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Monitoring of Hematologic, Cardiac, and Hepatic Function in Post-Menopausal Women with HR+/HER2− Metastatic Breast Cancer

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Abstract

Introduction

In the treatment of metastatic breast cancer (mBC), regular monitoring is key in helping physicians to make informed clinical decisions, managing treatment side effects, and maintaining patients’ quality of life. Therefore, we investigated the monitoring frequency in post-menopausal women with HR+/HER2− mBC stratified by first-line regimen.

Methods

Treatment monitoring was assessed using two complementary data sources: a medical chart review (chart review analysis) and a commercial claims database (claims analysis). Women with post-menopausal HR+/HER2− mBC who initiated first-line therapy for mBC were selected and classified under three cohorts, based on treatment received: cyclin-dependent kinase 4/6 (CDK4/6) inhibitor (i.e., palbociclib—the only CDK4/6 approved at the time of the study), endocrine therapy (ET), and chemotherapy. Frequency of monitoring [complete blood count (CBC), electrocardiogram (EKG), and liver function test (LFT)] and laboratory abnormalities detected during the first line of therapy were analyzed.

Results

In the chart review analysis, 64 US oncologists abstracted medical information on 401 eligible patients, including 210 CDK4/6 users, 121 ET users, 51 chemotherapy users; 19 patients used other regimens. All patients had ≥ 1 CBC; between 8.3% (ET users) and 39.5% (CDK4/6 users) had ≥ 1 EKG; and over 98% of patients had ≥ 1 LFT across all three cohorts. Among monitored patients, 64.6% had a CBC abnormality, with anemia (39.9%), leukopenia (27.4%), and neutropenia (26.7%) being the most common. Abnormal EKG readings were detected in 8.4, 0.0%, and 7.7% of CDK4/6, ET, and chemotherapy users, respectively. LFT abnormalities were detected in 14.1–26.0% of CDK4/6 and chemotherapy users, respectively. Similar frequency of monitoring was observed in the claims analysis, with the exception of EKG monitoring, for which the proportion of patients tested was higher.

Conclusion

Post-menopausal women with HR+/HER2− mBC receiving first-line therapy with CDK4/6, ET, or chemotherapy were regularly monitored regardless of the first-line regimen received.

Funding

Novartis Pharmaceuticals Corporation.

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Acknowledgements

Funding

Sponsorship for this study and article processing charges were funded by Novartis Pharmaceuticals Corporation. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take full responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Medical Writing, Editorial, and Other Assistance

Medical writing assistance was provided by Samuel Rochette, an employee of Analysis Group, Inc. Analysis Group received consulting fees from Novartis for the conduct of this study.

Disclosures

Anand A. Dalal is an employee of Novartis. Tania Small was an employee of Novartis at the time of this study and is currently an employee of Ipsen. Debbie Goldschmidt is an employee of Analysis Group, Inc., which received consulting fees from Novartis for the conduct of this study. Hela Romdhani is an employee of Analysis Group, Inc., which received consulting fees from Novartis for the conduct of this study. Sneha Kelkar is an employee of Analysis Group, Inc., which received consulting fees from Novartis for the conduct of this study. Patrick Gagnon–Sanschagrin is an employee of Analysis Group, Inc., which received consulting fees from Novartis for the conduct of this study. Annie Guérin is an employee of Analysis Group, Inc., which received consulting fees from Novartis for the conduct of this study. Genevieve Gauthier is an employee of Analysis Group, Inc., which received consulting fees from Novartis for the conduct of this study. Eric Q. Wu is an employee of Analysis Group, Inc., which received consulting fees from Novartis for the conduct of this study. Polly Niravath received honoraria from Novartis as a consultant.

Compliance with Ethics Guidelines

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For the commercial claims analysis, the data were de-identified and fully compliant with the patient confidentiality requirements of the Health Insurance Portability and Accountability Act; therefore, no ethical review by an institutional review board was required. For the retrospective chart review, we obtained institutional review board exemption from the New England Institutional Review Board.

Data Availability

Chart Review: The datasets analyzed during the current study are available from the corresponding author upon reasonable request. Please note that institutional review board confirmation will be needed before the data can be shared with additional parties. Claims Analysis: The claims database (Truven MarketScan Commercial Database) is proprietary, provided by a third-party vendor, and the authors do not have permission to disseminate the data without the vendor’s approval. The study sponsor has purchased access to the database (the authors have been granted access to the data on a contract per project use). Access to this data set is available to any other interested parties for a fee set by Truven Health Analytics (https://marketscan.truvenhealth.com/marketscanportal/).

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Authors and Affiliations

  1. Analysis Group, Inc., 1000 De La Gauchetière West, Suite 1200, Montreal, QC, H3B 4W5, Canada

    Annie Guérin, Patrick Gagnon-Sanschagrin, Hela Romdhani & Genevieve Gauthier

  2. Analysis Group, Inc., 10 Rockefeller Plaza, 15th floor, New York, NY, 10020, USA

    Debbie Goldschmidt & Sneha Kelkar

  3. Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hanover, 07936, NJ, USA

    Tania Small & Anand A. Dalal

  4. Analysis Group, Inc., 111 Huntington Ave, 14th floor, Boston, MA, 02199, USA

    Eric Q. Wu

  5. Houston Methodist Hospital, 6445 Main St, Houston, 77030, TX, USA

    Polly Niravath

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  1. Annie Guérin
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  2. Debbie Goldschmidt
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Correspondence to Annie Guérin.

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Guérin, A., Goldschmidt, D., Small, T. et al. Monitoring of Hematologic, Cardiac, and Hepatic Function in Post-Menopausal Women with HR+/HER2− Metastatic Breast Cancer. Adv Ther 35, 1251–1264 (2018). https://doi.org/10.1007/s12325-018-0740-y

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