March 2025, Pharmacia, an open-access, peer-reviewed journal (Pensoft), has published the article: “Incidence, patient characteristics and treatment patterns of early-stage triple-negative breast cancer (TNBC) in Bulgaria: A retrospective analysis based on real-world data.”

This Real-World Evidence (RWE) study, co-authored by leading Bulgarian oncologists, MSD Bulgaria, and Sqilline Health, provides the first nationwide analysis of early-stage TNBC in Bulgaria. It evaluates incidence, baseline characteristics, treatment pathways, and real-world time on treatment (rwTOT).

Sqilline’s Danny Platform powered the study by structuring fragmented hospital EHRs into standardized research datasets, enabling robust nationwide analysis. The study analyzed 521 early-stage TNBC patients (out of 613 TNBC, 11,820 total breast cancer cases) diagnosed between 2019 and 2021.

Introduction       

Triple-negative breast cancer (TNBC) is an aggressive subtype, usually representing 12-15% of breast cancers worldwide. However, the real-world epidemiology and treatment patterns in Bulgaria were previously unknown.

Key Summary Points

Objectives

    • Estimate the incidence of TNBC among newly diagnosed breast cancer patients in Bulgaria.
    • Assess demographic and clinical characteristics at the time of diagnosis.
    • Evaluate real-world treatment choices and time on treatment (rwTOT).

Challenges

    • Fragmented, unstructured EHRs across Bulgarian hospitals hinder standardized analysis.
    • Lack of national registries for breast cancer subtypes such as TNBC.
    • COVID-19 disruptions delayed treatment initiation and impacted data completeness.

Solution (Danny Platform’s Role)

    • Structured and harmonized hospital EHRs into analyzable datasets.
    • Enabled national-level incidence and treatment-pattern analysis.
    • Delivered reliable rwTOT and therapy-pathway insights despite fragmented data and pandemic effects.

Results

Patient Cohort

    • Total breast cancer cases (2019-2021): 11,820
    • TNBC cases: 613 (5.2%)
    • Early-stage TNBC: 521
    • Median age at diagnosis: 57 years

Treatment Patterns (Early-Stage TNBC)

    • Stage I–II: predominantly adjuvant therapy.
    • Stage III: more frequent neoadjuvant use.
    • Standard regimens: anthracycline + taxane most prescribed.

Real-World Time on Treatment (rwTOT)

    • Median: 6 months across systemic therapy regimens.
    • Pandemic years showed increased treatment delays (12-17%).

Conclusions

    • Danny Platform proved essential in transforming fragmented EHRs into actionable, real-world evidence to inform national oncology strategy.
    • TNBC incidence in Bulgaria is significantly lower than global benchmarks (5.2% vs. 12-15%).
    • Most treatment pathways follow global standards, but off-guideline therapies and delays were observed.
    • rwTOT analysis revealed gaps in treatment timelines, especially during the pandemic.
    • Danny Platform proved essential in transforming fragmented EHRs into actionable, real-world evidence to inform national oncology strategy.

Authors & Affiliations

Jeliazko Arabadjiev – Medical Oncology, Acibadem City Clinic Tokuda, Sofia

Assia Konsoulova – University Specialized Hospital for Active Oncology Treatment “Prof. Ivan Chernozmski”, Sofia

Rositsa Krasteva – MHAT Uni Hospital, Panagiurishte

Maria V. Dimitrova – MSD Bulgaria, Sofia

Maria J. Dimitrova – Faculty of Pharmacy, Medical University of Sofia, Sofia (Corresponding Author)

👉 Click here to read the full publication in Pharmacia.

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