Breast cancer requires a multidisciplinary treatment approach that incorporates surgery, radiotherapy, chemotherapies, and targeted therapies. Treatment decisions are influenced by disease stage, resectability, and HER2 and HR status. HER2-targeting therapy is the cornerstone of treatment regardless of HR status. This analysis provides insight on the current use of approved therapies for HER2-positive breast cancer in the EU5 and on factors driving physicians’ prescribing decisions.

Table of contents

  • Breast Cancer - Current Treatment - Detailed, Expanded Analysis (EU5)
    • Physician Prescribing Practices
      • Key Findings
      • Patient Characteristics
        • Bone is the most common site of first metastases
        • Menopausal Status of Stage I-III Breast Cancer Patients at Diagnosis
        • Performance Score of Patients with Stage I-III or Metastatic Breast Cancer at Treatment Initiation
        • Performance Score of Patients with Stage I-III Breast Cancer at Treatment Initiation
        • Performance Score of Newly Diagnosed Metastatic Breast Cancer Patients at Treatment Initiation
        • Sites of First Metastases in Patients with Newly Diagnosed vs. Recurrent Metastatic Breast Cancer
        • Sites of First Metastases in Patients with Newly Diagnosed Metastatic Breast Cancer
        • Sites of First Metastases in Breast Cancer Patients Originally Diagnosed with Stage I-III Disease
        • Newly Diagnosed Metastatic Breast Cancer Patients with Bone as First Site of Metastases: by Subpopulation
        • Newly Diagnosed Metastatic Breast Cancer Patients with Bone as First Site of Metastases: by Subpopulation and Country
        • Disease Aggressiveness by Subtype: Newly Diagnosed Metastatic Breast Cancer
        • Disease Aggressiveness by Subtype: Newly Diagnosed Metastatic Breast Cancer
      • Treatment Practices: Newly Diagnosed Patients
        • Herceptin-Based Therapies Are the Mainstay of Treatment for Newly Diagnosed HER2-Positive Breast Cancer
        • Almost All Breast Cancer Patients, Irrespective of Disease Stage, Receive Antineoplastic Drug Treatment
        • Drug-Treatment Rates for Newly Diagnosed Stage I-III and Metastatic Breast Cancer Patients
        • Neoadjuvant Drug-Treatment Rates: By Subpopulation
        • Neoadjuvant Drug-Treatment Rates: By Subpopulation and Country
        • Surgery Plus Radiotherapy Is the Most Popular Nonpharmacological Treatment Approach for Stage I-III Breast Cancer
        • Nonpharmacological Treatment of Newly Diagnosed Stage I-III and Metastatic Patients
        • Nonpharmacological Treatment of Newly Diagnosed Stage I-III Patients
        • Nonpharmacological Treatment of Newly Diagnosed Metastatic Patients
        • Adjuvant Prescribing of Subcutaneous Herceptin Has Overtaken Prescribing of IV Herceptin in the United Kingdom and Spain
        • Patient Share of Key Hormonal Drugs in the HR-Positive/HER2-Positive Newly Diagnosed First-Line Metastatic Setting: By Country
        • Patient Share of Key Therapies in the HR-Negative/HER2-Positive Adjuvant and Neoadjuvant Settings
        • Patient Share of Key Therapies in the HR-Negative/HER2-Positive Adjuvant Settings: By Country
        • Patient Share of Key Therapies in the HR-Negative/HER2-Positive Neoadjuvant Settings: By Country
        • Patient Share of Key Therapies in the HR-Negative/HER2-Positive Newly Diagnosed First-Line Metastatic Setting: By Country
        • Around Half of Early Stage HR+/HER2+ Patients Receive a Combination of HER2-targeted, Chemotherapy and Hormonal Therapy
        • Patient Share of Key Therapies in the HR-Positive/HER2-Positive Adjuvant and Newly Diagnosed First-Line Metastatic Settings
        • Patient Share of Key Therapies in the HR-Positive/HER2-Positive Adjuvant Setting: By Country
        • Patient Share of Key Therapies in the HR-Positive/HER2-Positive Newly Diagnosed First-Line Setting: By Country
