Back to Search
Start Over
Neoadjuvant treatment strategies for HER2-positive breast cancer: cost-effectiveness and quality of life outcomes.
- Source :
-
Breast cancer research and treatment [Breast Cancer Res Treat] 2020 May; Vol. 181 (1), pp. 43-51. Date of Electronic Publication: 2020 Mar 17. - Publication Year :
- 2020
-
Abstract
- Purpose: Achieving a pathologic complete response (pCR) with neoadjuvant therapy for HER2-positive breast cancer is associated with less recurrence and improved clinical outcomes compared to having residual cancer at surgery. However, recent data have demonstrated favorable outcomes for patients with residual HER2-positive cancer who received adjuvant trastuzumab emtansine (TDM-1). Therefore, we sought to determine the optimal chemotherapy/anti-HER2 treatment strategy.<br />Methods: We created a decision-analytic model for patients with stage II-III HER2-positive cancer that incorporated utilities based on toxicity and recurrence. We separately modeled hormone receptor-negative (HR-) and positive (HR+) disease and calculated quality-adjusted life years (QALYs) and costs through 5 years. Simulated patients received one of the following neoadjuvant treatments: three 'intensive' regimens (TCHP: docetaxel, carboplatin, trastuzumab, pertuzumab; THP + AC: taxol, trastuzumab, pertuzumab then doxorubicin and cyclophosphamide; THP: taxol, trastuzumab, pertuzumab) and two 'de-escalated' regimens (TH: taxol, trastuzumab; TDM-1) followed by adjuvant treatment based on pathologic response.<br />Results: Among 'intensive' neoadjuvant strategies, treatment with THP was more effective and less costly than TCHP or THP + AC. When 'de-escalated' strategies were included, TH became the most cost-effective. For HR-negative cancer, TH had 0.003 fewer quality-adjusted life years (QALYs) than THP but was less costly by $55,831, resulting in an incremental cost-effectiveness ratio of over $18M/QALY for THP, well above any threshold. For HR-positive cancer, neoadjuvant TH dominated the THP strategy.<br />Conclusion: An adaptive-treatment strategy beginning with neoadjuvant THP or TH followed by tailoring post-operative therapy reduces treatment costs, and spares toxicity compared to more intensive chemotherapy regimens for women with HER2-positive breast cancer.
- Subjects :
- Antibodies, Monoclonal, Humanized administration & dosage
Antineoplastic Combined Chemotherapy Protocols metabolism
Breast Neoplasms metabolism
Breast Neoplasms pathology
Carboplatin administration & dosage
Chemotherapy, Adjuvant economics
Cost-Benefit Analysis
Cyclophosphamide administration & dosage
Decision Support Techniques
Docetaxel administration & dosage
Doxorubicin administration & dosage
Female
Follow-Up Studies
Humans
Markov Chains
Middle Aged
Neoadjuvant Therapy economics
Neoadjuvant Therapy methods
Neoplasm Staging
Prognosis
Progression-Free Survival
Quality of Life
Trastuzumab administration & dosage
Antineoplastic Combined Chemotherapy Protocols economics
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Breast Neoplasms economics
Breast Neoplasms therapy
Receptor, ErbB-2 metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 1573-7217
- Volume :
- 181
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Breast cancer research and treatment
- Publication Type :
- Academic Journal
- Accession number :
- 32185586
- Full Text :
- https://doi.org/10.1007/s10549-020-05587-5