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Cheng LJ, Kim J, Mukherjee A, Milloy N, Unsworth M, Ng D. Real-world treatment patterns and quality of life among patients with locally advanced or metastatic urothelial carcinoma living in Saudi Arabia, South Korea, Taiwan, and Turkey. Int J Urol 2024. [PMID: 38787505 DOI: 10.1111/iju.15497] [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: 11/29/2023] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES To evaluate demographic and clinical characteristics, treatment patterns, and quality of life in patients with locally advanced or metastatic urothelial carcinoma in Asia. METHODS Data were drawn from the Adelphi Real World Metastatic Urothelial Carcinoma Disease Specific Programme™, a cross-sectional survey of medical oncologists/urologists and their adult patients in Saudi Arabia, South Korea, Taiwan, and Turkey. Exploratory patient-reported outcomes included the EQ-5D visual analog scale, European Organisation for Research and Treatment of Cancer Quality of Life of Patient Questionnaire global health, and Brief Pain Inventory. Analyses were descriptive. RESULTS Overall, 175 physicians reported data for 988 patients. Mean (standard deviation) patient age was 66.3 (10.8) years, 77% were men, and 82% had bladder tumors at diagnosis. Of patients receiving first- (n = 988), second- (n = 290), and third-line (n = 87) treatments, 81%, 35%, and 59% received chemotherapy, respectively, and 17%, 63%, and 34% received programmed cell death protein 1/ligand 1 inhibitors, respectively. Patient-reported (n = 319) mean (standard deviation) EQ-5D visual analog scale score was 51.8 (15.6), European Organisation for Research and Treatment of Cancer Quality of Life of Patient Questionnaire global health status score was 44.6 (19.9), and Brief Pain Inventory score was 6.5 (1.9; n = 315). CONCLUSION The most common first- and second-line treatments for locally advanced or metastatic urothelial carcinoma were chemotherapy and programmed cell death protein 1/ligand inhibitors, respectively. At third line, 10% of patients received best supportive care alone, underscoring an unmet need for effective third-line treatment options. Patients in all regions reported quality-of-life impairment.
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Affiliation(s)
- Li-Jen Cheng
- Medical Affairs, Astellas Pharma Singapore Pte, Ltd., Singapore
| | - Janet Kim
- Biostatistics, Astellas Pharma Global Development, Northbrook, Illinois, USA
| | | | | | | | - Daniel Ng
- Medical Affairs, Astellas Pharma Singapore Pte, Ltd., Singapore
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Gupta S, Costantino H, Ike C, Gupta S, Bhanegaonkar A, Su C, Thakkar S, Mackie DS, Devgan G, Katzenstein HM, Liu FX. Evaluating Oncologists' Practice Patterns and Decision-Making in Locally Advanced or Metastatic Urothelial Carcinoma: The US Physician PARADIGM Study. Oncologist 2024; 29:244-253. [PMID: 37846191 PMCID: PMC10911905 DOI: 10.1093/oncolo/oyad267] [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: 04/28/2023] [Accepted: 08/29/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The treatment landscape for locally advanced/metastatic urothelial carcinoma (la/mUC) has evolved. This study examined US prescribing patterns and clinical decision-making for first-line (1L) and first-line maintenance (1LM) treatment. MATERIALS AND METHODS US-based oncologists (N = 150) completed an online survey on patient demographics, practice patterns, and important factors considered in 1L/1LM selection. Multivariable logistic regression was used to assess factors associated with more vs less frequent 1L/1LM prescribing. RESULTS Physician reports estimated that 23% of patients with la/mUC had not received any systemic therapy in the previous 6 months; however, 46% received 1L, 32% received second-line, and 22% received subsequent-line systemic treatments. Of patients who were receiving 1L treatment, 72% were estimated to be receiving 1L platinum-based chemotherapy. Around 69% of patients eligible for 1LM received the treatment. Physicians categorized as frequent prescribers reported overall survival (OS), disease control rate (DCR), and rate of grade 3/4 adverse events (AEs) as factors associated with 1L treatment selection (all P < .05). OS, rate of grade 3/4 immune-mediated AEs, and inclusion in institutional guidelines were reported as attributes used in 1LM treatment selection (all P < .05). Multivariable analysis revealed OS, DCR, and rate of grade 3/4 AEs as important factors in oncologists' 1L treatment selection; academic practice setting and use of Response Evaluation Criteria in Solid Tumors version 1.1 were associated with 1LM use (all P < .05). CONCLUSION OS and AEs were found to be relevant factors associated with offering 1L and 1LM treatment. Variability exists in physicians' decision-making in the real-world setting for la/mUC.
