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Evaluating the Impact of Brain Metastases in Real-World Treatment Patterns and Healthcare Resource Utilization Among HER2-Positive Metastatic Breast Cancer Patients

Conference Correspondent

There is an increased clinical and economic burden associated with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer. Brain metastases signal significantly worse outcomes; however, there are limited data to weigh healthcare resource utilization among patients with HER2-positive metastatic breast cancer and brain metastases. Chiemeka Ike and colleagues used retrospective claims data to help describe therapeutic patterns and healthcare resource utilization among patients with HER2-positive metastatic breast cancer with or without brain metastases who received HER2-targeted therapy.

The IBM Watson Health™ MarketScan commercial claims and Medicare Supplemental databases were used to obtain data from July 2012 until December 2018. These data were used to assess patients with HER2-positive metastatic breast cancer.

Demographic and clinical characteristics, including treatment patterns by line of therapy and the presence or absence of brain metastases, and healthcare resource utilization were described. The study initiation (index) date was the first metastatic diagnosis. Measured overall and by brain metastases compared with non-brain metastases were healthcare resource utilization outcomes per patient per year in the follow-up period after metastatic diagnosis. These healthcare resource utilization outcomes included inpatient services, total length of stay, emergency department services, and outpatient services.

The study included 4509 patients. A total of 4406 patients had no evidence of brain metastases at index, and 103 (2.3%) patients had brain metastases. Yet, after study initiation 590 (13.1%) patients developed brain metastases.

At index, the mean age was 53.7 years. Overall median follow-up time was 23.2 months. Median time on treatment measured in months was 7.6, 7.2, and 6.2 for first-line, second-line, and third-line therapy, correspondingly.

Across all lengths of stay, trastuzumab-based regimens were most used. In first-line, trastuzumab emtansine use was 0.9%. In second-line and third-line, use was 9.7% and 13.0%, respectively. Trastuzumab emtansine was used more in patients with brain metastases than patients without brain metastases: in first-line (2.4% vs 0.9%), second-line (22.6% vs 7.7%), and third-line (25% vs 10.1%).

Overall, there was a range of lapatinib use extending from 1.6% in first-line to 8.3% in third-line. Patients with brain metastases more frequently used lapatinib when compared with patients with non-brain metastases (first-line: 11.8% vs 1.2%; second-line: 20.5% vs 1.8%; third-line: 21.2% vs 5.1%).

Per patient per year, the mean number of inpatient services was higher for patients with brain metastases; 1.2 patients compared with 0.5 patients without brain metastases. The average total length of stay of patients with brain metastases was 8.6 days versus 2.6 days when compared with patients with non-brain metastases. The average number of emergency department visits of patients with brain metastases was 2.5 compared with 1.2 without brain metastases. The mean number of outpatient services was 56.9; however, there was no difference in the number of outpatient services between brain metastases patients.

The authors concluded that among patients with HER2-positive metastatic breast cancer, the healthcare resource utilization of patients with brain metastases is significantly higher when compared with patients without brain metastases. This underscores the critical need for systemic therapies that are effective and improve outcomes and decrease the burden of disease, particularly the healthcare system burden for patients with HER2-positive metastatic breast cancer, especially those with brain metastases.

Source: Ike C, Schwartz N, Surinach A, et al. Real world treatment patterns and healthcare resource utilization among HER2+ metastatic breast cancer patients with and without brain metastases: a retrospective cohort study. Presented at: 2020 San Antonio Breast Cancer Symposium, December 8-11, 2020. Abstract PS14-15.

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