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Schuster SJ, Maziarz RT, Rusch ES, Li J, Signorovitch JE, Romanov VV, Locke FL, Maloney DG. Grading and management of cytokine release syndrome in patients treated with tisagenlecleucel in the JULIET trial. Blood Adv 2020; 4:1432-1439. [PMID: 32271899 PMCID: PMC7160283 DOI: 10.1182/bloodadvances.2019001304] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/22/2020] [Indexed: 01/24/2023] Open
Abstract
Chimeric antigen receptor T-cell (CAR-T) therapy yields durable responses in patients with relapsed/refractory diffuse large B-cell lymphoma (r/r DLBCL). Cytokine release syndrome (CRS) is a CAR-T therapy-related adverse event. To date, clinical trials of different CAR-T products have not been aligned on CRS grading scales and management algorithms. We assessed concordance between the Penn, Lee, and American Society for Transplantation and Cellular Therapy (ASTCT) grading systems by retrospectively regrading CRS events in the JULIET (A Phase 2, Single Arm, Multicenter Trial to Determine the Efficacy and Safety of CTL019 in Adult Patients With Relapsed or Refractory DLBCL) trial. Four medical experts with experience treating patients with 3 different CAR-T products independently regraded individual patient-level CRS events from the phase 2, global, pivotal JULIET trial (#NCT02445248). As of 8 December 2017, a total of 111 patients with r/r DLBCL underwent infusion with tisagenlecleucel. Sixty-four patients had CRS events graded per the Penn scale; on retrospective review, 63 and 61 patients had CRS events regraded per the Lee and ASTCT criteria, respectively. The Lee scale yielded concordance for 39, lower grade for 20, and higher grade for 5 events compared with the Penn scale. The ASTCT criteria provided concordance for 37, lower grade for 23, and higher grade for 4 events compared with the Penn scale. Sixteen (14%) of 111 patients in the JULIET trial received tocilizumab, all for severe events (Penn grade 3/4 CRS). This study is the first to assess concordance between 3 CRS grading scales using the same patient data set and to compare tocilizumab use according to the Lee scale in the JULIET trial and the ZUMA-1 (Long-Term Safety and Activity of Axicabtagene Ciloleucel in Refractory Large B-Cell Lymphoma) trial. This analysis describes key differences between grading scales and may inform CRS management practices.
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Affiliation(s)
- Stephen J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Richard T Maziarz
- Center for Hematologic Malignancies, Oregon Health & Science Knight Cancer Institute, Portland, OR
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Levy BP, Signorovitch JE, Yang H, Patterson-Lomba O, Xiang CQ, Parisi M. Effectiveness of first-line treatments in metastatic squamous non-small-cell lung cancer. ACTA ACUST UNITED AC 2019; 26:e300-e308. [PMID: 31285672 DOI: 10.3747/co.26.4485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Commonly used first-line (1L) chemotherapies for patients with advanced squamous-cell lung cancer (scc) include gemcitabine-platinum (gp), nab-paclitaxel-carboplatin (nabpc), and sb-paclitaxel-carboplatin (sbpc) regimens. However, no head-to-head trials have compared those treatments. In the present study, we compared the efficacy of 1L gp, nabpc, and sbpc in patients with scc and in patients with scc who subsequently received second-line (2L) immunotherapy. Methods Medical records of patients who initiated the 1L treatments of interest between June 2014 and October 2015 were reviewed by 132 participating physicians. Kaplan-Meier curves were used to evaluate overall survival (os), progression-free survival (pfs), and treatment discontinuation (td), and then Cox proportional hazards regression was used to compare the results between the cohorts. Results Medical records of 458 patients with scc receiving gp (n = 139), nabpc (n = 159), or sbpc (n = 160) as 1L therapy were reviewed. Median os was longer with nabpc (23.9 months) than with gp (16.9 months; adjusted hazard ratio vs. nabpc: 1.55; p < 0.05) and with sbpc (18.3 months; adjusted hazard ratio: 1.42; p = 0.10). No differences were observed in pfs (median pfs: 8.8, 8.0, and 7.6 months for gp, nabpc, and sbpc respectively; log-rank p = 0.76) or in td (median td: 5.5, 5.7, and 4.6 months respectively; p = 0.65). For patients who subsequently received 2L immunotherapy, no differences in os were observed (median os: 27.3, 25.0, and 23.0 months respectively; p = 0.59). Conclusions In a nationwide sample of scc patients, longer median os was associated with 1L nabpc than with gp and sbpc. Median os for all 1L agents considered was similar in the subgroup of patients who sequenced to a 2L immunotherapy.
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Affiliation(s)
- B P Levy
- Johns Hopkins Sidney Kimmel Cancer Center at Sibley Memorial Hospital, Washington, DC
| | | | - H Yang
- Analysis Group, Inc., Boston, MA
| | | | | | - M Parisi
- Celgene Corporation, Summit, NJ, U.S.A
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3
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Dimopoulos MA, Lonial S, Betts KA, Chen C, Zichlin ML, Brun A, Signorovitch JE, Makenbaeva D, Mekan S, Sy O, Weisel K, Richardson PG. Elotuzumab plus lenalidomide and dexamethasone in relapsed/refractory multiple myeloma: Extended 4-year follow-up and analysis of relative progression-free survival from the randomized ELOQUENT-2 trial. Cancer 2018; 124:4032-4043. [PMID: 30204239 DOI: 10.1002/cncr.31680] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/22/2018] [Accepted: 06/29/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND The randomized phase 3 ELOQUENT-2 study (NCT01239797) evaluated the efficacy and safety of elotuzumab plus lenalidomide and dexamethasone (ELd) versus lenalidomide and dexamethasone (Ld) in relapsed/refractory multiple myeloma (RRMM), and to date, has the longest follow-up of any monoclonal antibody in patients with RRMM. METHODS In this extended 4-year follow-up of the ELOQUENT-2 trial, the coprimary endpoints of progression-free survival (PFS) and overall response rate as well as the secondary endpoint of overall survival were assessed. In the absence of head-to-head trials comparing Ld-based triplet regimens to guide treatment selection, 4 randomized controlled trials-ELOQUENT-2, ASPIRE, TOURMALINE-MM1, and POLLUX-were indirectly compared to provide insight into the relative efficacy of these regimens in RRMM. RESULTS Data at 4 years were consistent with 2- and 3-year follow-up data: ELd reduced the risk of disease progression/death by 29% versus Ld (hazard ratio, 0.71) while maintaining safety. The greatest PFS benefit among the assessed subgroups was observed in patients at the median time or further from diagnosis (≥3.5 years) with 1 prior line of therapy, who had a 44% reduction in the risk of progression/death, and in patients in the high-risk category, who had a 36% reduction in favor of ELd. This regimen also showed a relative PFS benefit that was maintained beyond 50 months. CONCLUSIONS The sustained PFS benefit and long-term safety of ELd at 4 years, similar to those observed at 2 and 3 years, support ELd as a valuable therapeutic option for the long-term treatment of patients with RRMM.
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Affiliation(s)
| | - Sagar Lonial
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | | | - Clara Chen
- Bristol-Myers Squibb, Princeton, New Jersey
| | | | | | | | | | | | - Oumar Sy
- Bristol-Myers Squibb, Princeton, New Jersey
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Chen KS, Xie J, Tang W, Zhao J, Jeppesen PB, Signorovitch JE. Identifying a subpopulation with higher likelihoods of early response to treatment in a heterogeneous rare disease: a post hoc study of response to teduglutide for short bowel syndrome. Ther Clin Risk Manag 2018; 14:1267-1277. [PMID: 30100725 PMCID: PMC6065551 DOI: 10.2147/tcrm.s166081] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Teduglutide, a glucagon-like peptide-2 analog, has demonstrated efficacy in reducing parenteral support (PS) among patients with short bowel syndrome with intestinal failure (SBS–IF). This study aims to identify a subpopulation of SBS–IF patients for whom teduglutide has an especially pronounced effect. Patients and methods Data were from a 24-week, Phase III trial (Study of Teduglutide Effectiveness in Parenteral Nutrition-Dependent SBS Subjects; NCT00798967) that randomized SBS–IF patients with PS dependency to receive teduglutide (n=43) or placebo (n=43). Two prediction models (1 for each arm) were developed for response, defined as 20% reduction in weekly PS at Weeks 20 and 24. Potential predictors included demographics, disease characteristics, and concomitant medications. Patients were then ranked based on the effect score, an individualized predicted response rate difference with teduglutide versus placebo. A subpopulation of patients with a pronounced benefit from teduglutide versus placebo was identified. Baseline characteristics and clinical outcomes were compared between patients included versus those not included in the subpopulation. Results Six predictors of response to teduglutide were selected: older age, volvulus as the cause of major intestinal resection, baseline PS volume >6 L per week, longer time since start of PS dependency, absence of ileocecal valve, and lower percentage of colon remaining. Higher percentage of colon remaining and volvulus were the selected predictors for response to placebo. A subpopulation of patients more likely to respond to teduglutide was identified as those with the top 60% effect scores. The difference in response rate between teduglutide and placebo was 62% in the subpopulation, which was substantially higher than the difference of 33% in the overall population. Mean PS day reduction was also significantly higher for teduglutide compared to placebo in the subpopulation. Conclusion Pretreatment characteristics as predictors of response to teduglutide versus placebo within 24 weeks were identifiable in the clinical trial population of SBS–IF patients.
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Affiliation(s)
- Kristina S Chen
- Outcomes Research and Epidemiology, Shire Human Genetic Therapies, Inc., Cambridge, MA, USA,
| | - Jipan Xie
- Analysis Group, Inc., Los Angeles, CA, USA
| | | | - Jing Zhao
- Analysis Group, Inc., Boston, MA, USA
| | - Palle B Jeppesen
- Department of Medical Gastroenterology, Rigshospitalet, Copenhagen, Denmark
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5
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Armstrong AW, Betts KA, Signorovitch JE, Sundaram M, Li J, Ganguli AX, Wu EQ. Number needed to treat and costs per responder among biologic treatments for moderate-to-severe psoriasis: a network meta-analysis. Curr Med Res Opin 2018; 34:1325-1333. [PMID: 29619856 DOI: 10.1080/03007995.2018.1457516] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The clinical benefits of biologic therapies for moderate-to-severe psoriasis are well established, but wide variations exist in patient response. OBJECTIVES To determine the number needed to treat (NNT) to achieve a 75% and 90% reduction in the Psoriasis Area and Severity Index (PASI-75/90) with FDA-approved agents and evaluate the incremental cost per PASI-75 or PASI-90 responder. METHODS The relative probabilities of achieving PASI-75 and PASI-90, as well as NNTs, were estimated using a network meta-analysis. Costs (2017 USD) included drug acquisition and administration. The incremental cost per PASI-75 or PASI-90 responder for each treatment was estimated for the clinical trial period, and annually. RESULTS Compared with supportive care, the NNT to achieve PASI-75 was 1.18 for ixekizumab, 1.29 for secukinumab 300 mg, 1.37 for infliximab, 1.48 for adalimumab, 1.53 for secukinumab 150 mg, 1.58 for ustekinumab, 2.25 for etanercept, and 3.71 for apremilast. The one-year incremental cost per PASI-75 responder relative to supportive care was $59,830 for infliximab, $88,775 for secukinumab 300 mg, $91,837 for adalimumab, $95,898 for ixekizumab, $97,363 for ustekinumab, $105,131 for secukinumab 150 mg, $129,665 for apremilast, and $159,328 for etanercept. Results were similar for PASI-90. CONCLUSION The NNT and incremental cost per responder are meaningful ways to assess comparative effectiveness and cost effectiveness among psoriasis treatments.
