Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Mar 24, 2020; 11(3): 143-151
Published online Mar 24, 2020. doi: 10.5306/wjco.v11.i3.143
Efficacy, patterns of use and cost of Pertuzumab in the treatment of HER2+ metastatic breast cancer in Singapore: The National Cancer Centre Singapore experience
Sylwan Rahardja, Ryan Ying Cong Tan, Rehena Sultana, Fun Loon Leong, Elaine Hsuen Lim
Sylwan Rahardja, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
Ryan Ying Cong Tan, Fun Loon Leong, Elaine Hsuen Lim, National Cancer Centre Singapore, Singapore 169610, Singapore
Rehena Sultana, Duke-NUS Medical School, Singapore 169857, Singapore
Author contributions: Rahardja S, Tan RYC and Lim EH designed the research; Rahardja S, Tan RYC, Sultana R and Leong FL performed the research; Rahardja S, Tan RYC, and Sultana R analyzed the data; Rahardja S, Tan RYC, and Lim EH wrote the paper.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board at SingHealth CIRB B.
Informed consent statement: Institutional review board has granted waiver of informed consent based on ethical considerations.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors who have contributed their effort in the manuscript. All the authors have no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sylwan Rahardja, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore. sylwanrahardja@u.nus.edu
Received: November 1, 2019
Peer-review started: November 1, 2019
First decision: November 21, 2019
Revised: February 4, 2020
Accepted: February 23, 2020
Article in press: February 23, 2020
Published online: March 24, 2020
ARTICLE HIGHLIGHTS
Research background

Pertuzumab is an anti-HER2 agent that has demonstrated promising clinical efficacy in Phase III trials such as the CLEOPATRA trial. Given the incidence of breast cancer and the proportion of Stage IV breast cancers at diagnosis in an Asian population, there is a need to evaluate its efficacy in an Asian population, and review its costs.

Research motivation

We aim to study the use of Pertuzumab in National Cancer Centre Singapore in a predominantly Asian population.

Research objectives

We attempted to elucidate the clinical efficacy of Peruzumab in HER2-positive Metastatic breast cancer, evaluate the incidence of Grade 3 cardiotoxicity, and the costs of treatment. In so doing, we hope to guide policy makers on the use of Pertuzumab as an important arm of therapy for metastatic HER2-positive breast cancer.

Research methods

We systematically selected the patients based on inclusion criteria further described in the manuscript, and retrieved relevant clinical variables such as billing records, treatment history, patient demographics, response and side effects. Statistical analyses were conducted using SAS Institute Inc 2013.

Research results

This study demonstrated statistically significant difference in median overall survival favouring the Pertuzumab group, with low incidence of Grade 3 Cardiotoxicity. However, costs in the pertuzumab group remain significantly higher than the non-Pertuzumab group.

Research conclusions

We found that Pertuzumab had statistically significant survival benefit in an Asian population in Singapore. This study proposes that Pertuzumab should be adopted as first line therapy for HER2-positive metastatic breast cancer. To summarize the current knowledge, it supports the findings of CLEOPATRA trial, in an Asian population in Singapore. No similar study has been done in an Asian population in Singapore. The implications of this study is that further cost-effectiveness studies should be conducted on the usage of Pertuzumab.

Research perspective

This study demonstrated the clinical efficacy of Pertuzumab in an Asian population in Singapore, and serves as an impetus for future research on costs.