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Gibbons JB, Bennett CL, Carson KR, Anderson GF. Adjusting starting points for initial price offers: the example of ibrutinib. Am J Manag Care 2024; 30:193-196. [PMID: 38603534 DOI: 10.37765/ajmc.2024.89531] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
The Inflation Reduction Act of 2022 (IRA) allows the Medicare program to negotiate drug prices beginning in 2024. Based on the guidance in the statute, CMS has selected specific data items to use to adjust initial price offers for 10 drugs in the decision-making process. Although much of the data are publicly available, some of these data items will need to be collected directly from drug companies. A 2019 US House of Representatives Committee on Oversight and Accountability investigative report collected a wide range of data from manufacturers of 12 high-revenue drugs that show what is available from the drug companies, including development costs, marketing, pricing, competition, and patent status. This article focuses on the data obtained for ibrutinib, an oral medication for treating hematologic malignancies, which is one of the only drugs reviewed by the committee that also has been selected for Medicare price negotiation. We examine data that can be obtained only from the drug manufacturer that the IRA has explicitly identified as being used to determine the price and suggest potential negotiation strategies for CMS in response.
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Affiliation(s)
- Jason B Gibbons
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205.
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Riekhof F, Yan Y, Bennett CL, Sanfilippo KM, Carson KR, Chang SH, Georgantopoulos P, Luo S, Govindan S, Cheranda N, Afzal A, Schoen MW. Hospitalizations Among Veterans Treated for Metastatic Prostate Cancer With Abiraterone or Enzalutamide. Clin Genitourin Cancer 2024; 22:18-26.e3. [PMID: 37495480 DOI: 10.1016/j.clgc.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/13/2023] [Revised: 06/24/2023] [Accepted: 07/06/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Abiraterone and enzalutamide are second generation androgen receptor pathway inhibitors (ARPIs) used to treat advanced or metastatic prostate cancer. Without head-to-head comparative studies identifying 1 agent as preferred initial therapy, physician preferences guide initial ARPI choice. This study compares hospitalizations among patients treated initially with abiraterone versus enzalutamide. PATIENTS AND METHODS United States veterans treated with abiraterone or enzalutamide between May 13, 2011 and December 31, 2019; then compared hospitalization rate during first treatment with ARPI in the Veterans Healthcare Administration. Baseline incidence rate of hospitalization was determined from data 1 year prior to ARPI. Incidence Rate Difference (IRD) was calculated using χ2 test and difference in IRD using Poisson Regression. RESULTS 19,775 veterans were identified; 13,527 (68.4%) were initially treated with abiraterone and 6248 (31.6%) initially with enzalutamide. The enzalutamide cohort was older (75.8 vs. 74.5 years, P < .001) and had higher baseline comorbidities at ARPI initiation (4.4 vs. 4.0, P < .001). Patients were treated with enzalutamide longer than abiraterone (median 9.0 vs. 8.0 months, P < .001). Total hospitalizations increased from 465 per 1000 person-years in the year prior to treatment with abiraterone to 567 during treatment. Total hospitalizations increased from 417 per 1000 person-years in the year prior to treatment with enzalutamide to 430 during treatment. Total rate of hospitalization increased 22% for abiraterone compared to a 3% increase for enzalutamide in the 12 months after ARPI initiation (P < .0001). Abiraterone was associated with greater increase in rates of acute heart failure, atrial fibrillation, acute kidney injury, urinary tract infections, sepsis, and pneumonia. CONCLUSION By comparing the rate of hospitalization before vs. during treatment, real world analyses identified a 22% versus 3% increase in hospitalizations with abiraterone compared to enzalutamide respectively, despite being used in a younger population with less comorbid disease. Abiraterone was also associated with higher risk of infections, a novel finding.
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Affiliation(s)
- Forest Riekhof
- Saint Louis Veterans Affairs Medical Center, Saint Louis, MO; Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO
| | - Yan Yan
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Charles L Bennett
- Department of Clinical Pharmacy and Outcomes Sciences (CPOS), College of Pharmacy, University of South Carolina, Columbia, SC
| | - Kristen M Sanfilippo
- Saint Louis Veterans Affairs Medical Center, Saint Louis, MO; Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Kenneth R Carson
- Department of Medicine, Northwestern University Feinberg School of Medicine
| | - Su-Hsin Chang
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Peter Georgantopoulos
- Department of Clinical Pharmacy and Outcomes Sciences (CPOS), College of Pharmacy, University of South Carolina, Columbia, SC
| | - Suhong Luo
- Saint Louis Veterans Affairs Medical Center, Saint Louis, MO; Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Srinivas Govindan
- Saint Louis Veterans Affairs Medical Center, Saint Louis, MO; Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO
| | - Nina Cheranda
- Saint Louis Veterans Affairs Medical Center, Saint Louis, MO; Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO
| | - Amber Afzal
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Martin W Schoen
- Saint Louis Veterans Affairs Medical Center, Saint Louis, MO; Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO.
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Bennett CL, Gibbons JB, Trujillo A, Carson KR, Knopf K, Nabhan C, Rosen ST, Aboulafia DM. Congressional Investigation of RevAssist-Linked and General Pricing Strategies for Lenalidomide. JCO Oncol Pract 2024:OP2300579. [PMID: 38412398 DOI: 10.1200/op.23.00579] [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] [Received: 09/11/2023] [Revised: 12/07/2023] [Accepted: 01/05/2024] [Indexed: 02/29/2024] Open
Affiliation(s)
- Charles L Bennett
- SmartState Center for Medication Safety and Efficacy at the University of South Carolina, Columbia, SC
- Department of Health Systems Management and Policy, Colorado School of Public Health, Denver, Colorado
| | - Jason B Gibbons
- Department of Health Systems Management and Policy, Colorado School of Public Health, Denver, Colorado
| | - Antonio Trujillo
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kenneth R Carson
- Department of Hematology/Hematopoietic Cell Transplantation, The City of Hope Comprehesive Cancer Center, Duarte, CA
| | - Kevin Knopf
- SmartState Center for Medication Safety and Efficacy at the University of South Carolina, Columbia, SC
| | - Chadi Nabhan
- SmartState Center for Medication Safety and Efficacy at the University of South Carolina, Columbia, SC
| | - Steven T Rosen
- Department of Hematology/Hematopoietic Cell Transplantation, The City of Hope Comprehesive Cancer Center, Duarte, CA
- Floyd and Delores Jones Cancer Institute at Virginia Mason, Seattle, WA
| | - David M Aboulafia
- Floyd and Delores Jones Cancer Institute at Virginia Mason, Seattle, WA
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Schoen MW, Carson KR, Eisen SA, Bennett CL, Luo S, Reimers MA, Knoche EM, Whitmer AL, Yan Y, Drake BF, Sanfilippo KM. Correction to: Survival of veterans treated with enzalutamide and abiraterone for metastatic castrate resistant prostate cancer based on comorbid diseases. Prostate Cancer Prostatic Dis 2023; 26:811. [PMID: 37253974 PMCID: PMC10638080 DOI: 10.1038/s41391-023-00680-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Martin W Schoen
- Saint Louis Veterans Affairs Medical Center, Saint Louis, MO, USA.
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA.
| | | | - Seth A Eisen
- Saint Louis Veterans Affairs Medical Center, Saint Louis, MO, USA
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | | | - Suhong Luo
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Melissa A Reimers
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Eric M Knoche
- Saint Louis Veterans Affairs Medical Center, Saint Louis, MO, USA
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Alison L Whitmer
- Saint Louis Veterans Affairs Medical Center, Saint Louis, MO, USA
| | - Yan Yan
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Bettina F Drake
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Kristen M Sanfilippo
- Saint Louis Veterans Affairs Medical Center, Saint Louis, MO, USA
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
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Schoen MW, Carson KR, Eisen SA, Bennett CL, Luo S, Reimers MA, Knoche EM, Whitmer AL, Yan Y, Drake BF, Sanfilippo KM. Survival of veterans treated with enzalutamide and abiraterone for metastatic castrate resistant prostate cancer based on comorbid diseases. Prostate Cancer Prostatic Dis 2023; 26:743-750. [PMID: 36104504 PMCID: PMC10638085 DOI: 10.1038/s41391-022-00588-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/03/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Comorbid diseases influence patient outcomes, yet little is known about how comorbidities interact with treatments for metastatic castrate-resistant prostate cancer (mCRPC). No head-to-head trials have compared the efficacy of abiraterone and enzalutamide - oral androgen-receptor targeted agents (ARTAs) for mCRPC. In patients with comorbid disease, outcomes with ARTAs may differ due to disparate mechanisms of action, adverse events, and drug interactions. METHODS Retrospective observational study of US veterans initiating treatment for mCRPC with abiraterone or enzalutamide between September 2014 and June 2017. Treatment duration and overall survival (OS) was compared based on age and comorbid diseases. The association between ARTA and OS was assessed using Cox proportional hazards and propensity-score matched modeling while adjusting for potential confounders. Sensitivity analyses were performed based on patient age, comorbidities, and subsequent treatments for mCRPC. RESULTS Of 5822 veterans treated for mCRPC, 43.0% initially received enzalutamide and 57.0% abiraterone. Veterans initially treated with enzalutamide versus abiraterone were older (mean 75.8 vs. 75.0 years) with higher mean Charlson comorbidity index (4.4 vs. 4.1), and higher rates of cardiovascular disease or diabetes (74.2% vs. 70.6%). In the entire population, veterans initially treated with enzalutamide had longer median OS compared to those initially treated with abiraterone (24.2 vs. 22.1 months, p = 0.001). In veterans with cardiovascular disease or diabetes, median treatment duration with enzalutamide was longer (11.4 vs. 8.6 months, p < 0.001) with longer median OS compared to abiraterone (23.2 vs. 20.5 months, p < 0.001). In a propensity score matched cohort, enzalutamide was associated with decreased mortality compared to abiraterone (HR 0.90, 95% CI 0.84-0.96). CONCLUSIONS Veterans with cardiovascular disease or diabetes had longer treatment duration and OS with enzalutamide compared to abiraterone. Further study of ARTA selection may benefit men with metastatic castrate resistant prostate cancer and likely hormone sensitive prostate cancer, especially among patients with comorbid diseases.
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Affiliation(s)
- Martin W Schoen
- Saint Louis Veterans Affairs Medical Center, Saint Louis, MO, USA.
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA.
| | | | - Seth A Eisen
- Saint Louis Veterans Affairs Medical Center, Saint Louis, MO, USA
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | | | - Suhong Luo
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Melissa A Reimers
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Eric M Knoche
- Saint Louis Veterans Affairs Medical Center, Saint Louis, MO, USA
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Alison L Whitmer
- Saint Louis Veterans Affairs Medical Center, Saint Louis, MO, USA
| | - Yan Yan
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Bettina F Drake
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Kristen M Sanfilippo
- Saint Louis Veterans Affairs Medical Center, Saint Louis, MO, USA
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
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Chiattone C, Civallero M, Fischer T, Miranda E, Manni M, Zing NPC, Pileri SA, Montoto S, Horwitz SM, Cabrera ME, De Souza CA, Nagler A, Luminari S, Ferreri AJM, Carson KR, Re A, Rigacci L, Nassi L, Stepanishyna Y, Federico M, Inghirami G. Characteristics and clinical outcomes of patients with ALK-positive anaplastic large cell lymphoma: Report from the prospective international T-cell lymphoma project. Hematol Oncol 2022; 40:953-961. [PMID: 36083035 DOI: 10.1002/hon.3074] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 06/23/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 12/13/2022]
Abstract
The T-cell Lymphoma Project is an international registry prospective study that enrolled patients with newly diagnosed peripheral T-cell and NK-cell lymphomas (PTCL). The main objective was to define the clinical features and outcomes, establishing a robust benchmark for future clinical trials. Seventy-four institutions from 14 countries in North America, South America, Europe, and Asia collected data on patients diagnosed and treated at their respective centers between September 2006 and February 2018. Among 1553 PTCL patients, 131 (8.4% of the total cohort) were confirmed to have anaplastic large cell lymphoma - kinase positive (ALCL, ALK+). The median age of the patients was 39 years (18-84). Sixty-five patients (66%) had advanced-stage disease, although majority (45 patients, 54%) had a low-risk International Prognostic Index (IPI) score (0-1). Of 97 patients treated with chemotherapy, 97% received anthracycline-containing regimens. The overall response rate was 81%, with 69 patients (70%) achieving complete remission. Estimated OS and PFS at 3 years were 77% (95% CI: 54%-99%) and 68% (95% CI: 46%-90%), respectively, and at 5 years were very similar, 77% of OS (95% CI: 62%-92%) and 64% of PFS (95% CI: 34%-94%). Multivariate analysis for PFS showed advanced stage (hazard ratios [HR]: 4.72, 95% CI: 1.43-23.9, p = 0.015), elevated lactate dehidrogenade (LDH) (HR 4.85; 95% CI: 1.73-13.60, p = 0.001), and Eastern Cooperative Oncology Group Performance Status scale (ECOG-PS) ≥2 (HR: 5.25; 95% CI: 1.68-16.4, p = 0.024). For OS, elevated LDH (HR: 3.77; 95% CI: 1.98-14.17, p = 0.014) and ECOG-PS ≥2 (HR: 4.59; 95% CI: 1.46-14.39, p = 0.004) were identified. In summary, although the outcome of ALK+ ALCL is superior to that of other PTCLs, it remains sufficiently favorable, given the young median age of the patients. Our results confirm the usefulness of both IPI and Prognostic Index for T-cell Lymphoma (PIT) in identifying groups of patients with different outcomes. Clinical Trials ID: NCT01142674.
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Affiliation(s)
- Carlos Chiattone
- Santa Casa Medical School of Sao Paulo, Samaritano Hospital, São Paulo, Brazil
| | - Monica Civallero
- Department of CHIMOMO, University of Modena and Reggio Emilia, Modena, Italy
| | - Thais Fischer
- Santa Casa Medical School of Sao Paulo, Samaritano Hospital, São Paulo, Brazil
| | - Eliana Miranda
- Hematology and Hemotherapy Center, University of Campinas, São Paulo, Brazil
| | - Martina Manni
- Department of CHIMOMO, University of Modena and Reggio Emilia, Modena, Italy
| | - Natalia P C Zing
- Santa Casa Medical School of Sao Paulo, Samaritano Hospital, São Paulo, Brazil
| | - Stefano A Pileri
- Division of Diagnostic Haematopathology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Silvia Montoto
- Department of Haemato-Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Steven M Horwitz
- Department Medicine,, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Maria Elena Cabrera
- Sección Hematología, Hospital del Salvador, Universidad de Chile, Santiago de Chile, Chile
| | - Carmino A De Souza
- Hematology and Hemotherapy Center, University of Campinas, São Paulo, Brazil
| | - Arnon Nagler
- Hematology Division, BMT and Cord Blood Bank, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Andrés J M Ferreri
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Kenneth R Carson
- Oncology, Internal Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Alessandro Re
- UO Ematologia A.O. Spedali Civili di Brescia, Brescia, Italy
| | - Luigi Rigacci
- S.O.D. Ematologia Dipartimento Area Critica Medico Chirurgica A.O.U. Careggi, Firenze, Italy
| | - Luca Nassi
- Department of Translational Medicine, AOU Maggiore della Carità and University of Eastern Piedmont, Novara, Italy
| | | | - Massimo Federico
- Department of CHIMOMO, University of Modena and Reggio Emilia, Modena, Italy
| | - Giorgio Inghirami
- W Pathology and Laboratory Medicine, New York Presbyterian Hospital, Weill Cornell Medicine, Weill Cornell Medical College, New York, New York, USA
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Bennani NN, Tun AM, Carson KR, Geiger JL, Maeda LS, Savage KJ, Rose J, Pinter-Brown L, Lunning MA, Abramson JS, Bartlett NL, Vose JM, Evens AM, Smith SM, Horwitz SM, Ansell SM, Advani RH. Characteristics and Outcome of Extranodal NK/T-cell Lymphoma in North America: A Retrospective Multi-Institutional Experience. Clin Lymphoma Myeloma Leuk 2022; 22:e300-e309. [PMID: 34848181 DOI: 10.1016/j.clml.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/18/2021] [Accepted: 10/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Extranodal natural killer/T-cell lymphoma (ENKTL) is rare and clinical data from non-Asian countries are lacking. It is unclear whether outcomes and disease natural history is similar to reported Asian series. We assessed characteristics and outcomes of patients with ENKTL from major North American centers. PATIENTS AND METHODS We retrospectively identified patients with newly-diagnosed CD56 + ENKTL and studied disease characteristics and clinical outcomes. RESULTS One hundred and twenty-one patients with ENKTL diagnosed between June 1990 and November 2012 were identified. Eighty-three patients (69%) had stage I/II disease and were treated with combined modality therapy (CMT) (n = 53), chemotherapy alone (CT) (n = 14) or radiotherapy alone (RT) (n = 16). Thirty-eight patients (31%) had stage III/IV disease and were treated with CMT (n = 12), CT (n = 23), or RT (n = 3). The median follow-up for the entire cohort was 51 months. Patients with stage I/II disease, compared to those with stage III/IV disease, had superior 2-year progression free survival (PFS) 43% vs 19% (P = .03) and overall survival (OS) 59% vs. 29% (P= .004). Outcomes were similar for stage I/II patients who received CMT vs. RT alone with 2-year PFS (53% vs. 47%; P= .91) and OS (67% vs. 67%; P= .58). No significant differences in outcomes were noted based on race/ethnicity. CONCLUSIONS This series represents a large experience of ENKTL treated at several major North American academic centers. Our data are consistent with Asian studies: (1) majority of patients present with early-stage disease; (2) overall poor outcome regardless of race/ethnicity; (3) CMT likely yields favorable outcomes for suitable candidates with early-stage disease.
