Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Mar 24, 2020; 11(3): 143-151
Published online Mar 24, 2020. doi: 10.5306/wjco.v11.i3.143
Efficacy, patterns of use and cost of Pertuzumab in the treatment of HER2+ metastatic breast cancer in Singapore: The National Cancer Centre Singapore experience
Sylwan Rahardja, Ryan Ying Cong Tan, Rehena Sultana, Fun Loon Leong, Elaine Hsuen Lim
Sylwan Rahardja, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
Ryan Ying Cong Tan, Fun Loon Leong, Elaine Hsuen Lim, National Cancer Centre Singapore, Singapore 169610, Singapore
Rehena Sultana, Duke-NUS Medical School, Singapore 169857, Singapore
Author contributions: Rahardja S, Tan RYC and Lim EH designed the research; Rahardja S, Tan RYC, Sultana R and Leong FL performed the research; Rahardja S, Tan RYC, and Sultana R analyzed the data; Rahardja S, Tan RYC, and Lim EH wrote the paper.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board at SingHealth CIRB B.
Informed consent statement: Institutional review board has granted waiver of informed consent based on ethical considerations.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors who have contributed their effort in the manuscript. All the authors have no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sylwan Rahardja, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore. sylwanrahardja@u.nus.edu
Received: November 1, 2019
Peer-review started: November 1, 2019
First decision: November 21, 2019
Revised: February 4, 2020
Accepted: February 23, 2020
Article in press: February 23, 2020
Published online: March 24, 2020
Processing time: 136 Days and 18.3 Hours
Abstract
BACKGROUND

Pertuzumab is a humanized anti-human epidermal growth factor receptor 2 (HER2) monoclonal antibody found in a Phase III clinical trial to significantly improve median survival in HER2 positive metastatic breast cancer (MBC) when used in combination with a taxane and Trastuzumab, and its clinical efficacy has transformed the therapeutic landscape of HER2-positive breast cancer. There are currently few reports on the pattern of use and value of Pertuzumab in real world settings. Our study describes the clinical efficacy and treatment costs of Pertuzumab in HER2-positive MBC treated in a tertiary cancer centre in Singapore in a predominantly Asian population.

AIM

To investigate the clinical efficacy and treatment costs of Pertuzumab in HER2-positive MBC in an Asian population in Singapore.

METHODS

A retrospective study of 304 HER2-positive MBC patients seen at National Cancer Centre Singapore between 2011-2017 was conducted. Demographic and clinical data were extracted from electronic medical records. Clinical characteristics and billing data of patients who received Pertuzumab were compared with those who did not.

RESULTS

Thirty-one (62.0%) of the fifty (16.4%) patients who received Pertuzumab as first-line therapy. With a median follow-up of 21.5 mo, there was a statistically significant difference in the median overall survival between Pertuzumab and non-Pertuzumab groups [51.5 (95%CI: 35.8–60.0) vs 32.9 (95%CI: 28.1–37.5) mo; P = 0.0128]. Two (4.88%) patients in the Pertuzumab group experienced grade 3 (G3) cardiotoxicity. The median treatment cost incurred for total chemotherapy for the Pertuzumab group was 130456 Singapore Dollars compared to 34523 Singapore Dollars for the non-Pertuzumab group. The median percentage of total chemotherapy costs per patient in the Pertuzumab group spent on Pertuzumab was 50.3%.

CONCLUSION

This study shows that Pertuzumab use in the treatment of metastatic breast cancer is associated with a significantly better survival and a low incidence of serious cardiotoxicity. However, the proportionate cost of Pertuzumab therapy remains high and further cost-effectiveness studies should be conducted.

Keywords: Pertuzumab; Chemotherapy; Metastatic breast cancer; Treatment cost

Core tip: Pertuzumab is a humanized anti-human epidermal growth factor receptor 2 (HER2) monoclonal antibody found in a Phase III clinical trial to significantly improve median survival in HER2 positive metastatic breast cancer when used in combination with a taxane and Trastuzumab, and its clinical efficacy has transformed the therapeutic landscape of HER2-positive breast cancer. In our study, there was a statistically significant difference in the median overall survival between Pertuzumab and non-Pertuzumab groups [51.5 (95%CI: 35.8–60.0) vs 32.9 (95%CI: 28.1–37.5) mo; P = 0.0128] while the rate of grade 3 cardiotoxicity was low (4.88%). However, costs remain high.