Guidelines recommend that women with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer (mBC) initiate hormonal therapy before chemotherapy. This study compared outcomes of women with mBC who received chemotherapy first versus hormonal therapy.
A retrospective cohort study of women with mBC was conducted using a large US commercial health plan database between 1/1/2008-4/30/2013. Subjects had evidence of a HR+/HER2- tumor subtype in a cancer registry and use of chemotherapy or hormonal therapy in claims. Subjects were continuously enrolled for ≥6 months after metastasis and assigned to cohorts for receiving chemotherapy only or hormonal therapy only during first-line (CT-1L vs HT-1L). Adjusted incidence rates of clinically significant events were compared using a negative binomial model, and adjusted health care costs were compared using a generalized linear model.
324 women with HR+/HER2- mBC met the selection criteria; 179 (55%) received CT-1L and 145 (45%) received HT-1L. Mortality rates did not differ between cohorts [unadjusted incidence rate ratio (IRR): 1.67, 95% CI: 0.82-3.46; adjusted IRR: 0.64, 95% CI: 0.32-1.27). Adjusted average total all-cause health care costs were $11,090 for women with CT-1L and $6,743 for women with HT-1L (cost ratio: 1.64, 95% CI: 1.36-1.99).
Observed use of first-line chemotherapy (>50%) was higher than expected given the HR+ molecular profile of the tumors. Chemotherapy use during first-line did not appear to be associated with a survival benefit but was associated with significantly higher costs compared with the use of hormonal therapy during first-line; however, this comparison is limited by demographic and baseline characteristic differences between the 2 cohorts. This study contributes to understanding real-world treatment patterns and the associated clinical and economic outcomes of using chemotherapy versus hormonal therapy as a first-line treatment option for the HR+/HER2- mBC population.
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