1
|
Bascoul-Mollevi C, Barbieri A, Bourgier C, Conroy T, Chauffert B, Hebbar M, Jacot W, Juzyna B, De Forges H, Gourgou S, Bonnetain F, Touraine C, Anota A. Longitudinal analysis of health-related quality of life in cancer clinical trials: methods and interpretation of results. Qual Life Res 2020; 30:91-103. [PMID: 32809099 DOI: 10.1007/s11136-020-02605-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Health-related quality of life (HRQoL) is assessed by self-administered questionnaires throughout the care process. Classically, two longitudinal statistical approaches were mainly used to study HRQoL: linear mixed models (LMM) or time-to-event models for time to deterioration/time until definitive deterioration (TTD/TUDD). Recently, an alternative strategy based on generalized linear mixed models for categorical data has also been proposed: the longitudinal partial credit model (LPCM). The objective of this article is to evaluate these methods and to propose recommendations to standardize longitudinal analysis of HRQoL data in cancer clinical trials. METHODS The three methods are first described and compared through statistical, methodological, and practical arguments, then applied on real HRQoL data from clinical cancer trials or published prospective databases. In total, seven French studies from a collaborating group were selected with longitudinal collection of QLQ-C30. Longitudinal analyses were performed with the three approaches using SAS, Stata and R software. RESULTS We observed concordant results between LMM and LPCM. However, discordant results were observed when we considered the TTD/TUDD approach compared to the two previous methods. According to methodological and practical arguments discussed, the approaches seem to provide additional information and complementary interpretations. LMM and LPCM are the most powerful methods on simulated data, while the TTD/TUDD approach gives more clinically understandable results. Finally, for single-item scales, LPCM is more appropriate. CONCLUSION These results pledge for the recommendation to use of both the LMM and TTD/TUDD longitudinal methods, except for single-item scales, establishing them as the consensual methods for publications reporting HRQoL.
Collapse
Affiliation(s)
- Caroline Bascoul-Mollevi
- Biometrics Unit - CTD INCa, Institut du Cancer Montpellier, Univ. Montpellier, Montpellier, France. .,Institut de Recherche en Cancérologie de Montpellier Inserm U1194, University Montpellier, 208 rue des Apothicaire, Montpellier Cedex 5, 34298, Montpellier, France. .,National Platform Quality of Life and Cancer, Montpellier, France.
| | | | - Céline Bourgier
- Institut de Recherche en Cancérologie de Montpellier Inserm U1194, University Montpellier, 208 rue des Apothicaire, Montpellier Cedex 5, 34298, Montpellier, France.,Department of Radiation Oncology, Institut du Cancer Montpellier, University Montpellier, Montpellier, France
| | - Thierry Conroy
- Medical Oncology Department, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France.,Lorraine University, APEMAC, Team MICS, Nancy, France
| | - Bruno Chauffert
- Medical Oncology Department, Amiens University Hospital, Amiens, France
| | - Mohamed Hebbar
- Department of Medical Oncology, University Hospital, Lille, France
| | - William Jacot
- Institut de Recherche en Cancérologie de Montpellier Inserm U1194, University Montpellier, 208 rue des Apothicaire, Montpellier Cedex 5, 34298, Montpellier, France.,Department of Medical Oncology, Institut du Cancer Montpellier, University Montpellier, Montpellier, France
| | | | - Hélène De Forges
- Clinical Research and Innovation Department, Institut du Cancer Montpellier, University Montpellier, Montpellier, France
| | - Sophie Gourgou
- Biometrics Unit - CTD INCa, Institut du Cancer Montpellier, Univ. Montpellier, Montpellier, France.,National Platform Quality of Life and Cancer, Montpellier, France
| | - Franck Bonnetain
- National Platform Quality of Life and Cancer, Montpellier, France.,Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France.,UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, Bourgogne Franche-Comté University, Inserm, EFS BFC, Fédération Hospitalo-Universitaire INCREASE, Besançon, France
| | - Célia Touraine
- Biometrics Unit - CTD INCa, Institut du Cancer Montpellier, Univ. Montpellier, Montpellier, France.,National Platform Quality of Life and Cancer, Montpellier, France
| | - Amélie Anota
- National Platform Quality of Life and Cancer, Montpellier, France.,Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France.,UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire Et Génique, Bourgogne Franche-Comté University, Inserm, EFS BFC, Fédération Hospitalo-Universitaire INCREASE, Besançon, France
| |
Collapse
|
2
|
Sgarbura O, Gourgou S, Tosi D, Bakrin N, Bouazza N, Delaine S, De Forges H, Pocard M, Quénet F. MESOTIP: Phase II multicenter randomized trial evaluating the association of PIPAC and systemic chemotherapy vs. systemic chemotherapy alone as 1st-line treatment of malignant peritoneal mesothelioma. Pleura Peritoneum 2019; 4:20190010. [PMID: 31417958 PMCID: PMC6693480 DOI: 10.1515/pp-2019-0010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 05/13/2019] [Accepted: 05/19/2019] [Indexed: 12/29/2022] Open
Abstract
Background Malignant peritoneal mesothelioma (MPM) is a rare tumoral disease characterized by the diffuse involvement of the peritoneal serosa. The standard frontline treatment of MPM is cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) unless the peritoneal disease is considered unresectable. For unresectable patients the standard frontline treatment is a combination of cisplatin and pemetrexed but the prognosis remains ominous with only 13 months of overall survival (OS). Methods The proposed study is a multicenter randomized non-comparative study evaluating the association of Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) and systemic chemotherapy vs. systemic chemotherapy alone as first-line treatment of MPM. Patients will be randomized with a 2:1 ratio using a minimization technique. Sixty-six patients have to be enrolled. Stratification will be performed according to histology (epithelioid vs. sarcomatoid and biphasic), presence of extraperitoneal disease and center. Primary objective is OS and secondary objectives include progression-free survival (PFS), safety, compliance, feasibility, conversion to resectability, histological response to treatment and quality of life. Conclusions We expect to show that intensification of the first line treatment with PIPAC for initially unresectable MPM patients increases OS. Trial registration Prospective study. Clinicaltrials.gov: NCT03574493 EudraCT: 2019–001515-23.