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Affiliation(s)
- April W Armstrong
- a Keck School of Medicine , University of Southern California , Los Angeles , CA , USA
| | | | | | | | - Junlong Li
- b Analysis Group, Inc. , Boston , MA , USA
| | | | - Eric Q Wu
- b Analysis Group, Inc. , Boston , MA , USA
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6
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Papp KA, Yang M, Sundaram M, Jarvis J, Betts KA, Bao Y, Signorovitch JE. Comparison of Adalimumab and Etanercept for the Treatment of Moderate to Severe Psoriasis: An Indirect Comparison Using Individual Patient Data from Randomized Trials. Value Health 2018; 21:1-8. [PMID: 29304933 DOI: 10.1016/j.jval.2017.05.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 04/16/2017] [Accepted: 05/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To compare outcomes between adalimumab and etanercept in the treatment of moderate to severe plaque psoriasis. METHODS Study groups included patients randomized to adalimumab or placebo (REVEAL and CHAMPION trials) and those randomized to etanercept or placebo (M10-114 and M10-315 trials). Week 12 outcomes were compared between patients receiving adalimumab and those receiving etanercept after adjusting for cross-trial differences in patient characteristics using propensity score weighting and after subtracting effects of placebo. Outcomes included proportion of patients achieving 75% or more, 90% or more, and 100% reductions from baseline in the Psoriasis Area and Severity Index (PASI75, PASI90, PASI100, respectively), symptom resolution (pruritus = 0; psoriatic pain = 0), lesion resolution (minimal scores for plaque signs erythema, desquamation, and induration, and by body regions head, upper limbs, trunk, and lower limbs), absence of skin-related quality-of-life impact (Dermatology Life Quality Index [DLQI] = 0), "complete disease control" (patient's global assessment [PtGA] = 0), and adverse events. RESULTS After adjustment, baseline characteristics were balanced among study groups (adalimumab = 875 vs. placebo = 427; etanercept = 260 vs. placebo = 130). Compared with etanercept, adalimumab was associated with significantly better placebo-adjusted outcomes (PASI75: 62.3% vs. 42.6%; PASI90: 35.9% vs. 12.1%; PASI100: 13.1% vs. 4.9%; pruritus: 24.7% vs. 13.0%; psoriatic pain: 27.4% vs. 8.7%; DLQI: 27.7% vs. 11.7%; and PtGA: 16.4% vs. 10.6%; all P < 0.05), except for similar rates of adverse events and head-specific lesion resolution. CONCLUSIONS Compared with etanercept, adalimumab treatment for moderate to severe plaque psoriasis was associated with greater PASI reduction, higher rates of resolution of skin signs and symptoms, and greater improvements in dermatological life quality.
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Affiliation(s)
- Kim A Papp
- Probity Medical Research, and K. Papp Clinical Research, Waterloo, Ontario, Canada
| | - Min Yang
- Analysis Group Inc., Boston, MA, USA.
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7
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Gordon KB, Betts KA, Sundaram M, Signorovitch JE, Li J, Xie M, Wu EQ, Okun MM. Poor early response to methotrexate portends inadequate long-term outcomes in patients with moderate-to-severe psoriasis: Evidence from 2 phase 3 clinical trials. J Am Acad Dermatol 2017; 77:1030-1037. [PMID: 28993007 DOI: 10.1016/j.jaad.2017.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 08/02/2017] [Accepted: 08/08/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Most methotrexate-treated psoriasis patients do not achieve a long-term PASI75 (75% reduction from baseline Psoriasis Area and Severity Index score) response. Indications of nonresponse can be apparent after only 4 weeks of treatment. OBJECTIVE To develop a prediction rule to identify patients unlikely to respond adequately to methotrexate. METHODS Patient-level data from CHAMPION (NCT00235820, N = 110) was used to construct a prediction model for week 16 PASI75 by using patient baseline characteristics and week 4 PASI25. A prediction rule was determined on the basis of the sensitivity and specificity and validated in terms of week 16 PASI75 response in an independent validation sample from trial M10-255 (NCT00679731, N = 163). RESULTS PASI25 achievement at week 4 (odds ratio = 8.917) was highly predictive of response with methotrexate at week 16. Patients with a predicted response probability <30% were recommended to discontinue methotrexate. The rates of week 16 PASI75 response were 65.8% and 21.1% (P < .001) for patients recommended to continue and discontinue methotrexate, respectively. LIMITATIONS The CHAMPION trial excluded patients previously treated with biologics, and the M10-255 trial had no restrictions. CONCLUSION A prediction rule was developed and validated to identify patients unlikely to respond adequately to methotrexate. The rule indicates that 4 weeks of methotrexate might be sufficient to predict long-term response with limited safety risk.
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Affiliation(s)
| | | | | | | | - Junlong Li
- Analysis Group Inc, Boston, Massachusetts
| | - Meng Xie
- Analysis Group Inc, Boston, Massachusetts
| | - Eric Q Wu
- Analysis Group Inc, Boston, Massachusetts
| | - Martin M Okun
- AbbVie Inc, North Chicago, Illinois; Fort HealthCare, Fort Atkinson, Wisconsin
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8
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Yang M, Galebach PJ, Signorovitch JE, Garg V. Effectiveness and healthcare costs among stabilised rheumatoid arthritis patients with dose reduction of adalimumab or etanercept in real world. Clin Exp Rheumatol 2017; 35:791-798. [PMID: 28339358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/30/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES We assessed the level of maintained effectiveness and associated healthcare costs in stabilised rheumatoid arthritis (RA) patients who reduced doses of adalimumab or etanercept. METHODS Eligible patients were identified from a U.S. commercial insurance database using the following criteria: adults with ≥2 RA diagnoses; effectively treated on standard dose of adalimumab or etanercept for a 6-month baseline period; and ≥3 months of dose reduction within a 6-month assessment period following the index date (date of the first reduced dose). Effectiveness was estimated using a validated claims-based algorithm. Multivariate regression models were used to assess maintained effectiveness and healthcare costs in the short-term (months 7-12) and long-term (months 13-24) following the index date, while adjusting for baseline characteristics. Cost per patient maintaining effective treatment (CPME) was calculated as the average total healthcare costs divided by the proportion of patients with maintained effectiveness. RESULTS Both groups (etanercept=375; adalimumab=610) had 70% females and a mean age of 48 years. Adjusted rates of maintained effectiveness for etanercept vs. adalimumab were 57.5% vs. 64.7% (p=0.028) in the short-term and 44.3% vs. 51.9% (p=0.047) in the long-term. Adjusted healthcare costs were similar for etanercept- and adalimumab-treated patients (short-term: $15,043 vs. $15,041; long-term: $31,461 vs. $30,449). The CPME was $2,915 higher with etanercept-treated patients in short-term and $12,349 higher in long-term compared with adalimumab-treated patients. CONCLUSIONS Among stabilised RA patients who reduced biologic dosing, a greater proportion of adalimumab-treated patients maintained effectiveness than etanercept-treated patients. Adalimumab was associated with a lower total CPME than etanercept.
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Affiliation(s)
- Min Yang
- Analysis Group, Inc., Boston, MA, USA
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Swallow E, King S, Song J, Peeples M, Signorovitch JE, Liu Z, Prestifilippo J, Frost M, Kohrman M, Korf B, Krueger D, Sparagana S. Patterns of Disease Monitoring and Treatment Among Patients With Tuberous Sclerosis Complex-related Angiomyolipomas. Urology 2017; 104:110-114. [DOI: 10.1016/j.urology.2017.02.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/15/2017] [Accepted: 02/20/2017] [Indexed: 11/26/2022]
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10
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Pal SK, Signorovitch JE, Li N, Zichlin ML, Liu Z, Ghate SR, Perez JR, Vogelzang NJ. Patterns of care among patients receiving sequential targeted therapies for advanced renal cell carcinoma: A retrospective chart review in the USA. Int J Urol 2017; 24:272-278. [PMID: 28253548 DOI: 10.1111/iju.13314] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/16/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To assess real-world treatment patterns of targeted therapies after failure of first-line tyrosine kinase inhibitors in patients with advanced renal cell carcinoma. METHODS A large, retrospective review of medical charts of patients with advanced renal cell carcinoma in the USA was carried out. Descriptive statistics were used to summarize physicians' and patients' characteristics, treatment sequences, and reasons for treatment choices. P-values were calculated using χ2 -tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. A descriptive comparison was carried out between current results and those of a previous treatment pattern study conducted in 2012 to identify changes in treatment patterns over time. RESULTS Sunitinib and everolimus remained the most commonly-used first and second targeted therapies, respectively. Among patients who continued to a third targeted therapy, everolimus and axitinib were the most commonly-used treatments after second targeted therapy with a tyrosine kinase inhibitor and a mammalian target of rapamycin inhibitor, respectively. The use of pazopanib as first targeted therapy, and of axitinib and sorafenib as second targeted therapies, increased over time. Efficacy, treatment guidelines and a different mechanism of action were the main reasons given by physicians for choosing among second targeted therapies after failure of a first tyrosine kinase inhibitor. CONCLUSIONS The results of the present study document patterns of care during a period of rapid and ongoing therapeutic advancement in advanced renal cell carcinoma. Sequencing of therapies warrants ongoing analysis in light of new agents entering the advanced renal cell carcinoma treatment landscape.
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Affiliation(s)
- Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | | | - Nanxin Li
- Analysis Group, Boston, Massachusetts, USA
| | | | - Zhimei Liu
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Sameer R Ghate
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | | | - Nicholas J Vogelzang
- US Oncology Research, Comprehensive Cancer Centers of Nevada, Las Vegas, Nevada, USA
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Donohue JF, Betts KA, Du EX, Altman P, Goyal P, Keininger DL, Gruenberger JB, Signorovitch JE. Comparative efficacy of long-acting β2-agonists as monotherapy for chronic obstructive pulmonary disease: a network meta-analysis. Int J Chron Obstruct Pulmon Dis 2017; 12:367-381. [PMID: 28176892 PMCID: PMC5261557 DOI: 10.2147/copd.s119908] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Long-acting β2-agonists (LABAs) have demonstrated efficacy in patients with COPD in clinical trials. The purpose of this study was to assess the comparative efficacy of all available dosages of all LABA monotherapies using a network meta-analysis. METHODS A systematic literature review identified 33 randomized controlled trials of LABA monotherapies (salmeterol 50 μg twice daily [BID]; formoterol 12 μg BID; indacaterol 75, 150, and 300 μg once daily [OD]; olodaterol 5 and 10 μg OD, and vilanterol 25 μg OD). Clinical efficacy was evaluated at 12 and 24 weeks in terms of trough forced expiratory volume in 1 second (FEV1), transition dyspnea index focal score, St George's Respiratory Questionnaire total score, and rate of COPD exacerbations. The relative effectiveness of all LABA monotherapies was estimated by Bayesian network meta-analysis. RESULTS At 12 and 24 weeks, indacaterol 300 and 150 μg OD were associated with statistically significant improvement in trough FEV1 compared to all other LABA monotherapies; vilanterol 25 μg OD was superior to formoterol 12 μg BID. At 12 weeks, indacaterol 75 μg OD was associated with significant improvement in trough FEV1 compared to formoterol 12 μg BID and olodaterol (5 and 10 μg OD); salmeterol 50 μg BID was superior to formoterol 12 μg BID and olodaterol 5 μg OD. Indacaterol 300 μg OD was also associated with significant improvement in transition dyspnea index focal score compared to all other LABAs at 12 or 24 weeks. Indacaterol 150 μg OD had significantly better results in exacerbation rates than olodaterol 5 μg and olodaterol 10 μg OD. CONCLUSION Indacaterol 300 μg, followed by 150 and 75 μg, were the most effective LABA monotherapies for moderate to severe COPD.
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Affiliation(s)
- James F Donohue
- Department of Pulmonary Diseases and Critical Care Medicine, The University of North Carolina, Chapel Hill, NC
| | | | | | - Pablo Altman
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
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Vogelzang NJ, Signorovitch JE, Swallow E, Peeples M, Koo V, Perez JR, Ghate S, Pal SK. Temporal trends in overall survival and disease-specific survival among patients with advanced renal cell carcinoma during the targeted therapy era: A SEER-Medicare analysis. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e16096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Sameer Ghate
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
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13
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Heng DYC, Park J, Signorovitch JE, Yang H, Song J, Patel D, Lin C, Powles T. Outcomes of second targeted therapy in metastatic renal carcinoma: A retrospective chart review in the EU. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
558 Background: This study describes the real-world outcomes of metastatic renal cell carcinoma (mRCC) patients treated with everolimus (EVE), sorafenib (SOR), and axitinib (AXI) as 2nd targeted therapy in the UK, Germany, and France. Methods: A retrospective chart review was conducted among oncologists and urologists in the UK, Germany and France. Charts were reviewed for adult mRCC patients satisfying the following eligibility criteria: 1) experienced disease progression on 1st targeted therapy with sunitinib or pazopanib; 2) initiated 2nd targeted therapy with EVE, AXI, or SOR between 10/2012 and 6/2013. Kaplan-Meier analysis was used to estimate overall survival (OS) after initiation of 2nd targeted therapy among all patients and stratified by type of 2nd targeted therapy. Results: A total of 281 charts were reviewed, with 99, 91, and 91 mRCC patients receiving EVE, AXI, and SOR as 2nd targeted therapy, respectively. Mean age was 60.6 years old at initial mRCC diagnosis and 65.5% were male. The majority of patients used sunitinib (79.4%), with the rest using pazopanib (20.6%) as 1st targeted therapy. Median duration of 1st targeted therapy was 9.7 months. At the initiation of 2nd targeted therapy, 91.8% of patients had an ECOG score ≤ 2. The most common sites of metastases were lung (71.2%), bone (53.0%), and lymph nodes (47.0%). Median OS from the initiation of 2nd targeted therapy among all patients was 21.8 months (95% CI: 16.5-26.2). The median OS was 23.0, 23.5, and 18.7 for EVE, AXI, and SOR respectively. The majority of patients (87.5%) initiated 2nd targeted therapy on the recommended dose. Patients receiving AXI had a higher rate of dose increase (13.2%), compared to EVE (1.0%) and SOR (0.0%), while patients on EVE had a higher rate of dose decrease (12.1%), compared to AXI (5.5%) and SOR (8.8%). Conclusions: In this retrospective chart review study of several EU countries, the observed median OS was numerically comparable for EVE and AXI, but rates of dose adjustment differed by treatments. Retrospective chart reviews may be subject to selection bias and errors in data entry, and further analysis is underway to address confounding effects of unobserved patient characteristics.
