Clinical Outcomes Of Human Epidermal Growth Factor Receptor 2 Neu Positive Breast Cancer Patients At Aga Khan University Hospital, Nairobi; A Survival Analysis Study

Abstract

Worldwide, breast cancer in women is ranked as second and most common type of cancer. Also, known to be the most common cause of mortality in women population in less developed regions. Up to 25.6% of breast cancer patients in Kenya are diagnosed as having HER 2 positive disease according to Triple Negative Breast Cancer (TNBC) study that was conducted between 2012 to 2017. Adjuvant therapy reduces recurrence and mortality risks by 1/2 and 1/3 respectively, in early breast cancer stage, but the costs for one year of trastuzumab range from $70,000-$110,000 which is much high hence unaffordable for most of the patients in sub-Saharan Africa many of whom have to pay out of pocket for the drug . The aim of the study was to determine survival outcome of HER-2 Neu positive early breast cancer patients diagnosed and treated at Aga Khan University between 2012 and 2017 who received primary therapy (Neoadjuvant) and adjuvant treatment and those who got adjuvant chemotherapy plus trastuzumab. A retrospective cohort design which included HER2-positive, consecutive early breast cancer patients treated in adjuvant setting in routine practice in Aga khan University Hospital from 2012 to 2017. Analysis was done on 83 cases which had all the parameters of interest out of the 166 that were positive for Her-2 receptor status. The associations of patient tumour and socio demographic characteristics with predefined survival outcomes were analyzed using STATA version 15. 83 patients were diagnosed with HER2-positive early breast cancer disease, out of which 32 received adjuvant therapy alone and 34 received adjuvant plus Her 2 blockade. Results showed overall survival outcomes in Her-2 positive early breast cancer patients who received Trastuzumab in addition to neo-adjuvant and adjuvant therapy were not statistically different using Log-rank test (P-value=0.172. The unemployed patients had 6.23 higher hazard of death compared to those who were self-employed (CI 1.33-29.28; P.value-0.020). Patients with tertiary education had 91% rate of overall as compared to the primary level of education with (CI 0.02-0.04, P-0.03). Procedures for cancer treatment should be standardized across all hospitals in Kenya from time of diagnosis to clinical staging and finally treatment.