Burton Tanya, Byfield Stacey DaCosta, Smith Gregory L, Zanotti Giovanni, Bell Timothy J, Perkins Julia J, Horblyuk Ruslan, Teitelbaum April
a Optum , Waltham , MA , USA ;
b Optum , Eden Prairie , MN , USA ;
Curr Med Res Opin. 2016 Aug;32(8):1417-23. doi: 10.1080/03007995.2016.1178108. Epub 2016 May 12.
Guidelines recommend that women with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer (mBC) initiate hormonal therapy before chemotherapy. This study compared outcomes of women with mBC who received chemotherapy first vs hormonal therapy.
A retrospective cohort study of women with mBC was conducted using a large US commercial health plan database between January 1, 2008-April 30, 2013. Subjects had evidence of a HR+/HER2- tumor sub-type in a cancer registry and use of chemotherapy or hormonal therapy in claims. Subjects were continuously enrolled for ≥6 months after metastasis and assigned to cohorts for receiving chemotherapy only or hormonal therapy only during first-line (CT-1L vs HT-1L). Adjusted incidence rates of clinically significant events were compared using a negative binomial model, and adjusted healthcare costs were compared using a generalized linear model.
Three hundred and twenty-four women with HR+/HER2- mBC met the selection criteria; 179 (55%) received CT-1L and 145 (45%) received HT-1L. Mortality rates did not differ between cohorts (unadjusted incidence rate ratio (IRR) = 1.67, 95% CI = 0.82-3.46; adjusted IRR = 0.64, 95% CI = 0.32-1.27). Adjusted average total all-cause healthcare costs were $11 090 for women with CT-1L and $6743 for women with HT-1L (cost ratio =1.64, 95% CI =1.36-1.99).
Observed use of first-line chemotherapy (>50%) was higher than expected given the HR + molecular profile of the tumors. Chemotherapy use during first-line did not appear to be associated with a survival benefit, but was associated with significantly higher costs compared with the use of hormonal therapy during first-line; however, this comparison is limited by demographic and baseline characteristic differences between the two cohorts. This study contributes to understanding real-world treatment patterns and the associated clinical and economic outcomes of using chemotherapy vs hormonal therapy as a first-line treatment option for the HR+/HER2- mBC population.
指南建议，激素受体阳性/人表皮生长因子受体2阴性（HR+/HER2-）转移性乳腺癌（mBC）女性应在化疗前开始激素治疗。本研究比较了先接受化疗与先接受激素治疗的mBC女性的结局。
利用美国一个大型商业健康计划数据库，对2008年1月1日至2013年4月30日期间的mBC女性进行了一项回顾性队列研究。受试者在癌症登记处有HR+/HER2-肿瘤亚型的证据，且在理赔记录中有化疗或激素治疗的使用情况。受试者在转移后连续入组≥6个月，并被分配到仅接受化疗或仅接受激素治疗的队列中，进行一线治疗（CT-1L vs HT-1L）。使用负二项模型比较具有临床意义事件的调整发病率，使用广义线性模型比较调整后的医疗费用。
324例HR+/HER2- mBC女性符合入选标准；179例（55%）接受CT-1L，145例（45%）接受HT-1L。各队列之间的死亡率无差异（未调整发病率比（IRR）=1.67，95%置信区间（CI）=0.82-3.46；调整后IRR=0.64，95%CI=0.32-1.27）。CT-1L女性调整后的平均全因医疗费用为11090美元，HT-1L女性为6743美元（费用比=1.64，95%CI=1.36-1.99）。
鉴于肿瘤的HR+分子特征，观察到的一线化疗使用率（>50%）高于预期。一线使用化疗似乎与生存获益无关，但与一线使用激素治疗相比，费用显著更高；然而，这种比较受到两个队列之间人口统计学和基线特征差异的限制。本研究有助于了解现实世界中的治疗模式以及将化疗与激素治疗作为HR+/HER2- mBC人群一线治疗选择的相关临床和经济结局。