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Affiliation(s)
| | - Aung M Tun
- Division of Hematology, Mayo Clinic, Rochester, MN; Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Kansas City, KS
| | - Kenneth R Carson
- Research Service, St Louis Veterans Affairs Medical Center, St. Louis, MO; Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | | | | | - Kerry J Savage
- Centre for Lymphoid Cancer and Department of Medical Oncology, BC Cancer, Vancouver, BC
| | - Jim Rose
- Centre for Lymphoid Cancer and Department of Medical Oncology, BC Cancer, Vancouver, BC
| | | | - Matthew A Lunning
- Divisions of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Jeremy S Abramson
- Divisions of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Nancy L Bartlett
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Julie M Vose
- Divisions of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
| | | | - Sonali M Smith
- Divisions of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Steven M Horwitz
- Division of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
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Sanfilippo KM, Carson KR, Wang T, Luo S, Edwin N, Kuderer N, Keller JM, Gage BF. Evaluation of the Khorana score for prediction of venous thromboembolism in patients with multiple myeloma. Res Pract Thromb Haemost 2022; 6:e12634. [PMID: 35028491 PMCID: PMC8742966 DOI: 10.1002/rth2.12634] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/07/2021] [Accepted: 10/19/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Guidelines recommend thromboprophylaxis for patients with multiple myeloma (MM) at high risk for venous thromboembolism (VTE). However, the optimal risk prediction model for VTE in MM remains unclear. Khorana et al developed a VTE risk score (Khorana score) in ambulatory cancer patients receiving chemotherapy. We aimed to evaluate the predictive ability of the Khorana score in patients with MM. METHODS We identified patients with MM within the Veterans Affairs health care system between 2006 and 2013. The Khorana score was calculated before treatment initiation. Using logistic regression, the relationship between risk group and VTE was assessed at 3 and 6 months. We tested model discrimination using the concordance statistic. RESULTS In the cohort of 2870 patients with MM, there were 1328 at low risk (0 points), 1521 at intermediate risk (1-2 points), and 21 at high risk (≥3 points) for VTE by the Khorana score. The 6-month cumulative incidence of VTE was 5.1% (95% confidence interval [CI], 4.0%-6.4%) in low risk, 3.9% (95% CI, 3.0%-5.0%) in intermediate risk, 4.8% (95% CI, 0.3%-20.2%) in high risk. The Khorana score did not strongly discriminate between patients who did and did not develop VTEs at 3 or 6 months (concordance statistic, 0.58; 95% CI, 0.54-0.63; and 0.53, 95% CI, 0.50-0.57, respectively. CONCLUSIONS In conclusion, in this cohort of 2870 patients with MM, the Khorana score did not predict VTE. Our study supports the need to use myeloma-specific risk models to predict VTE risk in patients with MM.
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Affiliation(s)
- Kristen M. Sanfilippo
- Washington University School of Medicine in St. LouisSt. LouisMissouriUSA
- St. Louis Veterans Affairs Medical CenterSt. LouisMissouriUSA
| | | | - Tzu‐Fei Wang
- University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - Suhong Luo
- Washington University School of Medicine in St. LouisSt. LouisMissouriUSA
- St. Louis Veterans Affairs Medical CenterSt. LouisMissouriUSA
| | - Natasha Edwin
- ThedaCare Regional Cancer CenterAppletonWisconsinUSA
| | | | - Jesse M. Keller
- Washington University School of Medicine in St. LouisSt. LouisMissouriUSA
- St. Louis Veterans Affairs Medical CenterSt. LouisMissouriUSA
| | - Brian F. Gage
- Washington University School of Medicine in St. LouisSt. LouisMissouriUSA
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Bennett CL, Witherspoon B, Carson KR, Thomsen HS. Was There Something Rotten in Denmark: Nephrogenic System Fibrosis Cases Occurring in Copenhagen. Cancer Treat Res 2022; 184:87-102. [PMID: 36449190 DOI: 10.1007/978-3-031-04402-1_6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
More than half of all serious adverse drug reactions are identified seven years after FDA approval. One recent and unusual example involves a syndrome initially termed nephrogenic dermatopathic fibrosis, and then called nephrogenic systemic fibrosis (NSF).
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Affiliation(s)
- Charles L Bennett
- SONAR (Southern Network on Adverse Reactions) Program, University of South Carolina College of Pharmacy, Columbia, SC, 29208, USA
| | - Bartlett Witherspoon
- SONAR (Southern Network on Adverse Reactions) Program, University of South Carolina College of Pharmacy, Columbia, SC, 29208, USA
| | - Kenneth R Carson
- SONAR (Southern Network on Adverse Reactions) Program, University of South Carolina College of Pharmacy, Columbia, SC, 29208, USA
| | - Henrik S Thomsen
- SONAR (Southern Network on Adverse Reactions) Program, University of South Carolina College of Pharmacy, Columbia, SC, 29208, USA.
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Bennett CL, Witherspoon B, Carson KR. Rituximab-Associated Progressive Multifocal Leukoencephalopathy: A Twenty-Year Update. Cancer Treat Res 2022; 184:103-111. [PMID: 36449191 DOI: 10.1007/978-3-031-04402-1_7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Progressive multifocal leukoencephalopathy (PML) is a John-Cunningham virus-related central nervous system that is rarely observed in persons treated with the anti-CD20 monoclonal antibody, rituximab.
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Affiliation(s)
- Charles L Bennett
- SONAR (Southern Network on Adverse Reactions) Program, University of South Carolina College of Pharmacy, Columbia, SC, 29208, USA
| | - Bartlett Witherspoon
- SONAR (Southern Network on Adverse Reactions) Program, University of South Carolina College of Pharmacy, Columbia, SC, 29208, USA
| | - Kenneth R Carson
- SONAR (Southern Network on Adverse Reactions) Program, University of South Carolina College of Pharmacy, Columbia, SC, 29208, USA.
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Kraus AL, Yu-Kite M, Mardekian J, Cotter MJ, Kim S, Decembrino J, Snow T, Carson KR, Motyl Rockland J, Gossai A, Wilner K, Wang DD, Huang Bartlett C, Oharu N, Schnell P, VanArsdale T, Lu DR, Tursi JM. Real-World Data of Palbociclib in Combination With Endocrine Therapy for the Treatment of Metastatic Breast Cancer in Men. Clin Pharmacol Ther 2021; 111:302-309. [PMID: 34668577 DOI: 10.1002/cpt.2454] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/06/2021] [Indexed: 12/27/2022]
Abstract
This report examined the benefits and risks of palbociclib plus endocrine therapy (ET) in men with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (MBC). Palbociclib was evaluated using three independent data sources: real-world data from pharmacy and medical claims, a de-identified real-world data source derived from electronic health records (EHRs), and a global safety database. From medical and pharmacy records, 1,139 men with MBC were identified; in the first-line setting, median duration of treatment was longer with palbociclib plus ET (n = 37, 8.5 months, 95% confidence interval (CI), 4.4-13.0) than ET alone (n = 214, 4.3 months, 95% CI, 3.0-5.7) and specifically, was longer with palbociclib plus letrozole (n = 26, 9.4 months, 95% CI, 4.4-14.0) than letrozole alone (n = 63, 3.0 months, 95% CI, 1.8-4.8). In the EHR-derived database, 59 men received treatment for MBC; real-world response across all lines of therapy in the metastatic setting was reported in 4 of 12 patients (33.3%) in the palbociclib plus ET group vs. 1 of 8 (12.5%) patients in the ET group. Review of the global safety database did not identify any new safety signals in palbociclib-treated men. Real-world data indicated that men with MBC benefit from palbociclib plus ET, with a safety profile consistent with previous observations in women with MBC. Collective data on palbociclib in women and men in this report, including clinical trial data, real-world data, and a well-established risk/benefit profile, led to US approval of an expansion of the palbociclib indication to include men with MBC.
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Affiliation(s)
| | | | | | | | - Sindy Kim
- Pfizer Inc, San Diego, California, USA
| | | | - Tamara Snow
- Flatiron Health, Inc, New York, New York, USA
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12
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Bennani NN, Tun AM, Carson KR, Geiger JL, Maeda LS, Savage KJ, Rose J, Pinter-Brown L, Lunning MA, Abramson JS, Bartlett NL, Vose JM, Evens AM, Smith SM, Horwitz SM, Ansell SM, Advani RH. Characteristics and Outcome of Extranodal NK/T-Cell Lymphoma in North America: A Retrospective Multi-Institutional Experience. Clin Lymphoma Myeloma Leuk 2021; 22:e250-e260. [PMID: 34794912 DOI: 10.1016/j.clml.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Extranodal natural killer/T-cell lymphoma (ENKTL) is rare and clinicaldata from non-Asian countries are lacking. It is unclear whether outcomes and diseasenatural history is similar to reported Asian series. We assessed characteristics and outcomes of patients with ENKTL from major North American centers. PATIENTS AND METHODS We retrospectively identified patients with newly-diagnosedCD56 + ENKTL and studied disease characteristics and clinical outcomes. RESULTS 121 patients with ENKTL diagnosed between June 1990 and November 2012 were identified. Eighty-three patients (69%) had stage I/II disease and were treatedwith combined modality therapy (CMT) (n=53), chemotherapy alone (CT) (n=14) orradiotherapy alone (RT) (n=16). Thirty-eight patients (31%) had stage III/IV diseaseand were treated with CMT (n=12), CT (n=23), or RT (n=3). The median follow-up forthe entire cohort was 51 months. Patients with stage I/II disease, compared to thosewith stage III/IV disease, had superior 2-year progression free survival (PFS) 43% vs19% (p=0.03) and overall survival (OS) 59% vs 29% (p=0.004). Outcomes were similarfor stage I/II patients who received CMT vs RT alone with 2-year PFS (53% vs 47%;p=0.91) and OS (67% vs 67%; p=0.58). No significant differences in outcomes werenoted based on race/ethnicity. CONCLUSIONS This series represents a large experience of ENKTL treated at several major North American academic centers. OUR DATA ARE CONSISTENT WITH ASIAN STUDIES 1) majority of patients present with early-stage disease; 2) overall poor outcome regardless of race/ethnicity; 3) CMT likely yields favorable outcomes for suitable candidates with early-stage disease.
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Affiliation(s)
| | - Aung M Tun
- Division of Hematology, Mayo Clinic, Rochester, MN; Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Kansas City, KS
| | - Kenneth R Carson
- Research Service, St Louis Veterans Affairs Medical Center, St Louis, MO; Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | | | - Lauren S Maeda
- Division of Oncology, Stanford Cancer Institute, Stanford, CA
| | - Kerry J Savage
- Department of Medical Oncology, Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Jim Rose
- Department of Medical Oncology, Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | | | - Matthew A Lunning
- Divisions of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Jeremy S Abramson
- Divisions of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Nancy L Bartlett
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Julie M Vose
- Divisions of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE
| | | | - Sonali M Smith
- Divisions of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Steven M Horwitz
- Division of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
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13
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Trum NA, Zain J, Martinez XU, Parekh VI, Afkhami M, Abdulla F, Carson KR, Rosen ST, Bennett CL, Querfeld C. Mogamulizumab-associated rash frequently mimics cutaneous T-cell lymphoma recurrence but heralds a positive response to therapy: an updated single-center case series. Eur J Cancer 2021. [DOI: 10.1016/s0959-8049(21)00660-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Wong K, Carson KR, Crane J. Risk of stillbirth in singleton gestations following in vitro methods of conception: a systematic review and meta-analysis. BJOG 2021; 128:1563-1572. [PMID: 33683788 DOI: 10.1111/1471-0528.16691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In vitro methods of conception are associated with adverse perinatal outcomes. It is unclear if the risk of stillbirth is increased also. OBJECTIVE This systematic review and meta-analysis aimed to estimate the risk of stillbirth in singleton gestations following in vitro methods of conception compared to non-in vitro conceptions. SEARCH STRATEGY A comprehensive search in PubMed, Embase, CINAHL, and Cochrane Library was undertaken from database inception to February 2021, with backward citation tracking. SELECTION CRITERIA Eligible studies included randomized controlled trials, cohort studies, or case-control studies that assessed stillbirth following in vitro fertilisation and/or intracytoplasmic sperm injection in comparison to non-in vitro methods of conception, including spontaneous conceptions, intrauterine insemination, and ovarian stimulation. DATA COLLECTION AND ANALYSIS The Newcastle-Ottawa Scale was used to assess risk of bias. A summary odds ratio (OR) for stillbirth following in vitro methods of conception compared to non-in vitro methods was calculated using a random-effects model for meta-analysis. MAIN RESULTS Thirty-three cohort studies met inclusion criteria. There was an increased risk of stillbirth with in vitro methods: OR 1.41 (95% CI 1.20-1.65); however, the crude baseline risk of stillbirth was low (4.44/1000 total births). Subgroup analysis did not demonstrate an increased risk when in vitro methods were compared to conception without in vitro methods in the context of subfertility. CONCLUSIONS Compared to non-in vitro conceptions, in vitro conceptions have an increased risk of stillbirth. However, there is insufficient evidence to demonstrate whether this risk is associated with in vitro techniques or underlying subfertility. TWEETABLE ABSTRACT This meta-analysis found an increased risk of stillbirth in singletons from in vitro methods of conception.
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Affiliation(s)
- Kty Wong
- Department of Obstetrics and Gynecology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - K R Carson
- Department of Obstetrics and Gynecology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Jmg Crane
- Department of Obstetrics and Gynecology, Memorial University of Newfoundland, St. John's, NL, Canada
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15
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Bennett CL, Nagai S, Bennett AC, Hoque S, Nabhan C, Schoen MW, Hrushesky WJ, Luminari S, Ray P, Yarnold PR, Witherspoon B, Riente J, Bobolts L, Brusk J, Tombleson R, Knopf K, Fishman M, Yang YT, Carson KR, Djulbegovic B, Restaino J, Armitage JO, Sartor OA. The First 2 Years of Biosimilar Epoetin for Cancer and Chemotherapy-Induced Anemia in the U.S.: A Review from the Southern Network on Adverse Reactions. Oncologist 2021; 26:e1418-e1426. [PMID: 33586299 DOI: 10.1002/onco.13713] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/07/2020] [Accepted: 01/05/2021] [Indexed: 11/09/2022] Open
Abstract
Biosimilars are biologic drug products that are highly similar to reference products in analytic features, pharmacokinetics and pharmacodynamics, immunogenicity, safety, and efficacy. Biosimilar epoetin received Food and Drug Administration (FDA) approval in 2018. The manufacturer received an FDA nonapproval letter in 2017, despite receiving a favorable review by FDA's Oncologic Drugs Advisory Committee (ODAC) and an FDA nonapproval letter in 2015 for an earlier formulation. We discuss the 2018 FDA approval, the 2017 FDA ODAC Committee review, and the FDA complete response letters in 2015 and 2017; review concepts of litigation, naming, labeling, substitution, interchangeability, and pharmacovigilance; review European and U.S. oncology experiences with biosimilar epoetin; and review the safety of erythropoiesis-stimulating agents. In 2020, policy statements from AETNA, United Health Care, and Humana indicated that new epoetin oncology starts must be for biosimilar epoetin unless medical need for other epoetins is documented. Empirical studies report that as of 2012, reference epoetin use decreased from 40%-60% of all patients with cancer with chemotherapy-induced anemia to <5% of such patients because of safety concerns. Between 2018 and 2020, biosimilar epoetin use varied, increasing to 81% among one private insurer's patients covered by Medicare whose cancer care is administered with Oncology Analytics and to 41% with the same private insurer's patients with cancer covered by commercial health insurance and administered by the private insurer, to 0% in several Veterans Administration Hospitals, increasing to 100% in one large county hospital in California, and with yet-to-be-reported data from most oncology settings. We conclude that biosimilar epoetin appears to have overcome some barriers since 2015, although current uptake in the U.S. is variable. Pricing and safety considerations for all erythropoiesis-stimulating agents are primary determinants of biosimilar epoetin oncology uptake. IMPLICATIONS FOR PRACTICE: Few oncologists understand substitution and interchangeability of biosimilars with reference drugs. Epoetin biosimilar is new to the market, and physician and patient understanding is limited. The development of epoetin biosimilar is not familiar to oncologists.