        • Patient Share of Key HER2-Targeted Drugs in the HR-Positive/HER2-Positive Adjuvant and Neoadjuvant Settings
        • Patient Share of Key HER2-Targeted Drugs in the HR-Positive/HER2-Positive Adjuvant Setting: By Country
        • Subcutaneous Herceptin vs. IV Herceptin Prescribing in the Adjuvant HR-Positive/HER2-Positive Setting
        • Patient Share of Key HER2-Targeted Drugs in the HR-Positive/HER2-Positive Newly Diagnosed First-Line Metastatic Setting: By Country
        • Actual Treatment Duration with Hormonal Agents Is Over 10% Shorter Than Intended
        • Intended vs. Average Treatment Duration in the Adjuvant Setting
        • Intended vs. Average Treatment Duration in the Adjuvant Setting: By Country
        • Persistency and Compliance with Adjuvant Therapies Are High Across the EU5 Markets
        • Compliance Rate for Key Therapies in the HER2-Positive Adjuvant Setting
        • Discontinuation Rate for Key Therapies in the HER2-Positive Adjuvant Setting
        • About Half of Drug-Treated Newly Diagnosed Stage III Patients Achieve Cure
        • Recurrence, Progression, Cure, and Death in Drug-Treated, Newly Diagnosed Breast Cancer Patients
      • Treatment Practices: Recurrent Patients
        • Kadcyla Takes Precedence Over Herceptin in the Second-Line HER2-Positive Setting
        • Drug-Treatment Rates Decline in Later Lines of Treatment
        • Treatment Rates for Recurrent Metastatic Breast Cancer Patients
        • Palliative Radiotherapy Is the Most Common Nonpharmacological Treatment in the Metastatic Setting
        • Nonpharmacological Treatment of Recurrent Metastatic Breast Cancer Patients
        • Nonpharmacological Treatment of Recurrent Metastatic Breast Cancer Patients: By Country
        • Kadcyla Is the Most Frequently Prescribed Therapy in the HER2-Positive Second-Line Setting
        • Patient Shares of Key Therapies in the HR-Negative/HER2-Positive Second-Line Setting: By Country
        • Patient Shares of Key Therapies in the HR-Positive/HER2-Positive Second-Line Setting: By Country
        • Patient Shares of Key HER2-Targeting Drug Regimens in the HR-Positive/HER2-Positive Second-Line Setting: By Country
        • Patient Shares of Key Hormone Therapy Agents in the HR-Positive/HER2-Positive Second-Line Setting: By Country
        • Tykerb/Tyverb Demonstrates the Greatest Disparity Between Intended and Actual Treatment Duration
        • Intended vs. Average Treatment Duration in the HER2-Positive Second-Line Metastatic Setting
        • Intended vs. Average Treatment Duration in the HER2-Positive Second-Line Metastatic Setting: By Country
        • Kadcyla Demonstrates the Highest Compliance Rate in the HER2-Positive Second-Line Setting
        • Compliance Rate for Second-Line Therapies in HER2+ Metastatic Breast Cancer Patients
        • Over Two-Thirds of Breast Cancer Patients Are Eligible for at Least Four Lines of Treatment in the Metastatic Setting
        • Progression and Mortality Rates in Drug-Treated Metastatic Breast Cancer Patients
        • Progression and Mortality Rates in Drug-Treated Metastatic Breast Cancer Patients: By Country
      • Sequencing of Treatment
        • Herceptin Plus Perjeta Followed by Kadcyla and then Tykerb/Tyverb Is the Most Common HER2-Positive Treatment Algorithm
        • Sequential Treatment for HR-negative/HER2-positive Metastatic Breast Cancer
      • Recent/Anticipated Changes in Brand Usage/Treatment Approach
        • Herceptin SC to Continue to Overtake Herceptin IV
        • Recent or Anticipated Changes in Brand Usage/Treatment
    • Physician Insight on Medical Practice
      • Key Findings
      • Drivers of Treatment Selection
        • Efficacy Attributes Are the Most Important Prescribing Drivers
        • OS Benefit Drives Prescribing of HER2-Targeting Agents in All Treatment Settings