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Affiliation(s)
- Shilpa Gupta
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Chiemeka Ike
- EMD Serono, Inc., Rockland, MA, USA, an affiliate of Merck KGaA
| | - Shaloo Gupta
- Cerner Enviza, an Oracle company, Kansas City, MO, USA
| | | | - Cathy Su
- Cerner Enviza, an Oracle company, Kansas City, MO, USA
| | | | | | | | | | - Frank X Liu
- EMD Serono, Inc., Rockland, MA, USA, an affiliate of Merck KGaA
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Bueno APA, Clark O, Turnure M, Moreira ES, Chang J, Hou N, Li S, Kim R, Kearney M, Kirker M, Kanas G. Physician reported treatment patterns and outcomes in metastatic bladder cancer in the USA: the CancerMPact ® Survey 2020. Future Oncol 2024; 20:613-622. [PMID: 37357780 DOI: 10.2217/fon-2022-1066] [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] [Indexed: 06/27/2023] Open
Abstract
Aim: This study assessed physician-reported treatment patterns for metastatic bladder cancer. Materials & methods: A total of 106 USA-based physicians were surveyed in 2020 using the CancerMPact® online survey. Results: Among cisplatin-eligible patients, 86.1% received first-line (1L) platinum-containing chemotherapy, most commonly cisplatin plus gemcitabine, and 9.8% received immune checkpoint inhibitor monotherapy. Among cisplatin-ineligible patients, 46.5% received 1L platinum-containing chemotherapy, most commonly carboplatin plus gemcitabine and 46.2% received 1L immune checkpoint inhibitor therapy. Approximately 44% of patients who received 1L treatment received second-line (2L) therapy after progression. Conclusion: Platinum-containing chemotherapy was the most widely reported 1L treatment approach. A high proportion of patients received no 2L therapy. Validation in an updated dataset is warranted following the practice-changing approvals of avelumab 1L maintenance and additional 2L options.
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Affiliation(s)
- Ana Paula A Bueno
- Cerner Enviza, An Oracle Company, Av. das Nações Unidas 14171 15º andar, Morumbi São Paulo/SP CEP 04794-000, Brazil
| | - Otavio Clark
- Cerner Enviza, An Oracle Company, 2300 Oracle Wy, Austin, TX 78741, USA
| | - Matthew Turnure
- Cerner Enviza, An Oracle Company, 2300 Oracle Wy, Austin, TX 78741, USA
| | - Eloisa S Moreira
- Cerner Enviza, An Oracle Company, Av. das Nações Unidas 14171 15º andar, Morumbi São Paulo/SP CEP 04794-000, Brazil
| | - Jane Chang
- Pfizer Inc, 235 E 42nd St, New York, NY 10017, USA
| | - Ningqi Hou
- Pfizer Inc, 235 E 42nd St, New York, NY 10017, USA
| | - Si Li
- Pfizer Inc, 235 E 42nd St, New York, NY 10017, USA
| | - Ruth Kim
- Pfizer Inc, 235 E 42nd St, New York, NY 10017, USA
| | - Mairead Kearney
- Merck Healthcare KGaA, Frankfurter Strasse 250 Darmstadt, 64293, Germany
| | | | - Gena Kanas
- Cerner Enviza, An Oracle Company, 2300 Oracle Wy, Austin, TX 78741, USA
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Zhu K, Chang Y, Zhao D, Guo A, Cao J, Wu C, Guan Y, Ding S. Expression of HER2 in high-grade urothelial carcinoma based on Chinese expert consensus and the clinical effects of disitamab vedotin-tislelizumab combination therapy in the treatment of advanced patients. Front Pharmacol 2024; 15:1355081. [PMID: 38455962 PMCID: PMC10918465 DOI: 10.3389/fphar.2024.1355081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/07/2024] [Indexed: 03/09/2024] Open
Abstract
Background: A vast number of researchers have discovered high levels of human epidermal growth factor receptor-2 (HER2) expression in urothelial carcinoma (UC), but they do not use a uniform scoring system. Based on the 2021 edition of clinical pathological expert consensus on HER-2 testing in UC in China, we investigated the expression level and clinical significance of HER2 in high-grade UC. Furthermore, we looked at the prognosis of patients with locally advanced/metastatic UC after combining HER2 targeting antibody-drug conjugates (ADC) medication disitamab vedotin (DV) with programmed cell death protein 1 (PD-1) inhibitor tislelizumab. Patients and methods: From 2019 to 2022, we collected paraffin specimens of UC from the Department of Urology at the Provincial Hospital Affiliated to Shandong First Medical University. HER2 expression-related factors were investigated. Patients with advanced UC who have failed systemic chemotherapy at least once and had received immune checkpoint inhibitor (ICI) medication during second-line treatment were selected and treated with DV in combination with tislelizumab. We assessed the therapy's efficacy and safety. Results: 185 patients with high-grade UC were included in this investigation. 