巴西公共卫生系统中因无法获得抗HER2疗法治疗晚期乳腺癌导致的过早死亡估计。
Estimation of Premature Deaths From Lack of Access to Anti-HER2 Therapy for Advanced Breast Cancer in the Brazilian Public Health System.
作者信息
Debiasi Márcio, Reinert Tomás, Kaliks Rafael, Amorim Gilberto, Caleffi Maira, Sampaio Carlos, Fernandes Gustavo Dos Santos, Barrios Carlos H
机构信息
and , Latin American Cooperative Oncology Group; Márcio Debiasi, Hospital São Lucas da Pontificia Universidade Católica do Rio Grande do Sul; and , Hospital do Câncer Mãe de Deus; Maira Caleffi, Federacão Brasileira de Instituicões Filantrópicas de Apoio à Saúde da Mama; , Pontificia Universidade Católica do Rio Grande do Sul School of Medicine, Porto Alegre; , Hospital Israelita Albert Einstein; , Hospital Sírio-Libanês, São Paulo; Gilberto Amorim, Centro de Oncologia D'Or, São Cristóvão; , Clinica Assistência Multidisciplinar em Oncologia, Salvador; and , Sociedade Brasileira de Oncologia, Belo Horizonte, Brazil.
出版信息
J Glob Oncol. 2016 Jul 20;3(3):201-207. doi: 10.1200/JGO.2016.005678. eCollection 2017 Jun.
PURPOSE
Patients with human epidermal growth factor receptor 2 (HER2) -positive metastatic tumors treated in the public health system in Brazil do not have access to trastuzumab. This study aimed to estimate the impact of the lack of access to anti-HER2 therapies on the mortality of these patients.
METHODS
On the basis of published data, the number of patients with HER2-positive advanced breast cancer in 2016 who should receive anti-HER2 targeted therapy was estimated. Three different treatment groups were considered for this hypothetical cohort: chemotherapy alone, chemotherapy plus trastuzumab, and chemotherapy plus trastuzumab and pertuzumab. The number of patients alive after 2 years of follow-up was estimated on the basis of the efficacy results of the pivotal trials considering these interventions.
RESULTS
It was calculated that 2,008 women will be diagnosed with advanced HER2-positive breast cancer in Brazil in 2016. It was estimated that only 808 women would be alive in 2018 if they receive only chemotherapy (which is the treatment offered by the public health system). On the other hand, the bar rises to 1,408 women alive in 2018 if they receive chemotherapy plus trastuzumab and 1,576 women alive in 2018 if they receive the gold standard of chemotherapy plus trastuzumab and pertuzumab.
CONCLUSION
Trastuzumab is included in the WHO's list of essential medications, but the Brazilian public health system does not yet provide this treatment to its population with advanced disease. The introduction of trastuzumab and pertuzumab would have a positive effect, preventing premature deaths in women with metastatic HER2-positive breast cancer in Brazil.
目的
在巴西公共卫生系统接受治疗的人表皮生长因子受体2（HER2）阳性转移性肿瘤患者无法获得曲妥珠单抗。本研究旨在评估无法获得抗HER2治疗对这些患者死亡率的影响。
方法
根据已发表的数据，估算了2016年应接受抗HER2靶向治疗的HER2阳性晚期乳腺癌患者数量。针对这个假设队列考虑了三个不同的治疗组：单纯化疗、化疗加曲妥珠单抗、化疗加曲妥珠单抗和帕妥珠单抗。根据考虑这些干预措施的关键试验的疗效结果，估算随访2年后存活的患者数量。
结果
经计算，2016年巴西将有2008名女性被诊断为晚期HER2阳性乳腺癌。据估计，如果仅接受化疗（这是公共卫生系统提供的治疗），2018年只有808名女性存活。另一方面，如果接受化疗加曲妥珠单抗，2018年存活女性人数将增至1408名；如果接受化疗加曲妥珠单抗和帕妥珠单抗的金标准治疗，2018年存活女性人数将为1576名。
结论
曲妥珠单抗被列入世界卫生组织基本药物清单，但巴西公共卫生系统尚未为其患有晚期疾病的人群提供这种治疗。引入曲妥珠单抗和帕妥珠单抗将产生积极影响，可防止巴西转移性HER2阳性乳腺癌女性过早死亡。
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