Chavarri-Guerra Y, St Louis J, Bukowski A, Soto-Perez-de-Celis E, Liedke P E R, Symecko H, Moy B, Higgins M, Finkelstein D M, Goss P E
Global Cancer Institute, Boston, MA 02114, USA; Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Global Cancer Institute, Boston, MA 02114, USA; Avon International Breast Cancer Program, Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA.
Breast. 2017 Feb;31:197-201. doi: 10.1016/j.breast.2016.11.014. Epub 2016 Nov 25.
HER2-overexpressing breast cancer (BC) is common among young patients and poses a public health burden. Adjuvant anti-HER2/neu therapy with trastuzumab reduces the risk of recurrence and improves survival.
A web-based survey was sent to 386 physicians of the "TEACH" trial in 2011 to determine access to HER2/neu testing and treatment patterns for HER2-overexpressing BC.
There were 151 responders (39%) from 28 countries. Ninety-seven percent reported HER2/neu expression is routinely measured in their institutions by immunohistochemistry (85%), FISH (80%) and other methods (16%). Twenty percent of responders from Asia reported that the test was not routinely available. Forty-eight percent of participants reported instances when adjuvant HER2-directed therapy was recommended to a patient who eventually did not receive it. Reasons for not receiving trastuzumab was cost (73%, p < 0.0001) in low- and middle-income countries and co-morbidities in high-income countries (43%, p = 0.003).
This survey reflects the availability of HER2/neu testing and anti-HER2/neu therapy among physicians who participated in TEACH. A high proportion of women with HER2-overexpressing BC may not receive standard adjuvant therapy due to unavailability of the test and cost of therapy. Despite having some limitations, such as a possible selection bias of participating physicians, variable definitions of access to healthcare among respondents, and changes in trastuzumab availability since 2011, our results demonstrate that access to care and region of practice impact the implementation of cancer treatments.
人表皮生长因子受体2（HER2）过表达的乳腺癌（BC）在年轻患者中很常见，并且构成了公共卫生负担。曲妥珠单抗辅助抗HER2/neu治疗可降低复发风险并提高生存率。
2011年向“TEACH”试验的386名医生发送了一项基于网络的调查，以确定HER2过表达BC的HER2/neu检测情况和治疗模式。
来自28个国家的151名医生（39%）回复了调查。97%的回复者报告其所在机构常规通过免疫组织化学（85%）、荧光原位杂交（FISH，80%）和其他方法（16%）检测HER2/neu表达。来自亚洲的20%的回复者报告该检测并非常规可用。48%的参与者报告存在向患者推荐辅助性HER2靶向治疗但患者最终未接受的情况。未接受曲妥珠单抗的原因在低收入和中等收入国家是费用（73%，p<0.0001），在高收入国家是合并症（43%，p=0.003）。
这项调查反映了参与“TEACH”试验的医生中HER2/neu检测和抗HER2/neu治疗的可及性情况。由于检测不可用和治疗费用，高比例的HER2过表达BC女性可能无法接受标准辅助治疗。尽管存在一些局限性，如参与医生可能存在选择偏倚、受访者对医疗可及性的定义不同以及自2011年以来曲妥珠单抗可及性的变化，但我们的结果表明医疗可及性和执业地区会影响癌症治疗的实施。
