Treatment Patterns for Unresectable Locally Advanced or Metastatic Hormone Receptor-Positive HER2-Negative and Triple-Negative Breast Cancers in France
Author(s)
Delphine Hequet, MD1, Pierre Etienne Heudel, MD2, Clémentine LACUEILLE, MSc3, LAUREN INCHBOARD, MSc4, Afifa LAHRACHE, MD5, Olivier LIBERT, MD5, Emma LEVY, MSc6, Valentin DEBARGE, MSc6.
1Clinique Saint Jean de Dieu, Institut Bourdonnais, Paris, France, 2Medical Oncology Department, Centre Léon Bérard, Lyon, France, 3HORIANA, Bordeaux, France, 4Horiana, Bordeaux, France, 5Medical Affairs, Gilead Science, Boulogne-Billancourt, France, 6Market Access, Gilead Science, Boulogne-Billancourt, France.
1Clinique Saint Jean de Dieu, Institut Bourdonnais, Paris, France, 2Medical Oncology Department, Centre Léon Bérard, Lyon, France, 3HORIANA, Bordeaux, France, 4Horiana, Bordeaux, France, 5Medical Affairs, Gilead Science, Boulogne-Billancourt, France, 6Market Access, Gilead Science, Boulogne-Billancourt, France.
OBJECTIVES: Describe treatment pathways in French patients with unresectable locally advanced or metastatic breast cancer (mBC) in HER2-negative breast cancer before and after metastasis / unresectable diagnosis.
METHODS: We conducted a retrospective cohort study using the French National Healthcare Data System (SNDS) from 2018 to 2021, identifying incident mBC molecular subtypes from diagnosis and treatment codes. Molecular subtypes were determined by treatment combinations.
RESULTS: We identified 60,195 incident cases over 2018-2021, of which, 8,798 (14.5%) had no registered treatment after metastasis diagnosis and were not categorizable. There were 34,709 (57.7%) HR+/HER2- and 9,069 (15.1%) TNBC. Over a median time between cancer diagnosis and metastasis of 1.5 (TN) and 2.7 years (HR+/HER2-), most patients received treatment (72% both subtypes); with surgery (TN 60%, HR+/HER2- 53%), radiotherapy (TN 49%, HR+/HER2- 40%), chemotherapy (TN 43%, HR+/HER2-36%) and/or endocrine therapy (TN 17%, HR+/HER2- 48%). A combination of all four treatments was received by 11% of TN and 19% HR+/HER2-. After metastasis diagnosis, all categorized TNBC and HR+/HER2- patients received treatment. Median follow-up after metastasis diagnosis was 13.2 (TN) and 26.4 (HR+/HER2-) months. Most common post-metastasis treatments were chemotherapy (TN 100%, HR+/HER2- 51%) and endocrine therapy (TN 6%, HR+/HER2-100%), radiotherapy (TN 48%, HR+/HER2- 49%) and / or surgery (TN 11%, HR+/HER2- 12%). Over two thirds (69.3%) of HR+/HER2- patients received targeted therapy after metastatic diagnosis, compared to 28.9% of TN patients. Very few TN or HR+/HER2- patients received treatment via PARP inhibitors (TN: 3%, HR+/HER2- 1%).
CONCLUSIONS: A sizeable proportion of patients do not receive any treatment over their entire period and were uncategorisable. An additional 28% of TN and HR+/HER2- patients receive no treatment before metastatic diagnosis. PARP inhibitor use is infrequent. This raises questions about the adequacy of the treatment landscape in France and emphasizes the need to characterize patients who miss out on optimal treatment.
METHODS: We conducted a retrospective cohort study using the French National Healthcare Data System (SNDS) from 2018 to 2021, identifying incident mBC molecular subtypes from diagnosis and treatment codes. Molecular subtypes were determined by treatment combinations.
RESULTS: We identified 60,195 incident cases over 2018-2021, of which, 8,798 (14.5%) had no registered treatment after metastasis diagnosis and were not categorizable. There were 34,709 (57.7%) HR+/HER2- and 9,069 (15.1%) TNBC. Over a median time between cancer diagnosis and metastasis of 1.5 (TN) and 2.7 years (HR+/HER2-), most patients received treatment (72% both subtypes); with surgery (TN 60%, HR+/HER2- 53%), radiotherapy (TN 49%, HR+/HER2- 40%), chemotherapy (TN 43%, HR+/HER2-36%) and/or endocrine therapy (TN 17%, HR+/HER2- 48%). A combination of all four treatments was received by 11% of TN and 19% HR+/HER2-. After metastasis diagnosis, all categorized TNBC and HR+/HER2- patients received treatment. Median follow-up after metastasis diagnosis was 13.2 (TN) and 26.4 (HR+/HER2-) months. Most common post-metastasis treatments were chemotherapy (TN 100%, HR+/HER2- 51%) and endocrine therapy (TN 6%, HR+/HER2-100%), radiotherapy (TN 48%, HR+/HER2- 49%) and / or surgery (TN 11%, HR+/HER2- 12%). Over two thirds (69.3%) of HR+/HER2- patients received targeted therapy after metastatic diagnosis, compared to 28.9% of TN patients. Very few TN or HR+/HER2- patients received treatment via PARP inhibitors (TN: 3%, HR+/HER2- 1%).
CONCLUSIONS: A sizeable proportion of patients do not receive any treatment over their entire period and were uncategorisable. An additional 28% of TN and HR+/HER2- patients receive no treatment before metastatic diagnosis. PARP inhibitor use is infrequent. This raises questions about the adequacy of the treatment landscape in France and emphasizes the need to characterize patients who miss out on optimal treatment.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HSD115
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care, Real World Data & Information Systems
Disease
Oncology