Disparities in access to anti-HER2 therapies in neoadjuvant chemotherapy: A prognostic analysis based on real-world data comparing Brazil's public and private healthcare systems

IF 5.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Breast Pub Date : 2025-02-12 DOI:10.1016/j.breast.2025.104417

Marcelo Antonini , André Mattar , Denise Joffily Pereira da Costa Pinheiro , Isabela Bastos Maia , Marina Diógenes Teixeira , Andressa Gonçalves Amorim , Odair Ferraro , Larissa Chrispim de Oliveira , Marcellus do Nascimento Moreira Ramos , Francisco Pimentel Cavalcante , Felipe Zerwes , Marcelo Madeira , Romualdo Barroso-Sousa , Eduardo de Camargo Millen , Antonio Luiz Frasson , Fabricio Palermo Brenelli , Gil Facina , Rogério Fenile , Luiz Henrique Gebrim , Juliana Monte Real

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引用次数: 0

Abstract

Background

Trastuzumab has significantly improved the treatment of HER2-positive breast cancer, particularly in the neoadjuvant setting, where its combination with chemotherapy increases the pathologic complete response (pCR) rate. This retrospective cohort study assesses the implications of disparities in access to trastuzumab within the Brazilian public healthcare system, focusing on pCR, overall survival (OS) and disease-free survival (DFS) in non-metastatic, HER2-positive breast cancer patients undergoing neoadjuvant chemotherapy (NAC).

Methods

The study was conducted in the Hospital Pérola Byington (PEROLA), a public institution, and in the Hospital do Servidor Público Estadual (HSPE), a private institution. pCR was defined as the absence of residual invasive or in situ tumors in the breast and axillary nodes. OS and DFS were calculated by Kaplan-Meier survival analysis for a 5-year period.

Results

From 2011 to 2020, 381 patients at PEROLA and 78 at HSPE underwent NAC. Trastuzumab availability was higher at HSPE (83.4 % vs. 60.0 %, p < 0.0001). Use of trastuzumab correlated with significantly higher pCR rates at both the PEROLA (54.3 % vs. 26.4 %, p < 0.0001) and the HSPE (52.7 % vs. 26.4 %, p < 0.0001). HER2-positive patients with pCR at HSPE also had better OS (80 % vs. 61 %, p < 0.0001) and DFS (89 % vs. 67 %, p < 0.0001) compared to those at PEROLA.

Conclusion

There were significant differences in the provision of trastuzumab between the public and private healthcare systems, adversely affecting clinical outcomes and patient survival. The current data highlight the pressing need to address equity in cancer treatment to improve prognosis for every patient.

Abstract Image

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在新辅助化疗中获得抗her2治疗的差异：基于比较巴西公共和私人医疗保健系统的真实数据的预后分析

曲妥珠单抗显著改善了her2阳性乳腺癌的治疗，特别是在新辅助治疗中，曲妥珠单抗联合化疗增加了病理完全缓解（pCR）率。这项回顾性队列研究评估了巴西公共卫生系统中曲妥珠单抗可及性差异的影响，重点关注非转移性her2阳性乳腺癌患者接受新辅助化疗（NAC）的pCR、总生存期（OS）和无病生存期（DFS）。方法本研究在公立医院p罗拉·拜灵顿医院（PEROLA）和私立医院Servidor Público Estadual医院（HSPE）进行。pCR被定义为乳腺和腋窝淋巴结中没有残留的侵袭性或原位肿瘤。采用Kaplan-Meier生存分析计算5年的OS和DFS。结果2011 - 2020年，381例PEROLA患者和78例HSPE患者接受了NAC。曲妥珠单抗在HSPE组的可用性更高(83.4% vs. 60.0%, p <；0.0001)。使用曲妥珠单抗与PEROLA的pCR率显著升高相关(54.3% vs. 26.4%, p <；0.0001)和HSPE (52.7% vs. 26.4%, p <；0.0001)。在HSPE进行pCR的her2阳性患者也有更好的OS(80%比61%，p <；0.0001)和DFS (89% vs. 67%, p <；0.0001)与PEROLA相比。结论公立和私立医疗保健系统在曲妥珠单抗的提供方面存在显著差异，对临床结果和患者生存产生不利影响。目前的数据强调，迫切需要解决公平的癌症治疗，以改善预后的每一个病人。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Breast 医学-妇产科学

CiteScore

8.70

自引率

2.60%

发文量

165

审稿时长

59 days

期刊介绍： The Breast is an international, multidisciplinary journal for researchers and clinicians, which focuses on translational and clinical research for the advancement of breast cancer prevention, diagnosis and treatment of all stages.