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Affiliation(s)
- Charles L Bennett
- Toni Stephenson Lymphoma Center, the Hematologic Malignancies Research Institute, the Beckman Research Institute, of the City of Hope Cancer Center, Duarte, California.,College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | | | - Andrew C Bennett
- College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Shamia Hoque
- Department of Civil and Environmental Engineering, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina
| | - Chadi Nabhan
- College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Martin W Schoen
- Saint Louis University School of Medicine, Saint Louis, Missouri
| | | | - Stefano Luminari
- Hematology, AUSL IRCCS Reggio Emilia.,Department CHIMOMO, University of Modena and Reggio Emilia, Regio Emilia, Italy
| | - Paul Ray
- College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Paul R Yarnold
- College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Bart Witherspoon
- College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Josh Riente
- William J Bryan Dorn Veterans Administration Medical Center, Columbia, South Carolina
| | - Laura Bobolts
- Oncology Analytics, Atlanta, Georgia.,College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - John Brusk
- College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Rebecca Tombleson
- College of Pharmacy, University of South Carolina, Columbia, South Carolina.,College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Kevin Knopf
- College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Marc Fishman
- College of Pharmacy, University of South Carolina, Columbia, South Carolina.,Oncology Analytics, Atlanta, Georgia
| | - Y Tony Yang
- George Washington University School of Nursing and Milken Institute School of Public Health, Washington, DC
| | - Kenneth R Carson
- The Division of Hematology/Oncology, Department of Medicine, Rush University School of Medicine, Chicago, Illinois
| | - Benjamin Djulbegovic
- The City of Hope, Beckman Research Institute, Department of Computational and Quantitative Medicine, Division of Health Analytics, Evidence-based Medicine & Comparative Effectiveness Research, Duarte, CA
| | - John Restaino
- College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - James O Armitage
- The Department of Medicine, The University of Nebraska School of Medicine, Omaha, Nebraska
| | - Oliver A Sartor
- The Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
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16
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Bennett CL, Hoque S, Olivieri N, Taylor MA, Aboulafia D, Lubaczewski C, Bennett AC, Vemula J, Schooley B, Witherspoon BJ, Godwin AC, Ray PS, Yarnold PR, Ausdenmoore HC, Fishman M, Herring G, Ventrone A, Aldaco J, Hrushesky WJ, Restaino J, Thomsen HS, Yarnold PR, Marx R, Migliorati C, Ruggiero S, Nabhan C, Carson KR, McKoy JM, Yang YT, Schoen MW, Knopf K, Martin L, Sartor O, Rosen S, Smith WK. Consequences to patients, clinicians, and manufacturers when very serious adverse drug reactions are identified (1997-2019): A qualitative analysis from the Southern Network on Adverse Reactions (SONAR). EClinicalMedicine 2021; 31:100693. [PMID: 33554084 PMCID: PMC7846671 DOI: 10.1016/j.eclinm.2020.100693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adverse drug/device reactions (ADRs) can result in severe patient harm. We define very serious ADRs as being associated with severe toxicity, as measured on the Common Toxicity Criteria Adverse Events (CTCAE)) scale, following use of drugs or devices with large sales, large financial settlements, and large numbers of injured persons. We report on impacts on patients, clinicians, and manufacturers following very serious ADR reporting. METHODS We reviewed clinician identified very serious ADRs published between 1997 and 2019. Drugs and devices associated with reports of very serious ADRs were identified. Included drugs or devices had market removal discussed at Food and Drug Advisory (FDA) Advisory Committee meetings, were published by clinicians, had sales > $1 billion, were associated with CTCAE Grade 4 or 5 toxicity effects, and had either >$1 billion in settlements or >1,000 injured patients. Data sources included journals, Congressional transcripts, and news reports. We reviewed data on: 1) timing of ADR reports, Boxed warnings, and product withdrawals, and 2) patient, clinician, and manufacturer impacts. Binomial analysis was used to compare sales pre- and post-FDA Advisory Committee meetings. FINDINGS Twenty very serious ADRs involved fifteen drugs and one device. Legal settlements totaled $38.4 billion for 753,900 injured persons. Eleven of 18 clinicians (61%) reported harms, including verbal threats from manufacturer (five) and loss of a faculty position (one). Annual sales decreased 94% from $29.1 billion pre-FDA meeting to $4.9 billion afterwards (p<0.0018). Manufacturers of four drugs paid $1.7 billion total in criminal fines for failing to inform the FDA and physicians about very serious ADRs. Following FDA approval, the median time to ADR reporting was 7.5 years (Interquartile range 3,13 years). Twelve drugs received Box warnings and one drug received a warning (median, 7.5 years following ADR reporting (IQR 5,11 years). Six drugs and 1 device were withdrawn from marketing (median, 5 years after ADR reporting (IQR 4,6 years)). INTERPRETATION Because very serious ADRs impacts are so large, policy makers should consider developing independently funded pharmacovigilance centers of excellence to assist with clinician investigations. FUNDING This work received support from the National Cancer Institute (1R01 CA102713 (CLB), https://www.nih.gov/about-nih/what-we-do/nih-almanac/national-cancer-institute-nci; and two Pilot Project grants from the American Cancer Society's Institutional Grant Award to the University of South Carolina (IRG-13-043-01) https://www.cancer.org/ (SH; BS).
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Affiliation(s)
- Charles L. Bennett
- City of Hope National Medical Center in Duarte, California, United States
- University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - Shamia Hoque
- University of South Carolina College of Engineering and Computing in Columbia, South Carolina, United States
| | | | - Matthew A. Taylor
- University of South Carolina School of Medicine in Columbia, South Carolina, United States
| | - David Aboulafia
- Virginia Mason Medical Center in Seattle, Washington, United States
| | - Courtney Lubaczewski
- University of South Carolina College of Arts and Sciences in Columbia, South Carolina, United States
| | - Andrew C. Bennett
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - Jay Vemula
- University of South Carolina College of Arts and Sciences in Columbia, South Carolina, United States
| | - Benjamin Schooley
- University of South Carolina College of Engineering and Computing in Columbia, South Carolina, United States
| | - Bartlett J. Witherspoon
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - Ashley C Godwin
- University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - Paul S. Ray
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - Paul R. Yarnold
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - Henry C. Ausdenmoore
- City of Hope National Medical Center in Duarte, California, United States
- University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
- University of South Carolina College of Engineering and Computing in Columbia, South Carolina, United States
- University of South Carolina College of Arts and Sciences in Columbia, South Carolina, United States
- University of South Carolina School of Medicine in Columbia, South Carolina, United States
- University of Miami Miller School of Medicine in Miami, Florida, United States
- Uniformed Services University F. Edward Hebert School of Medicine in Bethesda, Maryland, United States
- Tulane University School of Medicine in New Orleans, Louisiana, United States
- Northwestern University Feinberg School of Medicine in Chicago, Illinois, United States
- Rush University School of Medicine in Chicago, Illinois, United States
- Saint Louis University School of Medicine in Saint Louis, Missouri, United States
- University of Copenhagen in Copenhagen, Denmark
- Caris Life Sciences in Chicago, Illinois, United States
- Highland Hospital in Oakland, California, United States
- Virginia Mason Medical Center in Seattle, Washington, United States
- New York Center for Oral and Maxillofacial Surgery in New Hyde Park, New York, United States
- University of Florida in Gainesville, Florida, United States
| | - Marc Fishman
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - Georgne Herring
- University of South Carolina College of Arts and Sciences in Columbia, South Carolina, United States
| | - Anne Ventrone
- University of South Carolina College of Arts and Sciences in Columbia, South Carolina, United States
| | - Juan Aldaco
- City of Hope National Medical Center in Duarte, California, United States
| | - William J. Hrushesky
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - John Restaino
- University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | | | - Paul R. Yarnold
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - Robert Marx
- University of Miami Miller School of Medicine in Miami, Florida, United States
| | | | - Salvatore Ruggiero
- New York Center for Oral and Maxillofacial Surgery in New Hyde Park, New York, United States
| | - Chadi Nabhan
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
- Caris Life Sciences in Chicago, Illinois, United States
| | - Kenneth R. Carson
- Rush University School of Medicine in Chicago, Illinois, United States
| | - June M. McKoy
- Northwestern University Feinberg School of Medicine in Chicago, Illinois, United States
| | - Y. Tony Yang
- George Washington University School of Nursing and Milken Institute School of Public Health in Washington, District of Columbia, United States
| | - Martin W. Schoen
- Saint Louis University School of Medicine in Saint Louis, Missouri, United States
| | - Kevin Knopf
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
- Highland Hospital in Oakland, California, United States
| | - Linda Martin
- The SONAR Project of University of South Carolina College of Pharmacy in Columbia, South Carolina, United States
| | - Oliver Sartor
- Tulane University School of Medicine in New Orleans, Louisiana, United States
| | - Steven Rosen
- City of Hope National Medical Center in Duarte, California, United States
| | - William K. Smith
- Uniformed Services University F. Edward Hebert School of Medicine in Bethesda, Maryland, United States
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17
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Carson KR, Bennett CL. Contemporary Clinical Trials Office: Doing More With Less. JCO Oncol Pract 2020; 17:1-2. [PMID: 33337916 DOI: 10.1200/op.20.00871] [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)
- Kenneth R Carson
- Division of Hematology/Oncology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL.,Tempus Labs, Inc., Chicago, IL
| | - Charles L Bennett
- University of South Carolina College of Pharmacy, Columbia, SC.,City of Hope National Medical Center, Duarte, CA
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18
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Schoen MW, Carson KR, Luo S, Gage BF, Li A, Afzal A, Sanfilippo KM. Venous thromboembolism in multiple myeloma is associated with increased mortality. Res Pract Thromb Haemost 2020; 4:1203-1210. [PMID: 33134785 PMCID: PMC7590313 DOI: 10.1002/rth2.12411] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/29/2020] [Accepted: 06/05/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In multiple myeloma, venous thromboembolism (VTE) is common, and treatments for myeloma, such as lenalidomide, increase the risk of thrombosis while improving survival. The association between VTE and survival is not well known. OBJECTIVES To determine the association between VTE and survival in multiple myeloma (MM) while adjusting for known confounders that affect risk of thrombosis and survival, including patient characteristics and treatment in a retrospective cohort of US veterans. PATIENTS/METHODS A cohort of patients with newly diagnosed MM treated within Veterans Health Administration between September 1, 1999, and June 30, 2014, was created to assess the association between VTE and mortality using Cox proportional hazards regression modeling while accounting for known prognostic factors and treatments. RESULTS The cohort comprised 4446 patients with myeloma, including 2837 patients diagnosed after lenalidomide approval in July 2006. VTE occurred in 327 (7.4%) patients within 1 year and occurred at a median of 77 days (interquartile range, 37-153) after starting therapy for MM. In all patients, VTE was associated with increased mortality at 6 months (adjusted hazard ratio [aHR], 1.67; 95% confidence interval [CI], 1.18-2.37). Patients in the post-lenalidomide cohort with VTE had an increased mortality at both 6 months (aHR, 2.31; 95% CI, 1.52-3.51) and 12 months (aHR, 1.66; 95% CI, 1.19-2.33) after treatment initiation. DISCUSSION This study shows that VTE during the first 6-12 months of therapy is associated with increased mortality in patients with MM. Studies evaluating thromboprophylaxis in patients at high risk of thrombosis are needed.
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Affiliation(s)
- Martin W. Schoen
- Division of Hematology and OncologySaint Louis University School of MedicineSaint LouisMOUSA
- Saint Louis Veterans Affairs Medical CenterSaint LouisMOUSA
| | | | - Suhong Luo
- Saint Louis Veterans Affairs Medical CenterSaint LouisMOUSA
| | - Brian F. Gage
- Division of General Medical SciencesWashington University School of MedicineSaint LouisMOUSA
| | - Ang Li
- Section of Hematology‐OncologyBaylor College of MedicineSeattleWAUSA
| | - Amber Afzal
- Division of HematologyWashington University School of MedicineSaint LouisMOUSA
| | - Kristen M. Sanfilippo
- Saint Louis Veterans Affairs Medical CenterSaint LouisMOUSA
- Division of HematologyWashington University School of MedicineSaint LouisMOUSA
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19
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Shao C, Li G, Huang L, Pruitt S, Castellanos E, Frampton G, Carson KR, Snow T, Singal G, Fabrizio D, Alexander BM, Jin F, Zhou W. Prevalence of High Tumor Mutational Burden and Association With Survival in Patients With Less Common Solid Tumors. JAMA Netw Open 2020; 3:e2025109. [PMID: 33119110 PMCID: PMC7596577 DOI: 10.1001/jamanetworkopen.2020.25109] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Tumor mutational burden (TMB) is a potential biomarker associated with response to immune checkpoint inhibitor therapies. The prognostic value associated with TMB in the absence of immunotherapy is uncertain. OBJECTIVE To assess the prevalence of high TMB (TMB-H) and its association with overall survival (OS) among patients not treated with immunotherapy with the same 10 tumor types from the KEYNOTE-158 study. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study evaluated the prognostic value of TMB-H, assessed by Foundation Medicine (FMI) and defined as at least 10 mutations/megabase (mut/Mb) in the absence of immunotherapy. Data were sourced from the deidentified Flatiron Health-FMI clinicogenomic database collected up to July 31, 2018. Eligible patients were aged 18 years or older with any of the following solid cancer types: anal, biliary, endometrial, cervical, vulvar, small cell lung, thyroid, salivary gland, mesothelioma, or neuroendocrine tumor. Patients with microsatellite instability-high tumors were excluded from primary analysis. For OS analysis, patients were excluded if immunotherapy started on the FMI report date or earlier or if patients died before January 1, 2012, and patients were censored if immunotherapy was started later than the FMI report date. Data were analyzed from November 2018 to February 2019. MAIN OUTCOMES AND MEASURES Overall survival was analyzed using the Kaplan-Meier method and Cox proportional hazards model, adjusting for age, sex, cancer types, practice type, and albumin level. RESULTS Of 2589 eligible patients, 1671 (64.5%) were women, and the mean (SD) age was 63.7 (11.7) years. Median (interquartile range) TMB was 2.6 (1.7-6.1) mut/Mb, and 332 patients (12.8%) had TMB-H (≥10 mut/Mb). Prevalence of TMB-H was highest among patients with small cell lung cancer (40.0%; 95% CI, 34.7%-45.6%) and neuroendocrine tumor (29.3%; 95% CI, 22.8%-36.6%) and lowest was among patients with mesothelioma (1.2%; 95% CI, 0.3%-4.4%) and thyroid cancer (2.7%; 95% CI, 1.2%-5.7%). Adjusted hazard ratio for OS of patients not treated with immunotherapy with TMB-H vs those without TMB-H was 0.94 (95% CI, 0.77-1.13). Comparable results were observed when including patients with high microsatellite instability tumors and calculating OS from first observed antineoplastic treatment date. CONCLUSIONS AND RELEVANCE These findings suggest that prevalence of TMB-H varies widely depending on tumor type and TMB-H does not appear to be a factor associated with OS among patients across these cancer types treated in the absence of immunotherapy.
