Exploring Breast Cancer Systemic Drug Therapy Patterns in Real-World Data

Abstract

Purpose: To explore medications and their administration patterns in real-world patients with breast cancer.

Methods: A retrospective study was performed using TriNetX, a federated network of deidentified, Health Insurance Portability and Accountability Act-compliant data from 21 health care organizations across North America. Patients diagnosed with breast cancer between January 1, 2013, and May 31, 2022, were included. We investigated a rule-based and unsupervised learning algorithm to extract medications and their administration patterns. To group similar administration patterns, we used three features in k-means clustering: total number of administrations, median number of days between administrations, and standard deviation of the days between administrations. We explored the first three lines of therapy for patients classified into six groups on the basis of their stage at diagnosis (early as stages I-III v late as stage IV) and the sensitivity of the tumor's receptors to targeted therapies: hormone receptor-positive/human epidermal growth factor 2-negative (HR+/ERBB2-), ERBB2-positive (ERBB2+/HR±), or triple-negative (TN; HR-/ERBB2-). To add credence to the derived regimens, we compared them to the National Comprehensive Cancer Network (NCCN): Breast Cancer (version 2.2023) recommendations.

Results: In early-stage HR+/ERBB2- and TN groups, the most common regimens were (1) cyclophosphamide and docetaxel, administered once every 3 weeks for three to six cycles and (2) cyclophosphamide and doxorubicin, administered once every 2 weeks for four cycles, followed by paclitaxel administered once every week for 12 cycles. In the early-stage ERBB2+/HR± group, most patients were administered carboplatin and docetaxel with or without pertuzumab and with trastuzumab (for six or more cycles). Medications most commonly administered in our data set (7,798 patients) agreed with recommendations from the NCCN in terms of medications (regimens), number of administrations (cycles), and days between administrations (cycle length).

Conclusion: Although there is a general agreement with the NCCN Guidelines, real-world medication data exhibit variability in the medications and their administration patterns.

FIG 1.

Cohort selection. HCOs, health care organizations.

FIG 2.

Regimen and LOT algorithm overview. LOT, line of therapy. See the description of Figure 2 in the Data Supplement.

FIG 3.

LOT for HR+/ERBB2– early-stage patients. ERBB2–, human epidermal growth factor 2–negative; HR+, hormone receptor–positive; LOT, line of therapy. See Data Supplement Table S4 for a description and an accompanying table.

FIG 4.

LOT for triple-negative early-stage patients. LOT, line of therapy. See Data Supplement Table S5 for a description and an accompanying table.

FIG 5.

LOT for ERBB2+ early-stage patients. ERBB2+/HR±, human epidermal growth factor 2–positive; LOT, line of therapy. See Data Supplement Table S6 for a description and an accompanying table.