Abstract

We investigated first-line (1L) treatment patterns and predictors of taxane use to better understand the evolving metastatic triple-negative breast cancer (mTNBC) treatment landscape. This retrospective analysis of the Truven Health MarketScan® (Somers, NY, USA) Database included women with mTNBC who received 1L therapy within six months of diagnosis (January 2005–June 2015). Multivariate logistic regression models identified predictors of taxane use, adjusting for prognostic factors. A total of 2271 women with newly diagnosed mTNBC received 1L treatment during the study period. Half received a 1L taxane (53%), more often in combination than as monotherapy (58% versus 42%), though this varied by specific taxane. Nab-Paclitaxel monotherapy increased substantially after 2010. More recent treatment year (odds ratio, 2.16 (95% CI 1.69–2.76]) and number of metastases (≥3 versus 1: 1.73 (1.25–2.40)) predicted taxane monotherapy versus combination. Having a health maintenance organization versus a preferred provider organization plan predicted less nab-paclitaxel versus paclitaxel (0.32 (0.13–0.80)) or docetaxel (0.30 (0.10–0.89)) use. More recent index year (2011–2015 vs. 2005–2010) was the only predictor favoring nab-paclitaxel versus paclitaxel (2.01 (1.26–3.21)) or docetaxel (3.63 (2.11–6.26)). Taxane-containing regimens remained the most common 1L mTNBC treatments. Paclitaxel and nab-paclitaxel use changed substantially over time, with nab-paclitaxel use associated with insurance coverage.

Highlights

  • Metastatic triple-negative breast cancer comprises 15% to 20% of all breast cancer diagnoses [1]

  • We evaluated the characteristics of patients receiving taxanes, and factors that might predict the use of taxane-based regimens for 1L treatment of Metastatic triple-negative breast cancer (mTNBC)

  • Patients with a HMO plan were less likely than those with a PPO plan to receive nab-paclitaxel compared with paclitaxel (OR, 0.32) or docetaxel (OR, 0.30)

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Summary

Introduction

Metastatic triple-negative breast cancer (mTNBC) comprises 15% to 20% of all breast cancer diagnoses [1]. Patients with mTNBC tend to be diagnosed at a younger age and have a worse prognosis than those with other subtypes of breast cancer [2,3,4]. A chart review study suggested that most, but not all, patients with mTNBC in US community practices receive a systemic treatment (83%); the observed progression-free survival (PFS). Real-world overall survival estimates range from 8 to 17 months [3,5,6]. International treatment guidelines have historically recommended taxanes and anthracyclines (for patients previously not exposed to anthracyclines) as the foundation of first-line (1L) chemotherapy for patients with mTNBC [7,8].

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