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Affiliation(s)
| | | | | | | | | | | | | | - Thomas Powles
- Barts Cancer Institute, Barts Health, and The Royal Free London NHS Foundation Trust, London, United Kingdom
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Vogelzang NJ, Pal SK, Signorovitch JE, Reichmann WM, Li N, Yang C, Liu Z, Perez JR, Jonasch E. Comparative effectiveness of everolimus and axitinib as second targeted therapies for metastatic renal cell carcinoma in the US: a retrospective chart review. Curr Med Res Opin 2016; 32:741-7. [PMID: 26744781 DOI: 10.1185/03007995.2016.1140028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Second targeted therapies for metastatic renal cell carcinoma (mRCC) include mammalian target of rapamycin inhibitors (mTORis) and tyrosine kinase inhibitors (TKIs). This observational study compares overall survival (OS) and progression-free survival (PFS) of patients treated with everolimus (an mTORi) and axitinib (a TKI) following first TKI, and assesses the impact of type and duration of first TKI on the relative effectiveness of these second targeted therapies. Methods Retrospective reviews of medical records were conducted by medical oncologists or hematologists/oncologists recruited from a nationwide panel. Included patients with mRCC were required to have discontinued a first TKI (sunitinib, sorafenib, or pazopanib) for medical reasons, and to have initiated everolimus or axitinib as second targeted therapy between February 2012 and January 2013. OS and PFS were compared between patients treated with everolimus vs. axitinib using multivariable Cox proportional hazards regression models. Comparative results were also stratified by type and duration of first TKI. Results Included patients (n = 325 for everolimus and n = 127 for axitinib) had a mean age of 61 years and 31% were female. Sunitinib was the most commonly used first TKI (73%). After adjusting for patient characteristics, no statistically significant differences were observed in OS or PFS between everolimus and axitinib. When stratifying by type and duration of first TKI, there was no statistically significant difference in OS between everolimus and axitinib in all subgroups except for patients with <6 months on sunitinib or sorafenib as first TKI. No significant difference in PFS was observed in any subgroup. Limitations Important limitations include potential missing or inaccurate data in medical charts, and confounding due to unobserved factors. Conclusions In this retrospective chart review, no significant differences were detected in OS or PFS between axitinib and everolimus as second targeted therapy. Longer duration of first TKI was not associated with increased effectiveness of subsequent axitinib compared to everolimus.
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Affiliation(s)
| | - Sumanta K Pal
- b City of Hope Comprehensive Cancer Center , Duarte , CA , USA
| | | | | | - Nanxin Li
- c Analysis Group Inc. , Boston , MA , USA
| | | | - Zhimei Liu
- d Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | | | - Eric Jonasch
- e MD Anderson Cancer Center , Houston , TX , USA
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Pal SK, Jonasch E, Signorovitch JE, Reichmann WM, Li N, Liu Z, Perez JR, Vogelzang NJ. Real-world dosing and drug costs with everolimus or axitinib as second targeted therapies for advanced renal cell carcinoma: a retrospective chart review in the US. J Med Econ 2016; 19:462-8. [PMID: 26652893 DOI: 10.3111/13696998.2015.1131705] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe dosing patterns and to compare the drug costs per month spent in progression-free survival (PFS) among patients with advanced renal cell carcinoma (aRCC) treated with everolimus or axitinib following a first tyrosine kinase inhibitor (TKI). METHODS A medical record retrospective review was conducted among medical oncologists and hematologists/oncologists in the US. Patient eligibility criteria included: (1) age ≥18 years; (2) discontinuation of first TKI (sunitinib, sorafenib, or pazopanib) for medical reasons; (3) initiation of axitinib or everolimus as a second targeted therapy during February 2012-January 2013. Real-world dosing patterns were summarized. Dose-specific drug costs (as of October 2014) were based on wholesale acquisition costs from RED BOOK Online. PFS was compared between everolimus and axitinib using a multivariable Cox proportion hazards model. Everolimus and axitinib drug costs per month of PFS were compared using multivariable gamma regression models. RESULTS A total of 325 patients received everolimus and 127 patients received axitinib as second targeted therapy. Higher proportions of patients treated with axitinib vs everolimus started on a higher than label-recommended starting dose (14% vs 2%) or experienced dose escalation (11% vs 1%) on second targeted therapy. The PFS did not differ significantly between patients receiving everolimus or axitinib (adjusted hazard ratio (HR) = 1.16; 95% confidence interval [CI] = 0.73-1.82). After baseline characteristics adjustment, axitinib was associated with 17% ($1830) higher drug costs per month of PFS compared to everolimus ($12,467 vs $10,637; p < 0.001). LIMITATIONS Retrospective observational study design and only drug acquisition costs considered in drug costs estimates. CONCLUSIONS Patients with aRCC receiving axitinib as second targeted therapy were more likely to initiate at a higher than label-recommended dose and were more likely to dose escalate than patients receiving everolimus. With similar observed durations of PFS, drug costs were significantly higher-by 17% per month of PFS-with axitinib than with everolimus.
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Affiliation(s)
- Sumanta K Pal
- a a City of Hope Comprehensive Cancer Center , Duarte , CA , USA
| | - Eric Jonasch
- b b MD Anderson Cancer Center , Houston , TX , USA
| | | | | | - Nanxin Li
- c c Analysis Group, Inc. , Boston , MA , USA
| | - Zhimei Liu
- d d Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | | | - Nicholas J Vogelzang
- e e US Oncology Research, Comprehensive Cancer Centers of Nevada , Las Vegas , NV , USA
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16
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Betts KA, Griffith J, Friedman A, Zhou ZY, Signorovitch JE, Ganguli A. An indirect comparison and cost per responder analysis of adalimumab, methotrexate and apremilast in the treatment of methotrexate-naïve patients with psoriatic arthritis. Curr Med Res Opin 2016; 32:721-9. [PMID: 26743448 DOI: 10.1185/03007995.2016.1140026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Apremilast was recently approved for the treatment of active psoriatic arthritis (PsA). However, no studies compare apremilast with methotrexate or biologic therapies, so its relative comparative efficacy remains unknown. This study compared the response rates and incremental costs per responder associated with methotrexate, apremilast, and biologics for the treatment of active PsA. METHODS A systematic literature review was performed to identify phase 3 randomized controlled clinical trials of approved biologics, methotrexate, and apremilast in the methotrexate-naïve PsA population. Using Bayesian methods, a network meta-analysis was conducted to indirectly compare rates of achieving a ≥20% improvement in American College of Rheumatology component scores (ACR20). The number needed to treat (NNT) and the incremental costs per ACR20 responder (2014 US$) relative to placebo were estimated for each of the therapies. RESULTS Three trials (MIPA for methotrexate, PALACE-4 for apremilast, and ADEPT for adalimumab) met all inclusion criteria. The NNTs relative to placebo were 2.63 for adalimumab, 6.69 for apremilast, and 8.31 for methotrexate. Among methotrexate-naïve PsA patients, the 16 week incremental costs per ACR20 responder were $3622 for methotrexate, $26,316 for adalimumab, and $45,808 for apremilast. The incremental costs per ACR20 responder were $222,488 for apremilast vs. methotrexate. CONCLUSION Among methotrexate-naive PsA patients, adalimumab was found to have the lowest NNT for one additional ACR20 response and methotrexate was found to have the lowest incremental costs per ACR20 responder. There was no statistical evidence of greater efficacy for apremilast vs. methotrexate. A head-to-head trial between apremilast and methotrexate is recommended to confirm this finding.
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Lin PL, Hao Y, Xie J, Li N, Zhong Y, Zhou Z, Signorovitch JE, Wu EQ. Physician experiences and preferences in the treatment of HR+/HER2- metastatic breast cancer in the United States: a physician survey. Cancer Med 2015; 5:209-20. [PMID: 26686532 PMCID: PMC4735772 DOI: 10.1002/cam4.580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 10/09/2015] [Accepted: 10/12/2015] [Indexed: 12/03/2022] Open
Abstract
Sequential endocrine therapy (ET) is recommended for postmenopausal women with hormone receptor‐positive (HR+)/human epidermal growth factor receptor 2‐negative (HER2−) metastatic breast cancer (mBC) and without visceral symptoms. Chemotherapy (CT) can be considered after sequential ETs, but is associated with adverse side effects. We assessed physicians' preferences and self‐reported prescribing patterns for ET and CT in the treatment of HR+/HER2− mBC at community practices in the United States. Community‐based oncologists/hematologists from a nationwide online panel who treated postmenopausal women with HR+/HER2− mBC were invited to complete a survey, blinded to the identity of study sponsor. Treatment preferences were collected by treatment class of ET‐based regimens versus CT and by agent for postmenopausal HR+/HER2− mBC patients after prior nonsteroidal aromatase inhibitor use in the adjuvant or mBC setting. Among 213 physicians who completed the survey, 78% were male, 71% were based in small/intermediate practices (2–9 oncologists/subspecialists), 55% had >10 years of experience, and 58% referred to the National Comprehensive Cancer Network Guidelines when treating mBC. Among first‐line ETs, anastrozole was the most frequently used treatment (35%), followed by everolimus‐based (EVE, 34%) and fulvestrant‐based (FUL, 15%) therapy. After first‐line ET, the most preferred second‐ and third‐line treatments were ET monotherapy (48% and 39%), ET combination therapy (31% and 19%), and CT monotherapy (13% and 30%). Comparing EVE versus FUL, physicians preferred EVE in all lines but first line. Efficacy was the most important consideration for treatment choice. Physicians prescribed CT in early lines mainly because of visceral symptoms. This survey of treatment patterns for HR+/HER2− mBC in community practice suggested that after first‐line ET, ET mono‐ or combination therapy was commonly used for the second‐ and third‐line treatments and CT monotherapy for third‐ or later line treatments. CTs were used in early lines for patients with visceral symptoms.
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Affiliation(s)
| | - Yanni Hao
- Novartis Pharmaceuticals CorporationEast HanoverNew Jersey
| | - Jipan Xie
- Analysis Group, Inc.New YorkNew York
| | - Nanxin Li
- Analysis Group, Inc.BostonMassachusetts
| | | | - Zhou Zhou
- Analysis Group, Inc.BostonMassachusetts
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18
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Song Y, Hao Y, Macalalad AR, Lin PL, Signorovitch JE, Wu EQ. Clinical Outcomes with First-line Endocrine Therapy or Chemotherapy in Postmenopausal HR+/HER2- Metastatic Breast Cancer. Breast Cancer (Auckl) 2015; 9:67-72. [PMID: 26380551 PMCID: PMC4560455 DOI: 10.4137/bcbcr.s30771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To describe patient profiles and clinical outcomes associated with first-line endocrine monotherapy (ET) and chemotherapy (CT) for postmenopausal HR+/HER2- metastatic breast cancer (mBC) patients. METHODS This is a retrospective chart review of 139 postmenopausal HR+/HER2- mBC patients initiating first-line ET monotherapy or CT. Overall survival (OS) was described using Kaplan-Meier curves. Exploratory comparative proportional hazards regression was conducted. RESULTS Patients on first-line CT had significantly more frequent liver metastases than patients on first-line ET monotherapy at baseline. The median OS was 35.5 months [95% confidence interval (CI), 22.7-41.2 months] for patients on first-line ET monotherapy and 22.2 months (95% CI, 13.6-25.9 months) for those on first-line CT (P = 0.021). Adjusting for baseline characteristics, the OS between first-line ET monotherapy and CT was not significantly different. CONCLUSIONS Patients who were prescribed CT as first-line treatment had evidence of more advanced disease at baseline and shorter OS than those who received ET monotherapy as first-line treatment, suggesting a need for additional safe and effective treatment options for these patients.
