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. 2023 Oct 20:26:e230045.
doi: 10.1590/1980-549720230045. eCollection 2023.

Overall survival and associated factors in women with metastatic breast cancer treated with trastuzumab at a public referral institution

[Article in English, Portuguese]
Débora Silva Gonçalves  1 , Arn Migowski  1   2 , Susanne Crocamo Ventilari da Costa  2 , Rodrigo Saar da Costa  2 , Katia Marie Simões E Senna  1 , Ivan Ricardo Zimmermann  3
Affiliations

Overall survival and associated factors in women with metastatic breast cancer treated with trastuzumab at a public referral institution

[Article in English, Portuguese]
Débora Silva Gonçalves et al. Rev Bras Epidemiol. .

Erratum in

  • ERRATUM.
    [No authors listed] [No authors listed] Rev Bras Epidemiol. 2023 Dec 4;26:e20230045erratum. doi: 10.1590/1980-549720230045erratum. Rev Bras Epidemiol. 2023. PMID: 38055552 Free PMC article.

Abstract
in English, Portuguese

Objective: To characterize associated factors and overall survival of women with metastatic breast cancer treated with trastuzumab after its incorporation into the SUS, and additionally to present the direct costs of this technology.

Methods: This is a retrospective cohort, based on data from computerized medical records from one of the units of the National Cancer Institute (INCA), in Rio de Janeiro-RJ, Brazil. Women with HER-2 positive metastatic breast cancer undergoing trastuzumab treatment from September 2017 to August 2018 were included. Overall survival was estimated using the Kaplan-Meier method and compared between groups using the log-rank test.

Results: 136 women were selected, whose median age at diagnosis was 51 years (range: 21-81 years). The median OS was 43.63 months (95%CI 33.92-53.34). It is observed that the median OS for the population already diagnosed with metastatic disease (stage IV) was significantly lower than for patients diagnosed in stages I-III (37.43 months vs. 48.6 months, p<0, 01). Women without previous use of trastuzumab had a higher median OS than patients pretreated with trastuzumab (45.16 months vs. 40.73 months, p<0.01).

Conclusion: Trastuzumab improves survival in HER-2 positive metastatic breast cancer. Brain and multiple metastases are associated with a worse prognosis. It is essential to avoid advanced staging and perform surgical treatment, with emphasis on radical mastectomy. The SUS must adopt policies and strategies for early diagnosis and guarantee access to trastuzumab, considering its high cost.

Objetivo:: Caracterizar fatores associados e sobrevida global de mulheres com câncer de mama metastático tratadas com trastuzumabe, após sua incorporação ao Sistema Único de Saúde, e apresentar os custos diretos dessa tecnologia.

Métodos:: Trata-se de uma coorte retrospectiva, baseada em dados de prontuários do Instituto Nacional do Câncer, no Rio de Janeiro (RJ). Foram incluídas mulheres com câncer de mama metastático HER-2 positivo em tratamento com trastuzumabe no período de setembro de 2017 a agosto de 2018. A sobrevida global foi estimada pelo método Kaplan-Meier e comparada entre grupos pelo teste de log-rank.

Resultados:: Foram selecionadas 136 mulheres, cuja mediana da idade do diagnóstico foi de 51 anos (amplitude: 21-81 anos). A mediana da sobrevida global foi de 43,63 meses (IC95% 33,92–53,34). Observa-se que a mediana da sobrevida global para a população já diagnosticada com doença metastática (estádio IV) foi significativamente menor do que para as pacientes diagnosticadas nos estádios I-III (37,43 meses vs. 48,6 meses, p<0,01). Já mulheres sem uso prévio de trastuzumabe apresentaram uma mediana de sobrevida global maior do que as pacientes pré-tratadas com trastuzumabe (45,16 meses vs. 40,73 meses, p<0,01).

Conclusão:: O trastuzumabe aumentou a sobrevida no câncer de mama metastático HER-2 positivo. Metástases cerebrais e múltiplas mostraram-se associadas a um pior prognóstico. É fundamental evitar o estadiamento avançado e realizar tratamento cirúrgico, destacando-se a mastectomia radical. O Sistema Único de Saúde deve adotar políticas e estratégias para o diagnóstico precoce e garantir acesso ao trastuzumabe, considerando seu alto custo.

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Conflict of interest statement

CONFLICT OF INTERESTS: nothing to declare

Figures

Figure 1
Figure 1. Probability of overall survival according to the Kaplan-Meier method for the general population of patients with metastatic breast cancer using trastuzumab from 09/2017 to 08/2018 in a reference hospital in oncology in Rio de Janeiro, Brazil.
Figure 2
Figure 2. Subgroup analysis for the probability of overall survival according to the Kaplan-Meier method for patients with metastatic breast cancer using trastuzumab from 09/2017 to 08/2018 at a reference hospital in oncology in Rio de Janeiro, Brazil.
Figure 3
Figure 3. Forest plot of the multivariate analysis for overall survival of patients with metastatic breast cancer using trastuzumab from 09/2017 to 08/2018 in a reference hospital in oncology in Rio de Janeiro, Brazil (scenario 2).
See this image and copyright information in PMC

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