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Sanglier T, Fabi A, Flores C, Flahavan EM, Pena-Murillo C, Meyer AM, Montemurro F. T-DM1 after Pertuzumab plus Trastuzumab: Treatment Sequence-Induced Selection Bias in HER2-Positive Metastatic Breast Cancer. Cancers (Basel) 2022; 14:2468. [PMID: 35626072 PMCID: PMC9139620 DOI: 10.3390/cancers14102468] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/04/2022] [Accepted: 05/11/2022] [Indexed: 12/10/2022] Open
Abstract
Real-world studies have suggested decreased trastuzumab emtansine (T-DM1) effectiveness in patients with metastatic breast cancer (mBC) who received prior trastuzumab plus pertuzumab (H + P). However, these studies may have been biased toward pertuzumab-experienced patients with more aggressive disease. Using an electronic health record-derived database, patients diagnosed with mBC on/after 1 January 2011 who initiated T-DM1 in any treatment line (primary cohort) or who initiated second-line T-DM1 following first-line H ± P (secondary cohort) from 22 February 2013 to 31 December 2019 were included. The primary outcome was time from index date to next treatment or death (TTNT). In the primary cohort (n = 757), the percentage of patients with prior P increased from 37% to 73% across the study period, while population characteristics and treatment effectiveness measures were generally stable. Among P-experienced patients from the secondary cohort (n = 246), median time from mBC diagnosis to T-DM1 initiation increased from 10 to 14 months (2013-2019), and median TTNT increased from 4.4 to 10.2 months (2013-2018). Over time, prior H + P prevalence significantly increased with no observable impact on T-DM1 effectiveness. Drug approval timing should be considered when assessing treatment effectiveness within a sequence.
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Affiliation(s)
- Thibaut Sanglier
- RWD Oncology, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland;
| | - Alessandra Fabi
- Precision Medicine in Breast Cancer Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Via A. Gemelli, 00168 Rome, Italy;
| | - Carlos Flores
- Genesis Research, 111 River St, Hoboken, NJ 07030, USA;
| | - Evelyn M. Flahavan
- RWD Hematology, Roche Products Ltd., Hexagon Place, Falcon Way, Shire Park, Welwyn Garden City AL7 1TW, UK;
| | - Claudia Pena-Murillo
- Global Product Development Medical Affairs, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland;
| | - Anne-Marie Meyer
- RWD Oncology, F. Hoffmann-La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland;
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Filippo Montemurro
- Breast Unit, Candiolo Cancer Institute, FPO, IRCCS, SP 142 Km3.95, 10060 Candiolo, Italy;
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