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Affiliation(s)
- Yan Song
- Analysis Group, Inc., Boston, MA, USA
| | - Yanni Hao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | | | - Eric Q Wu
- Analysis Group, Inc., Boston, MA, USA
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Li N, Hao Y, Xie J, Lin PL, Zhou Z, Zhong Y, Signorovitch JE, Wu EQ. Everolimus use and associated factors among post-menopausal women with hormonal receptor positive/human epidermal growth factor receptor 2 negative metastatic breast cancer. Curr Med Res Opin 2015; 31:1573-82. [PMID: 26074049 DOI: 10.1185/03007995.2015.1062358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Everolimus has been shown to be an effective HR+/HER2- mBC treatment in both clinical trials and real-world practice. The current study aims at understanding factors associated with everolimus use and how it is used in the real world. METHODS A retrospective chart review was conducted among postmenopausal HR+/HER2- mBC women who received everolimus, endocrine therapy (ET), or chemotherapy (CT) for mBC between 1 July 2012 and 15 April 2013 after an NSAI failure. Factors associated with everolimus use versus ET or CT were identified using multivariable logistic regressions. Reasons for prescribing everolimus and everolimus treatment patterns were described. RESULTS Liver metastasis and high tumor volume were associated with a higher likelihood of everolimus use versus ET (OR = 1.67, OR = 1.62) but a lower likelihood of everolimus use versus CT (OR = 0.43, OR = 0.30). Medicare-only insurance (OR = 0.30) as well as ECOG ≥2 (OR = 3.72) and prior CT in mBC (OR = 2.76) were associated with a lower and higher likelihood of everolimus use versus CT, respectively. The top reason for prescribing everolimus was efficacy (69-85%). About 15% and 29% of everolimus users in second line and third line or above received prior CT for mBC. Exemestane was the most common concomitant therapy with everolimus (56-87%). The majority of patients initiated everolimus at the labeled dose of 10 mg daily (>80%) and maintained this dose (>80%). CONCLUSIONS In the real world, everolimus was used in more severe patients than ET but less severe patients than CT based on visceral metastasis, tumor volume, and performance status. The top reason for prescribing everolimus was efficacy. A large proportion of patients received first or second line CT before everolimus initiation. The majority of patients used everolimus according to the labeled combination and dose. Future studies are needed to determine optimal sequencing of everolimus, ET, and CT for HR+/HER2- mBC.
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Affiliation(s)
- Nanxin Li
- a a Analysis Group Inc. , Boston , MA , USA
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Tauhid S, Chu R, Sasane R, Glanz BI, Neema M, Miller JR, Kim G, Signorovitch JE, Healy BC, Chitnis T, Weiner HL, Bakshi R. Brain MRI lesions and atrophy are associated with employment status in patients with multiple sclerosis. J Neurol 2015. [PMID: 26205635 PMCID: PMC4639581 DOI: 10.1007/s00415-015-7853-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Multiple sclerosis (MS) commonly
affects occupational function. We investigated the link between brain MRI and employment status. Patients with MS (n = 100) completed a Work Productivity and Activity Impairment (WPAI) (general health version) survey measuring employment status, absenteeism, presenteeism, and overall work and daily activity impairment. Patients “working for pay” were considered employed; “temporarily not working but looking for work,” “not working or looking for work due to age,” and “not working or looking for work due to disability” were considered not employed. Brain MRI T1 hypointense (T1LV) and T2 hyperintense (T2LV) lesion volumes were quantified. To assess lesional destructive capability, we calculated each subject’s ratio of T1LV to T2LV (T1/T2). Normalized brain parenchymal volume (BPV) assessed brain atrophy. The mean (SD) age was 45.5 (9.7) years; disease duration was 12.1 (8.1) years; 75 % were women, 76 % were relapsing-remitting, and 76 % were employed. T1LV, T1/T2, Expanded Disability Status Scale (EDSS) scores, and activity impairment were lower and BPV was higher in the employed vs. not employed group (Wilcoxon tests, p < 0.05). Age, disease duration, MS clinical subtype, and T2LV did not differ between groups (p > 0.05). In multivariable logistic regression modeling, adjusting for age, sex, and disease duration, higher T1LV predicted a lower chance of employment (p < 0.05). Pearson correlations showed that EDSS was associated with activity impairment (p < 0.05). Disease duration, age, and MRI measures were not correlated with activity impairment or other WPAI outcomes (p > 0.05). We report a link between brain atrophy and lesions, particularly lesions with destructive potential, to MS employment status.
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Affiliation(s)
- Shahamat Tauhid
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Renxin Chu
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Bonnie I Glanz
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Mohit Neema
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Jennifer R Miller
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Gloria Kim
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Brian C Healy
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Howard L Weiner
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Rohit Bakshi
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. .,Laboratory for Neuroimaging Research, Department of Radiology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. .,Laboratory for Neuroimaging Research, One Brookline Place, Brookline, MA, 02445, USA.
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Signorovitch JE, Betts KA, Song Y, Sorg RA, Li J, Behl AS, Kalsekar A. Comparative efficacy and safety of daclatasvir/asunaprevir versus IFN-based regimens in genotype 1b hepatitis C virus infection. J Comp Eff Res 2015; 4:593-605. [PMID: 26159375 DOI: 10.2217/cer.15.33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM Efficacy and safety comparison of daclatasvir/asunaprevir (DCV + ASV) versus peginterferon-α/ribavirin (A/R) alone or combined with telaprevir, boceprevir, simeprevir or sofosbuvir in chronic genotype 1b hepatitis C virus infection. METHODS Network meta-analysis (NMA) and matching-adjusted indirect comparisons (MAICs). RESULTS Among treatment-naive patients, DCV + ASV demonstrated higher sustained virologic response (SVR) rates than telaprevir + A/R, boceprevir + A/R and A/R in NMA and MAICs and simeprevir + A/R in NMA. DCV + ASV among treatment-experienced patients had higher SVR rates than telaprevir + A/R, boceprevir + A/R, simeprevir + A/R and A/R in MAICs. DCV + ASV had lower adverse events rates than comparators. CONCLUSION DCV + ASV demonstrated superior efficacy and safety compared with A/R-based regimens.
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Affiliation(s)
| | | | - Yan Song
- Analysis Group, Inc., Boston, MA 02199, USA
| | | | - Junlong Li
- Analysis Group, Inc., Boston, MA 02199, USA
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Xie J, Hao Y, Li N, Lin PL, Ohashi E, Koo V, Signorovitch JE, Wu EQ, Yardley DA. Comparative effectiveness of everolimus-based therapy versus endocrine monotherapy among postmenopausal women with HR+/HER2- metastatic breast cancer: a retrospective chart review in community oncology practices in the US. Curr Med Res Opin 2015; 31:1095-103. [PMID: 25971725 DOI: 10.1185/03007995.2015.1021906] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Everolimus-based therapy and endocrine monotherapy are used among postmenopausal women with hormone receptor-positive human epidermal growth factor receptor-2 negative (HR+/HER2-) metastatic breast cancer (mBC) whose disease progressed or recurred on a non-steroidal aromatase inhibitor (NSAI). However, limited evidence exists regarding the real-world comparative effectiveness of these agents. METHODS This retrospective chart review examined postmenopausal HR+/HER2- mBC patients in community-based oncology practices who received everolimus-based therapy or endocrine monotherapy (index therapy) as any line of therapy for mBC between 1 July 2012 and 15 April 2013 after NSAI failure. Time on treatment (TOT), progression-free survival (PFS), and time to chemotherapy (TTC) from index therapy initiation were compared using Kaplan-Meier analyses and Cox proportional hazards models adjusting for baseline characteristics. RESULTS A total of 243 and 270 patients received everolimus-based therapy or endocrine monotherapy in a quota-based sample. Patients treated with everolimus-based therapy had a higher proportion of visceral metastases, high tumor burden, and use of prior chemotherapies for mBC. After adjusting for baseline characteristics, everolimus-based therapy was associated with significantly longer TOT (HR = 0.67, 95% CI: 0.51-0.87) and PFS (HR = 0.75, 95% CI: 0.57-0.98) than endocrine monotherapy. No significant difference was found between everolimus-based therapy and endocrine monotherapy in TTC (HR = 0.81, 95% CI: 0.52-1.27). Results stratified by line of therapy were generally consistent with the overall results. LIMITATIONS Limitations include recall and information bias with potentially absent or erroneous chart data, unobserved factors due to non-randomization, inability to measure outcome assessments paired with measuring outcomes prior to exposures, and potential patient selection bias associated with chart review. CONCLUSIONS Among a nationwide sample of postmenopausal HR+/HER2- mBC patients treated in community oncology settings, treatment with everolimus-based therapy was associated with significantly longer TOT and PFS compared to endocrine monotherapy.
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Affiliation(s)
- Jipan Xie
- Analysis Group Inc. , New York, NY , USA
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Signorovitch JE, Pal SK, Reichmann WM, Li N, Liu Z, Perez JR, Vogelzang NJ, Jonasch E. Comparative effectiveness of everolimus (EVE) and axitinib (AXI) for 2 nd targeted therapy (TT) of metastatic renal cell carcinoma (mRCC) in the US: A retrospective chart review. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e15612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Zhimei Liu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | | | - Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Tan DSW, Araujo A, Zhang J, Signorovitch JE, Zhou ZY, Cai X, Liu G. Comparative efficacy of ceritinib and crizotinib in previously treated crizotinib-naïve anaplastic lymphoma kinase-positive (ALK+) advanced or metastatic non-small cell lung cancer (NSCLC): An adjusted indirect comparison. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Jie Zhang
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | | | | | - Geoffrey Liu
- Princess Margaret Cancer Centre, Department of Medical Oncology, University of Toronto, Toronto, ON, Canada
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Xie J, Hao Y, Li N, Lin PL, Ohashi E, Koo V, Signorovitch JE, Wu EQ. Comparative effectiveness of everolimus versus endocrine monotherapies among post-menopausal women with HR+/HER2- metastatic breast cancer: A retrospective chart review of community oncology practices in the US. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e11527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Yanni Hao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
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Perez JR, Pal SK, Signorovitch JE, Reichmann WM, Li N, Liu Z, Jonasch E, Vogelzang NJ. Changes in treatment patterns among patients receiving at least two targeted therapies for metastatic renal cell carcinoma (mRCC) in the US: A comparison of retrospective chart reviews conducted in 2012 and 2014. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e15620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Zhimei Liu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Wong MK, Jonasch E, Pal SK, Signorovitch JE, Lin PL, Wang X, Liu Z, Culver K, Scott JA, George DJ, Vogelzang NJ. Prognostic factors for survival following initiation of second-line treatment with everolimus for metastatic renal cell carcinoma: evidence from a nationwide sample of clinical practice in the United States. Expert Opin Pharmacother 2015; 16:805-19. [DOI: 10.1517/14656566.2015.1020298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Vogelzang NJ, Pal SK, Signorovitch JE, Reichmann WM, Chopra P, Liu Z, Perez JR, Jonasch E. Comparative effectiveness of everolimus (EVE) and axitinib (AXI) for second-line treatment of metastatic renal cell carcinoma (mRCC) in the United States: A retrospective chart review. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.7_suppl.500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
500 Background: EVE and AXI are approved as 2nd-line TTs for mRCC. This study compares OS and PFS among mRCC patients treated with EVE and AXI following 1st TKI. The extent to which the duration of 1st TKI can inform optimal selection of a 2nd-line TT is of interest. Methods: A retrospective patient chart review study was conducted. Medical oncologists or hematologists/oncologists who treated ≥3 mRCC patients in the past year were recruited from a national panel. Patient eligibility criteria included: 1) aged ≥18 years; 2) initiated and discontinued 1st TKI (sunitinib or pazopanib) for medical reasons; 3) initiated 2nd TT between 2/1/2012 and 1/31/2013. OS was defined as time from initiation of 2nd TT to death. PFS was defined as time from initiation of 2nd TT to physician/chart reported progression or death, whichever occurred first. Multivariable Cox proportional hazards models were used to estimate the hazard ratio (HR) for OS and PFS between EVE and AXI, adjusting for age, gender, type and duration of 1st TKI, response to 1st TKI, duration of mRCC at 2nd TT, disease profile, performance status, sites of metastases, and years of physician practice. Comparative effectiveness was also analyzed by the type and duration (<6, 6-12, >12 months) of 1st TKI. Results: A total of 298 and 122 patients received 2nd TT with EVE and AXI. After adjusting for baseline characteristics, there was no statistically significant difference between EVE and AXI in OS [HR (95% CI): 1.10 (0.69-1.75)] or PFS [HR (95% CI): 1.12 (0.81-1.54)]. When stratified by subgroups defined by type and duration of 1st TKI, there was no statistically significant difference in OS between EVE and AXI in all subgroups, except for patients with <6 months on sunitinib as 1st TKI in which AXI had longer OS (HR =3.95). There was no statistically significant difference in PFS between EVE and AXI in all subgroups. Conclusions: In this large, retrospective chart review study, there was no significant difference in OS or PFS between EVE and AXI. Subgroup analyses stratified by duration of 1st TKI did not suggest that longer duration of 1st TKI was associated with better efficacy for 2nd-line AXI vs. EVE.