127 patients (68.7%) were HER2 positive (IHC 2+/3+) according to the 2021 Clinical pathological expert consensus on HER2 testing in UC in China. The clinical stage of UC differed statistically significantly between the HER2-and HER2+ groups (p = 0.019). Sixteen advanced UC patients were treated with DV and tislelizumab for a median of 14 months. The disease control rate was 87.5%, while the objective response rate (ORR) was 62.5%. The ORR of HER2+ individuals was higher than that of HER2-individuals (70.0% vs. 50.0%). The median progression-free survival or overall survival was not reached. In this study, the incidence of treatment-related adverse events was 68.8% (11/16), with all of them being grade 1 or 2 adverse reactions. Conclusion: HER2 protein expressed at a high percentage in UC, and 68.7% patients expressed HER2 positive (IHC 2+/3+). HER2+ expression is positively correlated with higher clinical stage of UC. HER2 targeted ADC drug disitamab vedotin combining with PD-1 inhibitor tislelizumab has shown efficacy, safety and controllable adverse reactions in the treatment of advanced UC.
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Affiliation(s)
- Kejia Zhu
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Medical Integration and Practice Center, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Urology, Liaocheng People’s Hospital, Liaocheng, Shandong, China
- Engineering Laboratory of Urinary Organ and Functional Reconstruction of Shandong Province, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yao Chang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Urology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Delong Zhao
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Andong Guo
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jishuang Cao
- Department of Urology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chenrui Wu
- Department of Urology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yong Guan
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Medical Integration and Practice Center, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Urology, Liaocheng People’s Hospital, Liaocheng, Shandong, China
| | - Sentai Ding
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Engineering Laboratory of Urinary Organ and Functional Reconstruction of Shandong Province, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Urology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Filippi L, Schillaci O. NECTIN-4 targeted theranostics for urothelial cancer: getting ready for primetime? Expert Rev Anticancer Ther 2024; 24:1-4. [PMID: 37994866 DOI: 10.1080/14737140.2023.2288140] [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: 09/21/2023] [Accepted: 11/22/2023] [Indexed: 11/24/2023]
Abstract
Locally advanced and metastatic urothelial carcinoma (UC) presents a bleak prognosis, with limited treatment options. NECTIN-4, an overexpressed protein in UC, has become a target for therapy. Enfortumab vedotin (EV) gained Food and Drug Administration approval for advanced UC treatment, but patient selection based on NECTIN-4 expression remains challenging. In the study under evaluation, Duan et al. introduced a novel PET/CT imaging approach using 68Ga-N188, a molecular probe, to visualize NECTIN-4 expression in UC. Their study encompassed preclinical evaluations and translational assessments in both healthy individuals and UC patients. Results demonstrated the potential of 68Ga-N188 in identifying NECTIN-4 expression in UC lesions. Additionally, the study utilized long axial field-of-view (LAFOV) PET/CT, enhancing sensitivity and enabling dynamic studies for improved radiopharmaceutical evaluation. In summary, the study from Duan and colleagues introduces a promising molecular imaging technique that could aid in patient selection for EV therapy and the development of targeted drugs for UC. It also highlights the potential of LAFOV PET/CT in enhancing imaging precision and expanding future therapeutic possibilities for UC.
