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Patients with de novo MBC were more likely to receive CT (43.1% vs 13.4%, p < 0.001) and less likely to receive ET alone (47.9% vs 78.0%, p < 0.001). Insurance influenced first line therapy selection and patients with commercial insurance were more likely to receive CDK4/6i + ET compared to those with Medicare/Medicaid. The majority of patients who received CDKi + ET were < 65 years old (65.2%, p < 0.02). Dual agent CT was the more commonly prescribed compared to single agent in those who received CT (56% vs 44%). Of the patients with ER+/HER2- MBC, the majority of patients received ET alone (69%), followed by chemotherapy (22%), and CDK4/6i + ET (9%). Hormone therapy only was more common in patients who did not undergo biopsy (62.3% vs 37.7%, p < 0.001) or biomarker reassessment (62.7% vs 37.3%, p < 0.001). First line treatment selection was directly associated with receipt of biopsy and biomarker testing. Biopsy was more often performed at recurrence in patients receiving care at a high-volume center (74.3% vs 67.6%, p = 0.03) compared to low volume center (18.6% vs 26.6%, p = 0.03). Patients with highest co-morbidity index (2) were more likely to undergo biopsy confirmation (20.3% vs 13.0%, p = 0.02). Similarly, 48.7% of recurrent MBC patients underwent biomarker reassessment. Of the patients with recurrent MBC, 49.5% received a biopsy to confirm metastatic diagnosis. Patients had either Commercial (47%), Medicaid (4%), Medicare (35%) or multiple (13%) insurance. Approximately 15% of patients lived in areas of high deprivation (area of deprivation index, ADI, 8-10). Of the patients with MBC, there were a total of 677 patients with ER+/HER2- MBC. Results: We identified 1,101 patients with MBC (recurrent MBC, N = 715 de novo MBC, N = 386) with a median age of 66 (range 54 – 74). We identified receipt of biopsy and biomarker re-assessment at time of recurrence, receipt of first line treatment, categorized as CDK4/6 inhibitors (CDKi), chemotherapy (CT), or hormone therapy (HT) and examined factors influencing these practice patterns. Our cohort comprised of women > 18 years old with MBC who met enrollment criteria in one of four payors (Premara, Regence, Medicare, or Medicaid).
Methods: We collaborated with Hutchinson Institute for Cancer Outcomes Research (HICOR) to link enrollment and insurance claims records with Washington State cancer registries from 2008-2017. Real world data may demonstrate disparities in adherence to guidelines. National guidelines support numerous treatment options and do not capture the nuances of real-world practice. Background: Evidence-based recommendations for the management of metastatic breast cancer (MBC) endorse confirmation of recurrence with biopsy and reassessment of biomarker status.
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