Paul Cottu1, Bruno Coudert2, David Perol3, Anne Doly4, Julien Manson5, Olivier Aujoulat6, Hugues Barletta7, Nassera Chalabi8, Laurence Samelson9, Xavier Pivot10. 1. Medical Oncology Department, Institut Curie, 26 rue Ulm, 75005, Paris, France. Electronic address: paul.cottu@curie.fr. 2. Medical Oncology Department, Georges François Leclerc Comprehensive Cancer Center, 1 rue du Professeur Marion, 21000, Dijon, France. Electronic address: bcoudert@cgfl.fr. 3. Medical Oncology Department, Centre Léon Bérard Comprehensive Cancer Center, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France. Electronic address: david.perol@lyon.unicancer.fr. 4. Medical Biophysics, Auvergne University, 49 boulevard François Mitterrand, 63000 Clermont-Ferrand, France. Electronic address: anne.doly@gmail.com. 5. Pharmacy department, Centre Hospitalier René-Dubos, 6 avenue de l'Ile de France, CS, 95303, Cergy Pontoise, France. Electronic address: julien.manson@ght-novo.fr. 6. Pharmacy department, South Alsace Hospital Group, 87 avenue d'Altkirch, 68051, Mulhouse, France. Electronic address: dr.barletta@orange.fr. 7. Medical Oncology, Ramsay Générale de Santé, Hôpital Privé Drome Ardèche, 294 boulevard Charles de Gaulle, 07500, Valence, France. Electronic address: aujoulato@ghrmsa.fr. 8. Medical affairs, Roche SAS, 30 cours de l'île Seguin, 92650, Boulogne-Billancourt, France. Electronic address: nassera.chalabi@roche.com. 9. Market access, Roche SAS, 30 cours de l'île Seguin, 92650, Boulogne-Billancourt, France. Electronic address: laurence.samelon@roche.com. 10. Medical Oncology Department, Paul Strauss Comprehensive Cancer Center, 3 rue de la Porte de l'Hôpital, 67000, Strasbourg, France. Electronic address: XPivot@strasbourg.unicancer.fr.
Abstract
BACKGROUND: There is a growing need for real-world data on cancer treatments usage, especially to assess compliance with recommendations. We developed a French project using hospital data to analyse evolution in the therapeutic strategies implemented in patients with human epidermal growth factor receptor 2 (HER2)-overexpressed (HER2+) breast cancer (BC) and exposed to injectable HER2-targeted therapies, i.e. trastuzumab, pertuzumab or trastuzumab emtansine (T-DM1). PATIENTS AND METHODS: Data from 26,350 women with BC were extracted in September 2018 from the Electronic Pharmacy Record systems of 120 French randomly recruited hospitals. Evolution in the treatments used, and combination regimens were described from 2011, in accordance with the BC stage and treatment line. RESULTS: Overall, 21,119 patients treated since 2011 were analysed: 16,398 patients with early BC (eBC) and 6030 patients with metastatic BC (mBC) including patients treated at both stages. In eBC, 89.2% of patients received trastuzumab combined with at least taxanes (trastuzumab-taxane-anthracycline: 62.6%). Patients with mBC were treated in the first line (80.3%) and/or the second line (40.1%) and/or ≥ the third line (28.3%). After its approval in 2014, pertuzumab was first used in first-line therapy combinations in 67.4% of the total cases, while trastuzumab-taxane decreased from 47.2% to 9.2%. Similarly, T-DM1 was used as the second-line treatment in 53.8% of cases. CONCLUSIONS: Given recent changes in available treatments for patients with HER2+ BC, this large French project provides robust information on real-world evolution in therapeutic strategies. Our data suggest there is room for significant improvement in optimal drug utilisation. Such data will be useful to build drug-related indicators for future value-based pricing solutions.
BACKGROUND: There is a growing need for real-world data on cancer treatments usage, especially to assess compliance with recommendations. We developed a French project using hospital data to analyse evolution in the therapeutic strategies implemented in patients with humanepidermal growth factor receptor 2 (HER2)-overexpressed (HER2+) breast cancer (BC) and exposed to injectable HER2-targeted therapies, i.e. trastuzumab, pertuzumab or trastuzumab emtansine (T-DM1). PATIENTS AND METHODS: Data from 26,350 women with BC were extracted in September 2018 from the Electronic Pharmacy Record systems of 120 French randomly recruited hospitals. Evolution in the treatments used, and combination regimens were described from 2011, in accordance with the BC stage and treatment line. RESULTS: Overall, 21,119 patients treated since 2011 were analysed: 16,398 patients with early BC (eBC) and 6030 patients with metastatic BC (mBC) including patients treated at both stages. In eBC, 89.2% of patients received trastuzumab combined with at least taxanes (trastuzumab-taxane-anthracycline: 62.6%). Patients with mBC were treated in the first line (80.3%) and/or the second line (40.1%) and/or ≥ the third line (28.3%). After its approval in 2014, pertuzumab was first used in first-line therapy combinations in 67.4% of the total cases, while trastuzumab-taxane decreased from 47.2% to 9.2%. Similarly, T-DM1 was used as the second-line treatment in 53.8% of cases. CONCLUSIONS: Given recent changes in available treatments for patients with HER2+ BC, this large French project provides robust information on real-world evolution in therapeutic strategies. Our data suggest there is room for significant improvement in optimal drug utilisation. Such data will be useful to build drug-related indicators for future value-based pricing solutions.