Barron John J, Cziraky Mark J, Weisman Thomas, Hicks David G
HealthCore, Inc.,Wilmington, DE 19801, USA.
Oncologist. 2009 Aug;14(8):760-8. doi: 10.1634/theoncologist.2008-0288. Epub 2009 Aug 14.
Degree of physician adherence to 2001 guidelines recommending routine testing of human epidermal growth factor receptor 2 (HER2) status among newly diagnosed, recurrent, and metastatic breast cancer (BC) cases, and frequency of trastuzumab use in HER2-positive patients are not well documented.
Patients newly diagnosed with BC managed by an identifiable hematologist/oncologist between June 1, 2005 and June 30, 2006 were identified from an administrative claims database of three health plans (n = 3,521). From these, a subset of 380 patients was identified for medical chart review. HER2 testing (occurrence, type of test used), HER2 status (positive, negative, unknown), and trastuzumab usage were evaluated.
HER2 testing occurred in 88% of all newly diagnosed patients with BC and in 98.1% of those with stage 1 or higher breast cancer (n = 322), for whom testing is recommended. Among those with HER2 testing performed (n = 335), 21.5% were positive (HER2(+)), 77.3% were negative (HER2(-)), and 1.2% were unknown. Of the 52 patients who used trastuzumab, only one patient did not have documented HER2 overexpression. Of the 45 HER2(+) women who had stage 2 or higher BC, 13% did not receive trastuzumab.
HER2 testing status was extremely high among newly diagnosed BC patients treated by hematologists/oncologists in a managed care environment. There was almost no evidence of inappropriate prescribing of trastuzumab, but 1 of every 7.5 patients with HER2-overexpressing stage 2 or higher breast cancer did not receive the agent.
医生对2001年指南的遵循程度，该指南建议对新诊断、复发和转移性乳腺癌（BC）病例进行人表皮生长因子受体2（HER2）状态的常规检测，以及HER2阳性患者使用曲妥珠单抗的频率，目前尚无充分记录。
从三个健康计划的行政索赔数据库中识别出2005年6月1日至2006年6月30日期间由一名可识别的血液科医生/肿瘤内科医生管理的新诊断为BC的患者（n = 3521）。从中确定了380名患者的子集进行病历审查。评估了HER2检测（检测的发生情况、所用检测类型）、HER2状态（阳性、阴性、未知）和曲妥珠单抗的使用情况。
在所有新诊断的BC患者中，88%进行了HER2检测，在1期或更高分期乳腺癌患者（n = 322）中，98.1%进行了检测，对这些患者建议进行检测。在进行了HER2检测的患者中（n = 335），21.5%为阳性（HER2(+)），77.3%为阴性（HER2(-)），1.2%未知。在使用曲妥珠单抗的52名患者中，只有1名患者没有记录到HER2过表达。在45名患有2期或更高分期BC的HER2(+)女性中，13%没有接受曲妥珠单抗治疗。
在管理式医疗环境中，血液科医生/肿瘤内科医生治疗的新诊断BC患者中HER2检测状态极高。几乎没有证据表明曲妥珠单抗存在不当处方，但每7.5名HER2过表达的2期或更高分期乳腺癌患者中就有1名没有接受该药物治疗。
