Clinical, Cost Implications of HER2+ Breast Cancer in the New Era of Value-Based Care


An on-demand webcast available until December 20, 2018, offers CME and CPE credits for pharmacy directors, medical directors, and other managed care decision-makers on the topics of biosimilars, clinical pathways, and precision medicine related to human epidermal growth factor 2 (HER2)-positive breast cancer.

Journal of Clinical Pathways spoke with Adam M Brufsky, MD, PhD, department of medicine, University of Pittsburgh, and faculty co-chair of the webcast, regarding some of the key topics and data included in the activity.

Mr Bessette:  What does the latest evidence about HER-directed therapies tell us about personalized management of breast cancer?

Dr Brufsky:  The latest evidence suggests that we can use HER2 as a biomarker to determine therapy for women with early-stage breast cancer as well as metastatic breast cancer.  We can tailor therapy to women based on their HER2 status because the survival rates are quite dramatic for patients with HER2-positive early-stage breast cancer. For new negative diseases, the 5-year survival rates are in excess of 95%. For women who have HER2-positive, estrogen receptor-negative early-stage breast cancer that need neoadjuvant therapy, the pathological immune response rates are in excess of 70%. Clearly, we now can use HER2 to personalize therapy for women with early-stage breast cancer.

Mr Bessette: How have clinical pathways shaped breast cancer care, management, and cost in recent years?

Dr Brufsky: The idea behind pathways and the pathways I am most associated with (Via Oncology) is that they standardize about 80% of all care. Doing so can give patients a good idea of what their costs are going to be on a year-to-year basis. If we can find the most efficacious and least toxic regimens, pathways enable us to choose the regimen that is least costly. But the bottom line is that pathways have driven a lot more efficiency and evidence-based medicine in care. The important thing about pathways to remember is that they do not require 100%; our pathways take 80% of the low hanging fruit, or where we can get agreement amongst oncologists on 80% of what each disease entity can be treated as. I think at that point we can manage the efficacy and the efficiency of giving care.

Mr Bessette: What does the biosimilar landscape looked like for HER-positive cancer at the moment, and how do you see it panning out in the future?

Dr Brufsky: One biosimilar has already been approved and it likely will not be used until the last quarter of 2018 or the first quarter of 2019. However, there are a number of biosimilars that are likely to receive approval very soon. The idea behind biosimilars is that while there are minimal to no differences compared with the comparator compound, biosimilars are less expensive. Therefore, biosimilars are poised to decrease the cost of HER2-directed therapy.

To access Dr Brufksy’s webcast, click here.