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Affiliation(s)
| | - Gerald Li
- Foundation Medicine, Cambridge, Massachusetts
| | | | | | | | | | | | | | | | | | | | - Fan Jin
- Merck and Co, Kenilworth, New Jersey
| | - Wei Zhou
- Merck and Co, Kenilworth, New Jersey
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20
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Hoque S, Chen BJ, Schoen MW, Carson KR, Keller J, Witherspoon BJ, Knopf KB, Yang YT, Schooley B, Nabhan C, Sartor O, Yarnold PR, Ray P, Bobolts L, Hrushesky WJ, Dickson M, Bennett CL. End of an era of administering erythropoiesis stimulating agents among Veterans Administration cancer patients with chemotherapy-induced anemia. PLoS One 2020; 15:e0234541. [PMID: 32584835 PMCID: PMC7316310 DOI: 10.1371/journal.pone.0234541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/18/2020] [Indexed: 11/18/2022] Open
Abstract
Erythropoisis stimulating agent (ESA) use was addressed in Food and Drug Administration (FDA) Oncology Drug Advisory Committee (ODAC) meetings between 2004 and 2008. FDA safety-focused regulatory actions occurred in 2007 and 2008. In 2007, black box warnings advised of early death and venous thromboembolism (VTE) risks with ESAs in oncology. In 2010, a Risk Evaluation Strategies (REMS) was initiated, with cancer patient consent that mortality and VTE risks were noted with ESAs. We report warnings and REMS impacts on ESA utilization among Veterans Administration (VA) cancer patients with chemotherapy-induced anemia (CIA). Data were from Veterans Affairs database (2003–2012). Epoetin and darbepoetin use were primary outcomes. Segmented linear regression was used to estimate changes in ESA use levels and trends, clinical appropriateness, and adverse events (VTEs) among chemotherapy-treated cancer patients. To estimate changes in level of drug prescription rate after policy actions, model-specific indicator variables as covariates based on specific actions were included. ESA use fell by 95% and 90% from 2005, for epoetin and darbepoetin, from 22% and 11%, respectively, to 1% and 1%, respectively, among cancer patients with CIA, respectively (p<0.01). Following REMS in 2010, mean hematocrit levels at ESA initiation decreased from 30% to 21% (p<0.01). Black box warnings preceded decreased ESA use among VA cancer patients with CIA. REMS was followed by reduced hematocrit levels at ESA initiation. Our findings contrast with privately- insured and Medicaid insured cancer patient data on chemotherapy-induced anemia where ESA use decreased to 3% to 7% by 2010–2012. By 2012, the era of ESA administration to VA to cancer patients had ended but the warnings remain relevant and significant. In 2019, oncology/hematology national guidelines (ASCO/ASH) recommend that cancer patients with chemotherapy-induced anemia should receive ESAs or red blood cell transfusions after risk-benefit evaluation.
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Affiliation(s)
- Shamia Hoque
- Department of Civil and Environmental Engineering, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina, United States of America
- * E-mail:
| | - Brian J. Chen
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Martin W. Schoen
- Department of Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, United States of America
| | - Kenneth R. Carson
- The Washington University School of Medicine and the Saint Louis VA Medical Center, St. Louis, Missouri, United States of America
| | - Jesse Keller
- The Washington University School of Medicine and the Saint Louis VA Medical Center, St. Louis, Missouri, United States of America
| | | | - Kevin B. Knopf
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
| | - Y. Tony Yang
- George Washington University, Washington, DC, United States of America
| | - Benjamin Schooley
- Department of Integrated Information Technology, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina, United States of America
| | - Chadi Nabhan
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
| | - Oliver Sartor
- Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Paul R. Yarnold
- Medical University of South Carolina, Charleston, South Carolina, United States of America
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
| | - Paul Ray
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
| | - Laura Bobolts
- Oncology Analytics, Plantation, Florida, United States of America
- College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - William J. Hrushesky
- The Washington University School of Medicine and the Saint Louis VA Medical Center, St. Louis, Missouri, United States of America
- Medical University of South Carolina, Charleston, South Carolina, United States of America
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
| | - Michael Dickson
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
| | - Charles L. Bennett
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, United States of America
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Carson KR, Toriola AT, Luo S, Thomas T, Drake BF, Chang SH, Sanfilippo KM. Abstract IA27: Metformin use and pancreatic cancer survival: Are there racial differences? Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-ia27] [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: 11/16/2022] Open
Abstract
Abstract
Background: The effect of metformin use on survival among pancreatic ductal adenocarcinoma (PDAC) patients is controversial. Further, there are no data on African American patients. To address these, we analyzed data from the United States Veterans Health Administration (VHA).
Methods: We performed a population-based retrospective cohort study evaluating survival among 3,811 PDAC patients with pre-existing diabetes mellitus (DM), diagnosed with PDAC within the VHA between 1998 and 2013. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) using multivariable adjusted conventional Cox proportional hazards regression as well as the time-varying Cox proportional hazards regression to control for immortal time bias and confounders. All statistical tests were two-sided.
Results: In multivariable adjusted analyses using the conventional Cox model, there was an artificial survival benefit associated with metformin use: HR= 0.89 (95%CI 0.83-0.98, p-value=0.01). In multivariable adjusted analyses using the time-varying Cox model, metformin use was not associated with survival: HR=1.05 (95%CI 0.92-1.14, p-value=0.28). Results were similar among non-Hispanic white patients: HR=1.05 (95%CI 0.96-1.14, p-value=0.26) and African American patients: HR=1.01 (95%CI 0.86-1.19, p-value=0.88). Among patients who were metformin naïve at the time of PDAC diagnosis (N=1158), metformin use was associated with improved survival in non-Hispanic white: HR=0.78 (95%CI 0.61-0.99, p-value=0.04), but not African American patients: HR=1.20 (95%CI 0.75-1.93, p-value=0.45). The survival benefit among non-Hispanic whites was limited to patients with metastatic disease: HR=0.67 (95%CI 0.44-1.01, p-value=0.055). Among African American patients with metastatic disease, HR was 1.30 (95%CI 0.77-2.53, p-value=0.28). There was an interaction between race and metformin use in patients with metastatic disease (p-interaction=0.05).
Conclusions: Although metformin use was not associated with survival in patients with PDAC, the survival benefit limited to non-Hispanic white patients who were metformin naïve at the time of diagnosis deserves further study in a racially diverse study population.
Citation Format: Kenneth R. Carson, Adetunji T. Toriola, Suhong Luo, Theodore Thomas, Bettina F. Drake, Su-Hsin Chang, Kristen M. Sanfilippo. Metformin use and pancreatic cancer survival: Are there racial differences? [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr IA27.
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Affiliation(s)
| | | | - Suhong Luo
- Washington University School of Medicine, St. Louis, MO
| | | | | | - Su-Hsin Chang
- Washington University School of Medicine, St. Louis, MO
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Thomas A, Mian I, Tlemsani C, Pongor L, Takahashi N, Maignan K, Snider J, Li G, Frampton G, Ali S, Kim S, Nichols S, Rajapakse V, Guha U, Sharon E, Fujimoto J, Moran CA, Wistuba II, Wei JS, Khan J, Szabo E, Torres AZ, Carson KR. Clinical and Genomic Characteristics of Small Cell Lung Cancer in Never Smokers: Results From a Retrospective Multicenter Cohort Study. Chest 2020; 158:1723-1733. [PMID: 32464188 DOI: 10.1016/j.chest.2020.04.068] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 12/02/2019] [Revised: 04/11/2020] [Accepted: 04/16/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Small cell lung cancer (SCLC) has the strongest association with smoking among lung cancers. The characteristics of never smokers with SCLC is not known. RESEARCH QUESTION Are the clinical characteristics, prognostic factors, survival, genomic alterations, and tumor mutational burdens of SCLC in patients who have never smoked different from those who have smoked? STUDY DESIGN AND METHODS A retrospective multicenter cohort study of patients with clinician-confirmed SCLC was performed with the use of a longitudinal and nationally representative electronic medical records database. Smoking history was assessed through technology-enabled abstraction and confirmed for never smokers via chart review. Genomic characteristics of never smoker patients with SCLC were examined with the use of a next-generation sequencing-based gene panel and whole exome sequencing. RESULTS One hundred of 5,632 patients (1.8%) with SCLC were never smokers. Relative to smokers, never smokers were more likely to be female (66.0% vs 52.4%; P = .009) and present with extensive stage (70.0% vs 62.2%; P = .028). Never smokers had a higher proportion of patients in age groups 35 to 49 years (7.0% vs 3.0%; P = .006) and ≥80 years (17.0% vs 8.2%; P = .006). Known risk factors for lung cancer were found in <20% of never smokers. There were no overall survival differences between never smokers and smokers. Among patients with available genomic data (n = 9), never smoker SCLC were characterized by lower tumor mutational burden, a lower frequency of TP53 mutations, and an absence of mutational signatures related to tobacco exposure. INTERPRETATION The sex- and age-specific distribution of SCLC among never smokers, along with differences that were identified by genomic analyses, suggests a distinct biology of SCLC in never smokers compared with smokers.
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Affiliation(s)
- Anish Thomas
- Developmental Therapeutics Branch, Bethesda, MD.
| | - Idrees Mian
- Thoracic and GI Oncology Branch, Center for Cancer Research, Bethesda, MD
| | | | | | | | | | | | | | | | | | - Sehyun Kim
- Developmental Therapeutics Branch, Bethesda, MD
| | | | | | - Udayan Guha
- Thoracic and GI Oncology Branch, Center for Cancer Research, Bethesda, MD
| | - Elad Sharon
- Division of Cancer Treatment and Diagnosis, Bethesda, MD
| | - Junya Fujimoto
- Department of Pathology, MD Anderson Cancer Center, University of Texas, Houston, TX
| | - Cesar A Moran
- Department of Pathology, MD Anderson Cancer Center, University of Texas, Houston, TX
| | - Ignacio I Wistuba
- Department of Pathology, MD Anderson Cancer Center, University of Texas, Houston, TX
| | - Jun S Wei
- Genetics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Javed Khan
- Genetics Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Eva Szabo
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
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Lansigan F, Horwitz SM, Pinter-Brown LC, Carson KR, Shustov AR, Rosen ST, Pro B, Hsi ED, Federico M, Gisselbrecht C, Schwartz M, Bellm LA, Acosta M, Foss FM. Outcomes of Patients with Transformed Mycosis Fungoides: Analysis from a Prospective Multicenter US Cohort Study. Clin Lymphoma Myeloma Leuk 2020; 20:744-748. [PMID: 32532611 DOI: 10.1016/j.clml.2020.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/26/2020] [Accepted: 05/03/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION We examined patient characteristics, treatments, and outcomes of patients with transformed mycosis fungoides (tMF) from COMPLETE: a large, multicenter, prospective cohort study of peripheral T-cell lymphoma patients in the United States. METHODS Patients with tMF were enrolled in COMPLETE at the time of transformation. For this analysis, we identified patients with tMF with completed baseline, treatment, and follow-up records. Median survival was assessed using Kaplan-Meier methodology. RESULTS Of the 499 patients enrolled in COMPLETE, 17 had tMF. Median age was 61; 53% were male, 9 had elevated lactate dehydrogenase, and 9 had lymph node involvement. Approximately one-quarter of the patients were African American and 47% had CD30+ disease. Median time to transformation was 53 months. All patients received systemic therapy, with 19% receiving concomitant radiotherapy. Most patients (87%) received single agents, including liposomal doxorubicin, pralatrexate, and gemcitabine. Eight patients (50%) had reported responses to therapy. Median survival was 18 months. One- and 2-year survival rates were 56% and 44%, respectively. CONCLUSIONS tMF often expresses CD30 and presents with lymph node involvement. Responses have been seen with single agents, but survival remains poor. Novel treatment approaches are urgently needed to improve outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
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24
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Friedman DR, Carson KR, Weinberg JB. Reflections on and future of hematologic malignancies research in the Veterans Health Administration. Semin Oncol 2019; 46:346-350. [PMID: 31699443 DOI: 10.1053/j.seminoncol.2019.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/29/2019] [Accepted: 09/17/2019] [Indexed: 11/11/2022]
Abstract
Research in the Veterans Health Administration (VHA) has played an integral part in learning about cancer biology and treatment. Here we provide examples of past research performed in the VHA focusing on hematologic malignancies, and identify future opportunities for areas of research in this group of uncommon diseases that have specific importance for Veterans and the VHA. Veterans treated in the VHA and in the private sector deserve information that is focused on them, and is not an extrapolation from the larger population. Only by building upon and expanding existing research within the VHA can Veteran-specific results be collected and best practices be developed. In turn, such advances will benefit Veterans affected by these cancers with an improved quality of life and a longer lifespan.
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Affiliation(s)
- Daphne R Friedman
- Department of Medicine, Duke University School of Medicine, Durham, NC; Medicine Service, Durham VA Medical Center, Durham, NC.
| | - Kenneth R Carson
- Department of Medicine, St. Louis VA, St. Louis, MO; Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO.
| | - J Brice Weinberg
- Department of Medicine, Duke University School of Medicine, Durham, NC; Medicine Service, Durham VA Medical Center, Durham, NC.
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25
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Toriola AT, Luo S, Thomas TS, Drake BF, Chang SH, Sanfilippo KM, Carson KR. Metformin Use and Pancreatic Cancer Survival among Non-Hispanic White and African American U.S. Veterans with Diabetes Mellitus. Cancer Epidemiol Biomarkers Prev 2019; 29:169-175. [DOI: 10.1158/1055-9965.epi-19-0781] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/26/2019] [Accepted: 10/29/2019] [Indexed: 11/16/2022] Open
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Sanfilippo KM, Luo S, Wang TF, Fiala M, Schoen M, Wildes TM, Mikhael J, Kuderer NM, Calverley DC, Keller J, Thomas T, Carson KR, Gage BF. Predicting venous thromboembolism in multiple myeloma: development and validation of the IMPEDE VTE score. Am J Hematol 2019; 94:1176-1184. [PMID: 31379000 PMCID: PMC7058359 DOI: 10.1002/ajh.25603] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 07/29/2019] [Indexed: 01/06/2023]
Abstract
Venous thromboembolism (VTE) is a common cause of morbidity and mortality among patients with multiple myeloma (MM). The International Myeloma Working Group (IMWG) developed guidelines recommending primary thromboprophylaxis, in those identified at high-risk of VTE by the presence of risk factors. The National Comprehensive Cancer Network (NCCN) has adopted these guidelines; however, they lack validation. We sought to develop and validate a risk prediction score for VTE in MM and to evaluate the performance of the current IMWG/NCCN guidelines. Using 4446 patients within the Veterans Administration Central Cancer Registry, we used time-to-event analyses to develop a risk score for VTE in patients with newly diagnosed MM starting chemotherapy. We externally validated the score using the Surveillance, Epidemiology, End Results (SEER)-Medicare database (N = 4256). After identifying independent predictors of VTE, we combined the variables to develop the IMPEDE VTE score (Immunomodulatory agent; Body Mass Index ≥25 kg/m2 ; Pelvic, hip or femur fracture; Erythropoietin stimulating agent; Dexamethasone/Doxorubicin; Asian Ethnicity/Race; VTE history; Tunneled line/central venous catheter; Existing thromboprophylaxis). The score showed satisfactory discrimination in the derivation cohort, c-statistic = 0.66. Risk of VTE significantly increased as score increased (hazard ratio 1.20, P = <.0001). Within the external validation cohort, IMPEDE VTE had a c-statistic of 0.64. For comparison, when evaluating the performance of the IMWG/NCCN guidelines, the c-statistic was 0.55. In summary, the IMPEDE VTE score outperformed the current IMWG/NCCN guidelines and could be considered as the new standard risk stratification for VTE in MM.