        • Drivers of HER2-Targeting Agents’ Prescribing for Newly Diagnosed Stage I-III HER2-Positive Breast Cancer
        • Drivers of Herceptin SC Prescribing for Newly Diagnosed Stage I-III HER2-Positive Breast Cancer: By Country
        • Drivers of Herceptin IV Prescribing for Newly Diagnosed Stage I-III HER2-Positive Breast Cancer: By Country
        • Drivers of Herceptin Plus Perjeta Neoadjuvant Prescribing: By Country
        • Drivers of Kadcyla Prescriptions for Second-Line HR-Negative/HER-Positive Breast Cancer Treatment: By Country
        • Drivers of Hormone Therapy Prescribing for Previously Treated Metastatic HR-Positive/HER2-Positive Breast Cancer
        • Drivers of Faslodex Prescribing for Previously Treated Metastatic HR-Positive Breast Cancer: By Country
        • Drivers of Afinitor Plus Exemestane Prescribing for Previously Treated Metastatic HR-Positive Breast Cancer: By Country
        • Budget Constraints Are the Biggest Obstacle to Prescribing of Perjeta and Kadcyla
        • Obstacles to Herceptin Plus Perjeta Neoadjuvant Prescribing: By Country
        • Obstacles to Kadcyla Prescribing for Previously Treated Metastatic HER2-Positive Breast Cancer Patients: By Country
        • Adverse Events are Among the Main Causes of Dose Modification or Therapy Discontinuation
        • Reasons for Dose Modifications/Early Therapy Discontinuation in Metastatic Breast Cancer Patients
        • Reasons for Herceptin Dose Modification/Early Therapy Discontinuation
        • Reasons for Kadcyla Dose Modification/Early Therapy Discontinuation
        • Reasons for Herceptin-Perjeta Regimen Modification/Early Therapy Discontinuation
        • Reasons for Tyverb Dose Modification/Early Therapy Discontinuation
      • Face-to-Face Product Detailing Effectiveness
        • Oncologists Report Aggressive Sales Campaigns for HER2-Targeting Agents
        • Sales Representatives for HER2-Targeting Agents Contacted the Majority of Surveyed Oncologists Within the Past Month
        • Frequency of Contact with Sales Representatives
        • Most Frequently Discussed Topic with Sales Representatives Is Efficacy and Safety
        • Topics Discussed During Most Recent Visit
        • Topics Discussed by Herceptin Sales Representative During Most Recent Visit: By Country
        • Topics Discussed by Kadcyla Sales Representative During Most Recent Visit: By Country
        • Topics Discussed by Perjeta Sales Representative During Most Recent Visit: By Country
        • Topics Discussed by Afinitor Sales Representative During Most Recent Visit: By Country
        • Topics Discussed by Faslodex Sales Representative During Most Recent Visit: By Country
    • Methodology
      • Primary Market Research Methodology
      • Screening Question: Years of Practice
      • Screening Question: Number of Breast Cancer Patients Treated per Month
      • Screening Question: Antineoplastic Agents Prescribed Outside Clinical Trials
      • Screening Question: Antineoplastic Agents Prescribed Outside Clinical Trials
      • Screening Question: Type of Treatment Practice
      • Screening Question: Time Spent in Clinical Practice

Author(s): Anamika Ghosh, Ph.D.

Anamika Ghosh, Ph.D.,is a Senior Analyst for the oncology team at Decision Resources.

Prior to joining DRG, Anamika was a Research Lead with Evalueserve Pvt. Ltd., a business solutions provider to pharmaceutical companies. At Evalueserve, she worked on various strategic insights solutions for a variety of indications, including oncology, cardiovascular, ophthalmology etc. Anamika holds a PhD on host-pathogen interactions in the context of M. tuberculosis from the International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi, India, where she also worked as a Research Associate working on Dengue viral infection.


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