Among 5 treatment strategies, neoadjuvant trastuzumab plus paclitaxel and pertuzumab followed by adjuvant trastuzumab or dose-dense anthracycline/cyclophosphamide plus trastuzumab emtansine yielded improved health outcomes along with cost savings for patients with ERBB2-positive breast cancer (JAMA Netw Open. 2020;3[11]:e2027074. doi:10.1001/jamanetworkopen.2020.27074).
Neoadjuvant treatment options for ERBB2-positive breast cancer are associated with different pathologic complete response rates but the costs and health consequences of neoadjuvant-adjuvant combinations require analysis.
Authors aimed to examine the costs and disease outcomes associated with multiple strategies of neoadjuvant followed by adjuvant treatments for patients with ERBB2-positive breast cancer.
Four neoadjuvant regiments were studied in an economic evaluation informed by the KATHERINE trial. The strategies studied were: (1) HP: trastuzumab (H) plus pertuzumab (P), (2) THP: paclitaxel (T) plus H plus P, (3) DDAC-THP: dose-dense anthracycline/cyclophosphamide (DDAC) plus THP, (4) TCHP: docetaxel (T) plus carboplatin (C) plus HP. Costs and quality-adjusted life-years (QALYs) were estimated for each treatment strategy.
Strategy 3 was associated with the lowest costs and highest health benefits, with base-case analysis costs at $415 833 and 10.73 QALYs. A > 70% probably of cost-effectiveness was confirmed by probabilistic analysis.
“These results suggest that neoadjuvant THP followed by adjuvant H for patients with pCR or followed by adjuvant DDAC plus T-DM1 for patients with residual disease was associated with the highest health benefits and lowest costs for women with ERBB2-positive breast cancer compared with other treatment strategies considered,” concluded the study authors.—Lisa Kuhns