Collapse
Affiliation(s)
- Olivia Sgarbura
- Surgical oncology Department, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Sophie Gourgou
- Biometrics Unit, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Diego Tosi
- Early phase clinical trial unit, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - Naoual Bakrin
- Surgery Department, Lyon Sud University Hospital, Claude Bernard University, Lyon, France
| | - Nabila Bouazza
- Clinical Research Department, Montpellier Cancer Institute (ICM), Univ. Montpellier, Montpellier, France
| | - Stéphanie Delaine
- Clinical Research Department, Montpellier Cancer Institute (ICM), Univ. Montpellier, Montpellier, France
| | - Hélène De Forges
- Clinical Research Department, Montpellier Cancer Institute (ICM), Univ. Montpellier, Montpellier, France
| | - Marc Pocard
- INSERM U1275, CAP Paris-Tech, Carcinomatosis Peritoneum Paris Technology, Lariboisière Hospital, AP-HP, 2 rue Ambroise Paré – 75010 Paris – Université de Paris, France
| | - François Quénet
- Surgical oncology Department, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| |
Collapse
|
3
|
Darlix A, Hirtz C, Thezenas S, Maceski A, Gabelle A, Lopez-Crapez E, De Forges H, Firmin N, Guiu S, Jacot W, Lehmann S. The prognostic value of the Tau protein serum level in metastatic breast cancer patients and its correlation with brain metastases. BMC Cancer 2019; 19:110. [PMID: 30700265 PMCID: PMC6354387 DOI: 10.1186/s12885-019-5287-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 04/03/2018] [Accepted: 01/07/2019] [Indexed: 01/24/2023] Open
Abstract
Background Metastatic breast cancer (MBC) prognosis is variable, depending on several clinical and biological factors. A better prediction of a patient’s outcome could allow for a more accurate choice of treatments. The role of serum biomarkers in predicting outcome remains unclear in this setting. Tau, a microtubule-associated protein, is a neuronal marker that is also expressed in normal breast epithelial cells and cancer cells. Its tissue expression is associated with prognosis in MBC. However, the prognostic value of Tau serum levels in these patients is unknown. We aimed at evaluating the prognostic value of Tau (and other classical biomarkers) in MBC patients, and to assess its association with the presence of brain metastases (BM). Methods 244 MBC patients treated at our institution (2007–2015) were retrospectively selected. The usual MBC clinical and pathological variables were collected, altogether with CA15–3, CEA and HER2 extra-cellular domain (ECD) serum levels. Tau serum levels were measured with a novel immunoassay (digital ELISA) using Single Molecule Array (Simoa) technology. Overall survival (OS) was estimated with the Kaplan-Meier method. To investigate prognostic factors, a multivariate analysis was performed. Cut-offs were set using the Youden index method associated with receiver-operating characteristics (ROC) curves to evaluate the accuracy of biomarkers to identify patients with BM. Results With a median follow-up of 40.8 months, median OS was 15.5 months (95%CI 12.4–20.2). Elevated serum levels of Tau were independently associated with a poor outcome in the whole population as well as in patients with (n = 86) and without BM (n = 158). Median serum Tau levels tended to be higher in patients with BM (p = 0.23). In univariate analysis, patients with BM had an increased risk of serum Tau > 3.17 pg/mL (OR = 2.2, p = 0.049). In multivariate analysis, high values of Tau (OR = 3.98, p = 0.034) accurately identified patients with BM in our cohort. Conclusions Tau is a new biomarker of interest in MBC. Its serum level could represent an independent prognostic factor in these patients (both with and without BM). It also seems to be associated with the presence of BM. A validation of these results in an independent set of MBC patients is necessary to confirm these findings. Electronic supplementary material The online version of this article (10.1186/s12885-019-5287-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Amélie Darlix
- Department of Medical Oncology, Institut du Cancer de Montpellier, University of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier, France.
