Condition

Breast cancer

Clinical trials and treatment information for Breast cancer

20.6M
People Affected
200
Active Trials
4.1M
New Cases/Year
674K
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Trastuzumab (HER2-targeted therapy)
85% Effectiveness• 92% Confidence• 55% Safety• 89 trials• 75K participants
HIGH EvidenceGood ValueDose: 4 mg/kg loading dose, then 2 mg/kg weekly or 8 mg/kg loading, then 6 mg/kg every 3 weeks
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Comparative Safety Scale(Higher is safer)

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55
DangerousModerateSafe

Time to Effect

Weeks to months

Duration

Typically 1 year (adjuvant)

Response Rate

60%

Remission Rate

30%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

50

Common Side Effects:

Cardiotoxicity (decreased LVEF): 5%
Infusion-related reactions: 20%
Diarrhea: 25%
Nausea: 20%
Fatigue: 30%

Annual Cost of Care

Drug Cost

$50,000

Monitoring

$4,000

Side Effects

$2,000

Total Annual

$56,000

Cost-Effectiveness

GOOD

QALYs Gained

1.5

ICER

$85,000/QALY

Cost per Remission

$186,667

Cost per Responder

$93,333

Treatment Outcomes
Primary Outcomes
5-year Disease-Free Survival Rate78%
+10.3% (+8 percentage points)
5-year Overall Survival Rate85%
+9.4% (+8 percentage points)
Pathologic Complete Response (pCR) Rate30%
+83.3% (+25 percentage points)
Secondary Benefits
Objective Response Rate (ORR)35%
+57.1% (+20 percentage points)
Median Progression-Free Survival (PFS)7.4 months
+87.8% (+6.5 months)
Global Health Status (EORTC QLQ-C30 score)65/100
+15.4% (+10 points)
Common Side Effects
Cardiotoxicity (decreased LVEF)
+5%
Infusion-related reactions
+20%
Diarrhea
+25%

Clinical Trial Phases:

Phase 3Phase 4
2
Doxorubicin + Cyclophosphamide + Paclitaxel (AC-T Chemotherapy Regimen)
80% Effectiveness• 95% Confidence• 25% Safety• 21 trials• 150K participants
HIGH EvidenceGood ValueDose: Doxorubicin 60 mg/m2, Cyclophosphamide 600 mg/m2 (every 2-3 weeks); Paclitaxel 80 mg/m2 weekly or 175 mg/m2 every 3 weeks
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Comparative Safety Scale(Higher is safer)

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25
DangerousModerateSafe

Time to Effect

Weeks

Duration

3-6 months

Response Rate

70%

Remission Rate

40%

Number Needed to Treat (NNT)

6

Number Needed to Harm (NNH)

3

Common Side Effects:

Nausea and vomiting: 80%
Hair loss: 100%
Fatigue: 90%
Neutropenia/Infection: 40%
Cardiotoxicity (Doxorubicin): 5%
Peripheral neuropathy (Paclitaxel): 60%

Annual Cost of Care

Drug Cost

$15,000

Monitoring

$8,000

Side Effects

$5,000

Total Annual

$28,000

Cost-Effectiveness

GOOD

QALYs Gained

1

ICER

$70,000/QALY

Cost per Remission

$70,000

Cost per Responder

$40,000

Treatment Outcomes
Primary Outcomes
Tumor Size (Longest Diameter)3.5 cm
-70% (-2.45 cm)
Ki-67 Proliferation Index30%
-60% (-18%)
Number of Positive Axillary Lymph Nodes2 nodes
-75% (-1.5 nodes)
Secondary Benefits
CA 15-3 Tumor Marker50 U/mL
-70% (-35 U/mL)
Patient-Reported Pain Score (BPI Scale)6/10
-50% (-3 points)
Global Health Status (EORTC QLQ-C30)60/100
+10% (+6 points)
Common Side Effects
Nausea and vomiting
+80%
Hair loss
+100%
Fatigue
+90%

Clinical Trial Phases:

