1
|
Nagy AC, Tóth Á, Bak N, Ulambayar B, Ghanem AS, Sztanek F. Protective Influence of SGLT-2 Inhibitors Against Heart Failure in Type 2 Diabetes Mellitus Through Longitudinal Clinical Database Analysis. J Clin Med 2024; 13:7093. [PMID: 39685552 DOI: 10.3390/jcm13237093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 11/16/2024] [Accepted: 11/22/2024] [Indexed: 12/18/2024] Open
Abstract
Background: Sodium-glucose co-transporter 2 (SGLT-2) inhibitors, initially designed for type 2 diabetes, promote glucose excretion and lower blood glucose. Newer analogs like empagliflozin and dapagliflozin improve cardiovascular outcomes through mechanisms other than glycemic control, including blood pressure reduction and anti-inflammatory effects. Given the high cardiovascular risk present in diabetes, our study aims to emphasize the cardioprotective benefits of SGLT-2 inhibitors as a preventive therapy for heart failure (HF) in high-risk T2DM patients. Methods: Using data from 2542 patients identified by the ICD-10 E11 code from 2016 to 2020, this longitudinal study excluded those with E10 codes or those undergoing insulin treatment to focus on non-insulin-dependent T2DM. a multiple logistic regression model assessed HF incidence while adjusting for demographics and HbA1c. Results: SGLT-2 inhibitor use significantly lowered the odds of heart failure events (OR = 0.55, 95% CI: 0.31-0.99, p = 0.046), with a significant difference by gender (OR = 0.45, 95% CI: 0.28-0.71, p = 0.001) and eGFR (OR = 0.98, 95% CI: 0.97-0.99, p = 0.004). Conclusions: The real-world data highlight SGLT-2 inhibitors as promising for HF prevention and broader cardiometabolic health in T2DM, with potential value in managing complex comorbid profiles.
Collapse
Affiliation(s)
- Attila Csaba Nagy
- Department of Health Informatics, Faculty of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Ágnes Tóth
- Department of Integrative Health Sciences, Faculty of Health Sciences, University of Debrecen, 4028 Debrecen, Hungary
| | - Natália Bak
- Department of Health Informatics, Faculty of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Battamir Ulambayar
- Department of Health Informatics, Faculty of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Amr Sayed Ghanem
- Department of Health Informatics, Faculty of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Ferenc Sztanek
- Division of Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary
| |
Collapse
|
2
|
Kato T, Ines M, Minamisawa M, Benjumea D, Keohane D, Alvir J, Kim R, Chen Y, Peixoto T, Kent M, Wogen J, Ishii T, Crowley A, Sugino T, Izumiya Y. Tafamidis medication adherence and persistence in patients with transthyretin amyloid cardiomyopathy in Japan. ESC Heart Fail 2024; 11:2881-2888. [PMID: 38783561 PMCID: PMC11424365 DOI: 10.1002/ehf2.14736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/13/2023] [Accepted: 01/19/2024] [Indexed: 05/25/2024] Open
Abstract
AIMS This study aimed to describe baseline characteristics and adherence among patients with transthyretin amyloid cardiomyopathy (ATTR-CM) treated with tafamidis (VYNDAQEL®) in Japan using the Japanese Medical Data Vision (MDV) database. METHODS AND RESULTS This study was a non-interventional, retrospective cohort study of adult (≥18 years old) patients in the Japanese MDV claims database diagnosed with ATTR-CM and with at least two tafamidis prescriptions of dose strength 4 × 20 mg/day between 1 March 2019 and 31 August 2021. The date of the first prescription was defined as the index date, with follow-up time defined as the time between the first and last prescription plus the days' supply from the last refill. Baseline characteristics were assessed during a 12 month pre-index period. Adherence was measured using two metrics: (i) the modified medication possession ratio (mMPR), calculated by taking the sum of days supplied for all fills within the follow-up period, divided by the number of days of follow-up, and reported as a percentage, with