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Affiliation(s)
- Luca Filippi
- Nuclear Medicine Unit, Department of Oncohaematology, Fondazione PTV Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
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Maráz A, Nagy B, Macher T, Jeskó J, Tischler E, Csongvai C, Kearney M. Nationwide Study of Real-World Treatment Patterns and Clinical Outcomes in Patients with Metastatic Urothelial Carcinoma in Hungary. Adv Ther 2023; 40:5475-5488. [PMID: 37831384 PMCID: PMC10611888 DOI: 10.1007/s12325-023-02694-9] [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: 08/05/2023] [Accepted: 09/21/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Data describing real-world treatment patterns in patients with metastatic urothelial carcinoma (mUC) in Central-Eastern Europe are scarce, and data from Hungary have not been published. This retrospective, nationwide, real-world study investigated patient characteristics, treatment patterns, comorbidities, and clinical outcomes in patients with mUC in Hungary. METHODS Adults diagnosed with mUC from January 2016 through June 2021 were identified using the National Health Insurance Fund Administration database. Overall survival (OS) was estimated using the Kaplan-Meier method. RESULTS In total, 2523 patients with mUC were identified. Median follow-up was 7.1 months. Overall, 50% of patients received an identified systemic anticancer treatment; within this subgroup, first-line treatment was platinum-based chemotherapy (PBC) in 86%, non-PBC in 8%, and immune checkpoint inhibitor (ICI) in 6%. The proportion of patients receiving treatment increased from 41% in 2016 to 59% in 2020, driven by increased use of first-line PBC or first-line ICI treatment. Comorbidities were more common in patients receiving first-line ICI treatment vs PBC or non-PBC and in patients receiving carboplatin + gemcitabine vs cisplatin + gemcitabine. Overall, only 24% received a second-line treatment. Unadjusted median OS from the start of first-line treatment in the PBC, non-PBC, and ICI subgroups was 12.8, 7.5, and 6.3 months, respectively. Median OS from date of diagnosis in untreated patients was 7.8 months. OS comparisons adjusted for differences in baseline characteristics between subgroups could not be performed. CONCLUSION To our knowledge, this is the first study to assess treatment patterns in patients with mUC in clinical practice in Hungary, using the national health insurance database. Rates of first- and second-line treatment were consistent with those observed in other countries. Avelumab first-line maintenance treatment became available for reimbursement in Hungary in late 2022, after the study period. Given the evolving landscape of reimbursed treatments in Hungary, further analyses are warranted.
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Affiliation(s)
- Anikó Maráz
- Department of Oncotherapy, University of Szeged, Korányi Fasor 12, 6720, Szeged, Hungary.