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Affiliation(s)
| | | | | | | | | | - Zhimei Liu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | - Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Macalalad AR, Hao Y, Lin PL, Signorovitch JE, Wu EQ, Ohashi E, Zhou Z, Kelley C. Treatment patterns and duration in post-menopausal women with HR+/HER2- metastatic breast cancer in the US: a retrospective chart review in community oncology practices (2004-2010). Curr Med Res Opin 2015; 31:263-73. [PMID: 25350226 DOI: 10.1185/03007995.2014.980885] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Clinical guidelines prefer endocrine therapy (ET) as initial treatment for post-menopausal women with hormone receptor positive (HR+)/human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer (mBC). Chemotherapy (CT) should be reserved for patients who develop symptomatic visceral disease or have no clinical benefit after three sequential ET regimens. It is unclear if real-world clinical practice reflects these guidelines. OBJECTIVE To describe treatment patterns and treatment durations by lines of therapy for ET and CT among post-menopausal HR+/HER2- mBC patients. METHODS Charts were reviewed from a network of community-based oncology practices of eligible patients who had progressed after initiating adjuvant or first-line treatment for mBC between 1 January 2004 and 30 September 2010. Extracted chart data included demographics, treatment histories, and outcomes. Treatment duration was estimated using Kaplan-Meier estimators. RESULTS A total of 144 patients were studied. Patients received a median of two lines of ET, and <10% had three or more lines of ET before receiving CT. From first line to second line, the median treatment duration was 11.6 to 4.9 months for ET overall; 13.8 to 10.5 months for anastrozole; 18.6 to 7.0 months for letrozole; and 5.1 to 2.9 months for fulvestrant. For CT, the median duration was 5.1 months in the first line and 3.7 months and below in subsequent lines. CONCLUSION During the study period (1 January 2004 - 30 September 2012), most patients received <3 lines of ET before receiving CT. The drop in median duration of ET from first to second line suggests that single agent ETs might not be as effective beyond the first line. A key limitation of this study was the small sample size. In addition, more research is needed to further investigate the short treatment duration of fulvestrant across early lines of therapy (which could indicate lack of efficacy).
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Signorovitch JE, Betts KA, Reichmann WM, Thomason D, Galebach P, Wu EQ, Chen L, DeAngelo DJ. One-year and long-term molecular response to nilotinib and dasatinib for newly diagnosed chronic myeloid leukemia: a matching-adjusted indirect comparison. Curr Med Res Opin 2015; 31:315-22. [PMID: 25356603 DOI: 10.1185/03007995.2014.977992] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Nilotinib and dasatinib have shown superior rates of molecular response (MR) compared to imatinib for the treatment of newly diagnosed chronic myeloid leukemia (CML) in chronic phase (CP). This study indirectly compares MR in patients taking nilotinib 300 mg bid with that in those taking dasatinib 100 mg qd by 12 months and through 48 months. METHODS Patients in ENESTnd were re-weighted to match published baseline characteristics reported for DASISION using a propensity score model. After matching, differences in rates of major MR (MMR, measured as a 3 log reduction on the International Scale [IS]), MR(4.0) (4 log reduction on IS), and MR(4.5) (4.5 log reduction on IS) relative to imatinib were indirectly compared between nilotinib and dasatinib. Hazard ratios (HRs) were used to indirectly compare MR outcomes between nilotinib and dasatinib through 48 months of follow-up, while rate differences were used to compare progression to AP/BC between nilotinib and dasatinib by 48 months. RESULTS After matching, rates of MR by 12 months were higher with nilotinib vs dasatinib by 11.7% for MMR (p = 0.045), 8.2% for MR(4.0) (p = 0.029), and 8.5% for MR(4.5) (p < 0.001). Higher rates of MMR (HR = 1.44, p = 0.018) and MR(4.0) (HR = 1.58, p = 0.013) achievement were maintained with nilotinib compared to dasatinib through 48 months of follow-up. No statistically significant differences were observed for MR(4.5) through 48 months or progression to AP/BC by 48 months. LIMITATIONS LIMITATIONS include comparisons based solely on indirect evidence and HRs for MR(4.0) and MR(4.5) from the DASISION trial being extracted from cumulative incidence curves. CONCLUSIONS This indirect comparison suggests that nilotinib is associated with higher rates of achieving MMR, MR(4.0), and MR(4.5) by 12 months compared to dasatinib for the treatment of newly diagnosed CML-CP. In addition, higher rates of MR achievement with nilotinib were also maintained through 48 months of follow-up.
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Campone M, Yang H, Faust E, Kageleiry A, Signorovitch JE, Zhang J, Gao H. Cost of adverse events during treatment with everolimus plus exemestane or single-agent chemotherapy in patients with advanced breast cancer in Western Europe. J Med Econ 2014; 17:837-45. [PMID: 25164472 DOI: 10.3111/13696998.2014.959589] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Treatment options for recurrent or progressive hormone receptor-positive (HR+) advanced breast cancer include chemotherapy and everolimus plus exemestane (EVE + EXE). This study estimates the costs of managing adverse events (AEs) during EVE + EXE therapy and single-agent chemotherapy in Western Europe. METHODS An economic model was developed to estimate the per patient cost of managing grade 3/4 AEs for patients who were treated with EVE + EXE or chemotherapies. AE rates for patients receiving EVE + EXE were collected from the phase III BOLERO-2 trial. AE rates for single-agent chemotherapy, capecitabine, docetaxel, or doxorubicin were collected from published clinical trial data. AEs with at least 2% prevalence for any of the treatments were included in the model. A literature search was conducted to obtain costs of managing each AE, which were then averaged across Western European countries (when available). Per patient costs for managing AEs among patients receiving different therapies were reported in 2012 euros (€). RESULTS The EVE + EXE combination had the lowest average per patient cost of managing AEs (€730) compared to all chemotherapies during the first year of treatment (doxorubicin: €1230; capecitabine: €1721; docetaxel: €2390). The most costly adverse event among all patients treated with EVE + EXE was anemia (on average €152 per patient). The most costly adverse event among all patients treated with capecitabine, docetaxel, or doxorubicin was lymphocytopenia (€861 per patient), neutropenia (€821 per patient), and leukopenia (€382 per patient), respectively. CONCLUSIONS The current model estimates that AE management during the treatment of HR+ advanced breast cancer will cost one-half to one-third less for EVE + EXE patients than for chemotherapy patients. The consideration of AE costs could have important implications in the context of healthcare spending for advanced breast cancer treatment.
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Affiliation(s)
- Mario Campone
- Centre René Gauducheau, Service Oncologie Médicale , Nantes Saint-Herblain , France
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Signorovitch JE, Vogelzang NJ, Pal SK, Lin PL, George DJ, Wong MK, Liu Z, Wang X, Culver K, Scott JA, Jonasch E. Comparative effectiveness of second-line targeted therapies for metastatic renal cell carcinoma: synthesis of findings from two multi-practice chart reviews in the United States. Curr Med Res Opin 2014; 30:2343-53. [PMID: 25105304 DOI: 10.1185/03007995.2014.949645] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Second-line targeted therapies for metastatic renal cell carcinoma (mRCC) include mammalian target of rapamycin (mTOR) inhibitors and tyrosine kinase inhibitors (TKIs). This study compares the effectiveness of these therapies in a multi-practice chart review and synthesizes the findings with those of a similarly designed study. METHODS Medical oncologists/hematologists (N = 36) were recruited to review charts for patients aged ≥18 years, received a first-line TKI and initiated second-line targeted therapy in 2010 or later. The primary outcome was time from second-line initiation to treatment failure (TTF; discontinuation, physician-assessed progression, or death, whichever occurred first). TTF was compared among patients receiving second-line everolimus (EVE), temsirolimus (TEM), or TKI as a class, using a Cox proportional hazards model adjusting for type of initial TKI and response, histological subtype, performance status, and sites of metastasis. Hazard ratios (HRs) for TTF were pooled, in a meta-analysis, with previously reported HRs for progression-free survival from a chart review with a similar design. RESULTS A total of 138, 64 and 79 patients received second-line therapy with EVE, TEM or a TKI, respectively. Adjusting for baseline characteristics, EVE was associated with numerical, but not statistically significant, reductions of 28% (HR = 0.72; 95% CI [0.45-1.16]) and 26% (HR = 0.74; 95% CI [0.48-1.15]) in the hazard of TTF compared to TEM and TKI, respectively. After pooling the HRs from both studies, EVE was associated with significantly reduced hazards of TTF compared to TEM and TKI (HR = 0.73; 95% CI [0.57-0.93]; and HR = 0.75; 95% CI [0.57-0.98], respectively). LIMITATIONS LIMITATIONS include retrospective analyses with possible missing or erroneous chart data, confounding of unobserved factors due to non-randomization, and limited data for axitinib during the study period. CONCLUSIONS In pooled results from two independent multi-practice chart reviews of second-line mRCC treatment, EVE was associated with significantly reduced hazards of treatment failure compared to TEM and to TKIs as a class.
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Jonasch E, Signorovitch JE, Lin PL, Liu Z, Culver K, Pal SK, Scott JA, Vogelzang NJ. Treatment patterns in metastatic renal cell carcinoma: a retrospective review of medical records from US community oncology practices. Curr Med Res Opin 2014; 30:2041-50. [PMID: 24983741 DOI: 10.1185/03007995.2014.938730] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Vascular endothelial growth factor (VEGF) inhibitors, including targeted therapy with tyrosine kinase inhibitors (TKIs) and the angiogenesis inhibitor bevacizumab, and mammalian target of rapamycin (mTOR) inhibitors are now the standard of care for metastatic renal cell carcinoma (mRCC). However, real-world treatment patterns are not well characterized. OBJECTIVE To describe treatment patterns during the first, second, and third lines of targeted therapies for mRCC among community oncologists in the US. METHODS Participating physicians recruited from a nationwide panel each identified up to 15 adult mRCC patients who initiated a second therapy after January 2010. Information extracted from medical records included types of targeted therapies, reasons for treatment choices, patterns of treatment discontinuation, and dose adjustments. RESULTS Thirty-six physicians contributed charts from 433 mRCC patients. Seventy-seven percent of patients received a VEGF inhibitor as first targeted therapy; 23% received an mTOR inhibitor. Among first-line VEGF users, second-line treatments were 66% mTOR and 34% VEGF inhibitors. Among first-line mTOR users, second-line treatments were 94% VEGF and 6% mTOR inhibitors. Sunitinib followed by everolimus was the most commonly used treatment sequence. Estimated median duration for second targeted therapy was 8.6 months, and median overall survival (OS) and progression-free survival (PFS) were 27.4 and 10.8 months, respectively. Efficacy, treatment guidelines and mechanism of action were the most important considerations for treatment choice. LIMITATIONS LIMITATIONS include no adjustment for baseline characteristics, possible difference between physician-defined progression and central review in the clinical trial setting, and limited data availability for axitinib during the study period. CONCLUSION In this large retrospective chart review among community oncologists, VEGF-mTOR-VEGF was the most common treatment sequence for mRCC. The most common drugs were sunitinib in the first line and everolimus in the second line.
