Tsai Huei-Ting, Isaacs Claudine, Lynce Filipa C, O'Neill Suzanne C, Liu Chunfu, Schwartz Marc D, Selvam Nandini, Zhou Yingjun, Potosky Arnold L
Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
HealthCore, Inc., Alexandria, Virginia
J Natl Compr Canc Netw. 2017 May;15(5):601-607. doi: 10.6004/jnccn.2017.0063.
Studies have reported disparities by age and race in the initiation of adjuvant trastuzumab for the initial treatment of older women with early-stage breast cancer, but less is known about its initiation in younger patients. Therefore, we assessed temporal trends and clinical and demographic factors associated with trastuzumab initiation in a large, population-based cohort of patients aged <64 years in 5 states. Using a cancer registry and claims-linked data set of 13,398 women with incident invasive breast cancer from 2006 to 2011, we identified 934 patients aged <64 years with HER2-positive stage I-III breast cancer. We assessed trastuzumab initiation within the first 9 months after diagnosis and conducted logistic regression analyses to assess sociodemographic and clinical factors associated with trastuzumab initiation. From 2006 to 2011, trastuzumab initiation steadily increased in patients with node-positive (from 65% to 91%) and node-negative (from 39% to 75%) breast cancers. Several tumor-related factors were associated with trastuzumab initiation, including high histologic grades (adjusted odds ratio [aOR], 6.43; 95% CI, 3.27-12.65; and aOR, 3.25; 95% CI, 1.66-6.36, for grades 3 and 2, respectively), node-positive status (aOR, 1.88; 95% CI, 1.28-2.78; =.001), tumor size >2 cm (aOR, 1.50; 95% CI, 1.04-2.16; =.03), and hormone receptor-negative status (aOR, 1.51; 95% CI, 1.01-2.26; =.04). We found a null effect of race. Adjuvant trastuzumab therapy for early-stage breast cancer has been widely disseminated among women aged <64 years. The initiation of this targeted therapy was associated with higher-risk features, consistent with practice guidelines.
研究报告了在老年早期乳腺癌女性初始治疗中辅助使用曲妥珠单抗方面存在年龄和种族差异，但对于年轻患者中该药物的使用情况了解较少。因此，我们在5个州的一个基于人群的、年龄小于64岁的大型队列患者中评估了与曲妥珠单抗使用相关的时间趋势、临床及人口统计学因素。利用一个癌症登记处以及2006年至2011年期间13398例浸润性乳腺癌发病女性的医保理赔关联数据集，我们确定了934例年龄小于64岁的HER2阳性I - III期乳腺癌患者。我们评估了诊断后前9个月内曲妥珠单抗的使用情况，并进行了逻辑回归分析以评估与曲妥珠单抗使用相关的社会人口统计学和临床因素。从2006年到2011年，在淋巴结阳性（从65%增至91%）和淋巴结阴性（从39%增至75%）乳腺癌患者中，曲妥珠单抗的使用稳步增加。几个肿瘤相关因素与曲妥珠单抗的使用相关，包括高组织学分级（分别为3级和2级时，调整后的优势比[aOR]为6.43；95%置信区间[CI]为3.27 - 12.65；以及aOR为3.25；95% CI为1.66 - 6.36）、淋巴结阳性状态（aOR为1.88；95% CI为1.28 - 2.78；P =.001）、肿瘤大小>2 cm（aOR为1.50；95% CI为1.04 - 2.16；P =.03）以及激素受体阴性状态（aOR为1.51；95% CI为1.01 - 2.26；P =.04）。我们发现种族因素无影响。早期乳腺癌的辅助曲妥珠单抗治疗已在年龄小于64岁的女性中广泛传播。这种靶向治疗的使用与更高风险特征相关，这与实践指南一致。