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Affiliation(s)
- Kristen M Sanfilippo
- Division of Hematology/Oncology, Veterans Administration St. Louis Health Care System, St. Louis, Missouri
- Division of Hematology, Washington University School of Medicine Saint Louis, St. Louis, Missouri
| | - Suhong Luo
- Division of Hematology/Oncology, Veterans Administration St. Louis Health Care System, St. Louis, Missouri
| | - Tzu-Fei Wang
- Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Mark Fiala
- Division of Oncology, Washington University School of Medicine Saint Louis, St. Louis, Missouri
| | - Martin Schoen
- Division of Hematology/Oncology, Saint Louis University, St. Louis, Missouri
| | - Tanya M Wildes
- Division of Oncology, Washington University School of Medicine Saint Louis, St. Louis, Missouri
| | - Joseph Mikhael
- Applied Cancer Research and Drug Discovery,Translational Genomics Research Institute (TGen), City of Hope Cancer Center, Duarte, California
| | - Nicole M Kuderer
- Advanced Cancer Research Group, University of Washington, Seattle, Washington
| | - David C Calverley
- Division of Hematology/Oncology, Veterans Administration Portland Health Care System, Portland, Oregon
| | - Jesse Keller
- Division of Hematology/Oncology, Veterans Administration St. Louis Health Care System, St. Louis, Missouri
- Division of Hematology/Oncology, Saint Louis University, St. Louis, Missouri
| | - Theodore Thomas
- Division of Hematology/Oncology, Veterans Administration St. Louis Health Care System, St. Louis, Missouri
| | - Kenneth R Carson
- Division of Hematology/Oncology, Veterans Administration St. Louis Health Care System, St. Louis, Missouri
- Flatiron Health, New York, New York
| | - Brian F Gage
- Division of General Medical Sciences, Washington University School of Medicine Saint Louis, St. Louis, Missouri
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Chang SH, Gumbel J, Luo S, Thomas TS, Sanfilippo KM, Luo J, Colditz GA, Carson KR. Post-MGUS Diagnosis Serum Monoclonal-Protein Velocity and the Progression of Monoclonal Gammopathy of Undetermined Significance to Multiple Myeloma. Cancer Epidemiol Biomarkers Prev 2019; 28:2055-2061. [PMID: 31501149 DOI: 10.1158/1055-9965.epi-19-0132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 02/06/2019] [Revised: 06/05/2019] [Accepted: 09/03/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Multiple myeloma is a common hematologic malignancy consistently preceded by monoclonal gammopathy of undetermined significance (MGUS). Little is known about postdiagnosis clinical predictors of progression of MGUS to multiple myeloma to guide MGUS management. This study aimed to investigate whether the rate of rise in serum monoclonal protein concentration during the year after MGUS diagnosis-M-protein velocity-predicts progression of MGUS to multiple myeloma. METHODS Data from the U.S. Veterans Health Administration system were used. A retrospective cohort of patients with MGUS who progressed to multiple myeloma were matched on age at MGUS diagnosis and race in a 1:4 ratio to the patients with MGUS using incidence density sampling. Kaplan-Meier curves were plotted. Univariable and multivariable conditional logistic regression analyses were fitted from the matched risk sets. RESULTS A total of 128 cases and 490 matched controls were included. The case group contained a higher percentage of patients with M-protein velocity >0.1 g/dL/year than the control group (44.5% vs. 28.2%, P <0.0001). M-protein velocity of >0.1 g/dL during the year following MGUS diagnosis was positively associated with progression of MGUS to multiple myeloma (multivariable-adjusted odds ratio = 2.15; 95% confidence interval, 1.37-3.35). CONCLUSIONS Patients with a positive M-protein velocity during the year after MGUS diagnosis may be considered for more frequent monitoring for early detection and timely treatment of multiple myeloma. Future prevention studies could target these patients for intervention evaluation. IMPACT Our results suggest a new clinical predictor of progression to multiple myeloma following MGUS diagnosis, which has potential to identify high-risk patients for management and prevention.
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Affiliation(s)
- Su-Hsin Chang
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri.
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jason Gumbel
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri
| | - Suhong Luo
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Theodore S Thomas
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri
| | - Kristen M Sanfilippo
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jingqin Luo
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Kenneth R Carson
- Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, Missouri
- Flatiron Health, New York, New York
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Chen L, Carson KR, Staser KW, Mehta-Shah N, Schaffer A, Rosman IS, Musiek A. Mogamulizumab-Associated Cutaneous Granulomatous Drug Eruption Mimicking Mycosis Fungoides but Possibly Indicating Durable Clinical Response. JAMA Dermatol 2019; 155:968-971. [PMID: 31141114 DOI: 10.1001/jamadermatol.2019.0369] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lu Chen
- Division of Dermatology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri.,The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Kenneth R Carson
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri.,St Louis Veterans Health Administration Medical Center, St Louis, Missouri.,Flatiron Health Inc, New York, New York
| | - Karl W Staser
- Division of Dermatology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Neha Mehta-Shah
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - András Schaffer
- Department of Pathology and Immunology, Washington University School of Medicine in St Louis, St Louis, Missouri.,Tallahassee Associates of Dermatology, Florida State University College of Medicine, Tallahassee, Florida
| | - Ilana S Rosman
- Division of Dermatology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri.,Department of Pathology and Immunology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Amy Musiek
- Division of Dermatology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
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Andrews JM, Schmidt JA, Carson KR, Musiek AC, Mehta-Shah N, Payton JE. Novel cell adhesion/migration pathways are predictive markers of HDAC inhibitor resistance in cutaneous T cell lymphoma. EBioMedicine 2019; 46:170-183. [PMID: 31358475 PMCID: PMC6711861 DOI: 10.1016/j.ebiom.2019.07.053] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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] [Received: 06/20/2019] [Revised: 07/18/2019] [Accepted: 07/20/2019] [Indexed: 01/20/2023] Open
Abstract
Background Treatment for Cutaneous T Cell Lymphoma (CTCL) is generally not curative. Therefore, selecting therapy that is effective and tolerable is critical to clinical decision-making. Histone deacetylase inhibitors (HDACi), epigenetic modifier drugs, are commonly used but effective in only ~30% of patients. There are no predictive markers of HDACi response and the CTCL histone acetylation landscape remains unmapped. We sought to identify pre-treatment molecular markers of resistance in CTCL that progressed on HDACi therapy. Methods Purified T cells from 39 pre/post-treatment peripheral blood samples and skin biopsies from 20 patients were subjected to RNA-seq and ChIP-seq for histone acetylation marks (H3K14/9 ac, H3K27ac). We correlated significant differences in histone acetylation with gene expression in HDACi-resistant/sensitive CTCL. We extended these findings in additional CTCL patient cohorts (RNA-seq, microarray) and using ELISA in matched CTCL patient plasma. Findings Resistant CTCL exhibited high levels of histone acetylation, which correlated with increased expression of 338 genes (FDR < 0·05), including some novel to CTCL: BIRC5 (anti-apoptotic); RRM2 (cell cycle); TXNDC5, GSTM1 (redox); and CXCR4, LAIR2 (cell adhesion/migration). Several of these, including LAIR2, were elevated pre-treatment in HDACi-resistant CTCL. In CTCL patient plasma (n = 6), LAIR2 protein was also elevated (p < 0·01) compared to controls. Interpretation This study is the first to connect genome-wide differences in chromatin acetylation and gene expression to HDACi-resistance in primary CTCL. Our results identify novel markers with high pre-treatment expression, such as LAIR2, as potential prognostic and/or predictors of HDACi-resistance in CTCL. Funding NIH:CA156690, CA188286; NCATS: WU-ICTS UL1 TR000448; Siteman Cancer Center: CA091842.
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Affiliation(s)
- Jared M Andrews
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jennifer A Schmidt
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Kenneth R Carson
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Amy C Musiek
- Department of Medicine, Division of Dermatology, Washington University School of Medicine, St. Louis, MO, USA
| | - Neha Mehta-Shah
- Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jacqueline E Payton
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA.
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Bartlett CH, Mardekian J, Yu-Kite M, Cotter MJ, Kim S, Decembrino J, Snow T, Carson KR, Motyl Rockland J, Kraus AL, Wilner KD, Oharu N, Schnell P, Lu D(R, Tursi J. Real-world evidence of male breast cancer (BC) patients treated with palbociclib (PAL) in combination with endocrine therapy (ET). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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
1055 Background: The rarity of BC in men limits the feasibility of randomized clinical studies in this population. Treatment guidelines recommend that men with BC be treated similarly to postmenopausal women. PAL, a cyclin-dependent kinase 4/6 inhibitor, is used in men with metastatic BC (mBC) in real-world clinical practice, presenting an opportunity to utilize real-world evidence to enable healthcare providers to assess novel agents in this space. Methods: Two parallel approaches were taken. In the first approach, pharmacy and medical claims data from IQVIA Inc were retrospectively analyzed to describe the treatment patterns and duration of PAL + ET (aromatase inhibitor or fulvestrant) compared to ET in men with mBC. The second approach was a retrospective analysis of data derived from electronic health records in the Flatiron Health database to understand real-world clinical response to PAL + ET vs ET alone. Median duration of treatment (mDOT) was estimated by the Kaplan-Meier method. Results: Between Feb 2015 and Apr 2017, 12.9% (147/1139 [IQVIA dataset]) of men receiving treatment for mBC were prescribed PAL + ET for any line of therapy. The mDOT in the first-line setting was numerically longer in the PAL cohort (n=37) compared with the non-PAL cohort (n=214; 8.5 vs 4.3 mo, respectively). In particular, mDOT in the first-line setting was longer with PAL + letrozole (LET; n=26) than with LET alone (n=63; 9.4 vs 3.0 mo, respectively). In the Flatiron Health dataset between Feb 2015 and July 2017, the real-world maximum response rate in the PAL + ET cohort across all lines of therapy in the mBC setting (n=12) was 33.3% (2 complete responses [CR], 2 partial responses [PR]) vs 12.5% (0 CR, 1 PR) for the ET alone cohort (n=8). Conclusions: The real-world data sources used in this study support that men with mBC derive clinical benefit from the addition of PAL to ET. Given the challenges of conducting randomized clinical trials in men with mBC, noninterventional, real-world evidence data appear to be useful to delineate the benefit of such therapies in this setting. Funding: Pfizer.
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Park SI, Horwitz SM, Foss FM, Pinter-Brown LC, Carson KR, Rosen ST, Pro B, Hsi ED, Federico M, Gisselbrecht C, Schwartz M, Bellm LA, Acosta M, Advani RH, Feldman T, Lechowicz MJ, Smith SM, Lansigan F, Tulpule A, Craig MD, Greer JP, Kahl BS, Leach JW, Morganstein N, Casulo C, Shustov AR. The role of autologous stem cell transplantation in patients with nodal peripheral T-cell lymphomas in first complete remission: Report from COMPLETE, a prospective, multicenter cohort study. Cancer 2019; 125:1507-1517. [PMID: 30694529 DOI: 10.1002/cncr.31861] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/26/2018] [Accepted: 09/28/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND The role of autologous stem cell transplantation (ASCT) in the first complete remission (CR1) of peripheral T-cell lymphomas (PTCLs) is not well defined. This study analyzed the impact of ASCT on the clinical outcomes of patients with newly diagnosed PTCL in CR1. METHODS Patients with newly diagnosed, histologically confirmed, aggressive PTCL were prospectively enrolled into the Comprehensive Oncology Measures for Peripheral T-Cell Lymphoma Treatment (COMPLETE) study, and those in CR1 were included in this analysis. RESULTS Two hundred thirteen patients with PTCL achieved CR1, and 119 patients with nodal PTCL, defined as anaplastic lymphoma kinase-negative anaplastic large cell lymphoma, angioimmunoblastic T-cell lymphoma (AITL), or PTCL not otherwise specified, were identified. Eighty-three patients did not undergo ASCT, whereas 36 underwent consolidative ASCT in CR1. At the median follow-up of 2.8 years, the median overall survival was not reached for the entire cohort of patients who underwent ASCT, whereas it was 57.6 months for those not receiving ASCT (P = .06). ASCT was associated with superior survival for patients with advanced-stage disease or intermediate-to-high International Prognostic Index scores. ASCT significantly improved overall and progression-free survival for patients with AITL but not for patients with other PTCL subtypes. In a multivariable analysis, ASCT was independently associated with improved survival (hazard ratio, 0.37; 95% confidence interval, 0.15-0.89). CONCLUSIONS This is the first large prospective cohort study directly comparing the survival outcomes of patients with nodal PTCL in CR1 with or without consolidative ASCT. ASCT may provide a benefit in specific clinical scenarios, but the broader applicability of this strategy should be determined in prospective, randomized trials. These results provide a platform for designing future studies of previously untreated PTCL.
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Affiliation(s)
| | | | | | | | | | | | - Barbara Pro
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | | | | | | | | | | | - Mark Acosta
- Spectrum Pharmaceuticals, Inc, Irvine, California
| | | | - Tatyana Feldman
- Hackensack University Medical Center, Hackensack, New Jersey
| | | | | | - Frederick Lansigan
- Massachusetts General Hospital, Harvard University School of Medicine, Boston, Massachusetts
| | - Anil Tulpule
- University of Southern California, Los Angeles, California
| | | | | | - Brad S Kahl
- Washington University School of Medicine, St. Louis, Missouri
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Khozin S, Carson KR, Zhi J, Tucker M, Lee SE, Light DE, Curtis MD, Bralic M, Kaganman I, Gossai A, Hofmeister P, Torres AZ, Miksad RA, Blumenthal GM, Pazdur R, Abernethy AP. Real-World Outcomes of Patients with Metastatic Non-Small Cell Lung Cancer Treated with Programmed Cell Death Protein 1 Inhibitors in the Year Following U.S. Regulatory Approval. Oncologist 2018; 24:648-656. [PMID: 30591549 DOI: 10.1634/theoncologist.2018-0307] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [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: 05/23/2018] [Accepted: 11/15/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Evidence from cancer clinical trials has strong internal validity but can be difficult to generalize to real-world patient populations. Here we analyzed real-world outcomes of patients with metastatic non-small cell lung cancer (mNSCLC) treated with programmed cell death protein 1 (PD-1) inhibitors in the first year following U.S. regulatory approval. MATERIALS AND METHODS This retrospective study leveraged electronic health record (EHR) data collected during routine patient care in community cancer care clinics. The cohort included patients with mNSCLC who had received nivolumab or pembrolizumab for metastatic disease (n = 1,344) with >1 EHR-documented visit from January 1, 2011, to March 31, 2016. Patients with a > 90-day gap between advanced disease diagnosis and first EHR structured data entry were excluded. RESULTS Estimated median overall survival (OS) was 8.0 months (95% confidence interval 7.4-9.0 months). Estimated median OS was 4.7 months (3.4-6.6) for patients with anaplastic lymphoma kinase rearrangement- and epidermal growth factor receptor mutation-positive tumors, and 8.6 months (7.7-10.6) for patients without such mutations. Age at PD-1 inhibitor initiation or line of therapy did not impact OS. CONCLUSION This analysis suggests OS in real-world patients may be shorter than in conventional clinical trial patient cohorts, potentially due to narrow trial eligibility criteria. The lack of difference in OS by line of therapy or age at immunotherapy initiation suggests sustained benefit of PD-1 inhibitors in multitreated patients with mNSCLC and that age is not a predictor of outcome. Further studies are underway in patients with comorbidities, organ dysfunction, and multiple prior therapies. IMPLICATIONS FOR PRACTICE This study evaluated data derived from electronic health records of patients with metastatic non-small cell lung cancer treated with programmed cell death protein 1 (PD-1) inhibitors in the year following regulatory approval. This real-world cohort had shorter overall survival (OS) indexed to PD-1 inhibitor initiation than reported in clinical trials. Late-line treatment did not influence OS, and patients aged >75 at immunotherapy initiation did not have worse outcomes than younger patients. As new therapies enter clinical practice, real-world data can complement clinical trial evidence providing information on generalizability and helping inform clinical treatment decisions.
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Affiliation(s)
- Sean Khozin
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Kenneth R Carson
- Flatiron Health, New York, New York, USA
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jizu Zhi
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Richard Pazdur
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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Jungheim ES, Carson KR. Leveraging real-world data to move toward more personalized fertility treatment. Fertil Steril 2018; 109:608-609. [PMID: 29653708 DOI: 10.1016/j.fertnstert.2018.01.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Emily S Jungheim
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
| | - Kenneth R Carson
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri; Flatiron Health, Inc., New York, New York
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O’Connor JM, Fessele KL, Steiner J, Seidl-Rathkopf K, Carson KR, Nussbaum NC, Yin ES, Adelson KB, Presley CJ, Chiang AC, Ross JS, Abernethy AP, Gross CP. Speed of Adoption of Immune Checkpoint Inhibitors of Programmed Cell Death 1 Protein and Comparison of Patient Ages in Clinical Practice vs Pivotal Clinical Trials. JAMA Oncol 2018; 4:e180798. [PMID: 29800974 PMCID: PMC6143052 DOI: 10.1001/jamaoncol.2018.0798] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/16/2018] [Indexed: 12/16/2022]
Abstract
Importance The US Food and Drug Administration (FDA) is increasing its pace of approvals for novel cancer therapeutics, including for immune checkpoint inhibitors of programmed cell death 1 protein (anti-PD-1 agents). However, little is known about how quickly anti-PD-1 agents agents reach eligible patients in practice or whether such patients differ from those studied in clinical trials that lead to FDA approval (pivotal clinical trials). Objectives To assess the speed with which anti-PD-1 agents agents reached eligible patients in practice and to compare the ages of patients treated in clinical practice with the ages of those treated in pivotal clinical trials. Design, Setting, and Participants This retrospective cohort study, performed from January 1, 2011, through August 31, 2016, included patients from the Flatiron Health Network who were eligible for anti-PD-1 agents treatment of selected cancer types, which included melanoma, non-small cell lung cancer (NSCLC), and renal cell carcinoma (RCC). Main Outcomes and Measures Cumulative proportions of eligible patients receiving anti-PD-1 agents treatment and their age distributions. Results The study identified 3089 patients who were eligible for anti-PD-1 agents treatment (median age, 66 [interquartile range, 56-75] years for patients with melanoma, 66 [interquartile range, 58-72] years for patients with RCC, and 67 [interquartile range, 59-74] years for patients with NSCLC; 1742 male [56.4%] and 1347 [43.6%] female; 2066 [66.9%] white). Of these patients, 2123 (68.7%) received anti-PD-1 agents treatment, including 439 eligible patients with melanoma (79.1%), 1417 eligible patients with NSCLC (65.6%), and 267 eligible patients with RCC (71.2%). Within 4 months after FDA approval, greater than 60% of eligible patients in each cohort had received anti-PD-1 agents treatment. Overall, similar proportions of older and younger patients received anti-PD-1 agents treatment during the first 9 months after FDA approval. However, there were significant differences in age between clinical trial participants and patients receiving anti-PD-1 agents treatment in clinical practice, with more patients being older than 65 years in clinical practice (range, 327 of 1365 [60.6%] to 46 of 72 [63.9%]) than in pivotal clinical trials (range, 38 of 120 [31.7%] to 223 of 544 [41.0%]; all P < .001). Conclusions and Relevance Anti-PD-1 agents rapidly reached patients in clinical practice, and patients treated in clinical practice differed significantly from patients treated in pivotal clinical trials. Future actions are needed to ensure that rapid adoption occurs on the basis of representative trial evidence.