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Webb SM, Ware JE, Forsythe A, Yang M, Badia X, Nelson LM, Signorovitch JE, McLeod L, Maldonado M, Zgliczynski W, de Block C, Portocarrero-Ortiz L, Gadelha M. Treatment effectiveness of pasireotide on health-related quality of life in patients with Cushing's disease. Eur J Endocrinol 2014; 171:89-98. [PMID: 24760537 DOI: 10.1530/eje-13-1013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cushing's disease (CD) can significantly impair patients' health-related quality of life (HRQOL). This study investigated the treatment effectiveness of pasireotide on HRQOL of CD patients, and assessed the relationships between HRQOL and urinary free cortisol (UFC) and CD-related signs and symptoms. DESIGN In this phase III, randomized, double-blind study, patients with UFC ≥1.5×upper limit of normal (ULN) received s.c. pasireotide 600 or 900 μg twice daily. The trial primary endpoint was UFC at or below ULN at month 6 without dose titration. Open-label treatment continued through month 12. HRQOL was measured using the Cushing's Quality of Life Questionnaire (CushingQoL) instrument at baseline and follow-up visits until month 12 during which clinical signs and features of CD, and the Beck Depression Inventory II (BDI-II), were also collected. METHODS Pearson's/Spearman's correlations between changes in CushingQoL and changes in clinical signs and symptoms were assessed. Changes in CushingQoL and the proportion of patients achieving a clinically meaningful improvement in CushingQoL were also compared among patients stratified by mean UFC (mUFC) control status (controlled, partially controlled, and uncontrolled) at month 6. Analyses were also conducted at month 12, with multivariable adjustment for baseline characteristics and CushingQoL. RESULTS Change in CushingQoL was significantly correlated with changes in mUFC (r=-0.40), BMI (r=-0.39), weight (r=-0.41), and BDI-II (r=-0.54) at month 12 but not at month 6. The percentage of CushingQoL responders at month 12 based on month 6 mUFC control status were as follows: 63, 58.8, and 37.9% in the controlled, partially controlled, and uncontrolled groups respectively. Adjusted CushingQoL scores at month 12 were 58.3 for controlled patients (Δ=11.5 vs uncontrolled, P=0.012) and 54.5 for partially controlled patients (Δ=7.7 vs uncontrolled, P=0.170). CONCLUSIONS Pasireotide treatment can result in a meaningful HRQOL improvement among those who complete a 12-month treatment period, most often among patients achieving biochemical control.
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Affiliation(s)
- Susan M Webb
- Department of Medicine/EndocrinologyCentre for Biomedical Research on Rare Diseases (CIBERER Unit 747), Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, SpainDepartment of Quantitative Health SciencesUniversity of Massachusetts Medical School, Worcester, Massachusetts, USAJohn Ware Research GroupInc., Worcester, Massachusetts, USANovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USAAnalysis GroupInc., Boston, Massachusetts, USAIMS HealthBarcelona, SpainRTI Health SolutionsResearch Triangle Park, North Carolina, USANovartis Pharma AGBasel, SwitzerlandDepartment of EndocrinologyCentre for Postgraduate Medical Education, Warsaw, PolandDepartment of EndocrinologyDiabetology and Metabolism, University Hospital, Antwerp, BelgiumNational Institute of Neurology and Neurosurgery 'Manuel Velasco Suárez'Mexico City, MexicoDivision of EndocrinologyMedical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - John E Ware
- Department of Medicine/EndocrinologyCentre for Biomedical Research on Rare Diseases (CIBERER Unit 747), Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, SpainDepartment of Quantitative Health SciencesUniversity of Massachusetts Medical School, Worcester, Massachusetts, USAJohn Ware Research GroupInc., Worcester, Massachusetts, USANovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USAAnalysis GroupInc., Boston, Massachusetts, USAIMS HealthBarcelona, SpainRTI Health SolutionsResearch Triangle Park, North Carolina, USANovartis Pharma AGBasel, SwitzerlandDepartment of EndocrinologyCentre for Postgraduate Medical Education, Warsaw, PolandDepartment of EndocrinologyDiabetology and Metabolism, University Hospital, Antwerp, BelgiumNational Institute of Neurology and Neurosurgery 'Manuel Velasco Suárez'Mexico City, MexicoDivision of EndocrinologyMedical School, Federal University of Rio de Janeiro, Rio de Janeiro, BrazilDepartment of Medicine/EndocrinologyCentre for Biomedical Research on Rare Diseases (CIBERER Unit 747), Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, SpainDepartment of Quantitative Health SciencesUniversity of Massachusetts Medical School, Worcester, Massachusetts, USAJohn Ware Research GroupInc., Worcester, Massachusetts, USANovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USAAnalysis GroupInc., Boston, Massachusetts, USAIMS HealthBarcelona, SpainRTI Health SolutionsResearch Triangle Park, North Carolina, USANovartis Pharma AGBasel, SwitzerlandDepartment of EndocrinologyCentre for Postgraduate Medical Education, Warsaw, PolandDepartment of EndocrinologyDiabetology and Metabolism, University Hospital, Antwerp, BelgiumNational Institute of Neurology and Neurosurgery 'Manuel Velasco Suárez'Mexico City, MexicoDivision of EndocrinologyMedical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Anna Forsythe
- Department of Medicine/EndocrinologyCentre for Biomedical Research on Rare Diseases (CIBERER Unit 747), Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, SpainDepartment of Quantitative Health SciencesUniversity of Massachusetts Medical School, Worcester, Massachusetts, USAJohn Ware Research GroupInc., Worcester, Massachusetts, USANovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USAAnalysis GroupInc., Boston, Massachusetts, USAIMS HealthBarcelona, SpainRTI Health SolutionsResearch Triangle Park, North Carolina, USANovartis Pharma AGBasel, SwitzerlandDepartment of EndocrinologyCentre for Postgraduate Medical Education, Warsaw, PolandDepartment of EndocrinologyDiabetology and Metabolism, University Hospital, Antwerp, BelgiumNational Institute of Neurology and Neurosurgery 'Manuel Velasco Suárez'Mexico City, MexicoDivision of EndocrinologyMedical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Min Yang
- Department of Medicine/EndocrinologyCentre for Biomedical Research on Rare Diseases (CIBERER Unit 747), Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, SpainDepartment of Quantitative Health SciencesUniversity of Massachusetts Medical School, Worcester, Massachusetts, USAJohn Ware Research GroupInc., Worcester, Massachusetts, USANovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USAAnalysis GroupInc., Boston, Massachusetts, USAIMS HealthBarcelona, SpainRTI Health SolutionsResearch Triangle Park, North Carolina, USANovartis Pharma AGBasel, SwitzerlandDepartment of EndocrinologyCentre for Postgraduate Medical Education, Warsaw, PolandDepartment of EndocrinologyDiabetology and Metabolism, University Hospital, Antwerp, BelgiumNational Institute of Neurology and Neurosurgery 'Manuel Velasco Suárez'Mexico City, MexicoDivision of EndocrinologyMedical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Xavier Badia
- Department of Medicine/EndocrinologyCentre for Biomedical Research on Rare Diseases (CIBERER Unit 747), Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, SpainDepartment of Quantitative Health SciencesUniversity of Massachusetts Medical School, Worcester, Massachusetts, USAJohn Ware Research GroupInc., Worcester, Massachusetts, USANovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USAAnalysis GroupInc., Boston, Massachusetts, USAIMS HealthBarcelona, SpainRTI Health SolutionsResearch Triangle Park, North Carolina, USANovartis Pharma AGBasel, SwitzerlandDepartment of EndocrinologyCentre for Postgraduate Medical Education, Warsaw, PolandDepartment of EndocrinologyDiabetology and Metabolism, University Hospital, Antwerp, BelgiumNational Institute of Neurology and Neurosurgery 'Manuel Velasco Suárez'Mexico City, MexicoDivision of EndocrinologyMedical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lauren M Nelson
- Department of Medicine/EndocrinologyCentre for Biomedical Research on Rare Diseases (CIBERER Unit 747), Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, SpainDepartment of Quantitative Health SciencesUniversity of Massachusetts Medical School, Worcester, Massachusetts, USAJohn Ware Research GroupInc., Worcester, Massachusetts, USANovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USAAnalysis GroupInc., Boston, Massachusetts, USAIMS HealthBarcelona, SpainRTI Health SolutionsResearch Triangle Park, North Carolina, USANovartis Pharma AGBasel, SwitzerlandDepartment of EndocrinologyCentre for Postgraduate Medical Education, Warsaw, PolandDepartment of EndocrinologyDiabetology and Metabolism, University Hospital, Antwerp, BelgiumNational Institute of Neurology and Neurosurgery 'Manuel Velasco Suárez'Mexico City, MexicoDivision of EndocrinologyMedical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - James E Signorovitch
- Department of Medicine/EndocrinologyCentre for Biomedical Research on Rare Diseases (CIBERER Unit 747), Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, SpainDepartment of Quantitative Health SciencesUniversity of Massachusetts Medical School, Worcester, Massachusetts, USAJohn Ware Research GroupInc., Worcester, Massachusetts, USANovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USAAnalysis GroupInc., Boston, Massachusetts, USAIMS HealthBarcelona, SpainRTI Health SolutionsResearch Triangle Park, North Carolina, USANovartis Pharma AGBasel, SwitzerlandDepartment of EndocrinologyCentre for Postgraduate Medical Education, Warsaw, PolandDepartment of EndocrinologyDiabetology and Metabolism, University Hospital, Antwerp, BelgiumNational Institute of Neurology and Neurosurgery 'Manuel Velasco Suárez'Mexico City, MexicoDivision of EndocrinologyMedical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lori McLeod
- Department of Medicine/EndocrinologyCentre for Biomedical Research on Rare Diseases (CIBERER Unit 747), Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, SpainDepartment of Quantitative Health SciencesUniversity of Massachusetts Medical School, Worcester, Massachusetts, USAJohn Ware Research GroupInc., Worcester, Massachusetts, USANovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USAAnalysis GroupInc., Boston, Massachusetts, USAIMS HealthBarcelona, SpainRTI Health SolutionsResearch Triangle Park, North Carolina, USANovartis Pharma AGBasel, SwitzerlandDepartment of EndocrinologyCentre for Postgraduate Medical Education, Warsaw, PolandDepartment of EndocrinologyDiabetology and Metabolism, University Hospital, Antwerp, BelgiumNational Institute of Neurology and Neurosurgery 'Manuel Velasco Suárez'Mexico City, MexicoDivision of EndocrinologyMedical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mario Maldonado
- Department of Medicine/EndocrinologyCentre for Biomedical Research on Rare Diseases (CIBERER Unit 747), Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, SpainDepartment of Quantitative Health SciencesUniversity of Massachusetts Medical School, Worcester, Massachusetts, USAJohn Ware Research GroupInc., Worcester, Massachusetts, USANovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USAAnalysis GroupInc., Boston, Massachusetts, USAIMS HealthBarcelona, SpainRTI Health SolutionsResearch Triangle Park, North Carolina, USANovartis Pharma AGBasel, SwitzerlandDepartment of EndocrinologyCentre for Postgraduate Medical Education, Warsaw, PolandDepartment of EndocrinologyDiabetology and Metabolism, University Hospital, Antwerp, BelgiumNational Institute of Neurology and Neurosurgery 'Manuel Velasco Suárez'Mexico City, MexicoDivision of EndocrinologyMedical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Wojciech Zgliczynski
