Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.
Cancer. 2021 Jul 15;127(14):2562-2570. doi: 10.1002/cncr.33514. Epub 2021 Mar 17.
Anti human epidermal growth factor receptor 2 (anti-HER2) therapy with trastuzumab improves overall survival in patients with advanced, HER2-positive gastroesophageal adenocarcinoma (GEA) and is now incorporated into national guidelines. However, little is known about adherence to and determinants of timely HER2 testing and trastuzumab initiation in routine practice.
The authors performed a cross-sectional study of patients who had advanced GEA diagnosed between January 2011 and June 2019 in a nationwide electronic health record-derived database. The annual prevalences of both timely HER2 testing (defined within 21 days after advanced diagnosis) and timely trastuzumab initiation (defined within 14 days after a positive HER2 result) were calculated. Log-binomial regressions estimated adjusted prevalence ratios comparing timely HER2 testing and trastuzumab initiation by patient and tumor characteristics.
In total, the cohort included 6032 patients with advanced GEA of whom 1007 were HER2-positive. Between 2011 and 2019, timely HER2 testing increased from 22.4% to 44.5%, whereas timely trastuzumab initiation remained stable at 16.3%. No appreciable differences in timely testing or trastuzumab initiation were noted by age, sex, race, or insurance status. Compared with patients who had metastatic disease at diagnosis, patients who had early stage GEA who did not undergo surgery were less likely to receive timely HER2 testing and trastuzumab initiation (testing prevalence ratio, 0.69; 95% CI, 0.64-0.75; treatment prevalence ratio, 0.32; 95% CI, 0.18-0.56), as were patients with early stage disease who subsequently developed a distant recurrence (testing prevalence ratio, 0.56; 95% CI, 0.47-0.65; treatment prevalence ratio, 0.61; 95% CI, 0.24-1.55).
In patients with advanced GEA, guideline-recommended HER2 testing and anti-HER2 therapy remain underused. Uptake may improve with universal HER2 testing regardless of stage.
曲妥珠单抗等抗人表皮生长因子受体 2（anti-HER2）疗法可提高晚期 HER2 阳性胃食管腺癌（GEA）患者的总生存率，目前已被纳入国家指南。然而，在常规实践中，关于及时进行 HER2 检测和曲妥珠单抗起始治疗的依从性及其决定因素知之甚少。
作者对 2011 年 1 月至 2019 年 6 月期间在全国性电子病历数据库中诊断为晚期 GEA 的患者进行了一项横断面研究。计算了及时进行 HER2 检测（定义为晚期诊断后 21 天内）和及时开始曲妥珠单抗治疗（定义为 HER2 阳性结果后 14 天内）的年度患病率。采用对数二项式回归估计了患者和肿瘤特征比较下及时进行 HER2 检测和曲妥珠单抗起始治疗的调整后患病率比。
共有 6032 例晚期 GEA 患者，其中 1007 例为 HER2 阳性。2011 年至 2019 年期间，及时进行 HER2 检测的比例从 22.4%增加到 44.5%，而及时开始曲妥珠单抗治疗的比例则保持稳定在 16.3%。年龄、性别、种族或保险状况均未观察到及时检测或曲妥珠单抗起始治疗的明显差异。与诊断时即存在转移性疾病的患者相比，未行手术的早期 GEA 患者更不可能及时进行 HER2 检测和曲妥珠单抗治疗（检测的患病率比为 0.69；95%CI，0.64-0.75；治疗的患病率比为 0.32；95%CI，0.18-0.56），而疾病早期但随后发生远处转移的患者也不太可能及时进行 HER2 检测和曲妥珠单抗治疗（检测的患病率比为 0.56；95%CI，0.47-0.65；治疗的患病率比为 0.61；95%CI，0.24-1.55）。
在晚期 GEA 患者中，HER2 检测和抗 HER2 治疗的指南推荐仍未得到充分应用。无论疾病分期如何，普遍进行 HER2 检测可能会提高接受率。
