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Manoharan D, Thompson KG, Gage D, Scott JF. An organizational framework for patient-reported outcome instruments in dermatologic surgery: a systematic review and qualitative analysis. Arch Dermatol Res 2023; 316:15. [PMID: 38047921 DOI: 10.1007/s00403-023-02738-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 04/30/2023] [Accepted: 09/16/2023] [Indexed: 12/05/2023]
Abstract
Patient-reported outcomes (PROs) describe measures of a patient's experience throughout medical care as reported by the patient (Mercieca-Bebber et al. in Patient Relat Outcome Meas, 2018). Various PRO instruments exist. It is challenging to select appropriate instruments given the absence of an organizational framework which describes all measurable PROs in dermatologic surgery and represents which instruments measure which outcomes. Our objective was to systematically review all validated PRO instruments in dermatologic surgery and use qualitative analysis to develop an organizational framework representing PRO measures and instruments. PubMed/MEDLINE, Embase, CINAHL, PsycINFO, and Cochrane databases were searched to retrieve validated PRO instruments in the dermatologic surgery population. The constant comparative method of qualitative analysis was used to develop an organizational framework representing all PROs in dermatologic surgery. All instruments were sorted into this framework. The search identified 3195 articles; 35 validated instruments were extracted and qualitatively analyzed. The organizational framework sorted all instruments into 36 PRO measures aligned with the National Institutes of Health Patient-Reported Outcomes Measurement Information System (Gershon RC, Rothrock N, Hanrahan R, et al (2010) The use of PROMIS and assessment center to deliver patient-reported outcome measures in clinical research). Measures were grouped into four categories (expectations, satisfaction, quality of life, needs) describing how patients experience these outcomes and lenses through which researchers can evaluate them. In conclusion, we have proposed an organizational framework for use in choosing validated instruments to develop and answer PRO research questions.
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Affiliation(s)
- Divya Manoharan
- Department of Dermatology, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21287, USA.
| | - Katherine G Thompson
- Department of Dermatology, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21287, USA
| | - Davies Gage
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jeffrey F Scott
- Department of Dermatology, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21287, USA
- Clinical Skin Center of Northern Virginia, Fairfax, VA, USA
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DeTemple VK, Hassel JC, Sachse MM, Grimmelmann I, Leiter U, Gebhardt C, Eckardt J, Pföhler C, Angela Y, Hübbe H, Gutzmer R. Reinduction of Hedgehog Inhibitors after Checkpoint Inhibition in Advanced Basal Cell Carcinoma: A Series of 12 Patients. Cancers (Basel) 2022; 14:5469. [PMID: 36358887 PMCID: PMC9658899 DOI: 10.3390/cancers14215469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 08/23/2023] Open
Abstract
For patients with advanced basal cell carcinoma (aBCC) first-line treatment with hedgehog inhibitors (HHIs) and second-line treatment with PD1 inhibitors (PD1i) is available, offering combination and sequencing options. Here, we focus on the efficacy and safety of HHI reinduction after PD1i failure. Retrospective data analysis was performed with 12 patients with aBCC (locally advanced (n = 8)/metastatic (n = 4)). These patients (male:female 6:6, median age 68 years) initially received HHIs, leading to complete/partial response (66%) or stable disease (33%). Median treatment duration was 20.8 (2-64.5) months until discontinuation due to progression (n = 8), adverse events (n = 3), or patient request (n = 1). Subsequent PD1 inhibition (pembrolizumab 42%, cemiplimab 58%) yielded a partial response (8%), stable disease (33%), or progression (59%). Median treatment duration was 4.1 (0.8-16.3) months until discontinuation due to progression (n = 9), adverse events (n = 1), patient request (n = 1), or missing drug approval (n = 1). HHI reinduction resulted in complete/partial response (33%), stable disease (50%), or progression (17%). Median treatment duration was 3.6 (1-29) months. Response duration in the four responding patients was 2-29+ months. Thus, a subgroup of patients with aBCC responded to reinduction of HHI following PD1i failure. Therefore, this sequential treatment represents a feasible treatment option.
