1
|
Orbach D, Carton M, Khadir SK, Feuilly M, Kurtinecz M, Vokuhl C, Koscielniak E, Pierron G, Lemelle L, Sparber-Sauer M. Therapeutic benefit of larotrectinib over the historical standard of care in patients with locally advanced or metastatic infantile fibrosarcoma (EPI VITRAKVI study). ESMO Open 2024; 9:103006. [PMID: 38657345 DOI: 10.1016/j.esmoop.2024.103006] [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: 08/30/2023] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Patients with infantile fibrosarcoma (IFS) have shown strong and long-lasting responses to larotrectinib, a tropomyosin receptor kinase inhibitor (TRKi), in single-arm clinical trials. Conventional chemotherapy has also shown important efficacy. But, until now, no comparative data exist. This study aims to assess the therapeutic benefit of larotrectinib over the current standard of care (SOC) of chemotherapy in paediatric patients with locally advanced or metastatic IFS. PATIENTS AND METHODS EPI VITRAKVI is a retrospective, observational, externally controlled study (NCT05236257). Data of patients aged ≤21 years with locally advanced or metastatic IFS treated with larotrectinib in the phase I/II SCOUT trial (NCT02637687) were compared with those of an external historical control group (data of Institut Curie and Cooperative Weichteilsarkom Studiengruppe) treated with a chemotherapy-based regimen. Between-group differences were assessed after balancing groups using inverse probability of treatment weighting (IPTW). RESULTS In total, 93 patients were compared, 51 in the larotrectinib arm and 42 in the external control arm. After therapy, 4 patients (7.8%) in the larotrectinib group had a medical treatment failure event [start of new systemic treatment (2 cases), mutilating surgery (2 cases)] versus 15 (35.7%) in the external control group [start of new systemic treatment (6 cases), mutilating surgery (5 cases), radiation therapy (2 cases), and death (2 cases)]. Larotrectinib was associated with an 80% reduced likelihood of encountering a medical treatment failure event, when compared to the external control group (weighted and stratified hazard ratio 0.20, 95% confidence interval 0.06-0.63, P = 0.0060). These results were confirmed by sensitivity analyses, including exact matching, and subgroup analyses for number of lines of treatment. CONCLUSIONS Treatment with larotrectinib reduced the need of subsequent therapies compared to SOC with chemotherapy in children with locally advanced or metastatic IFS, regardless of the line of treatment.
Collapse
Affiliation(s)
- D Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris.
| | - M Carton
- Biometry Unit, Institut Curie, PSL Research University, Paris
| | | | - M Feuilly
- Bayer HealthCare SAS, La Garenne-Colombes, France
| | | | - C Vokuhl
- Section of Pediatric Pathology, Department of Pathology, University Hospital Bonn, Bonn
| | - E Koscielniak
- Klinikum der Landeshauptstadt Stuttgart gKAöR, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pädiatrie 5 (Pädiatrische Onkologie, Hämatologie, Immunologie), Stuttgart; Medizinische Fakultät der Universität Tübingen, Tübingen, Germany
| | - G Pierron
- Genetic Somatic Unit, PSL Research University, Institut Curie, Paris, France
| | - L Lemelle
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris
| | - M Sparber-Sauer
- Klinikum der Landeshauptstadt Stuttgart gKAöR, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pädiatrie 5 (Pädiatrische Onkologie, Hämatologie, Immunologie), Stuttgart; Medizinische Fakultät der Universität Tübingen, Tübingen, Germany
| |
Collapse
|
2
|
Carton M, Del Castillo JP, Colin JB, Kurtinecz M, Feuilly M, Pierron G, Arvis P, Khadir SK, Sparber-Sauer M, Orbach D. Larotrectinib versus historical standard of care in patients with infantile fibrosarcoma: protocol of EPI-VITRAKVI. Future Oncol 2023; 19:1645-1653. [PMID: 37133249 DOI: 10.2217/fon-2023-0114] [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] [Indexed: 05/04/2023] Open
Abstract
The EPI VITRAKVI study is a retrospective study designed to place the results of the single-arm Phase I/II larotrectinib SCOUT trial into context by comparison with external historical controls. Its primary objective is to compare the time to medical treatment failure between larotrectinib and the historical standard of care (chemotherapy) in patients with infantile fibrosarcoma. External historical cohorts have been selected by using objective criteria. The Inverse Probability of Treatment Weighting method will be used to adjust for potential confounding. The current publication illustrates how an external control arm study can complement data from a single-arm trial and addresses uncertainties encountered in the assessment of therapies targeting rare abnormalities where randomized controlled trials are considered not feasible. Clinical Trial Registration: NCT05236257 (ClinicalTrials.gov).
