Estimation of Premature Deaths From Lack of Access to Anti-HER2 Therapy for Advanced Breast Cancer in the Brazilian Public Health System
Estimation of Premature Deaths From Lack of Access to Anti-HER2 Therapy for Advanced Breast Cancer in the Brazilian Public Health System
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DOI：
10.1200/jgo.2016.005678
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发表时间：
2017-06-01
影响因子：
--
通讯作者：
Barrios, Carlos H.
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文献类型：
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作者：
Debiasi, Marcio;Reinert, Tomas;Barrios, Carlos H.
目的 在巴西公共卫生系统中接受治疗的人表皮生长因子受体 2 (HER2) 阳性转移性肿瘤患者无法获得曲妥珠单抗。本研究旨在评估无法获得抗 HER2 治疗对这些患者死亡率的影响。 方法根据已发表的数据，估计 2016 年应接受抗 HER2 靶向治疗的 HER2 阳性晚期乳腺癌患者人数。该假设队列考虑了三个不同的治疗组：单独化疗、化疗加曲妥珠单抗、化疗加曲妥珠单抗和帕妥珠单抗。根据考虑这些干预措施的关键试验的疗效结果估计了随访 2 年后存活的患者人数。结果 据计算，2016 年巴西将有 2,008 名女性被诊断出患有晚期 HER2 阳性乳腺癌。据估计，如果仅接受化疗（公共卫生系统提供的治疗），2018 年只有 808 名女性能够存活。另一方面，如果接受化疗加曲妥珠单抗，则 2018 年存活的女性人数将上升至 1,408 名；如果接受化疗加曲妥珠单抗和帕妥珠单抗的金标准，则 2018 年存活的女性人数将上升至 1,576 名。 结论 曲妥珠单抗已被列入世界卫生组织的基本药物清单，但巴西公共卫生系统尚未向晚期疾病人群提供这种治疗。曲妥珠单抗和帕妥珠单抗的引入将产生积极作用，防止巴西转移性 HER2 阳性乳腺癌女性过早死亡。 (C) 2016 年由美国临床肿瘤学会根据 Creative Commons Attribution 4.0 许可证获得许可
Purpose Patients with human epidermal growth factor receptor 2 (HER2) -positive metastatic tumors treated in the public health system in Brazil do not have access to trastuzumab. This study aimed to estimate the impact of the lack of access to anti-HER2 therapies on the mortality of these patients.Methods On the basis of published data, the number of patients with HER2-positive advanced breast cancer in 2016 who should receive anti-HER2 targeted therapy was estimated. Three different treatment groups were considered for this hypothetical cohort: chemotherapy alone, chemotherapy plus trastuzumab, and chemotherapy plus trastuzumab and pertuzumab. The number of patients alive after 2 years of follow-up was estimated on the basis of the efficacy results of the pivotal trials considering these interventions.Results It was calculated that 2,008 women will be diagnosed with advanced HER2-positive breast cancer in Brazil in 2016. It was estimated that only 808 women would be alive in 2018 if they receive only chemotherapy (which is the treatment offered by the public health system). On the other hand, the bar rises to 1,408 women alive in 2018 if they receive chemotherapy plus trastuzumab and 1,576 women alive in 2018 if they receive the gold standard of chemotherapy plus trastuzumab and pertuzumab.Conclusion Trastuzumab is included in the WHO's list of essential medications, but the Brazilian public health system does not yet provide this treatment to its population with advanced disease. The introduction of trastuzumab and pertuzumab would have a positive effect, preventing premature deaths in women with metastatic HER2-positive breast cancer in Brazil. (C) 2016 by American Society of Clinical Oncology Licensed under the Creative Commons Attribution 4.0 License