The presence or absence of insurance coverage for trastuzumab treatment was the strongest predictor of trastuzumab therapy use in Chinese patients.
In a recent study, researchers sought to determine the current trends of trastuzumab use in China and identify certain factors that may influence usage. Though information regarding the use of trastuzumab in the United States, Europe, and other developed countries is currently available, to date there have been no large-scale population-based surveys in China.
The retrospective, multicenter, cross-sectional study was conducted across 155 hospitals in 29 provinces and cities in China between July 2013 and June 2014. To participate in the study, patients needed to meet the following criteria: at least 18 years of age, had undergone surgery for breast cancer and received adjuvant/neoadjuvant therapy, had been diagnosed as having HER2-positive disease, and had stage I to stage III disease.
A total of 4994 HER2-positive breast cancer patients were enrolled in the study. Of these patients, 4879 received adjuvant therapy, 814 received neoadjuvant therapy, and 724 received both adjuvant and neoadjuvant therapy. Among the total patients enrolled in the study, only 29.8% (n = 1488) were given trastuzumab therapy; 30.5% of patients receiving adjuvant therapy were given trastuzumab, and 18.3% of those receiving neoadjuvant therapy were given trastuzumab.
Researchers found that more than two-thirds of patients with HER2-positive breast cancer in China did not receive HER2-targeted therapy, which is a stark contrast to what is seen in Western Europe and the United States, where it was estimated that, according to a prior study, both nations can supply enough trastuzumab to treat “virtually all patients with HER2-positive breast cancer.”
In addition, the presence or absence of insurance coverage for trastuzumab treatment was the strongest predictor of trastuzumab therapy use in Chinese patients, and patients who had coverage were more likely to be prescribed the therapy than those without. Furthermore, women who had to travel to receive treatment were less likely to receive trastuzumab.
Other factors that affected the use of trastuzumab therapy included lymph node involvement and later tumor stage at diagnosis. Researchers hypothesize that these findings could indicate that a patient is more willing to accept, or the physician is more willing to recommend, trastuzumab therapy when the cancer is more advanced.
The study authors hope that drawing attention to these factors will assist future efforts to standardize trastuzumab for the treatment of breast cancer in China.
Junjie L, Zhimin S, Binghe X, et al. Use of trastuzumab as an adjuvant/neoadjuvant therapy in patients with HER2-positive breast cancer in China: the Nvwa study. Medicine. 2018;97(21): e10350. doi: 10.1097/MD.0000000000010350.