Collapse
Affiliation(s)
- Matthieu Carton
- Biometry Unit, Institut Curie, PSL Research University, Paris, 75005, France
| | - Johanna Peña Del Castillo
- Klinikum der Landeshauptstadt Stuttgart gKAöR, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pädiatrie 5 (Pädiatrische Onkologie, Hämatologie, Immunologie), Stuttgart, 70174, Germany
| | | | | | - Marion Feuilly
- Bayer HealthCare SAS, La Garenne-Colombes, 92035, France
| | - Gaëlle Pierron
- Genetic Somatic Unit, PSL Research University, Institut Curie, Paris, 75005, France
| | | | | | - Monika Sparber-Sauer
- Klinikum der Landeshauptstadt Stuttgart gKAöR, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pädiatrie 5 (Pädiatrische Onkologie, Hämatologie, Immunologie), Stuttgart, 70174, Germany
- Medizinische Fakultät der Universität Tübingen, Tübingen, 72076, Germany
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation & Research for Children & AYA with Cancer), PSL Research University, Institut Curie, Paris, 75005, France
| |
Collapse
|
3
|
Orbach D, Lemelle L, Carton M, Khadir S, Feuilly M, Kurtinecz M, Vokuhl C, Koscielniak E, Pierron G, Sparber-Sauer M. 44O Comparison of clinical outcomes of patients with infantile fibrosarcoma (IFS) treated with larotrectinib in the SCOUT study versus historical cohort: The EPI-VITRAKVI study. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101081] [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: 04/05/2023] Open
|
4
|
Cella D, Evans J, Feuilly M, Neggers S, Van Genechten D, Herman J, Khan MS. Patient and Healthcare Provider Perspectives of First-Generation Somatostatin Analogs in the Management of Neuroendocrine Tumors and Acromegaly: A Systematic Literature Review. Adv Ther 2021; 38:969-993. [PMID: 33432541 PMCID: PMC7799425 DOI: 10.1007/s12325-020-01600-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/05/2020] [Indexed: 11/24/2022]
Abstract
Introduction Somatostatin analogs (SSAs) are used to treat neuroendocrine tumors (NETs) and acromegaly. Two first-generation SSAs, octreotide long-acting release (OCT LAR) and lanreotide autogel/depot (LAN), are available. A systematic literature review (SLR) was conducted to investigate which characteristics beyond efficacy are most important in patient and healthcare practitioner (HCP) experience of LAN and OCT when used to treat acromegaly and NETs. Methods MEDLINE, Embase, the Cochrane Library, and Database of Abstracts of Reviews of Effect were searched from database inception to January 2019 with terms for first-generation SSAs, NETs, acromegaly, preferences, decision-making, and human factors. Key congresses in 2016–2018 and SLR bibliographies were hand-searched. Two independent reviewers screened articles at title/abstract and full-text stage. Publications fulfilling pre-specified inclusion criteria reported patient or HCP perspectives of LAN or OCT, or any factors affecting treatment perspectives for NETs or acromegaly. Results A total of 1110 unique records were screened, of which 21 studies were included, reporting from the perspectives of patients (n = 18) and/or HCPs (n = 9). Perspectives were collected using shared decision-making frameworks, questionnaires, informal patient opinion, and a Delphi panel. Where patient preference was specifically reported, LAN was preferred in 4/5 studies and OCT LAR in 1/5. Common factors underlying treatment experience included technical problems with injections and associated pain, emotional quality/anxiety of injections, time and convenience of treatment administration, and independence. Immediate aspects of injections appeared most important to patients, though the possibilities of extended dosing intervals and self-/partner-injection with LAN were also notable factors. Conclusions Study outcomes favored LAN in this SLR, with factors surrounding injection administration most influential in treatment experience. The findings of this SLR provide a basis that could inform development of decision-making criteria, with patient and HCP treatment perspectives considered. Future studies should utilize a common method to report preference and associated drivers. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-020-01600-x.
