Master Program in Clinical Pharmacy, School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
BMC Cancer. 2023 Jun 20;23(1):567. doi: 10.1186/s12885-023-11061-4.
Taiwan's National Health Insurance has covered targeted therapy, namely cetuximab, for locally advanced head and neck cancers (LAHNC) since July 2009. This study examines treatment trends and survival effects of locally advanced head and neck cancer patients before and after Taiwan's National Health Insurance covered cetuximab.
We examined treatment trends and survival effects for patients with LAHNC using Taiwan's National Health Insurance Research Database. Patients who received treatment within 6 months were categorized as either nontargeted or targeted therapy groups. We analyzed treatment trends with the Cochran-Armitage trend test and explored factors associated with treatment selection and survival effects using multivariable logistic regression and Cox proportional hazards models.
Of the 20,900 LAHNC patients included in the study, 19,696 received nontargeted therapy, while 1,204 received targeted therapy. Older patients with more comorbid conditions, advanced stages and patients with hypopharynx and oropharynx cancers were more likely to receive targeted therapy with concomitant cetuximab treatment. Patients who received targeted therapy in addition to other treatment modalities had a greater risk of one-year and long-term all-cause mortality or cancer-specific mortality than those without receiving targeted therapy (P < 0.001).
Our study found an increasing trend in cetuximab utilization among LAHNC after reimbursement in Taiwan, but overall usage rates were low. LAHNC patients receiving cetuximab with other treatments had higher mortality risk than those receiving cisplatin, suggesting cisplatin may be preferred. Further research is needed to identify subgroups that could benefit from concomitant cetuximab treatment.
自 2009 年 7 月起，台湾全民健康保险已涵盖局部晚期头颈部癌症（LAHNC）的靶向治疗，即西妥昔单抗。本研究旨在探讨在台湾全民健康保险覆盖西妥昔单抗后，局部晚期头颈部癌症患者的治疗趋势和生存效果。
我们利用台湾全民健康保险研究数据库，对局部晚期头颈部癌症患者的治疗趋势和生存效果进行了研究。在 6 个月内接受治疗的患者被分为非靶向或靶向治疗组。我们采用 Cochran-Armitage 趋势检验分析了治疗趋势，并通过多变量逻辑回归和 Cox 比例风险模型探讨了与治疗选择和生存效果相关的因素。
在纳入研究的 20900 例局部晚期头颈部癌症患者中，19696 例接受了非靶向治疗，1204 例接受了靶向治疗，包括西妥昔单抗。患有更多合并症、晚期疾病以及患有下咽癌和口咽癌的老年患者更有可能接受西妥昔单抗联合靶向治疗。与未接受靶向治疗的患者相比，接受靶向治疗联合其他治疗方式的患者在一年内和长期全因死亡率或癌症特异性死亡率方面的风险更高（P<0.001）。
本研究发现，在台湾全民健康保险报销后，局部晚期头颈部癌症患者接受西妥昔单抗治疗的趋势呈上升趋势，但总体使用率仍然较低。与接受顺铂治疗的患者相比，接受西妥昔单抗联合其他治疗的局部晚期头颈部癌症患者的死亡率更高，这表明顺铂可能是首选治疗方法。需要进一步研究以确定哪些亚组可能从西妥昔单抗联合治疗中受益。