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Affiliation(s)
- Viola K. DeTemple
- Department for Dermatology, Johannes Wesling Medical Center Minden, Ruhr University Bochum, 32429 Minden, Germany
| | - Jessica C. Hassel
- Section Dermatooncology, Department of Dermatology, National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Michael M. Sachse
- Skin Cancer Center, Clinic for Dermatology, Allergology and Phlebology, Hospital Bremerhaven, 27574 Bremerhaven, Germany
| | - Imke Grimmelmann
- Skin Cancer Center Hannover, Clinic for Dermatology, Allergology and Venerology, Hannover Medical School, 30163 Hannover, Germany
| | - Ulrike Leiter
- Skin Cancer Centre Department of Dermatology, University of Tuebingen, 72074 Tübingen, Germany
| | - Christoffer Gebhardt
- Department for Dermatology and Venerology, University hospital Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany
| | - Julia Eckardt
- Skin Cancer Centre, Department for Dermatology, Venerology and Allergology, Charité, University Hospital Berlin, 10117 Berlin, Germany
| | - Claudia Pföhler
- Skin Cancer Centre, Department for Dermatology, Venerology and Allergology, Saarland University Medical Center and Saarland University Faculty of Medicine, 66421 Homburg, Germany
| | - Yenny Angela
- Department for Dermatology, Johannes Wesling Medical Center Minden, Ruhr University Bochum, 32429 Minden, Germany
| | - Hanna Hübbe
- Section Dermatooncology, Department of Dermatology, National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Ralf Gutzmer
- Department for Dermatology, Johannes Wesling Medical Center Minden, Ruhr University Bochum, 32429 Minden, Germany
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Verkouteren BJA, Sinx KAE, Reinders MGHC, Aarts MJB, Mosterd K. Update on Hedgehog Pathway Inhibitor Therapy for Patients with Basal Cell Naevus Syndrome or High-frequency Basal Cell Carcinoma. Acta Derm Venereol 2022; 102:980. [PMID: 35535645 PMCID: PMC9631257 DOI: 10.2340/actadv.v102.980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Some patients with basal cell carcinoma develop a large number of basal cell carcinomas during their lives. The most common underlying genetic disease that causes multiple basal cell carcinomas is basal cell naevus syndrome. Basal cell naevus syndrome is caused by a germline mutation in patched-1 (PTCH1), a tumour suppressor gene of the hedgehog signalling pathway. However, in a significant portion of patients with multiple basal cell carcinomas, no underlying genetic cause is found. Nevertheless, these patients can experience a treatment burden comparable to that of patients with basal cell naevus syndrome. They are referred to as high-frequency basal cell carcinoma patients. Hedgehog pathway inhibitors were the first group of targeted therapy for basal cell carcinomas. This study reviews the literature on hedgehog pathway inhibitor therapy for patients with basal cell naevus syndrome and high-frequency basal cell carcinoma, to provide an overview on efficacy, safety, dosing regimens, tumour resistance and reoccurrence, and health-related quality of life.
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Affiliation(s)
- Babette J A Verkouteren
- Department of Dermatology, Maastricht University Medical Center+, P. Debyelaan 25, NL-6229 HX Maastricht, The Netherlands.
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Gutzmer R, Schulze HJ, Hauschild A, Leiter U, Meier F, Haferkamp S, Ulrich C, Wahl RU, Berking C, Herbst R, Häckl M, Schadendorf D. Effectiveness, safety and utilization of vismodegib in locally advanced basal cell carcinoma under real-world conditions in Germany - The non-interventional study NIELS. J Eur Acad Dermatol Venereol 2021; 35:1678-1685. [PMID: 33931910 DOI: 10.1111/jdv.17332] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) can arise by the uncontrolled proliferation of cells from multiple epidermal compartments due to aberrant activation of the Hedgehog (Hh) signalling pathway. Vismodegib, a small-molecule inhibitor of this pathway, is approved for treatment of patients with locally advanced (la) BCC inappropriate for surgery or radiotherapy or patients with symptomatic metastatic (m) BCC. OBJECTIVES The aim of this non-interventional study was to assess effectiveness with a special focus on duration of response (DOR), safety and utilization of vismodegib for treatment of laBCC in daily practice in Germany. METHODS This non-interventional study (NIS) observed treatment of laBCC with vismodegib according to the German label in clinical practice. All available patients who had received at least one dose of vismodegib between commercial availability of vismodegib in Germany (02 August 2013) and 3 years before end of study (31 March 2016) could be included and were documented retrospectively and/or prospectively for up to 3 years. Primary effectiveness variable was DOR. Assessment of tumour response was carried out by the treating physicians. Exploratory variables included utilization of vismodegib, decision makers for therapy and method of tumour response evaluation. All statistical analyses were descriptive. RESULTS Between September 2015 and March 2019, 66 patients were observed at 26 German centres. The objective response rate (ORR) was 74.2% and the disease control rate (DCR) was 90.9%. The median DOR was 15.9 months (95% CI: 9.2; 25.7; n = 49 patients with response). The median progression-free survival (PFS) was 19.1 months and the median time to response (TTR) 2.7 months. A total of 340 adverse events were reported in 63 (95.5%) patients; no new safety signals were identified. CONCLUSIONS The NIS NIELS shows effectiveness and safety of vismodegib in patients with laBCC. It confirms the transferability of the results of the pivotal trial into routine clinical practice.
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Affiliation(s)
- R Gutzmer
- Klinik für Dermatologie, Mühlenkreiskliniken Minden, Akademisches der Universität Bochum, Minden, Germany
| | - H-J Schulze
- Hauttumorzentrum Hornheide-Münster, Münster, Germany
| | - A Hauschild
- Klinik für Dermatologie, UKSH Campus Kiel, Kiel, Germany
| | - U Leiter
- Zentrum für Dermatoonkologie, Universitätsklinikum Tübingen, Tübingen, Germany
| | - F Meier
- Hautkrebszentrum am Universitäts-Krebscentrum Dresden und Nationales Centrum für Tumorerkrankungen, Dresden, Germany.,Abteilung für Dermatologie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - S Haferkamp
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - C Ulrich
- Klinik für Dermatologie, Venerologie u. Allergologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - R U Wahl
- Klinik für Dermatologie und Allergologie, Universitätsklinikum der RWTH Aachen, Aachen, Germany
| | - C Berking
- Hautklinik, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), CCC Erlangen EMN, Erlangen, Germany
| | - R Herbst
- Hauttumorzentrum, Erfurt, Germany
| | - M Häckl
- Roche Pharma AG, Grenzach-Wyhlen, Germany
| | - D Schadendorf
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site, Essen, Germany
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