patients classified as adherent with an mMPR of ≥80%, and (ii) the proportion of days covered (PDC), calculated by taking the total number of days' supply dispensed during the follow-up period divided by the number of days of follow-up, adjusting for any days' supply overlap. A total of 210 patients were identified; the mean (standard deviation) age of the cohort was 77 (5.9) years, and the majority (89%) were male. The most common baseline cardiovascular comorbidities were heart failure (85%), ischaemic heart disease (66%), hypertensive diseases (49%), and diabetes (35%); 75% of patients received heart failure medications in the 12 months prior to index, with the most common being beta-blockers (49%), diuretics (48%), angiotensin receptor blockers (30%), angiotensin-converting enzyme inhibitors (22%), and sodium-glucose cotransporter-2 inhibitors (8.1%). Over an average 14 month follow-up, mean mMPR was 96% with a median of 100% [inter-quartile range (IQR): 97-101%]; 93% of patients were adherent (defined as an mMPR ≥ 80%). In the same follow-up period, mean PDC was 93.6% with a median of 99% (IQR: 93-100%). Persistence was high with 78% of patients having a 0 day gap between prescription refills. CONCLUSIONS This study found high adherence rates to tafamidis in this real-world Japanese patient population. Adherence rates in this study were similar to those reported by the tafamidis clinical trial and a previously published US commercial claims adherence analysis. Further studies should be conducted to assess the impact of real-world adherence on real-world outcomes.
Collapse
Affiliation(s)
- Takao Kato
- Department of Cardiovascular Medicine, Institute for Advancement of Clinical and Translational ScienceKyoto University HospitalKyotoJapan
| | | | - Masatoshi Minamisawa
- Department of Cardiovascular MedicineShinshu University School of MedicineMatsumotoJapan
| | | | | | | | | | | | | | | | | | | | | | | | - Yasuhiro Izumiya
- Department of Cardiovascular MedicineOsaka Metropolitan University Graduate School of MedicineOsakaJapan
| |
Collapse
|
3
|
Attal S, Kemner J, Alvir J, Barth S, Schuessler S. Tafamidis 61 mg Patient Characteristics and Persistency? A Retrospective Analysis of German Statutory Health Insurance Data (IQVIA™ LRx). Cardiol Ther 2024; 13:369-378. [PMID: 38615093 PMCID: PMC11093959 DOI: 10.1007/s40119-024-00365-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/18/2024] [Indexed: 04/15/2024] Open
Abstract
INTRODUCTION Tafamidis is the first drug approved by the European Commission for the treatment of wild-type or hereditary transthyretin amyloid cardiomyopathy (ATTR-CM) in adults to reduce cardiovascular mortality and cardiovascular-related hospitalization. Real-world treatment patterns of tafamidis 61 mg in Germany are not well studied in patients with ATTR-CM. METHODS This was a non-interventional, retrospective, observational cohort study of adult patients in Germany based on the IQVIA pharmacy claims database (IQVIA™ LRx). Patients included in the analysis were statutory insured and received at least one prescription of tafamidis 61 mg between March 1, 2020 and August 31, 2022. Treatment adherence was analyzed using the modified medical possession ratio (mMPR) and proportion of days covered (PDC). RESULTS Overall, 1565 adult patients received at least one tafamidis prescription in the study period. Their mean age was 78.3 years, 82.4% were male, and 23.2% were treated by a cardiologist. Persistency rates for patients treated with tafamidis 61 mg were high: 78.0% for 12 months and 65.1% for 24 months after treatment initiation. Patients also had high adherence rate on filling their prescriptions on time: 94.6% and 90.5% of patients had adherence rates of at least 80%, measured by mMPR and PDC, respectively. CONCLUSIONS In the IQVIA™ LRx database, patients prescribed tafamidis 61 mg in Germany displayed high adherence and persistency rates, which suggest good drug tolerability and ease of use.