Collapse
Affiliation(s)
- David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | | | - Sebastian Neggers
- Department of Medicine, Section Endocrinology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dirk Van Genechten
- Belgian Neuroendocrine Tumour (NET) and Multiple Endocrine Neoplasia (MEN) Association, Blankenberge, Belgium
- International Neuroendocrine Cancer Alliance (INCA), Boston, MA, USA
| | - Jackie Herman
- Canadian Neuroendocrine Tumour Society, Cornwall, ON, Canada
| | | |
Collapse
|
5
|
Shaunfield S, Webster KA, Kaiser K, Greene GJ, Yount SE, Lacson L, Benson AB, Halperin DM, Yao JC, Singh S, Feuilly M, Marteau F, Cella D. Development of the Functional Assessment of Cancer Therapy-Carcinoid Syndrome Symptom Index. Neuroendocrinology 2021; 111:850-862. [PMID: 32911478 DOI: 10.1159/000511482] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/08/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To develop a symptom-focused index to evaluate representative symptoms, treatment side effects, and emotional and functional well-being of patients with carcinoid syndrome (CS). METHODS The development of the Functional Assessment of Cancer Therapy-Carcinoid Syndrome Symptom Index (FACT-CSI) followed US Food and Drug Administration guidelines for the development of patient-reported outcome (PRO) measures and involved the following: (a) literature review; (b) interviews with 14 CS patients; (c) interviews with 9 clinicians; and (d) instrument development involving input from a range of PRO measure development and CS experts. The resulting draft instrument underwent cognitive interviews with 7 CS patients. RESULTS Forty-six CS sources were reviewed. Analysis of patient interviews produced 23 patient-reported symptoms. The most frequently endorsed physical symptoms were flushing, diarrhea, abdominal pain, fatigue, and food sensitivity/triggers. Seven priority CS emotional and functional themes were also identified by patients. Expert interviews revealed 12 unique priority symptoms - the most common being diarrhea, flushing, wheezing, edema, abdominal pain/cramping, fatigue, and 8 emotional and functional concerns. Through an iterative process of team and clinical collaborator meetings, data review, item reduction and measure revision, 24 items were selected for the draft symptom index representing symptoms, emotional concerns, global assessment of treatment side effects, and functional well-being. Cognitive interview results demonstrated strong content validity, including positive endorsement of item clarity (>86% across items), symptom relevance (>70% for most items), and overall measure content (86%). CONCLUSIONS The FACT-CSI is a content-relevant, symptom-focused index reflecting the highest priority and clinically relevant symptoms and concerns of people with CS.
Collapse
Affiliation(s)
- Sara Shaunfield
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA,
| | - Kimberly A Webster
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Karen Kaiser
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - George J Greene
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Susan E Yount
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Leilani Lacson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Al B Benson
- Department of Medical Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel M Halperin
- Department Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - James C Yao
- Department Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Simron Singh
- Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada
| | - Marion Feuilly
- Ipsen Pharma, Health Economics and Outcomes Research, Boulogne Billancourt, France
| | - Florence Marteau
- Ipsen Pharma, Health Economics and Outcomes Research, Boulogne Billancourt, France
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
6
|
Buchanan-Hughes A, Pashley A, Feuilly M, Marteau F, Pritchard DM, Singh S. Carcinoid Heart Disease: Prognostic Value of 5-Hydroxyindoleacetic Acid Levels and Impact on Survival: A Systematic Literature Review. Neuroendocrinology 2021; 111:1-15. [PMID: 32097914 DOI: 10.1159/000506744] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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] [Received: 11/15/2019] [Accepted: 02/23/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Carcinoid heart disease (CHD) can develop in patients with carcinoid syndrome (CS), itself caused by overproduction of hormones and other products from some neuroendocrine tumours. The most common hormone is serotonin, detected as high 5-hydroxyindoleacetic acid (5-HIAA). This systematic literature review summarises current literature on the impact of CHD on survival, and the relationship between 5-HIAA levels and CHD development, progression, and mortality. METHODS MEDLINE, Embase, Cochrane databases, and grey literature were searched using terms for CHD, 5-HIAA, disease progression, and mortality/survival. Eligible articles were non-interventional and included patients with CS and predefined CHD and 5-HIAA outcomes. RESULTS Publications reporting on 31 studies were included. The number and disease states of patients varied between studies. Estimates of CHD prevalence and incidence among patients with a diagnosis/symptoms indicative of CS were 3-65% and 3-42%, respectively. Most studies evaluating survival found significantly higher mortality rates among patients with versus without CHD. Patients with CHD reportedly had higher 5-HIAA levels; median urinary levels in patients with versus without CHD were 266-1,381 versus 67.5-575 µmol/24 h. Higher 5-HIAA levels were also found to correlate with disease progression (median progression/worsening-associated levels: 791-2,247 µmol/24 h) and increased odds of death (7% with every 100 nmol/L increase). CONCLUSIONS Despite the heterogeneity of studies, the data indicate that CHD reduces survival, and higher 5-HIAA levels are associated with CHD development, disease progression, and increased risk of mortality; 5-HIAA levels should be carefully managed in these patients.