- Department of Medicine/EndocrinologyCentre for Biomedical Research on Rare Diseases (CIBERER Unit 747), Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, SpainDepartment of Quantitative Health SciencesUniversity of Massachusetts Medical School, Worcester, Massachusetts, USAJohn Ware Research GroupInc., Worcester, Massachusetts, USANovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USAAnalysis GroupInc., Boston, Massachusetts, USAIMS HealthBarcelona, SpainRTI Health SolutionsResearch Triangle Park, North Carolina, USANovartis Pharma AGBasel, SwitzerlandDepartment of EndocrinologyCentre for Postgraduate Medical Education, Warsaw, PolandDepartment of EndocrinologyDiabetology and Metabolism, University Hospital, Antwerp, BelgiumNational Institute of Neurology and Neurosurgery 'Manuel Velasco Suárez'Mexico City, MexicoDivision of EndocrinologyMedical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Christophe de Block
- Department of Medicine/EndocrinologyCentre for Biomedical Research on Rare Diseases (CIBERER Unit 747), Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, SpainDepartment of Quantitative Health SciencesUniversity of Massachusetts Medical School, Worcester, Massachusetts, USAJohn Ware Research GroupInc., Worcester, Massachusetts, USANovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USAAnalysis GroupInc., Boston, Massachusetts, USAIMS HealthBarcelona, SpainRTI Health SolutionsResearch Triangle Park, North Carolina, USANovartis Pharma AGBasel, SwitzerlandDepartment of EndocrinologyCentre for Postgraduate Medical Education, Warsaw, PolandDepartment of EndocrinologyDiabetology and Metabolism, University Hospital, Antwerp, BelgiumNational Institute of Neurology and Neurosurgery 'Manuel Velasco Suárez'Mexico City, MexicoDivision of EndocrinologyMedical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lesly Portocarrero-Ortiz
- Department of Medicine/EndocrinologyCentre for Biomedical Research on Rare Diseases (CIBERER Unit 747), Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, SpainDepartment of Quantitative Health SciencesUniversity of Massachusetts Medical School, Worcester, Massachusetts, USAJohn Ware Research GroupInc., Worcester, Massachusetts, USANovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USAAnalysis GroupInc., Boston, Massachusetts, USAIMS HealthBarcelona, SpainRTI Health SolutionsResearch Triangle Park, North Carolina, USANovartis Pharma AGBasel, SwitzerlandDepartment of EndocrinologyCentre for Postgraduate Medical Education, Warsaw, PolandDepartment of EndocrinologyDiabetology and Metabolism, University Hospital, Antwerp, BelgiumNational Institute of Neurology and Neurosurgery 'Manuel Velasco Suárez'Mexico City, MexicoDivision of EndocrinologyMedical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Monica Gadelha
- Department of Medicine/EndocrinologyCentre for Biomedical Research on Rare Diseases (CIBERER Unit 747), Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, SpainDepartment of Quantitative Health SciencesUniversity of Massachusetts Medical School, Worcester, Massachusetts, USAJohn Ware Research GroupInc., Worcester, Massachusetts, USANovartis Pharmaceuticals CorporationEast Hanover, New Jersey, USAAnalysis GroupInc., Boston, Massachusetts, USAIMS HealthBarcelona, SpainRTI Health SolutionsResearch Triangle Park, North Carolina, USANovartis Pharma AGBasel, SwitzerlandDepartment of EndocrinologyCentre for Postgraduate Medical Education, Warsaw, PolandDepartment of EndocrinologyDiabetology and Metabolism, University Hospital, Antwerp, BelgiumNational Institute of Neurology and Neurosurgery 'Manuel Velasco Suárez'Mexico City, MexicoDivision of EndocrinologyMedical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Lin PL, Hao Y, Signorovitch JE, Macalalad AR, Wu EQ, Zhou Z, Song J, Ohashi E, Kelley C, Massarweh SA. Prescribing and monitoring patterns for HR+/HER2- advanced breast cancer: A survey of community-based oncologists. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e11551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Yanni Hao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
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Hao Y, Lin PL, Macalalad AR, Signorovitch JE, Wu EQ, Zhou Z, Song J, Ohashi E, Kelley C, Massarweh SA. Patient characteristics, treatment, and outcomes in recurrent HR+/HER2- advanced breast cancer after adjuvant therapy: A retrospective chart review of community-based practice. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e11550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yanni Hao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
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Hao Y, Signorovitch JE, Macalalad AR, Wu EQ, Lin PL, Zhou Z, Song J, Ohashi E, Kelley C, Massarweh SA. Treatment sequencing and duration among HR+/HER2- advanced breast cancer patients in community-based oncology practices. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e11549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yanni Hao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
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Signorovitch JE, Wu EQ, Betts KA, Reichmann WM, Thomason D, Galebach PJ, Chen L. One-year and longer-term molecular responses to nilotinib and dasatinib for newly diagnosed chronic myeloid leukemia: A matching-adjusted indirect comparison. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.7072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Lei Chen
- Novartis Pharmaceuticals, East Hanover, NJ
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Wu EQ, Hao Y, Signorovitch JE, Lin PL, Macalalad AR, Zhou Z, Song J, Ohashi E, Kelley C, Massarweh SA. Physician treatment preferences for HR+/HER2- advanced breast cancer patients: A survey of community oncology practices in the United States. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e11517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Yanni Hao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
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Lin PL, Macalalad AR, Hao Y, Signorovitch JE, Wu EQ, Zhou Z, Song J, Ohashi E, Kelley C, Massarweh SA. Characteristics, treatment, and outcomes of patients with de novo HR+/HER2- advanced breast cancer: A retrospective chart review of community-based oncology practices. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e11516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Yanni Hao
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
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41
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Wong MK, Yang H, Signorovitch JE, Wang X, Liu Z, Liu NS, Qi CZ, George DJ. Comparative outcomes of everolimus, temsirolimus and sorafenib as second targeted therapies for metastatic renal cell carcinoma: a US medical record review. Curr Med Res Opin 2014; 30:537-45. [PMID: 24329572 DOI: 10.1185/03007995.2013.871243] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare outcomes of metastatic renal cell carcinoma (mRCC) patients treated with everolimus, temsirolimus, and sorafenib following initial treatment with a tyrosine kinase inhibitor (TKI) in community and academic practices throughout the US. RESEARCH DESIGN AND METHODS Medical records of mRCC patients who received everolimus, temsirolimus or sorafenib as their second therapy following a TKI were retrospectively reviewed from a nationally representative panel of oncologists. Overall survival (OS) and progression-free survival (PFS) of second targeted therapies were compared using multivariable Cox proportional hazard models, with adjustment for demographics, disease severity and prior treatments. RESULTS A total of 233, 178, and 123 mRCC patients receiving everolimus, temsirolimus, and sorafenib, respectively, as second targeted therapies were included. Eighty-six percent used sunitinib and the remainder used sorafenib or pazopanib as their initial TKI. After adjusting for baseline characteristics, everolimus was associated with significantly prolonged OS (hazard ratio [HR] 0.60; CI 0.42-0.85; p = 0.004) and PFS (HR 0.73; CI 0.54-0.97; p = 0.032) compared to temsirolimus. Everolimus was associated with significantly longer OS (HR 0.66; CI 0.44-0.99; p = 0.045) and numerically longer PFS compared to sorafenib. No significant differences were observed between temsirolimus and sorafenib. LIMITATIONS Despite adjustment for multiple patient characteristics, comparisons between treatment groups may be confounded by unobserved factors in this retrospective observational study. Tolerability outcomes were not collected. CONCLUSIONS In this retrospective, non-randomized study of mRCC patients with prior TKI treatment, everolimus was associated with significantly prolonged OS and PFS compared to temsirolimus and significantly prolonged OS compared to sorafenib.
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Affiliation(s)
- Michael K Wong
- Norris Comprehensive Cancer Center, University of Southern California , Los Angeles, CA , USA
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42
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Thune JJ, Signorovitch JE, Kober L, McMurray JJ, Swedberg K, Rouleau J, Maggioni A, Velazquez E, Califf R, Pfeffer MA, Solomon SD. Predictors and prognostic impact of recurrent myocardial infarction in patients with left ventricular dysfunction, heart failure, or both following a first myocardial infarction. Eur J Heart Fail 2014; 13:148-53. [DOI: 10.1093/eurjhf/hfq194] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Jens Jakob Thune
- Cardiovascular Division; Brigham and Women's Hospital; 75 Francis Street Boston MA 02115 USA
- Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - James E. Signorovitch
- Cardiovascular Division; Brigham and Women's Hospital; 75 Francis Street Boston MA 02115 USA
| | - Lars Kober
- Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | | | | | | | | | | | | | - Marc A. Pfeffer
- Cardiovascular Division; Brigham and Women's Hospital; 75 Francis Street Boston MA 02115 USA
| | - Scott D. Solomon
- Cardiovascular Division; Brigham and Women's Hospital; 75 Francis Street Boston MA 02115 USA
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Sawicki GS, Ayyagari R, Zhang J, Signorovitch JE, Fan L, Swallow E, Latremouille-Viau D, Wu EQ, Shi L. A pulmonary exacerbation risk score among cystic fibrosis patients not receiving recommended care. Pediatr Pulmonol 2013; 48:954-61. [PMID: 23255309 DOI: 10.1002/ppul.22741] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 08/10/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pulmonary exacerbations (PEx) lead to substantial morbidity in cystic fibrosis (CF), and guidelines recommend chronic medication including dornase alfa and inhaled tobramycin. However PEx risk and medication use vary across patients. OBJECTIVE To develop a PEx risk score among CF patients not receiving guideline-recommended chronic respiratory medications. METHODS A cohort of patients with FEV1%-predicted between 25% and 75% without evidence of dornase alfa or inhaled tobramycin use in an index year, despite meeting guideline recommended criteria, was identified from the CF Foundation Patient Registry (2002-2008). This sample was randomly split into 2/3 for a development sample and 1/3 for a validation sample. A multivariable risk score was developed to predict PEx requiring hospitalization or home IV treatment using available patient characteristics. Its predictive performance was assessed in the validation sample. RESULTS Among 3,069 patient-years, 1,275 (42%) had PEx in the subsequent year. The risk score included, in order of decreasing impact on PEx risk, prior PEx, Pseudomonas aeruginosa, allergic bronchopulmonary aspergillosis, depression, methicillin-resistant Staphylococcus aureus, CF-related diabetes, Burkholderia cepacia, prior use of dornase alfa, bronchodilator use, prior use of inhaled tobramycin and lower FEV1%-predicted. Stratifying patients by risk score in the validation sample identified actual risks ranging from 14% in the lowest decile to 90% in the highest. The c-statistic was 0.8. CONCLUSIONS A PEx risk score for CF patients not receiving guideline-recommended chronic therapies was developed and validated, and identified patients with a wide range of risk. This score could identify high-risk patients in whom chronic therapies should be initiated or continued.
