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Concordance to National Comprehensive Cancer Network (NCCN) Clinical Practice Guideline (GL) Drug Therapy Recommendations for Metastatic Breast Cancer: An Analysis from the Commercial Managed Care Claims Database PharMetrics (PM)

Citation: J Clin Oncol 28:7s, 2010 (suppl; abstr 1032)

Author(s): E. M. Lepisto, K. Tangirala, J. L. Vandergrift, J. S. McClure, D. L. McNally, C. D. Mullins, B. S. Seal; National Comprehensive Cancer Network, Fort Washington, PA; Smith Hanley Consulting Group, Bridgewater, NJ; University of Maryland School of Pharmacy, Baltimore, MD; School of Pharmacy, University of Maryland, Baltimore, MD; sanofi-aventis, Bridgewater, NJ

Abstract:

Background: The NCCN GLs provide the standard of care for the treatment of women with metastatic breast cancer (mBC). The primary aim of the current project is to assess concordance between the NCCN GL recommendation for drug therapy and care received using the PM database (DB). The PM is a patient (pt) care DB that incorporates medical and pharmaceutical claims data for younger managed-care patients.

Methods: Claims for pts diagnosed with metastatic breast cancer from 2002 to 2008 were examined. Overall, 26,476 women with metastatic breast cancer were identified. Median age was 40 years.

Results: 26,260 (99%) patients were identified as premenopausal with 7,005 (28%) receiving antiestrogen (AE) therapy. Until 2005, the NCCN GLs recommended luteinizing hormone-releasing hormone (LHRH) agonists as an optional compliment to AE therapy for mBC. Prior to 2005, 37 of 2,838 pts (1%) received LHRH agonists. After 2005, 3% received nonconcordant therapy with LHRH agonists. After 2005, the NCCN GLs recommend bevacizumab therapy only with paclitaxel for treatment of mBC. 9,378 pts received antineoplastic therapy after 2005. Of this, 2.1% of pts were treated with bevacizumab therapy, 75% of which received therapy per NCCN GL recommendations. The use of bisphosphonates for pts with bone metastases is a category 1 recommendation in the NCCN GLs. Only 44% of patients with bone disease received GL concordant care. Additional drug therapy measures are in development. Comparisons with SEER/Medicare are being analyzed.

Conclusions: Less than half of mBC pts with bone disease received care concordant with the NCCN GLs. Few patients received bevacizumab therapy with moderate concordance. Almost all patients receiving AE therapy did not receive LHRH agonists as per NCCN GL recommendations.
 

 

 

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