Collapse
Affiliation(s)
- Sepideh Attal
- Pfizer PIO, 23-25 Avenue du Dr Lannelongue, 75668, Paris Cedex 14, France.
| | | | | | | | | |
Collapse
|
4
|
Saesen R, Van Hemelrijck M, Bogaerts J, Booth CM, Cornelissen JJ, Dekker A, Eisenhauer EA, Freitas A, Gronchi A, Hernán MA, Hulstaert F, Ost P, Szturz P, Verkooijen HM, Weller M, Wilson R, Lacombe D, van der Graaf WT. Defining the role of real-world data in cancer clinical research: The position of the European Organisation for Research and Treatment of Cancer. Eur J Cancer 2023; 186:52-61. [PMID: 37030077 DOI: 10.1016/j.ejca.2023.03.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 04/07/2023]
Abstract
The emergence of the precision medicine paradigm in oncology has led to increasing interest in the integration of real-world data (RWD) into cancer clinical research. As sources of real-world evidence (RWE), such data could potentially help address the uncertainties that surround the adoption of novel anticancer therapies into the clinic following their investigation in clinical trials. At present, RWE-generating studies which investigate antitumour interventions seem to primarily focus on collecting and analysing observational RWD, typically forgoing the use of randomisation despite its methodological benefits. This is appropriate in situations where randomised controlled trials (RCTs) are not feasible and non-randomised RWD analyses can offer valuable insights. Nevertheless, depending on how they are designed, RCTs have the potential to produce strong and actionable RWE themselves. The choice of which methodology to employ for RWD studies should be guided by the nature of the research question they are intended to answer. Here, we attempt to define some of the questions that do not necessarily require the conduct of RCTs. Moreover, we outline the strategy of the European Organisation for Research and Treatment of Cancer (EORTC) to contribute to the generation of robust and high-quality RWE by prioritising the execution of pragmatic trials and studies set up according to the trials-within-cohorts approach. If treatment allocation cannot be left up to random chance due to practical or ethical concerns, the EORTC will consider undertaking observational RWD research based on the target trial principle. New EORTC-sponsored RCTs may also feature concurrent prospective cohorts composed of off-trial patients.
Collapse
|
5
|
Tang M, Pearson SA, Simes RJ, Chua BH. Harnessing Real-World Evidence to Advance Cancer Research. Curr Oncol 2023; 30:1844-1859. [PMID: 36826104 PMCID: PMC9955401 DOI: 10.3390/curroncol30020143] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Randomized controlled trials (RCTs) form a cornerstone of oncology research by generating evidence about the efficacy of therapies in selected patient populations. However, their implementation is often resource- and cost-intensive, and their generalisability to patients treated in routine practice may be limited. Real-world evidence leverages data collected about patients receiving clinical care in routine practice outside of clinical trial settings and provides opportunities to identify and address gaps in clinical trial evidence. This review outlines the strengths and limitations of real-world and RCT evidence and proposes a framework for the complementary use of the two bodies of evidence to advance cancer research. There are challenges to the implementation of real-world research in oncology, including heterogeneity of data sources, timely access to high-quality data, and concerns about the quality of methods leveraging real-world data, particularly causal inference. Improved understanding of the strengths and limitations of real-world data and ongoing efforts to optimise the conduct of real-world evidence research will improve its reliability, understanding and acceptance, and enable the full potential of real-world evidence to be realised in oncology practice.