Collapse
|
7
|
Chen RC, Choueiri TK, Feuilly M, Meng J, Lister J, Marteau F, Falchook AD, Morris MJ, George DJ, Feldman DR. Quality-adjusted survival with first-line cabozantinib or sunitinib for advanced renal cell carcinoma in the CABOSUN randomized clinical trial (Alliance). Cancer 2020; 126:5311-5318. [PMID: 33022096 PMCID: PMC7756547 DOI: 10.1002/cncr.33169] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 12/03/2022]
Abstract
BACKGROUND Cabozantinib Versus Sunitinib as Initial Targeted Therapy for Patients With Metastatic Renal Cell Carcinoma of Poor or Intermediate Risk: The Alliance A031203 CABOSUN Trial (CABOSUN) was a randomized, open-label, phase 2 trial evaluating first-line cabozantinib versus sunitinib in patients with advanced renal cell carcinoma (aRCC). This post hoc analysis evaluated quality-adjusted survival using Quality-adjusted Time Without Symptoms of disease or Toxicity of treatment (Q-TWiST). METHODS Survival plots for cabozantinib and sunitinib (650-day follow-up) were partitioned into 3 health states: time spent before disease progression without toxicity (TWiST; toxicity based on National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.0] grade 3/4 adverse events), time spent before disease progression with toxicity (TOX; durations of adverse events based on published literature), and time after disease recurrence (relapse) or progression to death (REL). Q-TWiST was the sum of the mean time spent in each state, with each state weighted to reflect patient preferences (from 0 [worst] to 1 [best]) using utility scores. TWiST was always weighted as 1. Overall survival and time to disease progression were based on all randomized patients (157 patients); TOX was based on all randomized and treated patients (150 patients). RESULTS Across all utility combinations tested, Q-TWiST was found to be longer with cabozantinib versus sunitinib (range of differences, +24 days to +137 days). Q-TWiST differences that were found to be statistically significant (+92 days [95% confidence interval, 5-178 days] to +137 days [95% confidence interval, 60-214 days]) were of a clinically meaningful effect size (≥80 days), and were based on utility values that included those considered relevant for patients with aRCC (REL utility weight of 0.355, TOX utility weight of 0-1, and TWiST utility weight of 1). CONCLUSIONS In patients with aRCC, first-line cabozantinib was found to provide longer quality-adjusted survival compared with sunitinib. These findings may help to inform clinical decision making. LAY SUMMARY Cabozantinib and sunitinib are drugs that are used to treat patients with advanced kidney cancer. Clinical trials have shown that cabozantinib offers benefits over sunitinib, giving patients more time before their cancer progresses. It is important that this additional time before disease progression does not come at the expense of patients' quality of life, which can be affected by treatment side effects and/or ongoing cancer symptoms. Both quantity and quality of life are central to optimal treatment. In the current analysis of patients with advanced kidney cancer who were initiating treatment for the first time, cabozantinib provided more quality time before cancer progression compared with sunitinib.
Collapse
Affiliation(s)
- Ronald C. Chen
- Department of Radiation OncologyUniversity of Kansas Cancer CenterKansas CityKansas
| | - Toni K. Choueiri
- Lank Center for Genitourinary OncologyDana‐Farber Cancer Institute/Brigham and Women's HospitalBostonMassachusetts
| | - Marion Feuilly
- Department of OncologyIpsen Pharma SASBoulogne‐Billancourt CedexFrance
| | | | | | - Florence Marteau
- Department of OncologyIpsen Pharma SASBoulogne‐Billancourt CedexFrance
| | - Aaron D. Falchook
- Department of Radiation OncologyMemorial Cancer InstitutePembroke PinesFlorida
| | - Michael J. Morris
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Daniel J. George
- Department of Radiation OncologyUniversity of Kansas Cancer CenterKansas CityKansas
| | - Darren R. Feldman
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNew York
| |
Collapse
|
8
|
Khan MS, Walter T, Buchanan-Hughes A, Worthington E, Keeber L, Feuilly M, Grande E. Differential diagnosis of diarrhoea in patients with neuroendocrine tumours: A systematic review. World J Gastroenterol 2020; 26:4537-4556. [PMID: 32874063 PMCID: PMC7438200 DOI: 10.3748/wjg.v26.i30.4537] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/22/2020] [Accepted: 06/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Approximately 20% of patients with neuroendocrine tumours (NETs) develop carcinoid syndrome (CS), characterised by flushing and diarrhoea. Somatostatin analogues or telotristat can be used to control symptoms of CS through inhibition of serotonin secretion. Although CS is often the cause of diarrhoea among patients with gastroenteropancreatic NETs (GEP-NETs), other causes to consider include pancreatic enzyme insufficiency (PEI), bile acid malabsorption and small intestinal bacterial overgrowth. If other causes of diarrhoea unrelated to serotonin secretion are mistaken for CS diarrhoea, these treatments may be ineffective against the diarrhoea, risking detrimental effects to patient quality of life.
AIM To identify and synthesise qualitative and quantitative evidence relating to the differential diagnosis of diarrhoea in patients with GEP-NETs.
METHODS Electronic databases (MEDLINE, Embase and the Cochrane Library) were searched from inception to September 12, 2018 using terms for NETs and diarrhoea. Congresses, systematic literature review bibliographies and included articles were also hand-searched. Any study designs and publication types were eligible for inclusion if relevant data on a cause(s) of diarrhoea in patients with GEP-NETs were reported. Studies were screened by two independent reviewers at abstract and full-text stages. Framework synthesis was adapted to synthesise quantitative and qualitative data. The definition of qualitative data was expanded to include all textual data in any section of relevant publications.