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Affiliation(s)
- Jeremy M. O’Connor
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut
| | | | | | | | | | | | - Emily S. Yin
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Kerin B. Adelson
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Carolyn J. Presley
- The Ohio State University Comprehensive Cancer Center, Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Anne C. Chiang
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Yale Cancer Center, Yale University School of Medicine, New Haven, Connecticut
| | - Joseph S. Ross
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut
| | | | - Cary P. Gross
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut
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O'Connor JM, Seidl-Rathkopf K, Torres AZ, You P, Carson KR, Ross JS, Gross CP. Disparities in the Use of Programmed Death 1 Immune Checkpoint Inhibitors. Oncologist 2018; 23:1388-1390. [PMID: 30012876 DOI: 10.1634/theoncologist.2017-0673] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/01/2018] [Indexed: 01/13/2023] Open
Abstract
Amid growing excitement for immune checkpoint inhibitors of programmed death protein 1 (anti-PD1 agents), little is known about whether race- or sex-based disparities exist in their use. In this observational study, we constructed a large and mostly community-based cohort of patients with advanced stage cancers, including melanoma, non-small cell lung cancer (NSCLC), and renal cell carcinoma, to compare the odds of receiving systemic treatment with or without anti-PD1 agents by race and by sex. In multivariable models that adjusted for age, stage, and number of prior anticancer therapies, we found no significant race-based disparities in anti-PD1 treatment. However, among patients with NSCLC, males had significantly higher odds of receiving anti-PD1 treatment compared with females (odds ratio 1.13, 95% confidence interval 1.02-1.24, p = .02). This finding suggests that as anti-PD1 agents enter the market to transform patient care, it will be critical to monitor for disparities in the use of these drugs.
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Affiliation(s)
- Jeremy M O'Connor
- Yale University School of Medicine, New Haven, Connecticut, USA
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | - Paul You
- Flatiron Health, Inc., New York, New York, USA
| | | | - Joseph S Ross
- Yale University School of Medicine, New Haven, Connecticut, USA
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Cary P Gross
- Yale University School of Medicine, New Haven, Connecticut, USA
- National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA
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Chang SH, Luo S, O'Brian KK, Thomas TS, Colditz GA, Carlsson NP, Carson KR. Association between metformin use and progression of monoclonal gammopathy of undetermined significance to multiple myeloma in US veterans with diabetes mellitus: a population-based retrospective cohort study. Lancet Haematol 2017; 2:e30-6. [PMID: 26034780 DOI: 10.1016/s2352-3026(14)00037-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Multiple myeloma is one of the most common haematological malignancies in the USA and is consistently preceded by monoclonal gammopathy of undetermined significance (MGUS). We aimed to assess the association between metformin use and progression of MGUS to multiple myeloma. METHODS We did a retrospective cohort study of patients registered in the US Veterans Health Administration database and diagnosed with MGUS between Oct 1, 1999, and Dec 31, 2009. We included patients (aged >18 years) with at least one International Classification of Diseases (9th revision) code for diabetes mellitus and one treatment for their diabetes before MGUS diagnosis. We reviewed patient-level clinical data to verify diagnoses and extract any available data for size of baseline M-protein and type of MGUS. We defined metformin users as patients with diabetes who were given metformin consistently for 4 years after their diabetes diagnosis and before multiple myeloma development, death, or censorship. Our primary outcome was time from MGUS diagnosis to multiple myeloma diagnosis. We used Kaplan-Meier curves and Cox models to analyse the association between metformin use and MGUS progression. FINDINGS We obtained data for 3287 patients, of whom 2003 (61%) were included in the final analytical cohort. Median follow-up was 69 months (IQR 49–96). 463 (23%) participants were metformin users and 1540 (77%) participants were non-users. 13 (3%) metformin users progressed to multiple myeloma compared with 74 (5%) non-users. After adjustment, metformin use was associated with a reduced risk of progression to multiple myeloma (hazard ratio 0·47, 95% CI 0·25–0·87). INTERPRETATION For patients with diabetes diagnosed with MGUS, metformin use for 4 years or longer was associated with a reduced risk of progression of MGUS to multiple myeloma. Prospective studies are needed to establish whether this association is causal and whether these results can be extrapolated to non-diabetic individuals. FUNDING Barnes-Jewish Hospital Foundation, National Institutes of Health, Agency for Healthcare Research and Quality, American Cancer Society.
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Burke JM, Bibeau K, Kahl B, Carson KR, Zelenetz AD, Brander DM, Maddocks KJ, Gerecitano JF, Pathak AK, Cheson BD. Evidence of low incidence of myelodysplastic syndrome (MDS) in patients exposed to bendamustine treatment for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e19008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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
e19008 Background: CLL/SLL is a treatable malignancy, which is responsive to therapies that include bendamustine. However, as with many alkylating agents, there is concern for the development of secondary malignancies and MDS after exposure to bendamustine. We evaluated the risk of MDS using electronic medical records from a geographically diverse cohort of cancer patients (pts). Methods: Pathologically confirmedCLL/SLL pts with any exposure to bendamustine were identified in the Flatiron Health database (FHD, Flatiron Health, New York [122016]). This is a longitudinal US-based cohort with > 1.5 million cancer pts drawn from over 250 cancer clinics. Pts with bendamustine exposure and no history of MDS or other malignancy were included. Pts were followed longitudinally to identify incident cases of secondary malignancies or MDS. Results: Of 3140 CLL/SLL pts in the analytic cohort, 1022 met inclusion criteria. Median follow-up after bendamustine exposure was 1.7 years. Overall, 8% received bendamustine monotherapy, 84% received combination therapy, and 8% received cycles of bendamustine monotherapy and combination therapy. Of the 1022 pts, 205 (20%) had prior antineoplastic exposure, a risk factor for MDS. During the follow-up period, five pts developed MDS (0.48% of the bendamustine-exposed cohort), one of whom had prior antineoplastic exposure. Conclusions: This real-world study demonstrated that pts received bendamustine overwhelmingly as combination therapy, and 20% had prior antineoplastic exposure. MDS related to alkylators and purine analogs can have a latency of > 3 years; in this study a minority (~20%) of pts had > 3 years of follow-up. Thus, longer follow-up is required to draw definitive conclusions regarding the risk. Nevertheless, the FHD provides a source of oncology data for studying long-term outcomes of cancer pts, which have historically been difficult to capture in epidemiological studies. At a median of 1.7 years after exposure, the current study identified a low risk of MDS after controlling for potential confounders.
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Affiliation(s)
| | | | - Brad Kahl
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | | | | | | | | | | | | | - Bruce D. Cheson
- Georgetown University Hospital, Lombardi Comprehensive Cancer Center, Washington, DC
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Sanfilippo KM, Luo S, Gage BF, Carson KR. Reply to S. Suissa et al. J Clin Oncol 2017; 35:1378-1379. [PMID: 28165899 DOI: 10.1200/jco.2016.71.3958] [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)
- Kristen M Sanfilippo
- Kristen M. Sanfilippo, Saint Louis Veterans Health Administration Medical Center and Washington University School of Medicine, Saint Louis, MO; Suhong Luo, Saint Louis Veterans Health Administration Medical Center, Saint Louis, MO; Brian F. Gage, Washington University School of Medicine, Saint Louis, MO; and Kenneth R. Carson, Saint Louis Veterans Health Administration Medical Center and Washington University School of Medicine, Saint Louis, MO
| | - Suhong Luo
- Kristen M. Sanfilippo, Saint Louis Veterans Health Administration Medical Center and Washington University School of Medicine, Saint Louis, MO; Suhong Luo, Saint Louis Veterans Health Administration Medical Center, Saint Louis, MO; Brian F. Gage, Washington University School of Medicine, Saint Louis, MO; and Kenneth R. Carson, Saint Louis Veterans Health Administration Medical Center and Washington University School of Medicine, Saint Louis, MO
| | - Brian F Gage
- Kristen M. Sanfilippo, Saint Louis Veterans Health Administration Medical Center and Washington University School of Medicine, Saint Louis, MO; Suhong Luo, Saint Louis Veterans Health Administration Medical Center, Saint Louis, MO; Brian F. Gage, Washington University School of Medicine, Saint Louis, MO; and Kenneth R. Carson, Saint Louis Veterans Health Administration Medical Center and Washington University School of Medicine, Saint Louis, MO
| | - Kenneth R Carson
- Kristen M. Sanfilippo, Saint Louis Veterans Health Administration Medical Center and Washington University School of Medicine, Saint Louis, MO; Suhong Luo, Saint Louis Veterans Health Administration Medical Center, Saint Louis, MO; Brian F. Gage, Washington University School of Medicine, Saint Louis, MO; and Kenneth R. Carson, Saint Louis Veterans Health Administration Medical Center and Washington University School of Medicine, Saint Louis, MO
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Chang SH, Luo S, Thomas TS, O'Brian KK, Colditz GA, Carlsson NP, Carson KR. Obesity and the Transformation of Monoclonal Gammopathy of Undetermined Significance to Multiple Myeloma: A Population-Based Cohort Study. J Natl Cancer Inst 2016; 109:2758640. [PMID: 28040690 DOI: 10.1093/jnci/djw264] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 09/08/2016] [Accepted: 10/06/2016] [Indexed: 12/28/2022] Open
Abstract
Background Multiple myeloma (MM) is one of the most common hematologic malignancies in the United States and is consistently preceded by monoclonal gammopathy of undetermined significance (MGUS). This study investigates the role of obesity in the progression of MGUS to MM. Methods A retrospective identified cohort of patients in the US Veterans Health Administration database diagnosed with MGUS between October 1, 1999, and December 31, 2009, was followed through August 6, 2013. Patient-level clinical data were reviewed to verify MM diagnosis, if any. Survival analyses utilizing interval-censored data were used to investigate the risk of progression of MGUS to MM. Statistical tests were two-sided. Results The analytic cohort consisted of 7878 MGUS patients with a median follow-up of 68 months. Within the cohort, 39.8% were overweight and 33.8% were obese; 64.1% were of white race. During follow-up, 329 MGUS patients (4.2%) progressed to MM: 72 (3.5%) normal-weight patients (median follow-up = 61.9 months), 144 (4.6%) overweight patients (median follow-up = 69.1 months), and 113 (4.3%) obese patients (median follow-up = 70.6 months). In the multivariable analysis, overweight (hazard ratio [HR] = 1.55, 95% confidence interval [CI] = 1.16 to 2.06) and obesity (HR = 1.98, 95% CI = 1.47 to 2.68) were associated with an increased risk of transformation of MGUS to MM. Moreover, black race was associated with a higher risk of MM (HR = 1.98, 95% CI = 1.55 to 2.54). Conclusions Obesity and black race are risk factors for transformation of MGUS to MM. Future clinical trials should examine whether weight loss is a way to prevent the progression to MM in MGUS patients.
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Affiliation(s)
- Su-Hsin Chang
- Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (SHC, SL, TST, KKO, KRC); Division of Public Health Sciences, Department of Surgery (SHC, GAC, NPC, KRC), and Division of Oncology, Department of Internal Medicine (SL, KKO, KRC), Washington University School of Medicine, St. Louis, MO
| | - Suhong Luo
- Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (SHC, SL, TST, KKO, KRC); Division of Public Health Sciences, Department of Surgery (SHC, GAC, NPC, KRC), and Division of Oncology, Department of Internal Medicine (SL, KKO, KRC), Washington University School of Medicine, St. Louis, MO
| | - Theodore S Thomas
- Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (SHC, SL, TST, KKO, KRC); Division of Public Health Sciences, Department of Surgery (SHC, GAC, NPC, KRC), and Division of Oncology, Department of Internal Medicine (SL, KKO, KRC), Washington University School of Medicine, St. Louis, MO
| | - Katiuscia K O'Brian
- Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (SHC, SL, TST, KKO, KRC); Division of Public Health Sciences, Department of Surgery (SHC, GAC, NPC, KRC), and Division of Oncology, Department of Internal Medicine (SL, KKO, KRC), Washington University School of Medicine, St. Louis, MO
| | - Graham A Colditz
- Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (SHC, SL, TST, KKO, KRC); Division of Public Health Sciences, Department of Surgery (SHC, GAC, NPC, KRC), and Division of Oncology, Department of Internal Medicine (SL, KKO, KRC), Washington University School of Medicine, St. Louis, MO
| | - Nils P Carlsson
- Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (SHC, SL, TST, KKO, KRC); Division of Public Health Sciences, Department of Surgery (SHC, GAC, NPC, KRC), and Division of Oncology, Department of Internal Medicine (SL, KKO, KRC), Washington University School of Medicine, St. Louis, MO
| | - Kenneth R Carson
- Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (SHC, SL, TST, KKO, KRC); Division of Public Health Sciences, Department of Surgery (SHC, GAC, NPC, KRC), and Division of Oncology, Department of Internal Medicine (SL, KKO, KRC), Washington University School of Medicine, St. Louis, MO
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Carson KR, Horwitz SM, Pinter-Brown LC, Rosen ST, Pro B, Hsi ED, Federico M, Gisselbrecht C, Schwartz M, Bellm LA, Acosta MA, Shustov AR, Advani RH, Feldman TA, Lechowicz MJ, Smith SM, Lansigan F, Tulpule A, Craig MD, Greer JP, Kahl BS, Leach JW, Morganstein N, Casulo C, Park SI, Foss FM. A prospective cohort study of patients with peripheral T-cell lymphoma in the United States. Cancer 2016; 123:1174-1183. [PMID: 27911989 DOI: 10.1002/cncr.30416] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [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: 08/29/2016] [Revised: 09/27/2016] [Accepted: 10/03/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Long-term survival in patients with aggressive peripheral T-cell lymphoma (PTCL) is generally poor, and there currently is no clear consensus regarding the initial therapy used for these diseases. Herein, the authors analyzed treatment patterns and outcomes in a prospectively collected cohort of patients with a new diagnosis of nodal PTCL in the United States. METHODS Comprehensive Oncology Measures for Peripheral T-cell Lymphoma Treatment (COMPLETE) is a prospective multicenter cohort study designed to identify the most common prevailing treatment patterns used for patients newly diagnosed with PTCL in the United States. Patients with nodal PTCL and completed records regarding baseline characteristics and initial therapy were included in this analysis. All statistical tests were 2-sided. RESULTS Of a total of 499 patients enrolled, 256 (51.3%) had nodal PTCL and completed treatment records. As initial therapy, patients received doxorubicin-containing regimens (41.8%), regimens containing doxorubicin plus etoposide (20.9%), other etoposide regimens (15.8%), other single-agent or combination regimens (19.2%), and gemcitabine-containing regimens (2.1%). Survival was found to be statistically significantly longer for patients who received doxorubicin (log-rank P = .03). After controlling for disease histology and International Prognostic Index, results demonstrated a trend toward significance in mortality reduction in patients who received doxorubicin compared with those who did not (hazard ratio, 0.71; 95% confidence interval, 0.48-1.05 [P = .09]). CONCLUSIONS To the authors' knowledge, there is no clear standard of care in the treatment of patients with PTCL in the United States. Although efforts to improve frontline treatments are necessary, anthracyclines remain an important component of initial therapy for curative intent. Cancer 2017;123:1174-1183. © 2016 American Cancer Society.