Collapse
Affiliation(s)
- Monica Tang
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick 2031, Australia
- Correspondence:
| | | | - Robert J. Simes
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown 2050, Australia
| | - Boon H. Chua
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick 2031, Australia
- Faculty of Medicine and Health, UNSW Sydney, Sydney 2052, Australia
| |
Collapse
|
6
|
Wang Y, Zhang T, Huang Y, Li W, Zhao J, Yang Y, Li C, Wang L, Bi N. Real-world Safety and Efficacy of Consolidation Durvalumab after Chemoradiotherapy for Stage III Non-small-cell Lung Cancer: A Systematic Review and Meta-analysis. Int J Radiat Oncol Biol Phys 2021; 112:1154-1164. [PMID: 34963558 DOI: 10.1016/j.ijrobp.2021.12.150] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/12/2021] [Accepted: 12/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Consolidation durvalumab following chemoradiotherapy (CRT) has improved patient outcomes in stage III non-small-cell lung cancer (NSCLC) since the practice-changing results of the PACIFIC trial, while real-world evidence regarding the PACIFIC regimen has not been systematically reviewed. This meta-analysis comprehensively investigated the real-world toxicity and efficacy of this regimen and identified differences between the real world and clinical trials. METHODS Real-world studies (RWSs) on patients with stage III NSCLC treated with durvalumab after CRT were identified in MEDLINE, EMBASE, PubMed and the Cochrane Library databases. We summarized the differences in demographic and therapeutic characteristics between RWSs and the PACIFIC trial. A meta-analysis of short-term efficacy and adverse event rates was performed. Subgroup analyses were conducted to identify potential influencing factors. RESULTS Thirteen studies involving 1,885 patients were included. More elderly and poor performance status patients, prolonged interval from CRT completion to durvalumab exceeding 42 days, median infusions of durvalumab less than 20 cycles and sequential CRT were observed in the real world. The pooled 12-month overall-survival (OS) and progression-free-survival (PFS) rates were 90% (95% CI, 83%-98%) and 62% (95% CI, 56%-68%), respectively. Subgroup analysis determined that delay in durvalumab initiation beyond 42 days neither impacted 12-month OS (P=0.068) nor PFS (P=0.989). Pooled incidences of all-grade and ≥ grade 3 pneumonitis were 35% (95% CI, 22%-48%) and 6% (95% CI, 3%-8%), respectively. Higher all-grade pneumonitis rates were observed in the studies with a median age of patients > 65 years (P=0.008) and from Asian regions (P=0.017), whereas expanded-access-program-related studies reported significantly lower rates (P=0.024). CONCLUSIONS The safety and short-term efficacy of consolidation durvalumab in real-life use align with the PACIFIC trial. RWSs can be helpful for understanding the true efficacy and toxicity of consolidation durvalumab given the less restrictive eligibility criteria.
Collapse
Affiliation(s)
- Yu Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Tao Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yilin Huang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jingjing Zhao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yin Yang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Canjun Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Luhua Wang
- Department of radiation Oncology, National Cancer Center/ Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China..
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China..
| |
Collapse
|
7
|
Wilkinson S, Gupta A, Scheuer N, Mackay E, Arora P, Thorlund K, Wasiak R, Ray J, Ramagopalan S, Subbiah V. Assessment of Alectinib vs Ceritinib in ALK-Positive Non-Small Cell Lung Cancer in Phase 2 Trials and in Real-world Data. JAMA Netw Open 2021; 4:e2126306. [PMID: 34618040 PMCID: PMC8498851 DOI: 10.1001/jamanetworkopen.2021.26306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Quantitative assessment of bias from unmeasured confounding and missing data can help evaluate uncertainty in findings from indirect comparisons using real-world data (RWD). OBJECTIVE To compare the effectiveness of alectinib vs ceritinib in terms of overall survival (OS) in patients with ALK-positive, crizotinib-refractory, non-small cell lung cancer (NSCLC) and to assess the sensitivity of these findings to unmeasured confounding and missing data assumptions. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness research study compared patients from 2 phase 2 alectinib trials and real-world patients. Patients were monitored from June 2013 to March 2020. Comparisons of interest were between alectinib trial data vs ceritinib RWD and alectinib RWD vs ceritinib RWD. RWD treatment groups were selected from nationally representative cancer data from US cancer clinics, the majority from community centers. Participants were ALK-positive patients aged 18 years or older with advanced NSCLC, prior exposure to crizotinib, and Eastern Cooperative Oncology Group Performance Status (PS) of 0 to 2. Data analysis was performed from October 2020 to March 2021. EXPOSURES Initiation of alectinib or ceritinib therapy. MAIN OUTCOMES AND MEASURES The main outcome was OS. RESULTS In total, there were 355 patients: 183 (85 men [46.4%]) in the alectinib trial, 91 (43 men [47.3%]) in the ceritinib RWD group, and 81 (38 men [46.9%]) in the alectinib RWD group. Patients in the alectinib trial were younger (mean [SD] age, 52.53 [11.18] vs 57.97 [11.71] years), more heavily pretreated (mean [SD] number of prior therapy lines, 1.95 [0.72] vs 1.47 [0.81]), and had more favorable baseline ECOG PS (ECOG PS of 0 or 1, 165 patients [90.2%] vs 37 patients [77.1%]) than those in the ceritinib RWD group. The alectinib RWD group (mean [SD] age, 58.69 [11.26] years) had more patients with favorable ECOG PS (ECOG PS of 0 or 1, 49 patients [92.4%] vs 37 patients [77.1%]) and more White patients (56 patients [72.7%] vs 53 patients [62.4%]) compared with the ceritinib group. Compared with ceritinib RWD, alectinib-exposed patients had significantly longer OS in alectinib trials (adjusted hazard ratio [HR], 0.59; 95% CI, 0.44-0.75; P < .001) and alectinib RWD (HR, 0.46; 95% CI, 0.29-0.63; P < .001) after adjustment for baseline confounders. For the worst-case HR estimate of 0.59, residual confounding by a hypothetical confounder associated with mortality and treatment by a risk ratio greater than 2.24 was required to reverse the findings. Conclusions were robust to plausible deviations from random missingness for missing ECOG PS and underrecorded comorbidities and central nervous system metastases in RWD. CONCLUSIONS AND RELEVANCE Alectinib exposure was associated with longer OS compared with ceritinib in patients with ALK-positive NSCLC, and only substantial levels of bias examined reversed the findings. These findings suggest that quantitative bias analysis can be a useful tool to address uncertainty of findings for decision-makers considering RWD.
Collapse
Affiliation(s)
- Samantha Wilkinson
- Personalized Healthcare Data Science, Roche Products Limited, Welwyn Garden City, United Kingdom
| | | | - Nicolas Scheuer
- Health Economics, Reimbursement and Outcomes, Roche Products Limited, Welwyn Garden City, United Kingdom
| | | | | | | | | | - Joshua Ray
- Global Access, F. Hoffmann–La Roche Ltd, Basel, Switzerland
| | | | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston
| |
Collapse
|
8
|
Boyle JM, Hegarty G, Frampton C, Harvey-Jones E, Dodkins J, Beyer K, George G, Sullivan R, Booth C, Aggarwal A. Real-world outcomes associated with new cancer medicines approved by the Food and Drug Administration and European Medicines Agency: A retrospective cohort study. Eur J Cancer 2021; 155:136-144. [PMID: 34371443 PMCID: PMC8442759 DOI: 10.1016/j.ejca.2021.07.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 02/07/2023]
Abstract
Purpose Real-World Data (RWD) studies are increasingly used to support regulatory approvals, reimbursement decisions, and changes in clinical practice for novel cancer drugs. However, few studies have systematically appraised their quality or compared outcomes to pivotal trials. Methods All RWD studies (2010–2019) for drugs approved by the Food and Drug Administration (FDA) and European Medicines Agency (EMA) from 2010 to 2015 for solid organ tumours in the non-curative setting were identified. Quality assessment was undertaken using the Newcastle Ottawa Scale. Survival differences between each RWD study and the pivotal trial were determined using a related sample Wilcoxon signed-rank test. Results 293 RWD studies for 45 of the 57 drug indications approved by the FDA/EMA were identified. The most common tumour types were prostate cancer (29%, n = 86) and melanoma (15%, n = 43). A quarter of the studies had industry funding. No high-quality studies were identified, and 78% were low quality. Comparative survival analysis between RWD and pivotal trials was possible for 224 studies (37 drug indications). Differences in median survival between the RWD studies and their corresponding trial ranged from −32 months to 21 months (IQR –4·2 months to 1·6 months). Low-quality studies were more likely to report superior survival outcomes (23%) compared to higher quality studies (8%) (p = 0.02). Conclusion RWD study quality for novel cancer drugs is low and of insufficient rigour to inform reimbursement decisions and clinical practice. RWD studies seeking publication should provide a completed quality assessment tool on submission. Greater investment in properly designed RWD studies is required. Study provides a systematic appraisal of FDA/EMA approved drugs in real-world practice. Most novel FDA/EMA cancer drugs have real-world data (RWD) studies, but the quality is low. Variability in survival outcomes exists, and findings should be applied cautiously. Most RWD studies reported inferior survival outcomes compared to the pivotal trial. Pre-publication critical appraisal checklists should be used for RWD studies.