RESULTS Forty-seven publications (44 studies) were included, comprising a variety of publication types, including observational studies, reviews, guidelines, case reports, interventional studies, and opinion pieces. Most reported on PEI on/after treatment with somatostatin analogs; 9.5%-84% of patients with GEP-NETs had experienced steatorrhoea or confirmed PEI. Where reported, 14.3%–50.7% of patients received pancreatic enzyme replacement therapy. Other causes of diarrhoea reported in patients with GEP-NETs included bile acid malabsorption (80%), small intestinal bacterial overgrowth (23.6%-62%), colitis (20%) and infection (7.1%). Diagnostic approaches included faecal elastase, breath tests, tauroselcholic (selenium-75) acid (SeHCAT) scan and stool culture, although evidence on the effectiveness or diagnostic accuracy of these approaches was limited. Assessment of patient history or diarrhoea characteristics was also reported as initial approaches for investigation. From the identified evidence, if diarrhoea is assumed to be CS diarrhoea, consequences include uncontrolled diarrhoea, malnutrition, and perceived ineffectiveness of CS treatment. Approaches for facilitating differential diagnosis of diarrhoea include improving patient and clinician awareness of non-CS causes and involvement of a multidisciplinary clinical team, including gastroenterologists.
CONCLUSION Diarrhoea in GEP-NETs can be multifactorial with misdiagnosis leading to delayed patient recovery and inefficient resource use. This systematic literature review highlights gaps for further research on prevalence of non-CS diarrhoea and suitability of diagnostic approaches, to determine an effective algorithm for differential diagnosis of GEP-NET diarrhoea.
Collapse
Affiliation(s)
- Mohid S Khan
- Department of Gastroenterology and Neuroendocrine Tumours, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Thomas Walter
- Department d'Oncologie Médicale, Hospices Civils de Lyon, Lyon 69003, France
| | | | - Emma Worthington
- Evidence Development, Costello Medical, Cambridge CB1 2JH, United Kingdom
| | - Lucie Keeber
- Medical Affairs, Ipsen, Slough SL1 3XE, United Kingdom
| | - Marion Feuilly
- Health Economics and Outcomes Research, Ipsen, Boulogne-Billancourt 92100, France
| | - Enrique Grande
- Oncology Department, MD Anderson Cancer Center, Madrid 28033, Spain
| |
Collapse
|
9
|
Fust K, Maschio M, Kohli M, Singh S, Pritchard DM, Marteau F, Myrenfors P, Feuilly M. A Budget Impact Model of the Addition of Telotristat Ethyl Treatment to the Standard of Care in Patients with Uncontrolled Carcinoid Syndrome. Pharmacoeconomics 2020; 38:607-618. [PMID: 32157590 DOI: 10.1007/s40273-020-00896-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Carcinoid syndrome, a rare condition in patients with neuroendocrine tumours, characterised by flushing and diarrhoea, severely affects patients' quality of life. The current carcinoid syndrome standard of care includes somatostatin analogues, but some patients experience uncontrolled symptoms despite somatostatin analogue therapy. Telotristat ethyl is a novel treatment approved by the European Medicines Agency (EMA) and US FDA that significantly reduces bowel movement frequency in patients with uncontrolled carcinoid syndrome. OBJECTIVE We developed a model to evaluate the 5-year budget impact of introducing telotristat ethyl to standard care in Swedish patients with uncontrolled carcinoid syndrome. METHODS Treatment response in the 12-week phase III TELESTAR trial (NCT01677910) informed telotristat ethyl efficacy; subsequently, health states were captured by a Markov model using 4-week cycles. TELESTAR open-label extension data informed telotristat ethyl discontinuation. The number of treatment-eligible patients was estimated from literature reviews reporting the prevalence, incidence and mortality of carcinoid syndrome. A Swedish database study informed real-world costs related to carcinoid syndrome and carcinoid heart disease costs. Telotristat ethyl market share was assumed to increase annually from 24% (year 1) to 70% (year 5). RESULTS Over the 5-year model horizon, 44 patients were expected to initiate telotristat ethyl treatment. The cumulative net budget impact of adding telotristat ethyl to current standard of care was €172,346; per-year costs decreased from €66,495 (year 1) to €29,818 (year 5). Increased drug costs from adding telotristat ethyl were offset by reduced costs elsewhere. CONCLUSIONS The expected budget impact of adding telotristat ethyl to the standard of care in Sweden was relatively low, largely because of the rarity of carcinoid syndrome.
