A study of patients with hormone receptor–positive/human epidermal growth factor receptor 2–negative (HR+/HER2–) metastatic breast cancer has found that treatment with first-line chemotherapy offers no survival benefit compared with hormone therapy, despite having significantly higher associated costs.
Breast cancer is the most commonly occurring form of cancer among women in the United States, representing nearly 30% of all cancer cases for this demographic. Advances in genomic sequencing have allowed patients to receive more personalized treatment, tailored to their tumor molecular subtype.
For patients with HR+/HER2– metastatic breast cancer, guidelines recommend that patients initiate hormone therapy before chemotherapy. However, many of these patients continue to receive first-line chemotherapy.
In a study published in Current Medical Research and Opinion, researchers led by Tanya Burton, PhD, Optum, used claims and clinical data to compare the clinical and economic outcomes of using chemotherapy or hormonal therapy as first-line treatment for this patient population.
After a comprehensive analysis of the cancer registry, the researchers identified 324 eligible patients with the appropriate tumor subtype. Of these, 179 patients (55%) had claims data for chemotherapy use only, and 145 patients (45%) had claims for hormonal therapy use only, during first-line treatment. Researchers noted that the observed use of first-line chemotherapy was significantly higher than expected given the molecular profile of the patients’ tumors.
Patients treated with first-line chemotherapy tended to be slightly younger than those treated with first-line hormone therapy (51 years vs 55 years). A stage IV diagnosis was also less common among patients in the chemotherapy group than in the hormonal therapy group (35% vs 48%).
Rates of death were similar for both arms of the study, indicating no significant differences in survival benefit. Aside from neutropenia and nausea, for which the incidence rates were nearly 3 times lower for patients treated with hormonal therapy than for those treated with chemotherapy, no significant differences in the number of adverse events were observed between the two treatments.
However, the health care costs associated with chemotherapy were $10,727, significantly higher than those associated with hormonal therapy ($7037). The highest proportion of health care costs were for outpatient visits, followed by physician office visits and in-patient stays. Initial bone and liver metastasis were also found to be associated with higher costs compared with other initial metastasis sites.
The researchers concluded that, although chemotherapy as first-line treatment did not appear to have any significant impact on survival, it was associated with much higher costs than hormonal therapy. Therefore, this real-world study contributes to the understanding of the benefits associated with initiating hormonal therapy as first-line treatment in patients with HR+/HER2– metastatic breast cancer.—Sean McGuire
