Barzi Afsaneh, Lin Feng, Song Jinlin, Lam Clara, Nie Xiaoyu, Noman Ahmed, Kwong Winghan J
City of Hope Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
Daiichi Sankyo, Inc., 211 Mt Airy Road, Basking Ridge, NJ, 08920, USA.
Drugs Real World Outcomes. 2023 Sep;10(3):395-404. doi: 10.1007/s40801-023-00378-y. Epub 2023 Aug 4.
Trastuzumab in combination with chemotherapy is the standard first-line (1L) treatment for HER2+ metastatic gastric cancer (mGC) in the USA.
This study characterizes the real-world treatment patterns, healthcare resource use (HRU), and costs in patients with HER2+ mGC post-1L trastuzumab before approval of fam-trastuzumab deruxtecan-nxki.
This retrospective study used the IQVIA PharMetrics Plus Database (October 2014-September 2019) to identify adults with HER2+ mGC who discontinued trastuzumab-based regimens in 1L. Patient characteristics, second-line (2L) treatment patterns, and treatment duration were summarized. HRU and costs before and after discontinuation of 1L trastuzumab-based regimens as well as during 2L treatment were described.
Of the 190 HER2+mGC patients who discontinued 1L trastuzumab-based regimens, 136 (71.58%) initiated 2L treatments. Trastuzumab-based regimens were the most common in 2L (50.74%), followed by ramucirumab + paclitaxel (19.85%). The median time to 2L discontinuation was 2.37 months. During a mean follow-up of 9.8 months, mean per-patient-per-month (PPPM) healthcare costs post-1L trastuzumab-based regimens were higher in patients receiving 2L treatment than those without subsequent treatment (US$25,178 vs. US$14,812). The mean PPPM cost during 2L treatment was US$30,838, primarily driven by outpatient infusion costs (US$22,262).
The short duration of 2L treatment observed in this study is consistent with a lack of effective treatments post-1L trastuzumab prior to 2020. Re-use of trastuzumab treatment was common despite its limited efficacy and high treatment cost. The findings highlight the unmet medical needs and substantial burden faced by patients with HER2 +mGC previously treated with trastuzumab.
在美国，曲妥珠单抗联合化疗是HER2阳性转移性胃癌（mGC）的标准一线治疗方案。
本研究旨在描述在fam-trastuzumab deruxtecan-nxki获批之前，HER2阳性mGC患者在一线曲妥珠单抗治疗后真实世界的治疗模式、医疗资源使用（HRU）及费用情况。
这项回顾性研究使用IQVIA PharMetrics Plus数据库（2014年10月至2019年9月），以识别在一线治疗中停用基于曲妥珠单抗方案的HER2阳性mGC成年患者。总结患者特征、二线（2L）治疗模式及治疗持续时间。描述在停用一线基于曲妥珠单抗方案之前和之后以及二线治疗期间的医疗资源使用和费用情况。
在190例停用一线基于曲妥珠单抗方案的HER2阳性mGC患者中，136例（71.58%）开始了二线治疗。基于曲妥珠单抗的方案在二线治疗中最为常见（50.74%），其次是雷莫西尤单抗+紫杉醇（19.85%）。二线治疗停药的中位时间为2.37个月。在平均9.8个月的随访期间，接受二线治疗的患者在一线基于曲妥珠单抗方案治疗后的平均每月人均医疗费用高于未接受后续治疗的患者（25,178美元对14,812美元）。二线治疗期间的平均每月人均费用为30,838美元，主要由门诊输液费用（22,262美元）驱动。
本研究中观察到的二线治疗持续时间较短，这与2020年前一线曲妥珠单抗治疗后缺乏有效治疗方法一致。尽管曲妥珠单抗治疗疗效有限且费用高昂，但重新使用曲妥珠单抗治疗很常见。这些发现凸显了先前接受曲妥珠单抗治疗的HER2阳性mGC患者未满足的医疗需求和沉重负担。