Collapse
Affiliation(s)
- Kelly Fust
- Optum, 1325 Boylston Street, Boston, MA, 02215, USA
| | - Michael Maschio
- Formerly affiliated with Optum, 5500 North Service Road, Suite 501, Burlington, ON, L7L 6W6, Canada
| | - Michele Kohli
- Formerly affiliated with Optum, 5500 North Service Road, Suite 501, Burlington, ON, L7L 6W6, Canada
| | - Simron Singh
- Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - D Mark Pritchard
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Crown Street, Liverpool, L69 3BX, UK
| | - Florence Marteau
- Ipsen Pharma, 65 Quai Georges Gorse, 92100, Boulogne-Billancourt, France
| | | | - Marion Feuilly
- Ipsen Pharma, 65 Quai Georges Gorse, 92100, Boulogne-Billancourt, France.
| |
Collapse
|
10
|
Adelman DT, Truong-Thanh XM, Feuilly M, Houchard A, Cella D. MON-LB47 An International Simulated Use Study (PRESTO) to Evaluate Nurse Preferences Between the Lanreotide Autogel New Syringe and Octreotide Long-Acting Release Syringe. J Endocr Soc 2020. [PMCID: PMC7209620 DOI: 10.1210/jendso/bvaa046.2163] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: A new lanreotide autogel/depot (LAN) syringe was developed based on feedback from a human factors study to improve user experience. Methods: PRESTO was a multinational, simulated-use study in nurses with ≥2 years’ experience injecting LAN or octreotide long-acting release (OCT LAR) in patients with acromegaly and/or neuroendocrine tumors, which aimed to assess injector preference between the LAN new syringe and the current OCT LAR syringe. Participating nurses were invited to test both the LAN new syringe (120 mg) and the current OCT LAR syringe (20 mg or 30 mg), using injection pads. The sponsor was not involved in these sessions. In an anonymous web-based questionnaire, nurses reported overall preference (‘strong’ or ‘slight’; primary endpoint), and rated and ranked the importance of nine attributes for each syringe (1 [not at all] to 5 [very much]). Results: In total, 90 nurses attended injection sessions and completed valid questionnaires. Overall, 97.8% of nurses expressed a preference (85.6% ‘strong’, 12.2% ‘slight’) for LAN new syringe (p<0.0001 vs current OCT LAR). Attribute performance ratings were consistently higher for LAN new syringe vs current OCT LAR, with the greatest differences in ‘fast administration’ and ‘confidence the syringe will not be clogged’ (mean [standard deviation]: 2.6 [1.2] and 2.3 [1.5], respectively; p<0.0001). The attribute ranked most important was ‘confidence the syringe will not be clogged’ (24.4%) and least important was ‘convenience of syringe format, including packaging, from preparation to injection’ (34.4%). Conclusions: The PRESTO study showed that nurses preferred the user experience of the LAN new syringe over the current OCT LAR syringe across all attributes tested.
Collapse
|
11
|
Adelman D, Truong Thanh XM, Feuilly M, Houchard A, Cella D. Evaluation of Nurse Preferences Between the Lanreotide Autogel New Syringe and the Octreotide Long-Acting Release Syringe: An International Simulated-Use Study (PRESTO). Adv Ther 2020; 37:1608-1619. [PMID: 32157626 PMCID: PMC7140743 DOI: 10.1007/s12325-020-01255-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Somatostatin analogues are used to treat symptoms and slow tumour progression in patients with neuroendocrine tumours (NETs) and carcinoid syndrome and to reduce hormone secretion and pituitary tumour volume in patients with acromegaly. A new syringe for lanreotide autogel/depot (LAN) was developed following feedback from a human factors study to improve ease of injection compared with previous syringes. PRESTO aimed to assess preferences of nurses between the LAN new syringe and the octreotide long-acting release (LAR) syringe. METHODS PRESTO, a multinational, multicentre, prospective, noninterventional, simulated-use study, enrolled nurses with ≥ 2 years' experience injecting LAN and/or octreotide LAR in patients with NETs and/or acromegaly. Nurses administered injections into pads using the LAN new syringe and octreotide LAR syringe in a randomised sequence. In an anonymous web-based questionnaire, nurses reported their overall preference ('strong' or 'slight'; primary endpoint) and rated and ranked the importance of nine attributes for each syringe (1 [not at all] to 5 [very much]). RESULTS Overall, 90 nurses attended sessions and completed valid questionnaires. Most nurses (97.8%) expressed a preference (85.6% 'strong', 12.2% 'slight') for the LAN new syringe versus the octreotide LAR syringe (P < 0.0001). Attribute performance ratings (1 [not at all] to 5 [very much]) were consistently higher for the LAN new syringe versus the octreotide LAR syringe, with the greatest differences in 'fast administration' and 'confidence the syringe will not be clogged' (mean difference [SD]: 2.6 [1.2] and 2.3 [1.5], respectively; P < 0.0001). The attribute ranked most important was 'confidence the syringe will not be clogged' (24.4%); least important was 'convenience of syringe format, including packaging, from preparation to injection' (34.4%). CONCLUSIONS Nurses preferred the user experience of the LAN new syringe compared with the octreotide LAR syringe, with a particular preference for attributes related to product delivery with the LAN new syringe.
