Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Indian J Cancer. 2022 Jul-Sep;59(3):375-379. doi: 10.4103/ijc.IJC_841_19.
In a previous retrospective audit from our institution we reported that patients had limited access to HER2-targeted therapy due to financial constraints. Subsequently, the advent of biosimilar versions of trastuzumab and philanthropic support has potentially changed this situation. Herein, we reanalyzed and reported access to HER2-targeted therapy in a more recent cohort of patients.
Medical records of new breast cancer patients registered in one calendar year were retrospectively reviewed, supplemented by online pharmacy data to extract information on receptor status, use of HER2-targeted therapy, and other relevant variables. Since not all HER2 immunohistochemistry (IHC) 2+ tumors underwent fluorescent in-situ hybridization (FISH) testing, we estimated the probable HER2 amplified from this group based on a FISH amplified fraction in those HER2 2+ tumors who did undergo FISH.
Between January 2016 and December 2016, 4717 new BC patients were registered at our institution, of whom 729 (20.04%) had HER2 IHC 3+ tumors while 641 (17.62%) had HER2 IHC 2+ tumors. The final number of HER2 overexpressing/amplified tumors was estimated to be 928 (729 HER2 IHC 3+, 105 known FISH amplified, and 94 estimated FISH amplified), of whom 831 received treatment at our institution. Overall 474 (57.03%, 95% confidence interval [CI] 53.6-60.4) of these 831 patients received trastuzumab for durations ranging from 12 weeks to 12 months in the (neo)adjuvant setting or other durations in metastatic setting compared to 8.61% (95% CI 6.2-11.6) usage of HER2-targeted therapy in the 2008 cohort.
Access to HER2-targeted therapy has substantially increased among patients treated at a public hospital in the past decade, likely due to the advent of biosimilars, the use of shorter duration adjuvant regimens, and philanthropic support. However, further efforts are required to achieve universal access to this potentially life-saving treatment.
在我们机构之前的一项回顾性审计中，我们报告说由于经济限制，患者获得曲妥珠单抗靶向治疗的机会有限。随后，曲妥珠单抗生物类似药的出现和慈善支持改变了这种情况。在此，我们重新分析并报告了在最近的患者队列中获得曲妥珠单抗靶向治疗的机会。
回顾性分析了一年中登记的新乳腺癌患者的病历，并通过在线药房数据提取受体状态、曲妥珠单抗靶向治疗的使用及其他相关变量的信息。由于并非所有 HER2 免疫组化（IHC）2+肿瘤都进行了荧光原位杂交（FISH）检测，因此我们根据那些进行了 FISH 检测的 HER2 2+肿瘤中的 FISH 扩增分数，估计了这一组中可能的 HER2 扩增情况。
2016 年 1 月至 12 月期间，我院共登记新乳腺癌患者 4717 例，其中 729 例（20.04%）为 HER2 IHC 3+肿瘤，641 例（17.62%）为 HER2 IHC 2+肿瘤。HER2 过表达/扩增肿瘤的最终数量估计为 928 例（729 例 HER2 IHC 3+，105 例已知 FISH 扩增，94 例估计 FISH 扩增），其中 831 例在我院接受治疗。在这 831 例患者中，总体有 474 例（57.03%，95%置信区间[CI]53.6-60.4）在新辅助治疗或转移性疾病中接受了曲妥珠单抗治疗，治疗时间从 12 周至 12 个月不等，而在 2008 年队列中，HER2 靶向治疗的使用率仅为 8.61%（95%CI6.2-11.6）。
在过去十年中，在一家公立医院接受治疗的患者获得曲妥珠单抗靶向治疗的机会大大增加，这可能是由于生物类似药的出现、较短时间的辅助治疗方案的应用和慈善支持。然而，仍需要进一步努力，以实现这种潜在救命治疗的普遍可及性。
