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Survival, treatment patterns, and costs of HER2+ metastatic breast cancer patients in Ontario between 2005 to 2020

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Background

To enable the integration of novel therapies, it is critical to understand current long-term outcomes in HER2-positive metastatic breast cancer (mBC), including survival, treatment patterns, and costs. We sought to define these outcomes among patients with mBC in Ontario.

Methods

We conducted a retrospective population-level study in Ontario women diagnosed with breast cancer of any stage between January 1, 2005 and December 31, 2019, with follow-up until December 31, 2020. HER2-positivity was based on receipt of a HER2-targeted therapy (HER2-TT) in the first line (1L) metastatic setting. Administrative databases at ICES were used to assess outcomes.

Results

In Ontario, 2557 patients were diagnosed with mBC and received a HER2-TT, and of these 1606 were diagnosed with early-stage (stage I-III) that became metastatic (recurrent), while 951 were diagnosed with late stage/de novo mBC (stage IV). The average age of all patients was 54.8 years ± 12.7 years. Treatment regimens that included pertuzumab and trastuzumab (cohort name: pert_tras) were the most frequently used HER2-TT for 1L mBC (51.4%), while T-DM1 was the most frequent therapy (87.5%) in second line (2L). The median overall survival (mOS) from initiation of 1L pert_tras was not reached, whereas mOS from initiation of T-DM1 in 2L was 18.7 months. The overall mean cost per patient on pert_tras during 1L was $267,282. The main cost drivers were the cost of systemic therapy, followed by cancer clinic visits, with a mean cost per patient at $158,961 and $73,882, respectively.

Conclusion

The baseline characteristics and treatment patterns for patients who received HER2-TT in our study align with previously reported results. However, the mOS observed for 2L T-DM1 was shorter than that found in pivotal, clinical trial literature. As expected, anti-cancer systemic therapy costs were the main contributor to the over quarter-million dollar mean cost per patient on pert_tras in 1L.

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Data availability

Although the results tables and dataset creation plan are available upon request patient-level data is not available since it is physically housed at ICES, and cannot leave the premises due to data confidentiality and security.

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Acknowledgements

This study made use of de-identified data from the ICES Data Repository, which is managed by the ICES with support from its funders and partners: Canada’s Strategy for Patient-Oriented Research, the Ontario SPOR Support Unit, the Canadian Institutes of Health Research and the Government of Ontario. The opinions, results and conclusions reported are those of the authors. No endorsement by the Institute for Clinical Evaluative Sciences or any of its funders or partners is intended or should be inferred. Parts of this material are based on data and information compiled and provided by CIHI. However, the analyses, conclusions, opinions and statements expressed herein are those of the author, and not necessarily those of CIHI. Parts of this material are based on data and information provided by Cancer Care Ontario. The opinions, results, view, and conclusions reported in this paper are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred.

Funding

This study was funded by an unrestricted research grant from AstraZeneca Canada Inc.

Author information

Authors and Affiliations

  1. Sunnybrook Research Institute, HOPE Research Centre, 2075 Bayview Avenue, Toronto, M4N 3M5, Canada

    S. J. Seung & H. Saherawala

  2. AstraZeneca Canada, Mississauga, ON, Canada

    D. Moldaver & S. Shokar

  3. Canadian Breast Cancer Network, Ottawa, Canada

    C. Ammendolea

  4. Mount Sinai Hospital, Toronto, Canada

    C. Brezden-Masley

Authors
  1. S. J. Seung
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  2. H. Saherawala
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  3. D. Moldaver
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  5. C. Ammendolea
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  6. C. Brezden-Masley
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Corresponding author

Correspondence to S. J. Seung.

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Competing interests

SJS, HS and CA have no COIs. DM and SS are employees of AstraZeneca Canada. CBM has disclosures.

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Appendix

Appendix

See Table 5, 6, 7, 8, 9 and Figs. 4, 5, 6, 7, 8, 9, 10, 11, 12.

Table 5 First line to second line treatment regimens for recurred mBC patients (initially diagnosed with early-stage, i.e., stage I-III)
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Table 6 First line to second line treatment regimens for de novo stage IV mBC patients
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Table 7 Second line to third line treatment regimens for mBC patients
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Table 8 Second line to third line treatment regimens for recurred mBC patients (initially diagnosed with early-stage, i.e., stage I-III)
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Table 9 Second line to third line treatment regimens for de novo stage IV mBC patients
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Fig. 4
figure 4

Kaplan–Meier curves for first line metastatic therapy for recurred mBC patients

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Fig. 5
figure 5

Kaplan–Meier curves for first line metastatic therapy for de novo mBC patients

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Fig. 6
figure 6

Kaplan–Meier curves for second line metastatic therapy for recurred mBC patients

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Fig. 7
figure 7

Kaplan–Meier curves for second line metastatic therapy for de novo mBC patients

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Fig. 8
figure 8

Kaplan–Meier curves for third line metastatic therapies of the full cohort

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Fig. 9
figure 9

Kaplan–Meier curve for third line metastatic therapy for recurred mBC patients

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Fig. 10
figure 10

Kaplan–Meier curve for third line metastatic therapy for de novo mBC patients

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Fig. 11
figure 11

Kaplan–Meier curve for T-DM1 treatment with or without prior pertuzumab for recurred mBC patients

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Fig. 12
figure 12

Kaplan–Meier curve for T-DM1 treatment with or without prior pertuzumab for de novo mBC patients

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Seung, S.J., Saherawala, H., Moldaver, D. et al. Survival, treatment patterns, and costs of HER2+ metastatic breast cancer patients in Ontario between 2005 to 2020. Breast Cancer Res Treat 204, 341–357 (2024). https://doi.org/10.1007/s10549-023-07185-7

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  • DOI: https://doi.org/10.1007/s10549-023-07185-7

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