The landscape of use of NCCN-guideline chemotherapy regimens in stage I-IIIA breast cancer in an integrated healthcare delivery system.

Autor: Bhimani J; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA., O'Connell K; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Persaud S; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Blinder V; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Burganowski RP; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA., Ergas IJ; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA., Gallagher GB; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Griggs JJ; Department of Medicine, Division of Hematology/Oncology and Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA., Heon N; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Kolevska T; Department of Oncology, Kaiser Permanente Medical Center, Vallejo, CA, USA., Kotsurovskyy Y; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Kroenke CH; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.; Kaiser Permanente School of Medicine, Pasadena, CA, USA., Laurent CA; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA., Liu R; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.; San Francisco Medical Center, Kaiser Permanente Northern California, San Francisco, CA, USA., Nakata KG; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA., Rivera DR; Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA., Roh JM; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA., Tabatabai S; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Valice E; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA., Bandera EV; Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA., Aiello Bowles EJ; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA., Kushi LH; Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA., Kantor ED; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. kantore@mskcc.org.
Jazyk: angličtina
Zdroj: Breast cancer research and treatment [Breast Cancer Res Treat] 2024 Nov; Vol. 208 (2), pp. 405-414. Date of Electronic Publication: 2024 Aug 16.
DOI: 10.1007/s10549-024-07433-4
Abstrakt: Purpose: The National Comprehensive Cancer Network (NCCN) guidelines recommend a variety of drug combinations with specific administration schedules for the treatment of early-stage breast cancer, allowing physicians to deliver treatments recognizing individual patient complexities, including comorbidities, and patient-physician preference. While use of guideline regimens has shifted over time, there is little data to describe changes in how treatment for early-stage breast cancer has evolved over time.
Methods: In a cohort of 34,109 women treated for stage I-IIIA breast cancer between 2006-2019 at Kaiser Permanente Northern California and Kaiser Permanente Washington, we present the changes in chemotherapy regimens over time, and explore use of NCCN-guideline regimens (GR), guideline regimens used when said regimens were not included in guidelines, referred to as time-discordant regimens (TDR), and non-guideline regimens (NGR). Results are presented by drug combination and over time.
Results: Among 12,506 women receiving chemotherapy, 77.4% (n = 9681) received GRs, 9.1% (n = 1140) received TDRs, and 13.5% (n = 1685) received NGRs. In 2006, AC-T (cyclophosphamide-doxorubicin, paclitaxel) was the most common regimen, with TC (cyclophosphamide-docetaxel) becoming the most prevalent by 2019. NGRs were more common in cyclophosphamide-methotrexate-5-fluorouracil (CMF); cyclophosphamide-doxorubicin-paclitaxel-trastuzumab (ACTH); and paclitaxel-trastuzumab (TH). The use of GR has increased over time (p-trend < 0.001), while use of NGR (both in terms of administration schedule and drug combination) and TDR have decreased, although patterns vary by drug combination.
Conclusion: Chemotherapy delivery has changed markedly over time, with a move toward more use of GR. These data are important for understanding the landscape of chemotherapy delivery in community healthcare settings.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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