Collapse
Affiliation(s)
- Jemma M Boyle
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Elizabeth Harvey-Jones
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Joanna Dodkins
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Katharina Beyer
- Translational and Oncology Research (TOUR), King's College London, United Kingdom
| | - Gincy George
- Translational and Oncology Research (TOUR), King's College London, United Kingdom
| | - Richard Sullivan
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Institute of Cancer Policy, King's College London, United Kingdom
| | | | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Institute of Cancer Policy, King's College London, United Kingdom.
| |
Collapse
|
9
|
Turner JH. Ethics of Pharma Clinical Trials in the Era of Precision Oncology. Cancer Biother Radiopharm 2020; 36:1-9. [PMID: 32935997 DOI: 10.1089/cbr.2020.4129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Pharmaceutical industry clinical trials are ethically problematic: human research subjects are being used as a means to the end of demonstrating statistically significant efficacy of novel anticancer agents to achieve regulatory registration and marketing approval. Randomized controlled trial design is inequitable since control arm patients are denied access to the postulated best treatment. Most pharma studies do not provide clinically meaningful benefit of increased overall survival and enhanced quality of life (QOL) to cohorts and are not reliably generalizable to real-world patients. Precision oncology now enables prospective identification of patients expressing a specific cancer biomarker to determine their particular eligibility for evaluation of efficiency of molecular-targeted treatments. A patient-centered approach, collecting prospective real-world data in large populations, could provide real-world evidence of cost-effective, sustained clinical benefits of survival and QOL, while preserving the ethical beneficent compact between patient and doctor.
Collapse
Affiliation(s)
- J Harvey Turner
- Department of Nuclear Medicine, Fiona Stanley Fremantle Hospitals Group, The University of Western Australia, Murdoch, Australia
| |
Collapse
|
10
|
Turner JH. Real-World Evidence of Clinical Outcomes in Precision Radionuclide Oncology: The NIGHTCAP Study of 177Lu-PSMA in Metastatic Prostate Cancer. Curr Pharm Des 2020; 26:3799-3803. [PMID: 32164507 DOI: 10.2174/1381612826666200312141347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/04/2020] [Indexed: 01/26/2023]
Abstract
A novel approach to current radiopharmaceutical study design to document the efficiency of 177Lu- PSMA-radioligand therapy of metastatic prostate cancer is described in a proposed prospective, real-time, realworld audit of a large patient population worldwide. The NIGHTCAP (National Investigators Global Harmonisation Theragnostics of Cancer of Prostate) Study will establish real-world evidence (RWE) of overall survival (OS) and quality of life (QoL) in patients undergoing routine 177Lu-PSMA-radioligand therapy on harmonised compassionate patient-usage protocols throughout the world. Such long-term efficiency data will be contrasted with the short-term randomised controlled trial (RCT) assessments of efficacy predicated upon surrogate markers of survival outcomes, such as progression-free survival (PFS). The shortcomings of RCT evaluation of the clinical benefit of new anticancer agents are detailed in this review, which advocates RWE to determine efficiency. The real-time monitoring of QoL in the NIGHTCAP Study is independent of questionnaires, language differences, or oncologist bias, and relies upon individual patient self-assessment by choice of one of five emoji which best reflects their mood each day.
