ONCOLLEGE-001 project surveyed the global accessibility (ACC)/ affordability (AFF) to HER2-testing (H2T) & medicines for breast cancer (BC). The 1st analysis showed critical issues of ACC & AFF of H2T in lower- middle income countries. Part 2 of the survey focuses on ACC, AFF and prioritization of anti-HER2 medicines; here, we present the data for trastuzumab (T).
An internet-based survey was developed by the international ONCOLLEGE working group. Data were analyzed per country-income (World Bank groupings) and World Health Organization Regions. Responders authorized for the use of the data.
Responses were received from 210 providers (78% medical or clinical oncologists) across 45 countries (all income groups, all regions). 8% of providers reported no T available in their setting, of which 60% are from low and low-middle income countries (LMICs) and the remaining from upper- middle (UMIC). Where T was available, 15% of the responders reported ACC only as out of pocket expenditure (OOP) for patients, of which almost 70% from LMICs. More than 2/3 of the responders described to order the H2T regardless ACC to affordable trastuzumab for patients, retaining the prognostic information of HER2- overexpression to inform treatment decision- making (e.g. risk grouping for early breast cancer). The patterns of reimbursement for T influenced the percentage of eligible HER2 patients receiving the anti-HER2 drug: T is received in more than 50% of the eligible population in 8%, 41% and 74% in LMIC, UMIC and HIC (high- income) settings, respectively. In 71% of settings where trastuzumab is provided only as OOP, <1/4 of the eligible patients could access affordable T.
The heterogeneous pattern of ACC and AFF of H2T & anti-HER2 medicines influenced the chance of breast cancer patients to receive T. Data on the use of trastuzumab biosimilars and other HER2 blockers is under analysis. International systematized cross-cutting and comprehensive efforts across the cancer continuum are warranted to inform and shape the areas of research implementation for cancer - aiming to optimize the cure and care for all cancer patients and prevent catastrophic OOP.
Has not received any funding.
All authors have declared no conflicts of interest.