Clinical and Economic Considerations
Evidence supports the adjuvant use of trastuzumab in HER2-positive women with node-positive breast cancer and normal cardiac function. Further analysis of the current trials and possibly new trial designs will be necessary before the optimum duration of therapy and concurrent regimens are known. Additionally, further analysis or trials with more node-negative patients may be needed before treatment in this population can be evaluated.
Trastuzumab, like any other drug, is associated with risks and benefits that need to be weighed for each individual before the decision to use the drug can be made. It should not be used in women with compromised cardiac function, and cardiac function should be monitored periodically for all patients on the drug. The implications of cardiac toxicity are different in adjuvant therapy versus metastatic therapy. Patients with metastatic disease have a significantly shorter life expectancy, and the majority will probably die of cancer before heart failure. In the adjuvant setting, however, the risks and benefits of trastuzumab will have to be considered over a longer lifespan. Additionally, there is a risk of a life-threatening infusion reaction in all patients, and trastuzumab should be infused with caution, especially with the first dose.
The average wholesale price of trastuzumab is $2,928.89 for 440 mg.[19] For a 70-kg woman, each 2-mg/kg dose would cost about $1,000, and a yearly regimen would cost about $50,000. While about 5 to 10 women per 100,000 population have metastatic breast cancer, between 90 and 100 per 100,000 have localized breast cancer, and around 40 per 100,000 have regional breast cancer.[20] Thus, with a U.S. female population of over 143,000,000, about 7,000 to 14,000 women may have metastatic breast cancer, about 130,000 to 140,000 have localized breast cancer, and about 60,000 have regional breast cancer.[21] If trastuzumab is to be a standard part of an adjuvant regimen for HER2-positive patients, the cost of treating this population could increase by almost $1 billion for trastuzumab treatment alone. Additional costs for treating heart failure would also be incurred.
Evidence supports the adjuvant use of trastuzumab in HER2-positive women with node-positive breast cancer and normal cardiac function. Further analysis of the current trials and possibly new trial designs will be necessary before the optimum duration of therapy and concurrent regimens are known. Additionally, further analysis or trials with more node-negative patients may be needed before treatment in this population can be evaluated.
Trastuzumab, like any other drug, is associated with risks and benefits that need to be weighed for each individual before the decision to use the drug can be made. It should not be used in women with compromised cardiac function, and cardiac function should be monitored periodically for all patients on the drug. The implications of cardiac toxicity are different in adjuvant therapy versus metastatic therapy. Patients with metastatic disease have a significantly shorter life expectancy, and the majority will probably die of cancer before heart failure. In the adjuvant setting, however, the risks and benefits of trastuzumab will have to be considered over a longer lifespan. Additionally, there is a risk of a life-threatening infusion reaction in all patients, and trastuzumab should be infused with caution, especially with the first dose.
The average wholesale price of trastuzumab is $2,928.89 for 440 mg.[19] For a 70-kg woman, each 2-mg/kg dose would cost about $1,000, and a yearly regimen would cost about $50,000. While about 5 to 10 women per 100,000 population have metastatic breast cancer, between 90 and 100 per 100,000 have localized breast cancer, and around 40 per 100,000 have regional breast cancer.[20] Thus, with a U.S. female population of over 143,000,000, about 7,000 to 14,000 women may have metastatic breast cancer, about 130,000 to 140,000 have localized breast cancer, and about 60,000 have regional breast cancer.[21] If trastuzumab is to be a standard part of an adjuvant regimen for HER2-positive patients, the cost of treating this population could increase by almost $1 billion for trastuzumab treatment alone. Additional costs for treating heart failure would also be incurred.
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