Patients in the US with advanced breast cancer (ABC) are living longer than a decade ago, but similar progress has lagged worldwide, according to findings presented at the Advanced Breast Cancer 8th International Consensus Conference (ABC8) in Lisbon, Portugal.

The ABC Global Alliance contrasted the encouraging survival gains seen in the US with findings from its Global Decade Report 2015-2025, which presents a broader picture of global inequity, as the most effective therapies remain largely unavailable to patients in lower-income regions.

“The last decade has shown that progress is possible,” Fatima Cardoso, MD, president of the ABC Global Alliance wrote in the report. “The next decade must prove that progress can be equal for all.”

ABC Survival Rises in US

The retrospective analysis of US patient data, led by Thibaut Sanglier, PhD, senior principal data scientist at F. Hoffmann-La Roche, Basel, Switzerland, with Cardoso as principal investigator, drew on de-identified electronic health records from the Flatiron Health database. All patients had metastatic or advanced breast cancer and began systemic therapy between 2011 and 2025.

“We looked into data specifically related to the introduction of certain treatments…to try to understand if the improvements were related to the market authorization and availability of these [new] agents,” Cardoso told Medscape Medical News.

Patients were grouped in 3-year diagnosis blocks to assess changes in overall survival (OS) over time. They were further stratified by tumor subtype according to hormone receptor (HR) and HER2 status: HR-positive/HER2-negative, HER2-positive/HR-positive, HER2-positive/HR-negative, and triple-negative breast cancer (TNBC).

A total of 68,826 patients met inclusion criteria, with a median age of 64 years (interquartile range, 20 years); about 80% received care in community oncology practices. The subtype distribution was 67% HR-positive/HER2-negative, 10% HER2-positive/HR-positive, 6% HER2-positive/HR-negative, and 18% TNBC.

Median OS improved across all subtypes over the study period. Over the decade, median OS rose from 27.5 months to 34.3 months, a difference of almost 7 months.

“Population data always seem lower,” Cardoso noted, referring to the relatively modest survival improvement. “You have all sorts of patients, not the highly selected patients in clinical trials, and you also have patients who had access to the different types of treatments and others who did not.” 

For most patients, survival gains have not come at the expense of well-being, she added. “Overall, quality of life has increased in the last decade, and we had not seen that in the decade before.”

The greatest OS improvements were observed among patients with HER2-positive disease. Median OS for HER2-positive/HR-positive disease increased from approximately 42 to 53 months, and for HER2-positive/HR-negative disease from 33 to 52 months. Among patients with HR-positive/HER2-negative disease, median OS improved less dramatically, from 31.7 to 39.2 months. In TNBC, median OS rose only 2 months, from 11.2 to 13.2 months.

“In the last decade, we have seen an improvement in two of the three subtypes, and now we are reaching much better outcomes,” Cardoso said. “To achieve that, we need access to newer drugs. So it’s really linked.”

Eric P. Winer, MD, honorary chair of ABC8 and director of the Yale Cancer Center, New Haven, Connecticut, noted the same connection in an ABC Global Alliance press release.

“It’s important to say that these are patients treated in the United States, where patients often have better access to some of the newest therapies,” Winer said. “This study shows that research and development of new treatments can make a real difference to patients’ lives. Now we need to make sure that advanced breast cancer patients can access and benefit from these treatments wherever they are in the world.”

Global Decade Report Underscores Widening Inequity

The ABC Global Decade Report, a 168-page analysis with input from more than 120 countries, makes clear that the gains seen in the US have not been replicated in many lower-resource settings, where newer drugs and comprehensive services are far less available.

One example of these drugs highlighted in the report is trastuzumab, which has been the mainstay of treatment for HER2-positive ABC for nearly two decades. Trastuzumab is available to all patients in only 51% of low- and middle-income countries compared with 93% of high income countries.

“What we see in the report is that inequalities have increased, and they have not just increased between countries, they have increased within each country,” she said. “The US is very unequal in the access to the treatments, and therefore the outcomes are very different according to your ability to pay. These improvements in survival come at a very big financial cost.”

Similar patterns are emerging in parts of Europe, Cardoso noted, where national health systems can no longer routinely cover the newest agents. In such settings, patients with supplemental private insurance may receive cutting-edge therapies, while others are treated with older regimens.

“Now it is not infrequent in Europe that we treat differently according to the ability to pay,” she said.

Cardoso argued that narrowing these gaps will require rethinking how cancer drugs are developed, priced, and approved.

“The model that we have — drug development and drug financing — is a broken model, and it has to be changed,” Cardoso said. “It’s not sustainable in the US or anywhere else in the world.”

She said that certain stakeholders, including regulators, policy makers, and payers, are typically absent from conversations about these processes.

“I don’t think they can be isolated anymore,” Cardoso said.

In practical terms, Cardoso would like regulators to signal when small, statistically positive effects should only be reimbursed at lower prices so that health systems can reserve resources for drugs with larger survival or quality-of-life gains.

“If I buy a Ferrari, I know that I’m paying more, but I also know that I have a better car than if I go and buy something simpler, right?” Cardoso said. “But in the drug development. That’s not the case. Something is wrong in this model that needs to be changed.”

Beyond greater performance-based drug pricing, she also called for streamlining clinical trials to reduce unnecessary expense, noting that “about 80% of the data that we collect are never analyzed,” and suggesting that payers cover the cost of standard-of-care therapy while sponsors fund only the incremental costs of the experimental arm.

The ABC Global Alliance is promoting such strategies in the updated ABC Global Charter 2025-2035, which calls for more equitable access to essential medicines, routine use of evidence-based guidelines, and closer engagement with regulators and payers around value and affordability.

“Everybody — all the stakeholders — have to be seated at the same table and try to find solutions that, in the end, would benefit the patient,” Cardoso said.

Funding for the US retrospective study was provided by the ABC Global Alliance and F. Hoffmann-La Roche, and one author reported full-time employment with Roche. The ABC Global Decade Report was funded by the ABC Global Alliance, which received unrestricted educational grants from Roche, Pfizer, Novartis, and others.