Clinical, Sociodemographic, and Facility-Related Factors Influencing HER2-Targeted Therapy in Metastatic Hormone
Ismail Ajjawi1, Alejandro Rios1, Wei Wei1
1Yale School of Medicine, Yale University, New Haven, CT 06510, USA.
Abstract:
Background/Objectives: The use of HER2-targeted therapies has significantly improved survival outcomes in metastatic hormone receptor-negative, HER2-positive (HR-/HER2+) breast cancer. However, factors influencing their adoption remain unclear. This study examines clinical, sociodemographic, and facility-related determinants of HER2-targeted therapy utilization in metastatic HR-/HER2+ breast cancer. Methods: We conducted a retrospective cohort study of metastatic HR-/HER2+ breast cancer patients from the NCDB (2013-2020), categorizing them into HER2-targeted therapy recipients and non-recipients. Patients with missing key variables were excluded. Time periods were divided as pre-2015, 2016-2018, and 2019-2020 to reflect evolving treatment availability and uptake in the United States. Univariable and multivariable logistic regression identified factors associated with HER2-targeted therapy use. Cox proportional hazards regression and log-rank tests assessed overall survival. Results: Among 3060 metastatic HR-/HER2+ breast cancer patients, 2318 (75.8%) received HER2-targeted therapy. HER2-targeted therapy utilization increased from 64.6% in 2013 to 80.9% in 2016, marking an early period of rapid uptake. Usage remained consistently high from 2016 to 2018, followed by a slight decline and stabilization around 75% from 2019 to 2020. Factors positively associated with therapy use included diagnosis in 2016-2018 (OR 1.93, p < 0.001) and 2019-2020 (1.88, p < 0.001), private insurance (OR 1.76, p < 0.001), and treatment at academic facilities (OR 1.39, p = 0.031). Reduced likelihood of therapy use was observed in patients aged 71+ (OR 0.52, p < 0.001), Black race (OR 0.78, p = 0.018), Medicare insurance (OR 0.64, p < 0.001), and treatment at rural facilities (OR 0.59, p = 0.022). HER2-targeted therapy was associated with significantly improved survival (median 5.08 vs. 1.27 years, log-rank p < 0.001) and lower mortality risk (HR 0.52, p < 0.001). Conclusions: The adoption of HER2-targeted therapy has increased in recent years, yet disparities persist in access and utilization. Our findings highlight the need to address sociodemographic and facility-related barriers to ensure equitable treatment and improved survival outcomes for all patients.
Insights
HER2-targeted therapy significantly improves survival for metastatic hormone receptor-negative, HER2-positive breast cancer. However, disparities in access and utilization persist, necessitating efforts to address barriers for equitable care.
Area of Science:
- Oncology
- Clinical Medicine
- Health Services Research
Background:
- HER2-targeted therapies have revolutionized treatment for metastatic hormone receptor-negative, HER2-positive (HR-/HER2+) breast cancer.
- Understanding factors influencing the adoption of these life-extending therapies is crucial for optimizing patient outcomes.
Purpose of the Study:
- To examine clinical, sociodemographic, and facility-related determinants of HER2-targeted therapy utilization in metastatic HR-/HER2+ breast cancer.
- To assess the impact of HER2-targeted therapy on overall survival in this patient population.
Main Methods:
- Retrospective cohort study using the National Cancer Database (NCDB) from 2013-2020.
- Analysis of 3060 metastatic HR-/HER2+ breast cancer patients, comparing therapy recipients and non-recipients.
- Logistic regression and Cox proportional hazards models to identify factors associated with therapy use and survival.
Main Results:
- HER2-targeted therapy utilization increased from 64.6% in 2013 to 80.9% in 2016, then stabilized around 75%.
- Positive associations with therapy use included later diagnosis periods, private insurance, and academic facilities.
- Barriers to use included older age, Black race, Medicare insurance, and rural treatment facilities.
Conclusions:
- While HER2-targeted therapy adoption has grown, significant disparities in access and utilization remain.
- Addressing sociodemographic and facility-related barriers is essential for ensuring equitable treatment and improving survival outcomes for all metastatic HR-/HER2+ breast cancer patients.
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