publications

(4 citation statements)

References 17 publications

(19 reference statements)

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“…Our estimated median OS for luminal A, luminal B, HER2-enriched, and TNBC (41, 27, 26, and 19 months, respectively) is consistent with published estimates. 21 , 43 , 44 Studies by Khadkban et al 43 and Parikh et al 44 reported OS ranging from 21.2 to 31.4 months and 9 to 22 months, respectively, while Gogia et al 21 reported separate survival rates with respect to different types of molecular subtypes, ranging from 17.5 (95% CI, 11 to 19.2) months to 41.4 (95% CI, 30 to 52.8). Our results align closely with this real-world evidence in the Indian context (Fig 2 ).…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Denosumab in the Prevention of Skeletal-Related Events Among Patients With Breast Cancer With Bone Metastasis in India

Wadhwa,

Gupta,

Dixit

et al. 2024

JCO Glob Oncol

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PURPOSE Denosumab is clinically superior to zoledronic acid (ZA) for preventing and delaying time to first and subsequent skeletal-related events (SREs) among patients with breast cancer (BC) with bone metastases. We evaluated the cost and health benefits of denosumab and ZA (once every 4 weeks and once every 12 weeks) among four different molecular subtypes of BC with bone metastases in India. MATERIALS AND METHODS A Markov model was developed in Microsoft Excel to estimate lifetime health consequences and resulting costs among cohort of 1,000 patients with BC with bone metastasis, for three intervention scenarios, namely denosumab (once every 4 weeks), ZA (once every 4 weeks), and ZA (once every 12 weeks). The health outcomes were measured in terms of SREs averted and quality-adjusted life-years (QALYs) gained. The cost of each intervention scenario was measured using both the health system and the patient's perspectives. Indirect costs because of lost productivity were not included. The future costs and outcomes were discounted at the standard rate of 3%. RESULTS Over a lifetime, the incremental number of SREs averted with use of denosumab once every 4 weeks (compared with ZA once every 4 weeks and once every 12 weeks) among patients with luminal A, luminal B, human epidermal growth factor receptor 2–enriched, and triple negative breast cancer were estimated as 0.39, 0.26, 0.25, and 0.19, respectively. The number of QALYs lived were slightly higher in the denosumab arm (1.45-2.80) compared with ZA once every 4 weeks and once every 12 weeks arms (1.44-2.78). However, denosumab once every 4 weeks was not found to be a cost-effective alternative for either of the four molecular subtypes of breast cancer. ZA once every 12 weeks was found to be a cost-effective option with an average cost-effectiveness ratio ranging between ₹68,254 and ₹73,636. CONCLUSION ZA once every 12 weeks is the cost-effective treatment option for BC with bone metastases in India. The present study findings hold significance for standard treatment guidelines under India’s government-funded health insurance program.

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Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Denosumab in the Prevention of Skeletal-Related Events Among Patients With Breast Cancer With Bone Metastasis in India

Wadhwa,

Gupta,

Dixit

et al. 2024

JCO Glob Oncol

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“…[8] TNBC is said to be a disease with poor prognosis, suboptimal response to therapy and therefore is a disease with unmet needs. [9][10][11] Various biomarkers such as circulating tumor cells, cell-free DNA, and PD-L1 expression as well as novel therapeutic agents have been studied. [12][13][14][15] Till they become standard of care, is there a way of improving the survival in patients with TNBC?…”

Section: Discussionmentioning

confidence: 99%

Choosing Wisely – Implication based on Indian data in our patients with breast cancer (INR vs. USD)

Bapna

Patni

2021

IJMIO

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Objectives: Breast cancer is increasing in India due to aging population, better awareness among general public, willingness to seek treatment of cancers, and easier access to cancers centers. We present our single-center data over a 2-year period and discuss cost implications taking the example of metronomic chemotherapy maintenance and predictive markers in early breast cancer. Material and Methods: Prospectively collected data of all consecutive patients with breast cancer registered between September 2017 and August 2019 were evaluated. Clinical features, stage, receptor status, and other features were tabulated. Statistical analysis was using SAS version 9.4 – Chi-square test and Fisher’s exact test were performed. P ≤ 0.05 was considered as statistically significant. Results: For the 484 consecutive patients, the median age was 50 years. This included EBC (201, 42%), LABC (141, 29%), and MBC (142, 29%). ER expression was seen in 52% of cases (253/484), PR in 47% (229/484), and Her2 was positive in 47% (229/484). Finally, 83 patients (17%) were identified as TNBC. HR-positive Her2-negative EBC constituted 111/484 patients (23%). Discussion: If our 83 TNBC patients were given metronomic maintenance chemotherapy, their 3-year overall survival (OS) is projected to increase from 54% to 100% at a cost of INR 8191/- per patient (equivalent to USD 109/-). If our 111 HR-positive Her2-negative EBC patients were evaluated for risk by biomarker test validated in Indian patients, 76 of these would be spared the toxicity of adjuvant CT. This would also result in saving on the cost of chemotherapy medication of INR 4,035,296/- in India (equivalent to USD 53,699/- if treated in USD). In addition, they would also have better quality of life (QoL). Conclusion: It is possible to identify patients with low risk early breast cancer using Can assist and save them from unnecessary cost and/or toxicity.

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“…The gene mutation may originate from the maternal or the paternal side, and each offspring of a BRCA carrier has a 50% chance of inheriting the mutation. [ 34 35 ]…”

Section: Discussionmentioning

confidence: 99%

Practical consensus recommendation on when to do BRCA testing

Parikh

Wadhwa

Minhas

et al. 2018

South Asian J Cancer

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BRCA-mutation associated breast cancer and to future cancer risks and sensitivity to systemic therapies. Now that rapid genetic testing for BRCA1 and BRCA2 mutations is available, BRCA mutation status can be considered when making treatment and prevention decisions for BRCA testing, BRCA mutation carriers with breast cancer. Expert group used data from published literature, practical experience, and opinion of a large group of academic oncologists, to arrive at practical consensus recommendations for use by the community oncologists.

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Management of primary and metastatic triple negative breast cancer: Perceptions of oncologists from India

Abstract: This data offers insight into the perceptions and practice of a diverse cross-section of practicing oncologists in India with respect to their therapeutic choices in metastatic and adjuvant settings in triple negative breast cancer.

Cited by 4 publications

References 17 publications

Cost-Effectiveness Analysis of Denosumab in the Prevention of Skeletal-Related Events Among Patients With Breast Cancer With Bone Metastasis in India

Cost-Effectiveness Analysis of Denosumab in the Prevention of Skeletal-Related Events Among Patients With Breast Cancer With Bone Metastasis in India

Choosing Wisely – Implication based on Indian data in our patients with breast cancer (INR vs. USD)

Practical consensus recommendation on when to do BRCA testing

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