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Trends in Neoadjuvant Pembrolizumab Use in Triple-Negative Breast Cancer.

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Pembrolizumab use in neoadjuvant chemotherapy for triple-negative breast cancer (TNBC) is high and increasing nationally. However, patients in socioeconomically deprived areas show lower adoption rates, highlighting disparities in cancer treatment accessibility.

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Area of Science:

  • Oncology
  • Health Services Research
  • Pharmacoeconomics

Background:

  • Pembrolizumab combined with neoadjuvant chemotherapy (NAC) has demonstrated improved efficacy for triple-negative breast cancer (TNBC).
  • Understanding the real-world adoption patterns of NAC-pembrolizumab post-approval is crucial for assessing treatment accessibility.

Purpose of the Study:

  • To evaluate national trends in the utilization of neoadjuvant chemotherapy with pembrolizumab for TNBC.
  • To examine the influence of patient demographics and socioeconomic status on the adoption of this treatment regimen.

Main Methods:

  • Analysis of the Epic Cosmos database for patients with TNBC receiving NAC between 2021 and 2024.
  • Correlation of pembrolizumab use with patient race/ethnicity and Area Deprivation Index (ADI) scores.

Main Results:

  • Overall pembrolizumab use reached 76.2% among 6689 eligible TNBC patients, with significant year-over-year increases.
  • No disparities in use were found based on race or ethnicity.
  • Patients residing in areas with the highest ADI scores exhibited significantly lower pembrolizumab use rates (74.0% vs. 77.4%, P=0.04).

Conclusions:

  • High national adoption rates of pembrolizumab for TNBC were observed shortly after its approval.
  • While race and ethnicity did not correlate with treatment use, socioeconomic factors, indicated by ADI, played a role in access.
  • Findings suggest potential socioeconomic barriers to advanced cancer treatment adoption.