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Affiliation(s)
- Kenneth R Carson
- Research Service, St Louis Veterans Affairs Medical Center, St. Louis, Missouri.,Department of Medical Oncology, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Steven M Horwitz
- Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | - Steven T Rosen
- Provost and Chief Scientific Officer, Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Barbara Pro
- Department of Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Eric D Hsi
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Massimo Federico
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | - Mark A Acosta
- Research and Development, Spectrum Pharmaceuticals Inc, Irvine, California
| | - Andrei R Shustov
- Department of Medicine, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ranjana H Advani
- Department of Medicine, Stanford University Medical Center, Stanford, California
| | - Tatyana A Feldman
- Department of Hematology/Oncology, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey
| | - Mary Jo Lechowicz
- Department of Hematology and Oncology, Emory University, Atlanta, Georgia
| | - Sonali M Smith
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Frederick Lansigan
- Department of Medicine, Dartmouth Hitchcock Medical Center, Hanover, New Hampshire
| | - Anil Tulpule
- Department of Medicine, University of Southern California, Los Angeles, California
| | - Michael D Craig
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - John P Greer
- Department of Hematology, Vanderbilt University, Nashville, Tennessee
| | - Brad S Kahl
- Department of Medical Oncology, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Joseph W Leach
- Minnesota Oncology, Virginia Piper Cancer Institute, Minneapolis, Minnesota
| | | | - Carla Casulo
- Department of Medicine, University of Rochester, Rochester, New York
| | - Steven I Park
- Department of Internal Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Francine M Foss
- Department of Medical Oncology, Yale University, New Haven, Connecticut
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Burudpakdee C, Lin HM, Wang W, Seetasith A, Zhu Y, Bonthapally V, Carson KR. Clinical and economic burden of peripheral T-cell lymphoma in commercially insured patients in the United States: findings using real-world claims data. J Med Econ 2016; 19:965-72. [PMID: 27152635 DOI: 10.1080/13696998.2016.1187622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 10/21/2022]
Abstract
OBJECTIVE This retrospective cohort study utilized real-world claims data to assess the clinical and economic burden of peripheral T-cell lymphoma (PTCL) over the continuum of care in the US. METHODS Data were extracted from US administrative claims databases to identify adult patients with PTCL (ICD-9-CM code 202.7X) diagnosed between October 2007 and June 2011. Patients had to have ≥6 months of continuous enrollment before and ≥12 months of continuous enrollment after their index date (date of first PTCL diagnosis). PTCL patients were matched (1:5) by age, sex, region, plan type, payer type, and length of continuous enrollment, to a control group of randomly selected patients without PTCL. Patient-level healthcare resource utilization data and associated costs (in US dollars) were measured. Mean costs per patient per month were determined. RESULTS Of 2820 patients with PTCL, 1000 met all inclusion criteria (median age = 57 years; 57.5% male) and were matched to the control group (n = 5000). On an average monthly basis, PTCL patients were hospitalized more frequently (0.07 vs 0.01 admissions; p < 0.0001) and had a longer length of hospital stay (6.4 vs 4.0 days; p < 0.0001) compared with controls. PTCL patients also had higher monthly utilization of pharmacy services (2.85 vs 0.97 prescriptions; p < 0.0001), office visits (1.35 vs 0.34 visits; p < 0.0001), ER visits (0.07 vs 0.02 visits; p < 0.0001), hospice stays (0.05 vs 0.01 stays; p < 0.0001) and other patient services/procedures. Overall, PTCL patients incurred higher average monthly costs per patient compared with control patients ($6327.84 vs $388.39; p < 0.0001), driven mainly by hospitalizations (32.2% of overall costs) and pharmacy services (19.6%). CONCLUSIONS This is the first real-world study to quantify healthcare resource utilization, costly treatment, and overall medical expenditure in commercially insured PTCL patients. Better tolerated and more effective treatments may improve disease management and reduce the clinical and economic burden of PTCL.
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Affiliation(s)
- Chakkarin Burudpakdee
- a IMS Health , Fairfax , VA , USA
- b University of North Carolina at Charlotte , Charlotte , NC , USA
| | - Huamao Mark Lin
- c Millennium Pharmaceuticals , Inc., Cambridge , MA , USA , a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | | | | | - Yanyan Zhu
- c Millennium Pharmaceuticals , Inc., Cambridge , MA , USA , a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Vijayveer Bonthapally
- c Millennium Pharmaceuticals , Inc., Cambridge , MA , USA , a wholly owned subsidiary of Takeda Pharmaceutical Company Limited
| | - Kenneth R Carson
- e Washington University School of Medicine , St. Louis , MO , USA
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Xiao DY, Luo S, O'Brian K, Ganti A, Riedell P, Sanfilippo KM, Lynch RC, Liu W, Carson KR. Impact of sarcopenia on treatment tolerance in United States veterans with diffuse large B-cell lymphoma treated with CHOP-based chemotherapy. Am J Hematol 2016; 91:1002-7. [PMID: 27356783 DOI: 10.1002/ajh.24465] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/25/2016] [Accepted: 06/27/2016] [Indexed: 01/06/2023]
Abstract
While sarcopenia has been associated with decreased overall survival in diffuse large B-cell (DLBCL) patients, the impact of sarcopenia on treatment tolerance has not been well-studied. We evaluated the association of sarcopenia with febrile neutropenia hospitalization, treatment-related mortality, and ability to complete standard number of cycles in a retrospective cohort of United States veterans diagnosed with DLBCL between 1998 and 2008 and treated with cyclophosphamide, doxorubicin, vincristine, and prednisone, with or without rituximab. Baseline body composition parameters were evaluated using computed tomography analysis. In total, 522 patients were included in the study, of whom 245 (47%) had baseline sarcopenia. After controlling for other variables, baseline sarcopenia was independently associated with increased risk of febrile neutropenia hospitalization (adjusted Odds Ratio (aOR) 1.64, 95% confidence interval (CI) 1.01-2.65) and inability to complete standard number of treatment cycles (aOR 1.49, 95% CI 1.02-2.16) compared with no baseline sarcopenia. There was a non-statistically significant trend toward higher treatment-related mortality in sarcopenic patients than non-sarcopenic patients (aOR 1.77, 95% CI 0.92-3.41). Sarcopenia is associated with increased risk of treatment intolerance and may be useful in guiding treatment planning and supportive care measures. Am. J. Hematol. 91:1002-1007, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Daphne Y. Xiao
- Research Service; St. Louis Veterans Affairs Medical Center; St. Louis Missouri
- Department of Internal Medicine, Washington University School of Medicine; St. Louis Missouri
| | - Suhong Luo
- Research Service; St. Louis Veterans Affairs Medical Center; St. Louis Missouri
- Division of Oncology; Department of Internal Medicine; Washington University School of Medicine; St. Louis Missouri
| | - Katiuscia O'Brian
- Research Service; St. Louis Veterans Affairs Medical Center; St. Louis Missouri
- Division of Oncology; Department of Internal Medicine; Washington University School of Medicine; St. Louis Missouri
| | - Arun Ganti
- Department of Emergency Medicine; University of Michigan Health System; Ann Arbor Michigan
| | - Peter Riedell
- Division of Oncology; Department of Internal Medicine; Washington University School of Medicine; St. Louis Missouri
| | - Kristen M. Sanfilippo
- Research Service; St. Louis Veterans Affairs Medical Center; St. Louis Missouri
- Division of Oncology; Department of Internal Medicine; Washington University School of Medicine; St. Louis Missouri
| | - Ryan C. Lynch
- Division of Oncology; Department of Medicine; Stanford University School of Medicine/Stanford Cancer Institute; Stanford California
| | - Weijian Liu
- Research Service; St. Louis Veterans Affairs Medical Center; St. Louis Missouri
| | - Kenneth R. Carson
- Research Service; St. Louis Veterans Affairs Medical Center; St. Louis Missouri
- Division of Oncology; Department of Internal Medicine; Washington University School of Medicine; St. Louis Missouri
- Division of Public Health Sciences; Department of Surgery; Washington University School of Medicine; St. Louis Missouri
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Sanfilippo KM, Keller J, Gage BF, Luo S, Wang TF, Moskowitz G, Gumbel J, Blue B, O'Brian K, Carson KR. Statins Are Associated With Reduced Mortality in Multiple Myeloma. J Clin Oncol 2016; 34:4008-4014. [PMID: 27646948 DOI: 10.1200/jco.2016.68.3482] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose The 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) have activity in one of the pathways influenced by nitrogen-containing bisphosphonates, which are associated with improved survival in multiple myeloma (MM). To understand the benefit of statins in MM, we evaluated the association between statin use and mortality in a large cohort of patients with MM. Patients and Methods From the Veterans Administration Central Cancer Registry, we identified patients diagnosed with MM between 1999 and 2013. We defined statin use as the presence of any prescription for a statin within 3 months before or any time after MM diagnosis. Cox proportional hazards regression assessed the association of statin use with mortality, while controlling for known MM prognostic factors. Results We identified a cohort of 4,957 patients, of whom 2,294 received statin therapy. Statin use was associated with a 21% decrease in all-cause mortality (adjusted hazard ratio, 0.79; 95% CI, 0.73 to 0.86; P < .001) as well as a 24% decrease in MM-specific mortality (adjusted hazard ratio, 0.76; 95% CI, 0.67 to 0.86; P < .001). This association remained significant across all sensitivity analyses. In addition to reductions in mortality, statin use was associated with a 31% decreased risk of developing a skeletal-related event. Conclusion In this cohort study of US veterans with MM, statin therapy was associated with a reduced risk of both all-cause and MM-specific mortality. Our findings suggest a potential role for statin therapy in patients with MM. The putative benefit of statin therapy in MM should be corroborated in prospective studies.
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Affiliation(s)
- Kristen Marie Sanfilippo
- Kristen Marie Sanfilippo, Suhong Luo, Jason Gumbel, and Kenneth R. Carson, St Louis Veterans Health Administration Medical Center; Kristen Marie Sanfilippo, Jesse Keller, Brian F. Gage, Gerald Moskowitz, Katiuscia O'Brian, and Kenneth R. Carson, Washington University School of Medicine; Brandon Blue, St Louis University, St Louis, MO; and Tzu-Fei Wang, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Jesse Keller
- Kristen Marie Sanfilippo, Suhong Luo, Jason Gumbel, and Kenneth R. Carson, St Louis Veterans Health Administration Medical Center; Kristen Marie Sanfilippo, Jesse Keller, Brian F. Gage, Gerald Moskowitz, Katiuscia O'Brian, and Kenneth R. Carson, Washington University School of Medicine; Brandon Blue, St Louis University, St Louis, MO; and Tzu-Fei Wang, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Brian F Gage
- Kristen Marie Sanfilippo, Suhong Luo, Jason Gumbel, and Kenneth R. Carson, St Louis Veterans Health Administration Medical Center; Kristen Marie Sanfilippo, Jesse Keller, Brian F. Gage, Gerald Moskowitz, Katiuscia O'Brian, and Kenneth R. Carson, Washington University School of Medicine; Brandon Blue, St Louis University, St Louis, MO; and Tzu-Fei Wang, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Suhong Luo
- Kristen Marie Sanfilippo, Suhong Luo, Jason Gumbel, and Kenneth R. Carson, St Louis Veterans Health Administration Medical Center; Kristen Marie Sanfilippo, Jesse Keller, Brian F. Gage, Gerald Moskowitz, Katiuscia O'Brian, and Kenneth R. Carson, Washington University School of Medicine; Brandon Blue, St Louis University, St Louis, MO; and Tzu-Fei Wang, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Tzu-Fei Wang
- Kristen Marie Sanfilippo, Suhong Luo, Jason Gumbel, and Kenneth R. Carson, St Louis Veterans Health Administration Medical Center; Kristen Marie Sanfilippo, Jesse Keller, Brian F. Gage, Gerald Moskowitz, Katiuscia O'Brian, and Kenneth R. Carson, Washington University School of Medicine; Brandon Blue, St Louis University, St Louis, MO; and Tzu-Fei Wang, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Gerald Moskowitz
- Kristen Marie Sanfilippo, Suhong Luo, Jason Gumbel, and Kenneth R. Carson, St Louis Veterans Health Administration Medical Center; Kristen Marie Sanfilippo, Jesse Keller, Brian F. Gage, Gerald Moskowitz, Katiuscia O'Brian, and Kenneth R. Carson, Washington University School of Medicine; Brandon Blue, St Louis University, St Louis, MO; and Tzu-Fei Wang, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Jason Gumbel
- Kristen Marie Sanfilippo, Suhong Luo, Jason Gumbel, and Kenneth R. Carson, St Louis Veterans Health Administration Medical Center; Kristen Marie Sanfilippo, Jesse Keller, Brian F. Gage, Gerald Moskowitz, Katiuscia O'Brian, and Kenneth R. Carson, Washington University School of Medicine; Brandon Blue, St Louis University, St Louis, MO; and Tzu-Fei Wang, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Brandon Blue
- Kristen Marie Sanfilippo, Suhong Luo, Jason Gumbel, and Kenneth R. Carson, St Louis Veterans Health Administration Medical Center; Kristen Marie Sanfilippo, Jesse Keller, Brian F. Gage, Gerald Moskowitz, Katiuscia O'Brian, and Kenneth R. Carson, Washington University School of Medicine; Brandon Blue, St Louis University, St Louis, MO; and Tzu-Fei Wang, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Katiuscia O'Brian
- Kristen Marie Sanfilippo, Suhong Luo, Jason Gumbel, and Kenneth R. Carson, St Louis Veterans Health Administration Medical Center; Kristen Marie Sanfilippo, Jesse Keller, Brian F. Gage, Gerald Moskowitz, Katiuscia O'Brian, and Kenneth R. Carson, Washington University School of Medicine; Brandon Blue, St Louis University, St Louis, MO; and Tzu-Fei Wang, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Kenneth R Carson
- Kristen Marie Sanfilippo, Suhong Luo, Jason Gumbel, and Kenneth R. Carson, St Louis Veterans Health Administration Medical Center; Kristen Marie Sanfilippo, Jesse Keller, Brian F. Gage, Gerald Moskowitz, Katiuscia O'Brian, and Kenneth R. Carson, Washington University School of Medicine; Brandon Blue, St Louis University, St Louis, MO; and Tzu-Fei Wang, The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Xiao DY, Luo S, O'Brian K, Liu W, Carson KR. Weight change trends and overall survival in United States veterans with follicular lymphoma treated with chemotherapy. Leuk Lymphoma 2016; 58:851-858. [PMID: 27669828 DOI: 10.1080/10428194.2016.1217526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 12/30/2022]
Abstract
Understanding weight change patterns in follicular lymphoma (FL) may be important for the assessment of prognosis as well as the long-term care of survivors. A retrospective cohort of United States veterans with a new diagnosis of FL between October 1, 1998 and September 30, 2010 was assembled. Weight changes were evaluated before, during, and after treatment in 896 FL patients who received cyclophosphamide, doxorubicin, vincristine, and prednisone, with or without rituximab (CHOP ± R); cyclophosphamide, vincristine, and prednisone, with or without rituximab (CVP ± R); or rituximab monotherapy. Weight decreased an average of 1.4 kg during therapy, and >5% weight loss during this time period was associated with worse overall survival. Weight increased to an average of 1.4 kg above baseline by 24 months after treatment initiation, with 15% gaining greater than 10% of their baseline weight. Weight management strategies may be an important part of long-term survivorship planning.