Collapse
Affiliation(s)
- J Harvey Turner
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, WA 6009, Australia
| |
Collapse
|
11
|
Di Maio M, Perrone F, Conte P. Real-World Evidence in Oncology: Opportunities and Limitations. Oncologist 2019; 25:e746-e752. [PMID: 31872939 DOI: 10.1634/theoncologist.2019-0647] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/13/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
- Massimo Di Maio
- Department of Oncology, University of Turin; Ordine Mauriziano Hospital, Torino, Italy
| | - Francesco Perrone
- Clinical Trial Unit, National Cancer Institute, IRCCS Fondazione Pascale, Napoli, Italy
| | - Pierfranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova and Oncologia Medica 2, Istituto Oncologico Veneto, I.R.C.C.S., Padova, Italy
| |
Collapse
|
12
|
Turner JH. Theranostic Outcomes in Clinical Practice of Oncology: What, So What, Now What? What's More. Cancer Biother Radiopharm 2019; 34:135-140. [PMID: 30973278 DOI: 10.1089/cbr.2019.29006.jht] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
|
13
|
Abstract
The use of data from the real world to address clinical and policy-relevant questions that cannot be answered using data from clinical trials is garnering increased interest. Indeed, data from cancer registries and linked treatment records can provide unique insights into patients, treatments and outcomes in routine oncology practice. In this Review, we explore the quality of real-world data (RWD), provide a framework for the use of RWD and draw attention to the methodological pitfalls inherent to using RWD in studies of comparative effectiveness. Randomized controlled trials and RWD remain complementary forms of medical evidence; studies using RWD should not be used as substitutes for clinical trials. The comparison of outcomes between nonrandomized groups of patients who have received different treatments in routine practice remains problematic. Accordingly, comparative effectiveness studies need to be designed and interpreted very carefully. With due diligence, RWD can be used to identify and close gaps in health care, offering the potential for short-term improvement in health-care systems by enabling them to achieve the achievable.
Collapse
|
14
|
Davies J, Martinec M, Delmar P, Coudert M, Bordogna W, Golding S, Martina R, Crane G. Comparative effectiveness from a single-arm trial and real-world data: alectinib versus ceritinib. J Comp Eff Res 2018; 7:855-865. [DOI: 10.2217/cer-2018-0032] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare the overall survival of anaplastic lymphoma kinase-positive non-small-cell lung cancer patients who received alectinib with those who received ceritinib. Materials & methods: Two treatment arms (alectinib [n = 183] and ceritinib [n = 67]) were extracted from clinical trials and an electronic health record database, respectively. Propensity scores were applied to balance baseline characteristics. Kaplan–Meier and multivariate Cox regression were conducted. Results: After propensity score adjustment, baseline characteristics were balanced. Alectinib had a prolonged median overall survival (alectinib = 24.3 months and ceritinib = 15.6 months) and lower risk of death (hazard ratio: 0.65; 95% CI: 0.48–0.88). Conclusion: Alectinib was associated with prolonged overall survival versus ceritinib, which is consistent with efficacy evidence from clinical trials.
Collapse
Affiliation(s)
- Jessica Davies
- Roche Products Ltd, 6 Flacon Way, Shire Park, Welwyn Garden City, AL7 1TW, UK
| | | | - Paul Delmar
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Mathieu Coudert
- F. Hoffmann-La Roche Ltd, Boulogne-Billancourt Cedex, France
| | | | | | - Reynaldo Martina
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Gracy Crane
- Roche Products Ltd, 6 Flacon Way, Shire Park, Welwyn Garden City, AL7 1TW, UK
| |
Collapse
|