| | - Bence Nagy
- Healthware Consulting Ltd., Budapest, Hungary
| | | | | | - Erika Tischler
- Merck Kft., Budapest, Hungary
- Merck KGaA, Darmstadt, Germany
| | - Csaba Csongvai
- Merck Kft., Budapest, Hungary
- Merck KGaA, Darmstadt, Germany
| | - Mairead Kearney
- Global Value Demonstration, Market Access and Pricing (GVAP), The Healthcare Business of Merck KGaA, Darmstadt, Germany
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Bracarda S, Iacovelli R, Baldazzi V, Zucali PA, Gernone A, Conti GN, Pappagallo G, Brunelli M, Bruzzi P, Fiorini E, Magenta L, Diomede F, Mereta F, D’Aria I, Magliano D, Liberatori M, Cantù D, Croce D, Eandi S, Colombo GL, Ferrante F, Salè EO, Marinozzi A, Lenzi D, Remiddi F, Remiddi S. U-CHANGE Project: a multidimensional consensus on how clinicians, patients and caregivers may approach together the new urothelial cancer scenario. Front Oncol 2023; 13:1186103. [PMID: 37576880 PMCID: PMC10422043 DOI: 10.3389/fonc.2023.1186103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/29/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Advanced urothelial carcinoma remains aggressive and very hard to cure, while new treatments will pose a challenge for clinicians and healthcare funding policymakers alike. The U-CHANGE Project aimed to redesign the current model of care for advanced urothelial carcinoma patients to identify limitations ("as is" scenario) and recommend future actions ("to be" scenario). Methods Twenty-three subject-matter experts, divided into three groups, analyzed the two scenarios as part of a multidimensional consensus process, developing statements for specific domains of the disease, and a simplified Delphi methodology was used to establish consensus among the experts. Results Recommended actions included increasing awareness of the disease, increased training of healthcare professionals, improvement of screening strategies and care pathways, increased support for patients and caregivers and relevant recommendations from molecular tumor boards when comprehensive genomic profiling has to be provided for appropriate patient selection to ad hoc targeted therapies. Discussion While the innovative new targeted agents have the potential to significantly alter the clinical approach to this highly aggressive disease, the U-CHANGE Project experience shows that the use of these new agents will require a radical shift in the entire model of care, implementing sustainable changes which anticipate the benefits of future treatments, capable of targeting the right patient with the right agent at different stages of the disease.
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Affiliation(s)
- Sergio Bracarda
- President of Italian Society of Uro-Oncology, Department of Medical Oncology, Santa Maria Hospital, Terni, Italy
| | - Roberto Iacovelli
- Department of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Valentina Baldazzi
- Department of Medical Oncology, Santa Maria Annunziata Hospital, Florence, Italy
| | - Paolo Andrea Zucali
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Angela Gernone
- Department of Medical Oncology, Policlinico Universitario Azienda Ospedaliera (A.O), Bari, Italy
| | | | | | - Matteo Brunelli
- Pathology Unit, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Paolo Bruzzi
- Department of Clinical Epidemiology, National Institute for Cancer Research, Istituto Scientifico Tumori (IST), Genoa, Italy
| | | | | | - Francesco Diomede
- Federazione Associazioni Volontariato in Oncologia (F.A.V.O) Federation, Rome, Italy
| | | | | | | | - Monica Liberatori
- Department of Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Daniela Cantù
- Italian Association of Physiotherapists, Milan, Italy
| | - Davide Croce
- Centro di Ricerca sull’Economia e il Management in Sanità e nel Sociale, Libero Istituto Universitario Cattaneo (LIUC) Business School, Castellanza (VA), Turin, Italy
| | - Simone Eandi
- Social Innovation EcosystEm Development (SEEd) Medica Publishers, Turin, Italy
| | | | - Fulvio Ferrante
- Department of Diagnostic and Pharmaceutical Assistance, Unità Operativa Complessa (UOC) Pharmacy, Local Health Unit Azienda Sanitaria Locale (ASL) Frosinone, Frosinone, Italy
| | - Emanuela Omodeo Salè
- Department Hospital Pharmacy, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Andrea Marinozzi
- Clinical Pharmacy, Azienda Ospedaliera Universitaria (AOU) Ospedali Riuniti, Ancona, Italy
| | - Daniele Lenzi
- Medical Department, Azienda Ospedaliera Università, Siena, Italy
| | | | - Stefano Remiddi
- Medical Writing & Statistics Department, NUME PLUS, Florence, Italy
