Browsing by Subject "HER2-positive"

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Neoadjuvant versus adjuvant chemotherapy for older adults with stage I–III breast cancer
(2022-07-01) Zhang, Hanxi, M.S. in Pharmaceutical Sciences; Barner, Jamie C.; Moczygemba, Leticia R.; Rascati, Karen L; Kodali, Dhatri; Park, Chanhyun
Neoadjuvant chemotherapy (NAC) has been increasingly used in breast cancer. Little is known about its use among older women and about the comparisons between NAC and adjuvant chemotherapy (AdC) within each breast cancer subtype. This study of older women with breast cancer aimed to: 1) assess the trends of and factors related to NAC receipt; 2) compare survival between NAC and AdC; and 3) compare health care utilization and costs between NAC and AdC. This study used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and included older women (≥66 years) diagnosed with stage I–III breast cancer during 2010–2017 who received chemotherapy and surgery. Analyses were performed within each of six strata, defined based on the cancer subtype (hormone receptor [HR]-positive/human epidermal growth factor receptor 2 [HER2]-negative, HER2+, and triple-negative breast cancer [TNBC]) and stage (I–II and III). Trends of NAC receipt were tested with Cochran-Armitage tests. Overall and treated recurrence-free survival were compared between propensity score-matched NAC- and AdC-treated patients with Cox models. All-cause 1-year health care utilization and costs were compared between the matched patients with generalized linear models (GLMs). Among 8,495 patients included, 20.8% received NAC. NAC receipt increased significantly during 2010–2017, both overall and within each stratum (all p-values<.0001). Younger age groups, lower poverty, metropolitan residence, National Cancer Institute-designated cancer centers, later diagnosis years, lower comorbidity scores, and higher cancer stages were associated with NAC receipt in ≥1 stratum. No difference was found between NAC and AdC in survival after adjusting for multiple testing. Greater utilization was associated with NAC for institutional outpatient visits and physician office visits in most strata (adjusted p-values<.05), but a lower inpatient visit rate was associated with NAC in stage III TNBC (adjusted p<.05). Greater costs were associated with NAC for inpatient, institutional outpatient, physician service, and total costs in ≥1 stratum (adjusted p-values<.05). In conclusion, NAC use increased among older women in all subtypes and stages. Our observation of a trend toward an overall survival advantage of NAC in advanced HER2+ disease and toward an overall survival disadvantage of NAC in advanced TNBC warrants further research.