Review of Testing and Use of Adjuvant Trastuzumab across a Cancer Network — Are We Treating the Right Patients?

Coulson, S.G.; Kumar, Vineet; Manifold, I; Hatton, Matthew; Ramakrishnan, S.; Dunn, Kathleen; Purohit, O.P.; Bridgewater, Caroline; Coleman, Robert E.

doi:10.1016/j.clon.2010.02.011

Cited by 15 publications

(21 citation statements)

References 16 publications

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“…The majority of patients with EBC were tested for the presence of HER2. The frequency of HER2 positivity was 23%, which is a rate consistent with the 22% reported in another review of medical charts [9], although lower frequencies have also been reported [10,11]. Patients in whom the HER2 status was not examined did not qualify for adjuvant treatment with chemotherapy or had different disease characteristics.…”

Section: Discussionsupporting

confidence: 68%

“…However, we do not know whether these patients had been treated earlier with anthracyclines, which may increase the risk for trastuzumab-associated cardiotoxicity, nor the associated time interval between administration of the anthracycline and the start of trastuzumab [12]. A similar review of practice in the UK concerning the use of trastuzumab addresses whether chemotherapy should be avoided in particular subgroups of patients [11]. How treatment variations may influence survival times should be studied and optimal regimens for these groups should be determined.…”

Section: Discussionmentioning

confidence: 99%

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Guideline Adherence Regarding the Use of Expensive Drugs in Daily Practice: The Examples of Trastuzumab in Breast Cancer and Bortezomib in Multiple Myeloma

Boons

Wagner²,

Hugtenburg³

2016

Oncol Res Treat

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Background: The present study was designed to obtain insights into guideline adherence regarding the use of expensive drugs in The Netherlands in daily practice and into the patients' perspective on the decision-making process. Material and Methods: A retrospective review of medical charts regarding the use of trastuzumab in early and metastatic breast cancer (EBC/MBC) and bortezomib in multiple myeloma (MM) was conducted. Prescription according to clinical practice guidelines was assessed. The review was supplemented with patient interviews. Results: Of 702 adjuvant-treated EBC patients, 97% had a documented human epidermal growth factor receptor 2 (HER2) testing (23% HER2 positive). 92% (147/160) of the HER2-positive EBC patients were treated with trastuzumab. Of 594 MBC patients, 81% had a documented HER2 testing (19% HER2 positive). 82% (75/91) of the HER2-positive MBC patients were treated with trastuzumab. Of 68 MM patients, 50% were treated with bortezomib. Reasons not to treat were consistent with the guidelines. Patients were generally satisfied with the decision-making process; improvements in patient education were suggested (e.g., repeating the information given, adding information on side effects). Conclusions: Guidelines were generally well followed with respect to trastuzumab and bortezomib, indicating that funding did not influence the treatment decisions of physicians. In view of the growing numbers of both cancer patients and expensive new anticancer drugs, and increasing budget constraints, it is unclear whether the present-day policies will guarantee a similar level of guideline adherence. Patient involvement in decision-making could be increased by improving the patient education on treatment.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Guideline Adherence Regarding the Use of Expensive Drugs in Daily Practice: The Examples of Trastuzumab in Breast Cancer and Bortezomib in Multiple Myeloma

Boons

Wagner²,

Hugtenburg³

2016

Oncol Res Treat

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“…Of these, 56 (30 %) did not receive trastuzumab. The majority were not treated because of age >75 years, frailty, poor performance status, and/or comorbidities, while 10 (15 %) had a prior cardiac history and 13 (20 %) refused therapy [18]. Barron and colleagues [19] used data from 3 health plans in the U.S. Of 3521 women diagnosed with non-metastatic breast cancer, a subset was identified who underwent HER2 testing ( N = 335).…”

