Treatment Patterns and Outcomes of Patients With Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer in Tanzania

Abstract

PURPOSE: Human epidermal growth factor receptor 2 (HER2)-positive breast cancer (HER2+BC) is linked to poorer outcomes. Trastuzumab is the standard treatment, but its high cost limits access in resource-limited settings. This study evaluated the treatment patterns and survival outcomes of patients with HER2 BC in Tanzania. MATERIALS AND METHODS: A retrospective hospital-based study was conducted between January 2018 and May 2021 at two prominent public tertiary hospitals in Tanzania. The primary outcome was the 5-year overall survival (OS) rate. Independent variables included demographics, clinical characteristics, and treatment patterns. Survival analysis was conducted using the Kaplan-Meier method. The log-rank test was used in univariate analysis, whereas multivariate Cox regression was used in multivariate analysis. RESULTS: A total of 169 patients with nonmetastatic HER2+BC were included, with a median age of 50 years. Most patients were estrogen receptor-positive (50.3%) and diagnosed with stage III BC (58.6%). About 70.4% of patients received trastuzumab, whereas neoadjuvant chemotherapy was administered to 24.3%, and 95.9% underwent mastectomy. Trastuzumab was primarily used in the adjuvant setting rather than the neoadjuvant setting and was more accessible to patients with higher socioeconomic status. The 5-year OS was 65%, with a median survival of 72 months. Trastuzumab reduced the mortality risk by 74%. Extended therapy with trastuzumab benefited patients with hormone receptor-negative HER2+BC more than those who were hormone receptor-positive. Advanced-stage disease increased mortality risk, whereas postmenopausal status and nonsmoking were associated with lower mortality. A higher Eastern Cooperative Oncology Group score (>1) was associated with an increased mortality risk. CONCLUSION: Trastuzumab significantly improves OS in resource-limited settings, particularly in patients with hormone receptor-negative HER2+BC. There are disparities in access to trastuzumab in Tanzania.