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Affiliation(s)
- Daphne Y Xiao
- a Research Service , St. Louis Veterans Affairs Medical Center , St. Louis , MO , USA.,b Department of Internal Medicine , Washington University School of Medicine , St. Louis , MO , USA
| | - Suhong Luo
- a Research Service , St. Louis Veterans Affairs Medical Center , St. Louis , MO , USA.,c Division of Oncology, Department of Internal Medicine , Washington University School of Medicine , St. Louis , MO , USA
| | - Katiuscia O'Brian
- a Research Service , St. Louis Veterans Affairs Medical Center , St. Louis , MO , USA.,c Division of Oncology, Department of Internal Medicine , Washington University School of Medicine , St. Louis , MO , USA
| | - Weijian Liu
- a Research Service , St. Louis Veterans Affairs Medical Center , St. Louis , MO , USA
| | - Kenneth R Carson
- a Research Service , St. Louis Veterans Affairs Medical Center , St. Louis , MO , USA.,c Division of Oncology, Department of Internal Medicine , Washington University School of Medicine , St. Louis , MO , USA.,d Division of Public Health Sciences, Department of Surgery , Washington University School of Medicine , St. Louis , MO , USA
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Bennett CL, Berger JR, Sartor O, Carson KR, Hrushesky WJ, Georgantopoulos P, Raisch DW, Norris LB, Armitage JO. Progressive multi-focal leucoencephalopathy among ibrutinib-treated persons with chronic lymphocytic leukaemia. Br J Haematol 2016; 180:301-304. [PMID: 27649938 DOI: 10.1111/bjh.14322] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Charles L Bennett
- The Southern Network on Adverse Reactions (SONAR) Program, South Carolina College of Pharmacy, Columbia, SC, USA.,The Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,SC Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Joseph R Berger
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Oliver Sartor
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Kenneth R Carson
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - William J Hrushesky
- The Southern Network on Adverse Reactions (SONAR) Program, South Carolina College of Pharmacy, Columbia, SC, USA.,The Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,SC Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.,Oncology Analytics Inc, Plantation, FL, USA
| | - Peter Georgantopoulos
- The Southern Network on Adverse Reactions (SONAR) Program, South Carolina College of Pharmacy, Columbia, SC, USA.,The Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Dennis W Raisch
- College of Pharmacy, Pharmacoeconomics, Epidemiology, Public Policy, Outcomes Research Program, University of New Mexico, Albuquerque, NM, USA
| | - LeAnn B Norris
- The Southern Network on Adverse Reactions (SONAR) Program, South Carolina College of Pharmacy, Columbia, SC, USA
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Tunis MC, Dawod B, Carson KR, Veinotte LL, Marshall JS. Toll-like receptor 2 activators modulate oral tolerance in mice. Clin Exp Allergy 2016; 45:1690-702. [PMID: 26242919 PMCID: PMC5019435 DOI: 10.1111/cea.12605] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 06/18/2015] [Accepted: 07/03/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Toll-like receptor 2 (TLR2) is a widely expressed pattern recognition receptor critical for innate immunity. TLR2 is also a key regulator of mucosal immunity implicated in the development of allergic disease. TLR2 activators are found in many common foods, but the role of TLR2 in oral tolerance and allergic sensitization to foods is not well understood. OBJECTIVE The purpose of this study was to evaluate the impacts of TLR2 expression and TLR2 activation on oral tolerance to food antigens in a murine model. METHODS Mice were fed ovalbumin (OVA) or peanut butter with or without the addition of low doses of TLR2 activators Pam3 CSK4 or FSL-1. Oral tolerance was assessed by analysing antibody responses after a systemic antigen challenge. OVA-specific Tregs were assessed in the Peyer's patches, mesenteric lymph nodes, and spleen in wild-type and TLR2(-/-) mice. Low-dose Pam3 CSK4 was also tested as an oral adjuvant. RESULTS Oral tolerance was successfully induced in both wild-type and TLR2(-/-) recipient mice, with an associated regulatory T-cell response. Oral TLR2 activation, with low-dose Pam3 CSK4 or FSL-1, during oral antigen exposure was found to alter oral tolerance and was associated with the development of substantial IgE and IgA responses to foods upon systemic challenge. Low-dose oral Pam3 CSK4 treatment also selectively enhanced antigen-specific IgA responses to oral antigen exposure. CONCLUSIONS AND CLINICAL RELEVANCE TLR2 is not necessary for oral tolerance induction, but oral TLR2 activation modulates humoral IgE and IgA responses during tolerance development. Low-dose Pam3 CSK4 is also an effective oral adjuvant that selectively enhances IgA production. These observations are pertinent to the optimization of oral allergen immunotherapy and oral vaccine development.
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Affiliation(s)
- M C Tunis
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada.,Dalhousie Inflammation Group, Dalhousie University, Halifax, NS, Canada
| | - B Dawod
- Dalhousie Inflammation Group, Dalhousie University, Halifax, NS, Canada.,Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - K R Carson
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada.,Dalhousie Inflammation Group, Dalhousie University, Halifax, NS, Canada
| | - L L Veinotte
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada.,Dalhousie Inflammation Group, Dalhousie University, Halifax, NS, Canada
| | - J S Marshall
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada.,Dalhousie Inflammation Group, Dalhousie University, Halifax, NS, Canada.,Department of Pathology, Dalhousie University, Halifax, NS, Canada
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Hicks LK, Rajasekhar A, Bering H, Carson KR, Kleinerman J, Kukreti V, Ma A, Mueller BU, O'Brien SH, Panepinto JA, Pasquini MC, Sarode R, Wood WA. Identifying existing Choosing Wisely recommendations of high relevance and importance to hematology. Am J Hematol 2016; 91:787-92. [PMID: 27152483 DOI: 10.1002/ajh.24412] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/26/2016] [Accepted: 05/03/2016] [Indexed: 01/03/2023]
Abstract
Choosing Wisely (CW) is a medical stewardship initiative led by the American Board of Internal Medicine Foundation in collaboration with professional medical societies in the United States. In an effort to learn from and leverage the work of others, the American Society of Hematology CW Task Force developed a method to identify and prioritize CW recommendations from other medical societies of high relevance and importance to patients with blood disorders and their physicians. All 380 CW recommendations were reviewed and assessed for relevance and importance. Relevance was assessed using the MORE(TM) relevance scale. Importance was assessed with regard to six guiding principles: harm avoidance, evidence, aggregate cost, relevance, frequency and impact. Harm avoidance was considered the most important principle. Ten highly relevant and important recommendations were identified from a variety of professional societies. Recommendations focused on decreasing unnecessary imaging, blood work, treatments and transfusions, as well as on increasing collaboration across disciplines and considering value when recommending treatments. Many CW recommendations have relevance beyond the society of origin. The methods developed by the ASH CW Task Force could be easily adapted by other Societies to identify additional CW recommendations of relevance and importance to their fields. Am. J. Hematol. 91:787-792, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Lisa K. Hicks
- St. Michael's Hospital; University of Toronto; Toronto Ontario Canada
| | | | - Harriet Bering
- Harvard Vanguard Medical Associates; Beverly Massachusetts
| | | | | | - Vishal Kukreti
- University of Toronto, University Health Network; Toronto Ontario
| | - Alice Ma
- University of North Carolina; Chapel Hill North Carolina
| | | | | | - Julie A. Panepinto
- Medical College of Wisconsin/Children's Hospital of Wisconsin; Milwaukee Wisconsin
| | | | - Ravi Sarode
- UT Southwestern Medical Center; Dallas Texas
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Krysiak K, Gomez F, White BS, Matlock M, Miller CA, Fulton RS, Kreisel F, Cashen AF, Carson KR, Berrien-Elliott MM, Bartlett NL, Wilson RK, Mardis ER, Griffith M, Griffith OL, Fehniger TA. Abstract LB-326: Identification of novel recurrent mutations in follicular lymphoma. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-lb-326] [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: 11/16/2022]
Abstract
Abstract
Follicular lymphoma (FL) is the most common indolent non-Hodgkin lymphoma and although often responsive to treatment remains incurable with conventional therapies. Approximately 30% of patients will undergo transformation to a more aggressive, clonally related malignancy (t-FL). Our understanding of the genomic landscape of FL is limited when compared to other hematologic malignancies such as acute myeloid leukemia or diffuse large B-cell lymphoma.
To better understand the FL genomic landscape and identify novel recurrent mutations, we performed exome sequencing on fresh frozen samples from a discovery cohort of 24 patients with FL prior to treatment (12), FL relapsed after prior therapy (6) or t-FL (6) with paired normal skin samples. From this analysis, we identified 898 genes harboring mutations. We combined these results with a list of 819 recurrently mutated genes from 10 sequencing studies of other B-cell malignancies to develop a custom capture reagent targeting the coding regions and UTRs of 1717 genes. We applied this reagent to the initial discovery samples and an additional 81 FFPE tumor samples from patients with FL (80) or t-FL (1), achieving >20x coverage for >75% of the targeted region.
Through this approach, we confirmed previously described mutations in chromatin/epigenetic modifiers (MLL2 [60%], CREBBP [55%], EP300 [19%], EZH2 [17%], MEF2B [7.6%]), histones linkers (HIST1H1C/E [21%]), transcription factors (IRF8 [13%], STAT6 [12%]), and the BCR signaling pathway (CD79B [5.7%], CARD11 [11.4%], BCL10 [2.8%], TNFAIP3 [2.8%]). Additionally, we identified mutations in novel genes within the previously implicated BCR pathway (CD22 [3.8%], BTK [8.6%], HVCN1 [7.6%]) and multiple hits in complexes not previously described in association with FL such as the Swi/Snf nucleosome remodeling complex (ARID1A/B [8.6%], SMARCA4 [4.8%], SMARCB1 [1.9%], BCL7A [21%], BCL11A [1.9%], PBRM1 [1.9%], DPF1 [1%], ACTB [1%]), hotspot mutations in vacuolar ATPases (ATP6V1B2 [8.6%], VMA21 [4.8%]) and others (EGR1/2 [6.7%], POU2AF1 [6.7%]). Though many of these mutations have been independently reported in patients, those studies lacked sufficient size to evaluate their statistical significance. In contrast, the strength of our approach is illustrated in our finding of 54 genes significantly mutated above background mutation rates (FDR<0.15). Clinical outcomes and treatment regimen data were available for 100 patients, and as expected, the FLIPI score was predictive of PFS. Notably, improved PFS was observed in treated patients harboring novel HVCN1 mutations (p<0.05). In contrast, CREBBP mutations were associated with reduced PFS (p<0.05). Although larger cohort sizes are required to more robustly associate clinical outcomes and mutation profiles, we have identified novel recurrent mutations and pathways in FL. Such discoveries are key to understanding the etiology of and the development of novel therapeutic approaches for FL.
Citation Format: Kilannin Krysiak, Felicia Gomez, Brian S. White, Matthew Matlock, Chris A. Miller, Robert S. Fulton, Friederike Kreisel, Amanda F. Cashen, Kenneth R. Carson, Melissa M. Berrien-Elliott, Nancy L. Bartlett, Richard K. Wilson, Elaine R. Mardis, Malachi Griffith, Obi L. Griffith, Todd A. Fehniger. Identification of novel recurrent mutations in follicular lymphoma. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr LB-326.
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Affiliation(s)
| | - Felicia Gomez
- Washington University in Saint Louis, Saint Louis, MO
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Xiao DY, Luo S, O'Brian K, Sanfilippo KM, Ganti A, Riedell P, Lynch RC, Liu W, Kahl BS, Cashen AF, Fehniger TA, Carson KR. Longitudinal Body Composition Changes in Diffuse Large B-cell Lymphoma Survivors: A Retrospective Cohort Study of United States Veterans. J Natl Cancer Inst 2016; 108:djw145. [PMID: 27381623 DOI: 10.1093/jnci/djw145] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/26/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Body composition parameters are associated with long-term health outcomes. We assessed longitudinal body composition changes in diffuse large B-cell lymphoma (DLBCL) survivors and identified clinical variables associated with the long-term development of sarcopenia and visceral obesity. METHODS A retrospective cohort of United States veterans with DLBCL treated with cyclophosphamide, doxorubicin, vincristine, and prednisone, with or without rituximab, was assembled. Muscle, subcutaneous fat, and visceral fat areas were measured with computed tomography analysis. Data were analyzed with repeated-measures analysis of variance and logistic regression. All statistical tests were two-sided. RESULTS Three hundred forty-two patients were included. Muscle area initially decreased during treatment, then returned to baseline by 24 months after treatment. Subcutaneous fat area increased from baseline by 6.5% (95% confidence interval [CI] = 2.6% to 10.5%) during treatment and by 21.4% (95% CI = 15.7% to 27.2%) by 24 months after treatment. Visceral fat area increased from baseline by 4.5% (95% CI = -0.9% to 9.9%) during treatment and by 21.6% (95% CI = 14.8% to 28.4%) by 24 months after treatment. Variables associated with long-term development of sarcopenia included: baseline sarcopenia (adjusted odds ratio [aOR] = 17.21, 95% CI = 8.48 to 34.94), older than age 60 years (aOR = 2.93, 95% CI = 1.46 to 5.88), and weight loss greater than 5% during treatment (aOR = 2.40, 95% CI = 1.12 to 5.14). Variables associated with long-term visceral fat gain included: weight gain greater than 5% during treatment (aOR = 4.60, 95% CI = 2.42 to 8.74). CONCLUSIONS DLBCL survivors undergo unfavorable long-term body composition changes. Patients at risk for the long-term development of sarcopenia or visceral obesity can be identified based on clinical risk factors and targeted for lifestyle interventions.
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Affiliation(s)
- Daphne Y Xiao
- Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL)
| | - Suhong Luo
- Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL)
| | - Katiuscia O'Brian
- Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL)
| | - Kristen M Sanfilippo
- Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL)
| | - Arun Ganti
- Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL)
| | - Peter Riedell
- Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL)
| | - Ryan C Lynch
- Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL)
| | - Weijian Liu
- Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL)
| | - Brad S Kahl
- Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL)
| | - Amanda F Cashen
- Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL)
| | - Todd A Fehniger
- Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL)
| | - Kenneth R Carson
- Affiliations of authors: Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO (DYX, SL, KO, KMS, WL, KRC); Division of Public Health Sciences, Department of Surgery (KRC), and Division of Oncology, Department of Internal Medicine (SL, KO, KMS, PR, BSK, AFC, TAF, KRC), Washington University School of Medicine (DYX), St. Louis, MO; Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, MI (AG); Division of Oncology, Department of Medicine, Stanford University School of Medicine/Stanford Cancer Institute, Stanford, CA (RCL)
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Sanfilippo KM, Wang TF, Gage BF, Luo S, Riedell P, Carson KR. Incidence of venous thromboembolism in patients with non-Hodgkin lymphoma. Thromb Res 2016; 143:86-90. [PMID: 27208462 DOI: 10.1016/j.thromres.2016.05.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 03/10/2016] [Revised: 04/23/2016] [Accepted: 05/10/2016] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Patients with non-Hodgkin lymphoma (NHL) have an increased risk of venous thromboembolism (VTE). Current risk-prediction models classify NHL as a single entity. We aimed to quantify the difference in VTE risk in follicular lymphoma (FL) versus diffuse large B cell lymphoma (DLBCL). METHODS Using a prospective cohort study, we identified 2730 patients (2037 DLBCL; 693 FL) within the Veteran's Administration Central Cancer Registry. A competing risk model assessed the association between VTE risk and histology in the first year after NHL diagnosis. We assessed the effect of additional risk factors for VTE in NHL. RESULTS In univariate analysis, DLBCL was associated with increased risk of VTE compared to FL in the first year after diagnosis; this association was no longer significant in adjusted analysis (adjusted hazard ratio (aHR) 1.52; 95% CI 0.97-2.40). Major risk factors for VTE included history of VTE before NHL diagnosis (aHR 4.73, p≤0.0001) and time period during chemotherapy administration (aHR 7.60, p≤0.0001). Additional risk factors included: stage III/IV disease (p=0.02), BMI≥30 (p=0.02), B-symptoms (p=0.02), and doxorubicin (p=0.04). The cumulative incidence of VTE was highest in the period following diagnosis and decreased over time for both histologies. CONCLUSION DLBCL is associated with increased risk of VTE compared to FL. This risk is markedly attenuated when adjusting for additional risk factors. The strongest predictors for development of VTE included: time period during chemotherapy administration (especially doxorubicin) and history of VTE. This knowledge can assist clinicians in identifying NHL patients at high risk for VTE.
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Affiliation(s)
- K M Sanfilippo
- Department of Medicine, Washington University School of Medicine Saint Louis, United States; Saint Louis Veterans Health Administration Medical Center, The Ohio State University Comprehensive Cancer Center, United States.
| | - T F Wang
- Department of Medicine, The Ohio State University Comprehensive Cancer Center, United States
| | - B F Gage
- Department of Medicine, Washington University School of Medicine Saint Louis, United States
| | - S Luo
- Saint Louis Veterans Health Administration Medical Center, The Ohio State University Comprehensive Cancer Center, United States
| | - P Riedell
- Department of Medicine, Washington University School of Medicine Saint Louis, United States
| | - K R Carson
- Department of Medicine, Washington University School of Medicine Saint Louis, United States; Saint Louis Veterans Health Administration Medical Center, The Ohio State University Comprehensive Cancer Center, United States
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