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He W, Chen C, Lin T, Xu Q, Ye C, Du J, Huang J. Epidemiology, treatments, and related biomarkers of locally advanced or metastatic urothelial carcinoma in Chinese population: A scoping review. Cancer Med 2023; 12:15384-15403. [PMID: 37387501 PMCID: PMC10417093 DOI: 10.1002/cam4.6112] [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: 01/15/2023] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVE Bladder cancer is the 13th most common cancer in China with the predominant histologic type being urothelial carcinoma (UC). Locally advanced and metastatic (la/m) UC accounts for 12% of UC and the five-year survival rate is only 39.4%, imposing a significant disease and economic burden on the patients. The aim of this scoping review is to synthesize existing evidence of epidemiology, the landscape of treatment options and associated efficacy and safety profiles, as well as treatment-related biomarkers among Chinese la/mUC patients. METHODS A systematic search was conducted on five databases (PubMed, Web of Science, Embase, Wanfang, and CNKI) from January 2011 to March 2022 based on the scoping review criteria in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews. RESULTS A total of 6211 records were identified, and further review resulted in 41 relevant studies that met all criteria. Additional searches were conducted on epidemiology and treatment-related biomarkers of bladder cancer to supplement the evidence. Among 41 studies, 24 reported on platinum-based chemotherapy, eight on non-platinum-based chemotherapy, six on immunotherapy, two on targeted therapy, and one on surgery. Efficacy outcomes were summarized by line of therapy. Treatment-related biomarkers including PD-L1, HER2, and FGFR3 alterations were identified, and the alteration rate of FGFR3 of Chinese UC patients was lower than that of the western patients. CONCLUSIONS Despite chemotherapy has been the main treatment choice for decades, appealing new therapeutic strategies including ICIs, targeted therapies and ADCs were applied in clinical practice. Further research on epidemiology and treatment-related biomarkers of la/mUC patients is needed given only a limited number of studies have been identified thus far. High genomic heterogeneity and complexity of molecular features were observed among la/mUC patients; thus, further studies are required to identify critical drivers and promote potential precise therapies.
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Affiliation(s)
- Wang He
- Department of UrologySun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene RegulationSun Yat‐sen Memorial Hospital, State Key Laboratory of Oncology in South ChinaGuangzhouChina
| | - Changhao Chen
- Department of UrologySun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene RegulationSun Yat‐sen Memorial Hospital, State Key Laboratory of Oncology in South ChinaGuangzhouChina
| | - Tianxin Lin
- Department of UrologySun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene RegulationSun Yat‐sen Memorial Hospital, State Key Laboratory of Oncology in South ChinaGuangzhouChina
| | - Qian Xu
- Xi'an Janssen Pharmaceutical Ltd.BeijingChina
| | - Chong Ye
- Xi'an Janssen Pharmaceutical Ltd.BeijingChina
| | - Jieyi Du
- Xi'an Janssen Pharmaceutical Ltd.BeijingChina
| | - Jian Huang
- Department of UrologySun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene RegulationSun Yat‐sen Memorial Hospital, State Key Laboratory of Oncology in South ChinaGuangzhouChina
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Bloudek B, Wirtz HS, Hepp Z, Timmons J, Bloudek L, McKay C, Galsky MD. Oncology Simulation Model: A Comprehensive and Innovative Approach to Estimate and Project Prevalence and Survival in Oncology. Clin Epidemiol 2022; 14:1375-1386. [PMID: 36404878 PMCID: PMC9673939 DOI: 10.2147/clep.s377093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/21/2022] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE We demonstrate a new model framework as an innovative approach to more accurately estimate and project prevalence and survival outcomes in oncology. METHODS We developed an oncology simulation model (OSM) framework that offers a customizable, dynamic simulation model to generate population-level, country-specific estimates of prevalence, incidence of patients progressing from earlier stages (progression-based incidence), and survival in oncology. The framework, a continuous dynamic Markov cohort model, was implemented in Microsoft Excel. The simulation runs continuously through a prespecified calendar time range. Time-varying incidence, treatment patterns, treatment rates, and treatment pathways are specified by year to account for guideline-directed changes in standard of care and real-world trends, as well as newly approved clinical treatments. Patient cohorts transition between defined health states, with transitions informed by progression-free survival and overall survival as reported in published literature. RESULTS Model outputs include point prevalence and period prevalence, with options for highly granular prevalence predictions by disease stage, treatment pathway, or time of diagnosis. As a use case, we leveraged the OSM framework to estimate the prevalence of bladder cancer in the United States. CONCLUSION The OSM is a robust model that builds upon existing modeling practices to offer an innovative, transparent approach in estimating prevalence, progression-based incidence, and survival for oncologic conditions. The OSM combines and extends the capabilities of other common health-economic modeling approaches to provide a detailed and comprehensive modeling framework to estimate prevalence in oncology using simulation modeling and to assess the impacts of new treatments on prevalence over time.