Collapse
Affiliation(s)
- Daphne Adelman
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | | | - Marion Feuilly
- Health Economics and Outcomes Research, Ipsen, Boulogne-Billancourt, France
| | | | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
12
|
Cheung WY, Feuilly M, Laforty C, Liovas A, McKechnie H, Loree JM. A real-world observational study of somatostatin analogue use and costs in Canada. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
608 Background: Somatostatin analogue (SSA) use is indicated in acromegaly and neuroendocrine tumours for symptomatic relief and tumour control. Two long-acting SSAs (lanreotide and octreotide) are currently available, but comparative real-world data on their use are limited. This study evaluated SSA use and costs in Canada. Methods: Claims data from the IQVIA Private Drug Plan (PDP), Ontario Drug Benefit (ODB) program and Régie de l’assurance-maladie du Québec (RAMQ) were compiled. Injection burden, rescue medication use and costs were compared (using unpaired t-test or Wilcoxon test) over a 12-month period from first SSA prescription. Patients (pts) were eligible if the first prescription was dispensed Sept. 2015–Jun. 2018. Results: 908 pts were included: lanreotide 120 mg, N=375; octreotide long-acting release (LAR) 30 mg, N=533. Lanreotide treatment was associated with a lower weighted average injection burden for 12 months when compared to octreotide (12.54 vs 13.44 injections/pt, respectively; p<0.0001). Pts receiving lanreotide also had lower mean use of rescue medications than those treated with octreotide (0.01 vs 0.05 claims/pt/year), although this difference was greatest during the first month of treatment (mean difference: 0.19; p<0.0001), after which differences in rescue medication use were only significant (p<0.05) at Months 5 and 6. Mean total annual costs (rescue medication + LAR) were lower for lanreotide than octreotide ($27,829.35/pt [N=373] vs $31,255.49/pt [N=530], respectively, p<0.0001). Conclusions: In the absence of clinical trials directly comparing the SSAs, factors driving treatment selection are unclear. Findings from our real-world observational study suggest treatment with lanreotide to be less burdensome and costly than octreotide and may inform treatment discussions with pts. References1. Ipsen Biopharmaceuticals. Somatuline Autogel Product Monograph. 2018. Available at: https://cnetscanada.org/wp-content/uploads/2018/06/Somatuline-Product-Monograph.pdf; 2. Novartis Pharmaceuticals Canada Inc. Sandostatin LAR Product Monograph. 2018. Available at: http://www.ask.novartispharma.ca/download.htm?res=sandostatin_scrip_e.pdf&resTitleId=789.
Collapse
Affiliation(s)
- Winson Y. Cheung
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | - Anna Liovas
- Ipsen Biopharmaceuticals Canada, Mississauga, ON, Canada
| | | | | |
Collapse
|
13
|
Lesén E, Björstad Å, Björholt I, Marlow T, Bollano E, Feuilly M, Marteau F, Welin S, Elf AK, Johanson V. Real-world treatment patterns, resource use and costs of treating uncontrolled carcinoid syndrome and carcinoid heart disease: a retrospective Swedish study. Scand J Gastroenterol 2018; 53:1509-1518. [PMID: 30449217 DOI: 10.1080/00365521.2018.1531653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To quantify healthcare resource use (HRU) and costs in relation to carcinoid syndrome (CS) and carcinoid heart disease (CHD) in a real-world setting, and to provide perspective on treatment patterns. MATERIALS AND METHODS Patient data and HRU were collected retrospectively from three Swedish healthcare registers. Adult patients diagnosed with metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs) grade 1 or 2 and CS who purchased somatostatin analogs (SSAs), and experienced controlled (defined by SSAs use) and uncontrolled (defined by SSAs dose escalation) CS for ≥8 months during the study period were included. Patients diagnosed with CHD from the date of the GEP-NET diagnosis were included in the CHD study group. RESULTS Overall, total HRU cost increased with uncontrolled CS and CHD. Total resource cost was 15,500€/patient during controlled CS (8 months), rising to 21,700€/patient during uncontrolled CS (8 months), representing an increase of ∼40% (6200€/patient). Costs/patient were driven mainly by SSA use, tumor-related medical interventions and examinations. The total mean cost/year of disease was 1100€/patient without CHD, compared to 4600€/patient with CHD, a difference of 3500€/patient. Excluding SSA cost burden, the main drivers of increased cost in CHD patients were surgical interventions and echocardiography. CONCLUSIONS This study provides a comprehensive overview of the treatment patterns and burden of uncontrolled CS symptoms and CHD using Swedish national register data. Increases in medical interventions and examinations HRU and increased SSA use suggest that SSA dose escalation alone may not effectively control the symptoms associated with uncontrolled CS, highlighting an unmet treatment need in this patient group.