| | - Christophe Hirtz
- Laboratoire de Biochimie et Protéomique Clinique, University of Montpellier, Institute of Regenerative Medicine - Biotherapy IRMB, CHU Montpellier, INSERM, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Simon Thezenas
- Biometrics Unit, Institut du Cancer de Montpellier, University of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier, France
| | - Aleksandra Maceski
- Laboratoire de Biochimie et Protéomique Clinique, University of Montpellier, Institute of Regenerative Medicine - Biotherapy IRMB, CHU Montpellier, INSERM, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Audrey Gabelle
- Memory Resources and Research Center, University of Montpellier MUSE, CHU Montpellier, 80 avenue Augustin Fliche, 34295, Montpellier, France
| | - Evelyne Lopez-Crapez
- Translational Research Unit, Institut du Cancer de Montpellier, University of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier, France
| | - Hélène De Forges
- Clinical Research Unit, Institut Régional du Cancer de Montpellier, University of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier, France
| | - Nelly Firmin
- Department of Medical Oncology, Institut du Cancer de Montpellier, University of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier, France
| | - Séverine Guiu
- Department of Medical Oncology, Institut du Cancer de Montpellier, University of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier, France
| | - William Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier, University of Montpellier, 208 Avenue des Apothicaires, 34298, Montpellier, France
| | - Sylvain Lehmann
- Laboratoire de Biochimie et Protéomique Clinique, University of Montpellier, Institute of Regenerative Medicine - Biotherapy IRMB, CHU Montpellier, INSERM, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| |
Collapse
|
4
|
Quenet F, Elias D, Roca L, Goere D, Ghouti L, Pocard M, Facy O, Arvieux C, Lorimier G, Pezet D, Marchal F, Loi V, Meeus P, De Forges H, Stanbury T, Paineau J, Glehen O. A UNICANCER phase III trial of hyperthermic intra-peritoneal chemotherapy (HIPEC) for colorectal peritoneal carcinomatosis (PC): PRODIGE 7. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.18_suppl.lba3503] [Citation(s) in RCA: 228] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
LBA3503 Background: Promising results have been obtained during the last decade using cytoreductive surgery (CRS) plus HIPEC for selected patients with colorectal PC who are amenable to complete macroscopic resection. This is the first trial to evaluate the specific role of HIPEC, after CRS, for the treatment of PC of colorectal origin. Methods: Prodige 7 is a randomized phase III, multicenter trial. Patients with histologically proven and isolated PC, peritoneal cancer index (PCI) ≤25 were eligible. Randomization (1:1) was stratified by center, complete macroscopic resection (R0/1 vs R2), and neoadjuvant systemic chemotherapy. Patients were treated with CRS plus HIPEC with oxaliplatin or CRS alone, in association with systemic chemotherapy. The primary endpoint was the overall survival (OS). Secondary endpoints were relapse-free survival (RFS) and toxicity. 264 patients were required to show a gain in median OS from 30 to 48 months (HR = 0.625) with a two-sided α = 0,046 and 80% power. Results: 265 patients from 17 centers were included between February 2008 and January 2014: 132 in Arm without HIPEC and 133 in Arm with HIPEC. The median age was 60 years (range: 30-74). Baseline characteristics were well balanced. The overall post-operative mortality rate was 1.5% and was not different between the two arms. The morbidity rates did not differ statistically at 30 days. At 60 days, the grade 3-5 morbidity rate was significantly higher with HIPEC (24.1% vs. 13.6%, p= 0.030). After a median follow up of 63.8 months (95% CI: 58.9-69.8), the median OS was 41.2 months (95% CI 35.1-49.7) in the non-HIPEC Arm and 41.7 months (95% CI: 36.2-52.8) in the HIPEC Arm, HR = 1.00 (95% CI: 0.73-1.37) p = 0.995. The median RFS was 11.1 months (95% CI: 9-12.7) in non-HIPEC Arm and 13.1 months (95% CI: 12.1-15.7) in HIPEC Arm, HR = 0.90 (95% CI: 0.69-1.90) (p = 0.486), whilst the 1-year RFS rates were 46.1% in non-HIPEC Arm and 59 % in the HIPEC Arm. Conclusions: The therapeutic curative management of PC from colorectal cancer by CRS shows satisfactory survival results. While the addition of HIPEC with oxaliplatin does not influence the OS. Clinical trial information: NCT00769405.
Collapse
Affiliation(s)
- François Quenet
- Institut Régional du Cancer de Montpellier, Montpellier, France
| | | | - Lise Roca
- Institut Regional du Cancer Montpellier Val d'Aurelle, Montpellier, France
| | | | | | - Marc Pocard
- Hopital Lariboisiere AP-HP, Service de Chirurgie Digestie et Cancérologie, Paris, France
| | | | | | | | | | | | | | | | - Hélène De Forges
- Institut régional du Cancer de Montpellier (ICM), Montpellier, France
| | | | | | - Olivier Glehen
- Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | | |
Collapse
|