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Impact of CDK4/6 inhibitors on chemotherapy utilization in earlier therapy lines for HR+/HER2– metastatic breast cancer in the United States

  • Epidemiology
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Abstract

Purpose

Delaying chemotherapy remains a vital goal in therapeutic management of HR+/HER2– metastatic breast cancer (MBC). However, recent reports continue to highlight substantially high chemotherapy utilization in earlier therapy lines. In this study, we explored the impact of cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitor therapy class, introduced in 2015, on early chemotherapy utilization in an older population of patients with HR+/HER2– MBC in the United States (US).

Methods

Using an interrupted time series design, patients with a confirmed diagnosis of MBC aged ≥ 65 years initiating systemic therapy during 2010–2019 were selected from the SEER-Medicare database. The proportion of chemotherapy use was summarized quarterly based on the date of treatment initiation separately in the first, second, and third lines. Segmented regression models adjusted for autocorrelation over time were fitted to estimate trends before and after the availability of CDK4/6 inhibitors in the first quarter of 2015.

Results

Of the 3244 eligible women (median age at diagnosis: 74 years), all initiated first-line therapy; 47.9% (n = 1581) initiated second-line therapy, and 50.1% (n = 792) initiated third-line therapy. Overall utilization of chemotherapy (alone or in combination) during the study period was 15.7% for the first line, 19.6% for the second line, and 24.8% for the third line. Chemotherapy utilization in the period immediately after introduction of CDK4/6 inhibitor therapy decline by estimated 2.5% in the first line (P = 0.408), 15.5% in the second line (P = 0.005), and 16.3% in the third line (P = 0.003).

Conclusions

This population-based study illustrates that chemotherapy utilization in earlier therapy lines for HR+/HER2– MBC declined steadily between 2010 and 2019. These declines were significantly accelerated by the introduction of CDK4/6 therapy class in 2015, notably in the second- and third-line settings.

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Data availability

The datasets that support the findings of this study are available from the National Cancer Institute. Restrictions apply to the accessibility of these data, which were purchased and used under license/data use agreement for this study.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The acquisition of SEER-Medicare data for this study was supported by the University of Houston, College of Pharmacy.

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Authors and Affiliations

  1. Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX, USA

    Ravi K. Goyal, Hua Chen, Susan Abughosh & Michael L. Johnson

  2. Division of Geriatric and Palliative Medicine, McGovern Medical School, University of Texas, Houston, TX, USA

    Holly M. Holmes

  3. RTI Health Solutions, Research Triangle Park, NC, USA

    Ravi K. Goyal & Sean D. Candrilli

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  1. Ravi K. Goyal
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Contributions

RKG contributed to study design, data analysis, and interpretation, and drafting/revision of the manuscript; HC, SA, HMH, SDC, and MLJ contributed to study design, interpretation of results, and critical review of the manuscript.

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Correspondence to Ravi K. Goyal.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was reviewed by the Institutional Review Board at the University of Houston and received “exempt” determination.

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Goyal, R.K., Holmes, H.M., Chen, H. et al. Impact of CDK4/6 inhibitors on chemotherapy utilization in earlier therapy lines for HR+/HER2– metastatic breast cancer in the United States. Breast Cancer Res Treat 198, 159–166 (2023). https://doi.org/10.1007/s10549-022-06845-4

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