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Affiliation(s)
- Gregory S Sawicki
- Division of Respiratory Diseases, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
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Erder MH, Xie J, Signorovitch JE, Chen KS, Hodgkins P, Lu M, Wu EQ, Sikirica V. Authors' reply to Alatorre et al.: "cost effectiveness of guanfacine extended-release versus atomoxetine for the treatment of attention-deficit/hyperactivity disorder: application of a matching-adjusted indirect comparison". Appl Health Econ Health Policy 2013; 11:307. [PMID: 23592392 PMCID: PMC3663979 DOI: 10.1007/s40258-013-0025-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- M. Haim Erder
- Shire Development LLC, 725 Chesterbrook Blvd, Wayne, PA 19087 USA
| | - Jipan Xie
- Analysis Group, Inc., Boston, MA USA
| | | | - Kristina S. Chen
- Shire Development LLC, 725 Chesterbrook Blvd, Wayne, PA 19087 USA
| | - Paul Hodgkins
- Shire Development LLC, 725 Chesterbrook Blvd, Wayne, PA 19087 USA
| | - Mei Lu
- Analysis Group, Inc., Boston, MA USA
| | | | - Vanja Sikirica
- Shire Development LLC, 725 Chesterbrook Blvd, Wayne, PA 19087 USA
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Signorovitch JE, Vogelzang NJ, Pal SK, Lin PL, George DJ, Wong MK, Liu Z, Wang X, Culver KW, Scott JA, Jonasch E. Comparative effectiveness of second-line targeted therapies for metastatic renal cell carcinoma: Analysis of two practice-based chart reviews. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e15504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15504 Background: Second-line targeted therapies for metastatic renal cell carcinoma (mRCC) include mammalian target of rapamycin (mTOR) inhibitors and tyrosine kinase inhibitors (TKIs). This study aimed to compare practice-based effectiveness of these therapies in a recent chart review, and to compare findings with a previous chart review (Yang et al., 2012. ASCO). Methods: Community-based medical oncologists/hematologists (N=36) reviewed charts for ≤ 15 patients each. Included patients were aged ≥ 18 years, received a 1st-line TKI and initiated 2nd-line targeted therapy in 2010 or later. The primary outcome was time from 2nd-line initiation to treatment failure (TTF; discontinuation, physician-assessed progression, or death, whichever occurred first). TTF was compared among patients receiving 2nd-line everolimus (EVE), temsirolimus (TEM), or TKI as a class (sunitinib, sorafenib, pazopanib or axitinib), using a multivariable Cox proportional hazards model adjusting for characteristics including type of initial TKI and response, histological subtype, performance status, and sites of metastasis. Hazard ratios (HRs) for TTF were pooled with previously-reported HRs for progression-free survival (PFS) from a previous chart review in a meta-analysis. Results: A total of 138, 64 and 79 patients received 2nd-line therapy with EVE, TEM or a TKI, respectively. Mean age was 63 years, mean duration of mRCC 13.5 months, and median follow-up 6 months. After adjusting for baseline characteristics, EVE was associated with a 28% and 26% reduction in the hazard of TTF compared to TEM and TKI, respectively. Pooling both studies, EVE was associated with significantly reduced hazards of TTF compared to TEM and TKI (Table). TTF differences between TEM and TKI were not significant. Conclusions: In two retrospective chart reviews EVE was associated with consistently reduced hazards of 2nd-line treatment failure in mRCC compared to TEM and TKIs. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | - Zhimei Liu
- Novartis Pharmaceuticals Corp, East Hanover, NJ
| | | | | | | | - Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Lin PL, Pal SK, Jonasch E, Signorovitch JE, Liu Z, Culver KW, Scott JA, Vogelzang NJ. Association between guideline-adherent imaging and overall survival following second-line targeted therapy for metastatic renal cell carcinoma. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e15538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15538 Background: NCCN guidelines recommend imaging at 2-6 months after initiation of targeted therapy for metastatic renal cell carcinoma (mRCC). This study assessed the association between guideline-adherent imaging and overall survival in mRCC. Methods: Thirty-six community-based medical oncologists/hematologists reviewed charts for ≤ 15 mRCC patients each. Included patients were aged ≥ 18 years and initiated 2nd targeted therapy in 2010 or later. Patients alive up to month 6 were categorized into 3 groups based on time of first imaging test: early (0-60 days), guideline-adherent (61-180 days), and delayed(> 180 days). Overall survival (OS) was compared using multivariable Cox proportional hazards models adjusted for age, gender, duration of mRCC, prior treatments, comorbidities, metastatic sites, 1st targeted therapy, ECOG and MSKCC status, 2nd targeted therapy, and progression status (based on symptoms or imaging) in the first 6 months on 2nd line therapy. Reasons for imaging were also assessed. Results: Among the 192 patients included in the analysis, 25 received early imaging, 136 received guideline-adherent imaging, and 31 received delayed imaging. First imaging tests were more likely due to worsening symptoms or changes in a palpable mass, as opposed to routine monitoring, among patients with delayed vs. guideline adherent imaging (20.0% vs. 7.1%, P = 0.005). After adjusting for baseline characteristics, guideline-adherent imaging was associated with a 64% lower hazard of death compared to delayed imaging (hazard ratio (HR) = 0.36, 95% confidence interval (CI) 0.14 to 0.93, P = 0.035). Adjusted 1-year survival was 82% in the guideline-adherent compared to 67% in the delayed imaging group. The hazard of death did not differ between those with early vs. guideline-adherent imaging (HR = 1.05, 95% CI 0.35-3.12, P = 0.927). Conclusions: Among patients surviving 6 months after the initiation of 2nd targeted therapy for mRCC, timely first imaging within 2-6 months, consistent with guidelines, was associated with significantly prolonged overall survival compared to delayed imaging. Further investigation is warranted with larger samples.
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Affiliation(s)
| | | | - Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Zhimei Liu
- Novartis Pharmaceuticals Corp, East Hanover, NJ
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Wong MK, Jonasch E, Pal SK, Signorovitch JE, Lin PL, Liu Z, Wang X, Culver KW, Scott JA, George DJ, Vogelzang NJ. Survival following initiation of everolimus for second-line treatment of metastatic renal cell carcinoma: Prognostic factors in clinical practice and comparison to clinical trials. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e15500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15500 Background: Current overall survival (OS) for metastatic renal cell carcinoma (mRCC) patients in clinical practice may differ from clinical trials. We aimed to identify and validate prognostic factors for OS in practice-based patients receiving 2nd-line everolimus (EVE), and to compare their OS vs. the RECORD-1 trial of EVE for mRCC. Methods: Two separate samples of oncologists/hematologists reviewed charts for patients initiating 2nd-line EVE between 2009 and 2011 following a 1st-line tyrosine kinase inhibitor (TKI). OS was defined as time from EVE initiation to death (censored at last follow-up). In the 1st sample of charts (the study sample), prognostic factors were identified via multivariable Cox proportional hazards models with stepwise selection. Prognostic factors considered included age, duration of mRCC and 1st-line treatment, metastatic sites, diabetes, histological subtype, ECOG and KPS score, and progression during 1st-line treatment. Model performance was assessed in the 2nd sample (the validation sample). Kaplan-Meier (KM) estimates for OS were compared between chart data and RECORD-1. Results: The study and validation samples included 220 and 97 patients, respectively. Significant prognostic factors were clear cell histology (hazard ratio (HR) = 2.9), KPS score <80% (HR = 2.9), duration of mRCC <1 year (HR = 2.7), progression on 1st-line TKI (HR = 2.2), and liver metastasis (HR = 1.9) (all P <.05). In the validation sample, KM estimates for 1-year OS were 90% for patients with 0-2 risk factors, 62% for patients with 3 risk factors, and 20% for patients with 4-5 risk factors (log-rank P <.001). OS estimates were consistent between both chart samples with 1-year OS probabilities of 67% and 68% and median OS of 19 and 23 months. In RECORD-1 1-year OS was 60% and median OS was 14.8 months (Motzer et al., 2010, Cancer). Conclusions: Prognostic factors for OS following 2nd-line EVE for mRCC in clinical practice were consistent with those previously identified in trial data. However, OS with 2nd-line EVE in clinical practice was longer than observed in trial data, and was not associated with type of 1st-line TKI.
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Affiliation(s)
| | - Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Zhimei Liu
- Novartis Pharmaceuticals Corp, East Hanover, NJ
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Signorovitch JE, Macaulay D, Diener M, Yan Y, Wu EQ, Gruenberger JB, Frier BM. Hypoglycaemia and accident risk in people with type 2 diabetes mellitus treated with non-insulin antidiabetes drugs. Diabetes Obes Metab 2013; 15:335-41. [PMID: 23121373 PMCID: PMC3593162 DOI: 10.1111/dom.12031] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 09/25/2012] [Accepted: 10/24/2012] [Indexed: 12/11/2022]
Abstract
AIMS To assess associations between hypoglycaemia and risk of accidents resulting in hospital visits among people with type 2 diabetes receiving antidiabetes drugs without insulin. METHODS People with type 2 diabetes who were not treated with insulin were identified from a US-based employer claims database (1998-2010). Following initiation of an antidiabetes drug, the occurrence of accidents resulting in hospital visits was compared between people with, and without, claims for hypoglycaemia using multivariable Cox proportional hazard models adjusted for demographics, comorbidities, prior treatments and prior medical service use. Additional analyses were stratified by age 65 years or older. RESULTS A total of N = 5582 people with claims for hypoglycaemia and N = 27,910 with no such claims were included. Accidents resulting in hospital visits occurred in 5.5 and 2.8% of people with, and without, hypoglycaemia, respectively. After adjusting for baseline characteristics, hypoglycaemia was associated with significantly increased hazards for any accident [hazard ratio (HR) 1.39, 95% CI 1.21-1.59, p < 0.001], accidental falls (HR 1.36, 95% CI 1.13-1.65, p < 0.001) and motor vehicle accidents (HR 1.82, 95% CI 1.18-2.80, p = 0.007). In age-stratified analyses, hypoglycaemia was associated with greater hazards of driving-related accidents in people younger than age 65 and falls in people aged 65 or older. CONCLUSIONS In people with type 2 diabetes receiving antidiabetes drugs without insulin, hypoglycaemia was associated with a significantly higher risk of accidents resulting in hospital visits, including accidents related to driving and falls.
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Affiliation(s)
- J E Signorovitch
- Health Economics and Outcomes Research, Analysis Group, Inc., Boston, MA 02199, USA.
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Jonasch E, Signorovitch JE, Lin PL, Liu Z, Culver KW, Pal SK, Scott JA, Vogelzang NJ. Outcomes of second-targeted therapy for mRCC: A retrospective chart review of community practices in the United States. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.6_suppl.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
424 Background: Sequential use of targeted therapies has become standard practice for the treatment of metastatic renal cell carcinoma (mRCC). This study describes treatment outcomes of the 2nd-targeted therapy among patients with mRCC treated in the community setting. Methods: A retrospective chart review and survey was conducted during May through June 2012 among community-based oncologists or hematologists. Charts were reviewed for adult mRCC patients initiated on 2nd -targeted therapy on or after January 1, 2010. Abstracted data included patient demographics, disease characteristics, treatment duration, dose adjustment, progression, mortality, and imaging test patterns. Kaplan-Meier analysis was used to estimate treatment duration, overall survival (OS) and progression-free survival (PFS) during 2nd-targeted therapy. Patients were censored at the most recent contact. Results: Charts were reviewed for 433 mRCC patients. Mean age was 63 years at initial mRCC diagnosis and 64% were male. The most commonly used 2nd targeted therapies were everolimus (36% of patients), temsirolimus (17%), pazopanib (15%), and sunitinib (14%). The median duration of 2nd -targeted therapy was 10.5 months (95% CI: 8.8-11.5). The majority of patients (73%) had no dose adjustment on 2nd-targeted therapy; the most common reason for adjustment was drug toxicity (70%). Among the 44% of patients who discontinued 2nd-targeted therapy, disease progression was the most common reason for discontinuation. The proportion of patients who received imaging test within 3, 6, and 12 months after 2nd-line treatment initiation was 57%, 92%, and 99%, respectively. Routine monitoring (83%) was the most common reason for imaging tests. Median durations of OS and PFS after initiation of the 2nd-targeted therapy were 30.4 months (95% CI: 23.5-not reached) and 10.7 months (95% CI: 8.4-12.2), respectively. Conclusions: In this large, retrospective chart review study, median treatment duration of 2nd -targeted therapy was 10.5 months, median OS was 30.4 months, and median PFS was 10.7 months. Median treatment duration in community practice was longer than in clinical trials for targeted therapies in mRCC.
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Affiliation(s)
- Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Zhimei Liu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
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Vogelzang NJ, Signorovitch JE, Lin PL, Liu Z, Culver KW, Scott JA, Pal SK, Jonasch E. Sequential use of targeted therapies for metastatic renal cell carcinoma: A physician survey and chart review of community oncology practices in the United States. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.6_suppl.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
418 Background: Multiple targeted agents are available to treat metastatic renal cell carcinoma (mRCC) and no consensus has been reached for optimal treatment sequencing. This study describes physician-reported treatment preferences, reasons for treatment choices, and current treatment patterns for mRCC in the community setting. Methods: A physician survey and retrospective chart review was conducted during May and June 2012 among community-based oncologists or hematologists who had ≥5 mRCC patients under their care in 2011. Charts were reviewed for adult mRCC patients initiated on 2nd-targeted therapy after January 2010 to collect information on current treatment sequence in mRCC patients and reasons for treatment choices. A parallel survey collected physician treatment preferences for 1st-, 2nd-, and 3rd-targeted therapies for mRCC patients with good or poor prognosis. Results: The study included surveys from 36 physicians and charts from 433 mRCC patients. The majority of patients (77%) received a tyrosine kinase inhibitor (TKI) and the rest (23%) received a mammalian target of rapamycin inhibitor (mTOR) as the 1st-targeted therapy. Sunitinib was the most common TKI and temsirolimus was the most common mTOR in the 1st-line setting. Among patients receiving 1st-line TKI, 34% received TKI (pazopanib was most used TKI) and 66% received mTOR (everolimus was most used mTOR) in the 2nd-line. Among 1st-line mTOR users, 94% used TKI (sunitinib was most used) and 6% mTOR (everolimus was most used) for 2nd-line. TKI-mTOR-TKI was the most commonly observed treatment sequence. Physician-stated preferences for 1st and 2nd targeted therapies were largely consistent with the results from the chart review, though actual mTOR use in the 2nd-line was greater than expected. Treatment guidelines and evidence from clinical trials were the top-ranked factors impacting treatment choices. Conclusions: In this large, retrospective chart review, TKI-mTOR-TKI was the most commonly observed treatment sequence for mRCC in the community setting.
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Affiliation(s)
| | | | | | - Zhimei Liu
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | | | | | - Eric Jonasch
- The University of Texas MD Anderson Cancer Center, Houston, TX
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