Collapse
Affiliation(s)
- Eva Lesén
- a PharmaLex, formerly Nordic Health Economics AB , Gothenburg , Sweden
| | - Åse Björstad
- a PharmaLex, formerly Nordic Health Economics AB , Gothenburg , Sweden
| | - Ingela Björholt
- a PharmaLex, formerly Nordic Health Economics AB , Gothenburg , Sweden
| | - Tom Marlow
- a PharmaLex, formerly Nordic Health Economics AB , Gothenburg , Sweden
| | - Entela Bollano
- b Department of Cardiology , Sahlgrenska University Hospital , Gothenburg , Sweden
| | | | | | - Staffan Welin
- d Department of Endocrine Oncology , Uppsala University Hospital , Uppsala , Sweden
| | - Anna-Karin Elf
- e Department of Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Viktor Johanson
- e Department of Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| |
Collapse
|
14
|
Cella D, Beaumont JL, Hudgens S, Marteau F, Feuilly M, Houchard A, Lapuerta P, Ramage J, Pavel M, Hörsch D, Kulke MH. Relationship Between Symptoms and Health-related Quality-of-life Benefits in Patients With Carcinoid Syndrome: Post Hoc Analyses From TELESTAR. Clin Ther 2018; 40:2006-2020.e2. [PMID: 30477789 DOI: 10.1016/j.clinthera.2018.10.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/12/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Patients with metastatic neuroendocrine tumors and carcinoid syndrome (CS) may experience chronic, recurring symptoms despite somatostatin analogue therapy. Little is known about the relationship between bowel movement (BM) frequency, patient-reported symptoms and health-related quality of life (QoL). Data from the TELESTAR study were used in exploratory, post hoc analyses to understand the relationship between durable reductions in BM frequency, symptom relief, and health-related QoL. METHODS Patients with metastatic neuroendocrine tumors and CS in the Phase III TELESTAR study were randomized (1:1:1) to receive telotristat ethyl (TE) 250 mg, TE 500 mg, or placebo three times daily (TID) during a 12-week double-blind treatment period (DBTP). All patients received TE 500 mg TID in an open-label extension (OLE) to Week 48. Durable response was predefined. Analyses compared durable responders (DRs) and non-durable responders (NDRs), irrespective of treatment group, at Weeks 12, 24, and 48. FINDINGS At the start of the DBTP, 135 patients were randomized, 45 patients each to TE 250 mg, TE 500 mg, and placebo. After the 12-week DBTP, 48 of 135 patients were DRs (TE 250 mg, n = 20; TE 500 mg, n = 19; placebo, n = 9). Of the 115 patients who entered the OLE, 35 were DRs initially randomized to TE 250 mg (n = 18) or 500 mg (n = 17), 29 of whom maintained a durable response throughout the OLE. Of the 71 DBTP-NDRs (inclusive of patients initially randomized to placebo), 28 became OLE-DRs. There were 29 NDRs initially randomized to placebo who entered the OLE, 16 of whom became DRs when switched to TE 500 mg. DRs during the DBTP had greater symptom improvements in the DBTP; these improvements continued over the OLE. DBTP-DRs also maintained more meaningful QoL improvements in EORTC QLQ-C30 global health status, nausea and vomiting, pain, diarrhea, and EORTC QLQ-GINET21 gastrointestinal symptoms over the DBTP and OLE periods than DBTP-NDRs. IMPLICATIONS These results suggest that sustained improvements in BM frequency in patients with CS may have multifaceted, long-term effects on a patient's well-being. ClinicalTrials.gov identifiers: NCT01677910.
Collapse
Affiliation(s)
- David Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Jennifer L Beaumont
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Terasaki Research Institute, Los Angeles, CA, USA
| | | | | | | | | | | | - John Ramage
- Hampshire Hospitals, Basingstoke, United Kingdom
| | - Marianne Pavel
- Universitatsklinikum Erlangen, Erlangen, Germany; Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | |
Collapse
|
15
|
Chen RC, Feuilly M, Meng J, Lister J, Marteau F, Morris MJ, George DJ, Choueiri TK. Quality-adjusted time without symptoms or toxicity (Q-TWiST): Analysis of cabozantinib (Cabo) vs sunitinib (Sun) in patients with advanced renal cell carcinoma (aRCC) of intermediate or poor risk (Alliance A031203). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.4556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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)
- Ronald C. Chen
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Jie Meng
- Analytica LASER, Loerrach, Germany
| | | | | | | | | | | |
Collapse
|
16
|
Feldman DR, Feuilly M, Meng J, Lister J, Marteau F, Morris MJ, George DJ, Choueiri TK. ECOG score analysis as a proxy for health-related quality of life assessment in patients with poor or intermediate risk metastatic renal cell carcinoma from the CABOSUN trial (Alliance A031203). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Jie Meng
- Analytica LASER, Loerrach, Germany
| | | | | | | | | | | |
Collapse
|
17
|
Marteau F, Williams P, Feuilly M, Arnould B. Identifying symptom and quality of life improvements in patients with carcinoid syndrome treated with telotristat ethyl: Qualitative patient exit interviews from the TELESTAR Trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx368.015] [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: 11/14/2022] Open
|