Weighing value in HER2+ breast cancer treatment

Targeted treatments of HER2-positive breast cancers have dramatically prolonged many patients’ lives. But treatment outcomes in clinical trial settings don’t always translate into comparable real-world clinical value, noted Sunil Verma, MD, MSEd, FRCP(C), at the American Society of Clinical Oncology (ASCO) Annual Meeting 2016 in Chicago.

VermaVerma, who is professor and head of the department of oncology, and medical director of the Tom Baker Cancer Centre at the University of Calgary, in Alberta, Canada, chaired a June 6 session, “Updates and Controversies in HER2-Positive Breast Cancer.

“There’s a disconnect,” said Verma. “We have nearly doubled overall survival for metastatic HER2-positive breast cancer-a substantial record. … The question is, what is the value of these treatments?”

Assessing treatment value

Assessing treatments’ value for complex and evolving diseases like breast cancer can be a daunting challenge. A treatment’s value hinges on clinical costs and benefits to the patient, in terms of survival impacts, toxicities, and quality-of-life.

New tools such as ASCO’s 2015 Value Framework can help make sense of such considerations in the context of drug acquisition costs.

One important component of value is cost-effectiveness, or the relative costs and outcomes of different treatments: Does a given agent achieve a clinical goal as well as another treatment option, but at a lower cost?

Healthcare economists use different measures of cost effectiveness, like Incremental Cost Effectiveness Ratio (ICER) or Quality Adjusted Life Year (QALY), a measure of patient life expectancy and quality of life.

The cost-effectiveness picture for HER2-positive breast cancer treatments is pretty clear for trastuzumab (Herceptin, Genentech), Verma said.

Studies from the U.S., Canada, U.K., Australia and Europe all show that adjuvant trastuzumab (Herceptin, Genentech) for HER2-positive breast cancer is cost-effective, Verma noted. (But that may not be true in certain developing countries; less than 10% of low- and middle-income countries have access to anti-HER2 therapies, he noted.)

“Trastuzumab in adjuvant settings is clearly cost-effective across the board,” Verma said. “First-line trastuzumab? Again-it’s quite consistent.”

Still, he said, the cost-effectiveness picture is less clear for newer targeted therapies.

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