| Summary: | Sarah Sharman Moser,1 Lior Apter,1,2 Idit Livnat,3 Roni Ginsburg,3 Adva Yarden,3 Michal Drori,1 Anat Drizon,1 Gabriel Chodick,1,4 Nava Siegelmann-Danieli1,4 1Maccabi Institute for Research and Innovation (Maccabitech), Maccabi Healthcare Services, Tel Aviv, Israel; 2Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel; 3Medical Affairs, AstraZeneca, Kefar Sava, Israel; 4Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelCorrespondence: Sarah Sharman Moser, Email moser_sa@mac.org.ilBackground: In this observational study, we analyzed the treatment patterns and clinical outcomes of patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (mBC) who developed brain metastases during their disease in a 2.7 million-member public health-provider in Israel.Methods: Newly diagnosed patients with mBC who initiated first-line treatment between January 2013 and June 2021 were identified. Time on treatment (ToT) and overall survival (OS) were assessed at a minimum of 6 months follow-up (cutoff: December 2021).Results: We identified a total of 61 patients: 98.4% females, median age 50 years (IQR = 44– 63), 85% invasive ductal tumors, 44% hormone receptor positive, 51% performance status 0– 1. The median duration of follow-up was 6.2 years. All patients initiated a combination treatment of trastuzumab, pertuzumab, and chemotherapy (TPC), and 72% moved to second-line treatment during the study follow-up period (82% ado-trastuzumab emtansine). The median ToT for first-line and second-line treatments were 16.9 months (95% CI = 13.9– 27.7) and 7.9 months (95% CI = 5.6– 10.9), respectively. The median overall survival (OS) was 45.5 months (95% CI = 35.4– 71.2) from the initiation of first-line treatment. When considering the timing of brain metastases, the median OS was 36.3 months (95% CI = 10.0–NR) for those diagnosed upfront (n = 15, 25%), 59.1 months (95% CI = 32.5–NR) for those diagnosed while on TPC (n = 25, 41%), and 40.8 months (95% CI = 35.4–NR) for those diagnosed at a later stage (n = 21, 34%). The median OS from brain metastases diagnosis was 25.1 months (95% CI = 17.0– 34.6).Conclusion: Patients with upfront brain involvement at the time of mBC diagnosis had shorter survival compared to those who started TPC without brain metastases. Nonetheless, the overall results from this study compare favorably with previous studies and contribute to understanding the value of traditional treatment options, which will serve as a baseline for future treatment strategies in the real-world setting.Keywords: HER2 positive, metastatic, breast cancer, observational study, real-world
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