Phase 3Phase 4
3
Radiation Therapy
75% Effectiveness• 95% Confidence• 25% Safety• 1471 trials• 120K participants
HIGH EvidenceGood ValueDose: Typically 40-50 Gy in 15-25 fractions, or hypofractionated regimens
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Comparative Safety Scale(Higher is safer)

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25
DangerousModerateSafe

Time to Effect

Weeks to months post-treatment

Duration

3-6 weeks

Response Rate

80%

Remission Rate

50%

Number Needed to Treat (NNT)

10

Number Needed to Harm (NNH)

5

Common Side Effects:

Skin irritation/redness: 85%
Fatigue: 70%
Breast pain/swelling: 50%
Lung inflammation (radiation pneumonitis): 5%
Lymphedema: 10%

Annual Cost of Care

Drug Cost

$0

Monitoring

$2,000

Side Effects

$1,000

Total Annual

$60,000

Cost-Effectiveness

GOOD

QALYs Gained

0.8

ICER

$60,000/QALY

Cost per Remission

$120,000

Cost per Responder

$75,000

Treatment Outcomes
Primary Outcomes
5-year Local Recurrence Rate (after lumpectomy)15% without radiation
-60% (-9 percentage points)
5-year Disease-Free Survival70% without radiation
+10% (+7 percentage points)
10-year Overall Survival75% without radiation
+4% (+3 percentage points)
5-year Regional Nodal Recurrence Rate8% without regional nodal radiation
-75% (-6 percentage points)
Secondary Benefits
10-year Breast Cancer Specific Mortality20% without radiation
-15% (-3 percentage points)
Need for Salvage Mastectomy (due to local recurrence, 10-year)10% without radiation post-lumpectomy
-70% (-7 percentage points)
Patient-Reported Body Image (BREAST-Q Satisfaction with Breasts, 1-year post-RT)BREAST-Q Score: 60/100 (post-surgery)
+5% (+3 points)
Common Side Effects
Skin irritation/redness
+85%
Fatigue
+70%
Breast pain/swelling
+50%

Clinical Trial Phases:

Phase 3Phase 4
4
Tamoxifen (Hormone Therapy)
70% Effectiveness• 98% Confidence• 60% Safety• 251 trials• 200K participants
HIGH EvidenceExcellent ValueDose: 20 mg daily
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Comparative Safety Scale(Higher is safer)

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60
DangerousModerateSafe

Time to Effect

Months to years (for recurrence prevention)

Duration

5-10 years

Response Rate

50%

Remission Rate

20%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

150

Common Side Effects:

Hot flashes: 80%
Nausea: 25%
Vaginal discharge/dryness: 20%
Endometrial cancer: 0.2%
Deep vein thrombosis: 1%

Annual Cost of Care

Drug Cost

$100

Monitoring

$500

Side Effects

$300

Total Annual

$900

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.7

ICER

$5,000/QALY

Cost per Remission

$4,500

Cost per Responder

$1,800

Treatment Outcomes
Primary Outcomes
Risk of Breast Cancer Recurrence (ER-positive)10-year cumulative recurrence risk: 25%
-40% (-10 percentage points (from 25% to 15%))
Risk of Breast Cancer Mortality (ER-positive)10-year cumulative breast cancer mortality risk: 12%
-30% (-3.6 percentage points (from 12% to 8.4%))
Risk of Contralateral Breast Cancer (ER-positive)10-year cumulative risk of contralateral breast cancer: 7%
-40% (-2.8 percentage points (from 7% to 4.2%))
Secondary Benefits
LDL Cholesterol130 mg/dL
-15% (-19.5 mg/dL)
Bone Mineral Density (Lumbar Spine) in Post-menopausal WomenBMD (Lumbar Spine) 0.900 g/cm²
+1.5% (+0.0135 g/cm²)
Total Cholesterol210 mg/dL
-10% (-21 mg/dL)
Common Side Effects
Hot flashes
+80%
Nausea
+25%
Vaginal discharge/dryness
+20%

Clinical Trial Phases:

Phase 3Phase 4
5
Palbociclib (CDK4/6 Inhibitor)
65% Effectiveness• 90% Confidence• 45% Safety• 74 trials• 15K participants
HIGH EvidencePoor ValueDose: 125 mg daily for 21 days, followed by 7 days off, in combination with endocrine therapy
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Comparative Safety Scale(Higher is safer)

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45
DangerousModerateSafe

Time to Effect

Weeks to months

Duration

Until disease progression or unacceptable toxicity

Response Rate

60%

Remission Rate

20%

Number Needed to Harm (NNH)

5

Common Side Effects:

Neutropenia: 80%
Fatigue: 40%
Nausea: 25%
Diarrhea: 20%

Annual Cost of Care

Drug Cost

$140,000

Monitoring

$5,000

Side Effects

$3,000

Total Annual

$148,000

Cost-Effectiveness

POOR

QALYs Gained

0.3

ICER

$350,000/QALY

Cost per Remission

$740,000

Cost per Responder

$246,667

Treatment Outcomes
Primary Outcomes
Progression-Free Survival (PFS)Median 14.5 months (endocrine therapy alone)
+90.3% (+13.1 months)
Overall Response Rate (ORR)28.0% (endocrine therapy alone)
+69.3% (+19.4%)
Clinical Benefit Rate (CBR)60.7% (endocrine therapy alone)
+36.1% (+21.9%)
Overall Survival (OS)Median 41.7 months (endocrine therapy alone)
+28.8% (+12.0 months)
Secondary Benefits
Time to ChemotherapyMedian 17.6 months (endocrine therapy alone)
+48.9% (+8.6 months)
Time to Definitive Deterioration in QoL (EORTC QLQ-C30 Global Health Status)Median 13.9 months (endocrine therapy alone)
+59% (+8.2 months)
Pain Score (BPI-SF Worst Pain; scale 0-10)5.5/10
-27.3% (-1.5 points)
Common Side Effects
Neutropenia
+80%
Fatigue
+40%
Nausea
+25%

Clinical Trial Phases:

Phase 3Phase 4
6
Pembrolizumab (Immunotherapy)
55% Effectiveness• 85% Confidence• 40% Safety• 72 trials• 20K participants
MODERATE EvidencePoor ValueDose: 200 mg every 3 weeks or 400 mg every 6 weeks
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
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40
DangerousModerateSafe

Time to Effect

Weeks to months

Duration

Up to 2 years or until disease progression/unacceptable toxicity

Response Rate

30%

Remission Rate

10%

Number Needed to Harm (NNH)

10

Common Side Effects:

Fatigue: 30%
Nausea: 20%
Diarrhea: 15%
Pruritus: 20%
Immune-related adverse events (colitis, hepatitis, pneumonitis, endocrinopathies): 15%

Annual Cost of Care

Drug Cost

$180,000

Monitoring

$6,000

Side Effects

$4,000

Total Annual

$190,000

Cost-Effectiveness

POOR

QALYs Gained

0.2

ICER

$400,000/QALY

Cost per Remission

$1,900,000

Cost per Responder

$633,333

Treatment Outcomes
Primary Outcomes
Tumor Size Reduction (Sum of Longest Diameters of Target Lesions)75 mm
-45% (-33.75 mm)
Patient-Reported Pain SeverityPain NRS score: 6/10
-33.3% (-2 points)
Intra-tumoral CD8+ T-cell DensityCD8+ T-cell density: 50 cells/mm²
+100% (+50 cells/mm²)
Secondary Benefits
Quality of Life (Global Health Status)EORTC QLQ-C30 GHS/QoL score: 50/100
+20% (+10 points)
Fatigue SeverityEORTC QLQ-C30 Fatigue score: 60/100
-25% (-15 points)
Tumor Metabolic ActivitySUVmax from PET scan: 12
-50% (-6)
Common Side Effects
Fatigue
+30%
Nausea
+20%
Diarrhea
+15%

Clinical Trial Phases:

Phase 3