Background/Objectives: The use of HER2-targeted therapies has significantly improved survival outcomes in metastatic hormone receptor-negative, HER2-positive (HR−/HER2+) breast cancer. However, factors influencing their adoption remain unclear. This study examines clinical, sociodemographic, and facility-related determinants of HER2-targeted therapy utilization in metastatic HR−/HER2+ breast cancer.Methods: We conducted a retrospective cohort study of metastatic HR−/HER2+ breast cancer patients from the NCDB (2013–2020), categorizing them into HER2-targeted therapy recipients and non-recipients. Patients with missing key variables were excluded. Time periods were divided as pre-2015, 2016–2018, and 2019–2020 to reflect evolving treatment availability and uptake in the United States. Univariable and multivariable logistic regression identified factors associated with HER2-targeted therapy use. Cox proportional hazards regression and log-rank tests assessed overall survival.Results: Among 3060 metastatic HR−/HER2+ breast cancer patients, 2318 (75.8%) received HER2-targeted therapy. HER2-targeted therapy utilization increased from 64.6% in 2013 to 80.9% in 2016, marking an early period of rapid uptake. Usage remained consistently high from 2016 to 2018, followed by a slight decline and stabilization around 75% from 2019 to 2020. Factors positively associated with therapy use included diagnosis in 2016–2018 (OR 1.93,p< 0.001) and 2019–2020 (1.88,p< 0.001), private insurance (OR 1.76,p< 0.001), and treatment at academic facilities (OR 1.39,p= 0.031). Reduced likelihood of therapy use was observed in patients aged 71+ (OR 0.52,p< 0.001), Black race (OR 0.78,p= 0.018), Medicare insurance (OR 0.64,p< 0.001), and treatment at rural facilities (OR 0.59,p= 0.022). HER2-targeted therapy was associated with significantly improved survival (median 5.08 vs. 1.27 years, log-rankp< 0.001) and lower mortality risk (HR 0.52,p< 0.001).Conclusions: The adoption of HER2-targeted therapy has increased in recent years, yet disparities persist in access and utilization. Our findings highlight the need to address sociodemographic and facility-related barriers to ensure equitable treatment and improved survival outcomes for all patients.
**背景/目的：** HER2靶向治疗的应用显著改善了转移性激素受体阴性、HER2阳性（HR−/HER2+）乳腺癌患者的生存结局。然而，影响其应用的因素尚不明确。本研究探讨了转移性HR−/HER2+乳腺癌患者中，影响HER2靶向治疗应用的临床、社会人口学及医疗机构相关决定因素。 **方法：** 我们利用美国国家癌症数据库（NCDB，2013–2020年）对转移性HR−/HER2+乳腺癌患者进行了一项回顾性队列研究，将其分为接受HER2靶向治疗组与未接受组。排除关键变量缺失的患者。为反映美国治疗可及性与应用情况的变化，将时间段划分为2015年之前、2016–2018年及2019–2020年。采用单变量和多变量逻辑回归分析识别与HER2靶向治疗使用相关的因素。使用Cox比例风险回归和对数秩检验评估总生存期。 **结果：** 在3060例转移性HR−/HER2+乳腺癌患者中，2318例（75.8%）接受了HER2靶向治疗。HER2靶向治疗的应用率从2013年的64.6%上升至2016年的80.9%，标志着早期应用的快速增长期。2016年至2018年使用率持续保持高位，随后在2019年至2020年间略有下降并稳定在75%左右。与治疗使用呈正相关的因素包括：在2016–2018年（OR 1.93，p < 0.001）和2019–2020年（OR 1.88，p < 0.001）确诊、拥有私人保险（OR 1.76，p < 0.001）以及在学术型医疗机构接受治疗（OR 1.39，p = 0.031）。治疗使用可能性降低的情况见于：年龄≥71岁（OR 0.52，p < 0.001）、黑人种族（OR 0.78，p = 0.018）、拥有医疗保险（OR 0.64，p < 0.001）以及在农村医疗机构接受治疗（OR 0.59，p = 0.022）的患者。HER2靶向治疗与显著改善的生存期（中位生存期5.08年 vs. 1.27年，对数秩检验p < 0.001）及更低的死亡风险（HR 0.52，p < 0.001）相关。 **结论：** 近年来HER2靶向治疗的应用有所增加，但在可及性和使用方面仍存在差异。我们的研究结果强调，需要解决社会人口学和医疗机构相关的障碍，以确保所有患者获得公平的治疗并改善其生存结局。
肿瘤(癌症)患者之家