Section: Discussionmentioning

confidence: 99%

Non-initiation and early discontinuation of adjuvant trastuzumab in women with localized HER2-positive breast cancer

et al. 2014

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One year of trastuzumab therapy is recommended for women with HER2-positive breast cancer ≥1.0 cm in size to increase survival and is considered for women with tumors 0.5–0.9 cm in size. We analyzed compliance with trastuzumab among women with HER2-positive breast cancer in a prospective cohort study. Of 1145 recruited patients with breast cancer, 152 were HER2-positive (13.2 %), of whom 126 had tumors ≥1.0 cm; 110/126 (87.3 %) of these initiated trastuzumab. Non-receipt was associated with older age, better prognosis tumors, and with non-receipt of adjuvant chemotherapy. Of the 110 who initiated treatment, 18 (15 %) did not complete treatment, 15 (83 %) of them because of cardiotoxicity. Of 20 women with tumors 0.5–0.9 cm, 5 (25 %) initiated trastuzumab. Compliance with trastuzumab was very high among those with HER2-positive breast cancer, as was the completion of the recommended therapy.

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“…Two studies conducted in the UK have recently been reported [55,56], which address similar questions in the context of a national healthcare system. In the UK, the National Institute for Health and Clinical Excellence guidance has recommended adjuvant trastuzumab for women with positive HER2 test results with normal left ventricular ejection fraction and without cardiac contraindications to trastuzumab therapy since 2005 [57].…”

Section: Discussionmentioning

confidence: 99%

“…In the UK, the National Institute for Health and Clinical Excellence guidance has recommended adjuvant trastuzumab for women with positive HER2 test results with normal left ventricular ejection fraction and without cardiac contraindications to trastuzumab therapy since 2005 [57]. Coulson et al [55] evaluated patients who received HER2 testing between September 2007 and August 2008 in the North Trent Cancer Network. In this study, 15.1% of tested subjects were HER2 positive, and 67% of HER2 -positive subjects were treated with trastuzumab.…”

Section: Discussionmentioning

confidence: 99%

<i>HER2</i> Evaluation and Its Impact on Breast Cancer Treatment Decisions

Goddard

Weinmann

Richert-Boe

et al. 2011

Public Health Genomics

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Background: Eighteen to twenty percent of breast cancer tumors show abnormal amplification of the Human Epidermal growth factor Receptor 2 (HER2) gene and increased expression of the associated protein. HER2 amplification is associated with rapid tumor proliferation and shorter disease-free and overall survival. Because women with HER2 amplification are more likely to benefit from treatment with the drug trastuzumab, testing for HER2 is recommended to guide therapy. However, little is known about use of HER2 testing in real-world settings. This study examined uptake, use, appropriateness of HER2 testing, and the relationship between HER2 test results and treatment decisions. Methods: We assessed electronic data from 3,634 patients with invasive breast cancer diagnosed from 1998 to 2007 in a large integrated health system. We collected data on patient and tumor characteristics, HER2 testing status, test results, and trastuzumab treatment. Results:From 1998 to 2000, the percent of patients who underwent HER2 evaluation increased from 12 to 94%; <3% of women with ductal carcinoma in situ, for whom HER2 testing is not recommended, were tested. Trastuzumab use increased 5-fold after 2004, when guidelines expanded to include recommending adjuvant treatment for early-stage breast cancer in addition to metastatic treatment. Ninety-five percent of women receiving trastuzumab had a positive HER2 result. After 2004, 55% of women with invasive breast cancer and overexpression of HER2 received trastuzumab treatment; this ranged from 44% of women with localized breast cancer to 80% of women with distant metastatic disease. Conclusions:These findings illustrate appropriate and effective implementation of a HER2 testing strategy in a managed care setting.

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Review of Testing and Use of Adjuvant Trastuzumab across a Cancer Network — Are We Treating the Right Patients?

Cited by 15 publications

References 16 publications

Guideline Adherence Regarding the Use of Expensive Drugs in Daily Practice: The Examples of Trastuzumab in Breast Cancer and Bortezomib in Multiple Myeloma

Guideline Adherence Regarding the Use of Expensive Drugs in Daily Practice: The Examples of Trastuzumab in Breast Cancer and Bortezomib in Multiple Myeloma

Non-initiation and early discontinuation of adjuvant trastuzumab in women with localized HER2-positive breast cancer

<i>HER2</i> Evaluation and Its Impact on Breast Cancer Treatment Decisions

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