文章：

健康社会决定因素及其他预测因子在HR+/HER2−转移性乳腺癌患者启动CDK4/6抑制剂治疗中的作用

Social Determinants of Health and Other Predictors in Initiation of Treatment with CDK4/6 Inhibitors for HR+/HER2− Metastatic Breast Cancer

原文发布日期：7 June 2024

DOI: 10.3390/cancers16122168

类型: Article

开放获取: 是

英文摘要：

In hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2−) metastatic breast cancer (MBC), cyclin-dependent kinase 4/6 inhibitors (CDK4/6is) have replaced endocrine therapy alone as the standard of care; however, several barriers to treatment initiation still exist. We assessed social determinants of health (SDOH) and other factors associated with the initiation of CDK4/6i for HR+/HER2− MBC in the Medicare population. Using a retrospective cohort design, patients aged ≥65 years and diagnosed during 2015–2017 were selected from the SEER-Medicare database. Time from MBC diagnosis to first CDK4/6i initiation was the study outcome. The effect of SDOH measures and other predictors on the outcome was assessed using the multivariable Fine and Gray hazard modeling. Of 752 eligible women, 352 (46.8%) initiated CDK4/6i after MBC diagnosis (median time to initiation: 27.9 months). In adjusted analysis, SDOH factors significantly associated with CDK4/6i initiation included high versus low median household income (HHI) (hazard ratio [HR] = 1.70; 95% CI = 1.03–2.81) and the percentage of population with high versus low Medicare-only coverage (HR = 1.54; 95% CI = 1.04–2.27). In summary, older Medicare patients with HR+/HER2− MBC residing in areas with high median HHI and a high proportion of Medicare-only coverage had higher rates of initiating CDK4/6i, suggesting inequitable access to these novel, effective treatments and a need for policy intervention.

摘要翻译： 

在激素受体阳性/人表皮生长因子受体2阴性（HR+/HER2−）转移性乳腺癌（MBC）的治疗中，细胞周期蛋白依赖性激酶4/6抑制剂（CDK4/6is）已取代单纯内分泌治疗成为标准治疗方案；然而，治疗启动仍面临多重障碍。本研究评估了Medicare人群中影响HR+/HER2− MBC患者启动CDK4/6i治疗的健康社会决定因素及其他相关因素。采用回顾性队列设计，从SEER-Medicare数据库中筛选2015-2017年期间确诊的年龄≥65岁患者。研究终点为从MBC确诊至首次启动CDK4/6i治疗的时间间隔。通过多变量Fine and Gray风险模型评估健康社会决定因素指标及其他预测因子对治疗启动的影响。在752名符合条件的研究对象中，352名（46.8%）在MBC确诊后启动了CDK4/6i治疗（中位启动时间：27.9个月）。校正分析显示，与CDK4/6i治疗启动显著相关的健康社会决定因素包括：高与低家庭收入中位数（风险比[HR] = 1.70；95% CI = 1.03–2.81），以及仅享有Medicare保险人群比例的高与低（HR = 1.54；95% CI = 1.04–2.27）。综上所述，居住在家庭收入中位数较高、Medicare单一保险覆盖率较高地区的老年HR+/HER2− MBC患者，其CDK4/6i治疗启动率更高，这提示新型有效治疗的可及性存在不平等现象，亟需政策干预。

原文链接：

Social Determinants of Health and Other Predictors in Initiation of Treatment with CDK4/6 Inhibitors for HR+/HER2− Metastatic Breast Cancer