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Affiliation(s)
| | | | | | | | | | - Caroline McKay
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | - Matthew D Galsky
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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10
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Scherrer E, Kang A, Bloudek LM, Koshkin VS. HER2 expression in urothelial carcinoma, a systematic literature review. Front Oncol 2022; 12:1011885. [PMID: 36338710 PMCID: PMC9635895 DOI: 10.3389/fonc.2022.1011885] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/30/2022] [Indexed: 11/30/2022] Open
Abstract
Background Urothelial carcinoma (UC) is a common malignancy with significant associated mortality. Recent clinical trials suggest an emerging role for HER2-targeted therapy. Testing for HER2 expression in UC is not part of current routine clinical practice. In consequence, the prevalence of HER2 expression in UC is not well defined. Methods A systematic literature review (SLR) was conducted to characterize HER2 expression in both locally advanced unresectable or metastatic (LA/mUC) and earlier stage UC, classified as HER2+, HER2-low, HER2-. HER2+ was defined as an immunohistochemistry (IHC) score of 3+ or IHC 2+ and ISH/FISH+. HER2-low was defined as an IHC score of 2+ and ISH/FISH- or IHC 1+. HER2- was defined as an IHC score of 0. Weighted averages were calculated to generate an estimate of the population prevalence. Results A total of 88 studies were identified, with 45, 30, and 13 studies investigating LA/mUC, earlier stage UC, and mixed stage/unspecified, respectively. The most common assays used were Dako HercepTest and Ventana Pathway anti-HER2/neu (4B5) for IHC to assess HER2 protein expression; Abbott PathVysion HER-2 DNA Probe Kit, FoundationOne CDx, and Guardant360 CDx for assessing HER2 gene amplification. The most frequently cited scoring guidelines were ASCO/CAP guidelines for breast cancer and gastric cancer, though most studies defined their own criteria for HER2 expression. Using the pre-specified definition, HER2+ prevalence ranged from 6.7% to 37.5% with a weighted average of 13.0% in LA/mUC. Only 1 study presented data that could be classified as HER2+ based on pre-specified criteria in earlier stage UC patients, and this study represented a likely outlier, at 76.0%. Conclusion The results from this SLR help to shed light on HER2 expression in UC, a potentially clinically relevant biomarker-driven subpopulation for emerging HER2-directed regimens. Results of this SLR illuminate the variability in how HER2+ status expression levels are being assessed and how HER2+ is defined. Consensus on standardized HER2 testing and scoring criteria is paramount to better understand the clinical relevance in patients with UC.
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Affiliation(s)
| | | | | | - Vadim S. Koshkin
- Helen Diller Family Cancer Center, University of California San Francisco, San Francisco, CA, United States
- *Correspondence: Vadim S. Koshkin,
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Yamada T, Nakane K, Enomoto T, Tomioka M, Taniguchi T, Ishida T, Ozawa K, Takagi K, Ito H, Takeuchi S, Kawase M, Kawase K, Kato D, Takai M, Iinuma K, Yokoi S, Nakano M, Koie T. Oncological Outcomes in Patients with Metastatic Urothelial Carcinoma after Discontinuing Pembrolizumab as a Second-Line Treatment: A Retrospective Multicenter Real-World Cohort Study. Biomedicines 2022; 10:biomedicines10092243. [PMID: 36140344 PMCID: PMC9496337 DOI: 10.3390/biomedicines10092243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
The treatment options are currently limited, and the oncological outcomes remain unclear, for patients with metastatic urothelial carcinoma (mUC) with or without third-line systemic therapy. We aimed to evaluate the oncological outcomes in real-world daily clinical practice after platinum-based chemotherapy followed by pembrolizumab for mUC. This retrospective, multicenter cohort study included patients with mUC who received second-line pembrolizumab in Japan. The patients were divided into the treatment group (those who received third-line treatment) and the BSC group (those who did not receive other treatments). The primary endpoint of this study was to evaluate the oncological outcomes. Of 126 patients enrolled in this study, 40 received third-line therapy. The median follow-up period was 8.0 months. The median overall survival (OS) times were nine months in the BSC group and 17 months in the treatment group (p < 0.001). The median progression-free survival (PFS) times were 4 months in the BSC group and 14 months in the treatment group (p < 0.001). In the multivariate analysis, performance status and liver metastasis were significantly associated with OS. Third-line therapy may have clinical potential advantages for improving the oncological outcomes in patients with mUC.
