December 13, 2019
The most cost-effective treatment strategy for women with HER2-positive stage II to III breast cancer in a simulated clinical practice cohort was neoadjuvant trastuzumab + paclitaxel + pertuzumab followed by adjuvant trastuzumab for patients with pathologic complete response and by adjuvant dose-dense anthracycline/cyclophosphamide and T-DM1 for those with residual disease. Researchers presented findings from their analysis of five treatment strategies during a session at the San Antonio Breast Cancer Symposium in San Antonio, Texas.
“Several neoadjuvant and adjuvant treatment options exist for patients with HER2-positive stage II to III breast cancer. Recent results of the KATHERINE trial showed that adjuvant T-DM1 can reduce distant recurrence risk in patients without pathologic complete response (pCR) after neoadjuvant chemotherapy,” researchers explained in a session abstract. “However, pCR rates can range between 20% and 80% depending on treatment regimen and subtype. Given the high cost of T-DM1 and other HER2-targeted agents, understanding the relationship between the costs and health consequences of various neoadjuvant-adjuvant treatment combinations is needed.”
Researchers developed a model to analyze the cost-effectiveness of five strategies:
- neoadjuvant dose-dense anthracycline/cyclophosphamide (ddAC) followed by paclitaxel (T), trastuzumab (H), and pertuzumab (P) (ddAC/THP) + adjuvant H for residual disease and for pCR;
- neoadjuvant ddAC/THP + adjuvant T-DM1 for residual disease and adjuvant H for pCR;
- neoadjuvant THP + adjuvant ddAC followed by T-DM1 for residual disease and adjuvant H for pCR;
- neoadjuvant HP + adjuvant ddAC/THP followed by T-DM1 for residual disease and adjuvant H for pCR; and
- neoadjuvant docetaxel, carboplatin, H, and P + adjuvant-T-DM1 for residual disease and adjuvant H for pCR.
Strategy 3 was the dominating strategy, researchers reported, with an estimated average 10.56 gain in quality-adjusted life years and $274,550 in costs per patient.
In addition, “probabilistic sensitivity analysis indicated Strategy 3 to have the highest probability of cost-effectiveness and expected net benefit across a wide range of willingness-to-pay thresholds ($0-250,000),” researchers added. “These findings persisted when changing a number of assumptions, including increasing starting age and varying pCR rates and distant recurrence probability after an initial local recurrence.”
Kunst NR, Wang SY, Hood A, et al. Cost-effectiveness of different neoadjuvant followed by adjuvant treatment combination strategies for women with HER2-positive breast cancer. December 13, 2019.