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Affiliation(s)
- Toyohiro Yamada
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Keita Nakane
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Torai Enomoto
- Department of Urology, Matsunami General Hospital, Hashima-gun 5016062, Japan
| | - Masayuki Tomioka
- Department of Urology, Japanese Red Cross Takayama Hospital, Takayama 5068550, Japan
- Department of Urology, Chuno Kosei Hospital, Seki 5013802, Japan
| | - Tomoki Taniguchi
- Department of Urology, Chuno Kosei Hospital, Seki 5013802, Japan
- Department of Urology, Ogaki Municipal Hospital, Ogaki 5038502, Japan
| | - Takashi Ishida
- Department of Urology, Gifu Municipal Hospital, Gifu 5008513, Japan
| | - Kaori Ozawa
- Department of Urology, Ogaki Municipal Hospital, Ogaki 5038502, Japan
| | - Kimiaki Takagi
- Department of Urology, Daiyukai Daiichi Hospital, Ichinomiya 4918551, Japan
| | - Hiroki Ito
- Department of Urology, Toyota Memorial Hospital, Toyota 4718513, Japan
| | - Shinichi Takeuchi
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Kota Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Daiki Kato
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Manabu Takai
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Koji Iinuma
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
| | - Shigeaki Yokoi
- Department of Urology, Central Japan International Medical Center, Minokamo 5058510, Japan
| | - Masahiro Nakano
- Department of Urology, Gifu Prefectural General Medical Center, Gifu 5008717, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu 5011194, Japan
- Correspondence: ; Tel.: +81-582306000
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12
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Hepp Z, Shah SN, Liang SY, Tan K, Balakrishna S. Real-world outcomes in locally advanced or metastatic urothelial carcinoma following platinum and PD-1/L1 inhibitor therapy. Future Oncol 2021; 17:4343-4353. [PMID: 34350778 DOI: 10.2217/fon-2021-0573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To investigate real-world overall survival (rwOS) and real-world progression-free survival (rwPFS) in locally advanced/metastatic urothelial carcinoma postplatinum and postprogrammed death receptor-1/death ligand 1 inhibitors. Patients & methods: Adult patients diagnosed with locally advanced/metastatic urothelial carcinoma from 1 January 2011 to 31 December 2018 and treated with taxane monotherapy or any therapy postplatinum and post-PD-1/L1 inhibitors were included from a nationwide electronic health record-derived oncology database. Results: Median rwOS among 72 patients treated with taxane monotherapy was 7.6 months (95% CI: 5.2-14.4) and rwPFS was 2.9 months (95% CI: 2.4-4.0). Among 208 patients treated with any therapy, median rwOS was 8.9 months (95% CI: 7.3-10.6) and rwPFS was 3.6 months (95% CI: 2.7-4.7). Conclusion: Short duration of rwOS and rwPFS were observed, highlighting the need for effective and safe treatments in this patient population.
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Affiliation(s)
- Zsolt Hepp
- Health Economics and Outcomes Research, Seagen Inc., 21823 30th Drive SE, Bothell, WA 98021, USA
| | - Sonali N Shah
- Health Economics and Outcomes Research, Astellas Pharma Inc., One Astellas Way, Northbrook, IL 60062, USA
| | - Shang-Ying Liang
- Health Economics and Outcomes Research, Seagen Inc., 21823 30th Drive SE, Bothell, WA 98021, USA
| | - Katherine Tan
- Flatiron Health, 233 Spring Street, New York, NY 10013, USA
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