1
|
Ross TL, Na R, Au-Yeung G, DeFazio A, Friedlander M, Sivakumaran T, Livingstone K, Nagle CM, O'Neill H, Williams M, Webb PM, Beesley VL. Are exercise and sitting time during chemotherapy for ovarian cancer associated with treatment-related side-effects, chemotherapy completion and survival? Gynecol Oncol 2024; 190:53-61. [PMID: 39146755 DOI: 10.1016/j.ygyno.2024.07.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 07/22/2024] [Accepted: 07/30/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE To evaluate if exercise and sitting time during chemotherapy were associated with chemotherapy side-effects, completion of planned chemotherapy and survival. METHODS We used data from the Ovarian cancer Prognosis And Lifestyle (OPAL) Study, a national prospective cohort of adults with newly-diagnosed epithelial ovarian cancer. At 3-monthly questionnaires we asked about exercise and sitting time in the past week, and treatment-related side-effects. Details about treatment, toxicities, progression and death were abstracted from medical records. We used linear, logistic and Cox regression, respectively, to assess associations between both exercise and sitting time, and chemotherapy side-effects and completion (≥85% relative dose intensity) and survival. RESULTS 503 eligible participants were included in one or more analyses. Patients participating in higher-intensity exercise (≥30 min of moderate-vigorous exercise/week; 24%) reported significantly better Functional Assessment of Chronic Illness/Cancer Therapy (FACIT)-Fatigue (32.2 vs. 26.7) and FACT-Trial Outcome Index (69.4 vs. 61.7) scores, and were less likely to have clinician-reported moderate-severe neurotoxicity (odds ratio [OR]:0.50; 95% confidence interval [95%CI]:0.29-0.88), than minimal exercisers (<30 min moderate-vigorous exercise/week & <120 min walking/week; 52%). Participating in higher-intensity exercise was also possibly associated with greater chemotherapy completion (OR:1.70; 95%CI:0.90-3.20), particularly for paclitaxel. Sitting time was not associated with chemotherapy completion. For patients with advanced disease who underwent cytoreduction and received first-line carboplatin and paclitaxel, there was a suggestion higher-intensity exercise during chemotherapy may improve survival (HR:0.68; 95%CI:0.47-1.01). CONCLUSIONS Patients with ovarian cancer who carry out moderate-vigorous exercise during chemotherapy have fewer side-effects and potentially better completion of planned chemotherapy and overall survival.
Collapse
Affiliation(s)
- Tanya L Ross
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Renhua Na
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | - George Au-Yeung
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3010, Australia
| | - Anna DeFazio
- The Westmead Institute for Medical Research, Sydney, Australia; Department of Gynaecological Oncology, Westmead Hospital, Sydney, Australia; The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Michael Friedlander
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | - Tharani Sivakumaran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3010, Australia
| | | | - Christina M Nagle
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | | | | | - Penelope M Webb
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | - Vanessa L Beesley
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia; School of Nursing, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
2
|
Katsuda T, Nishio S, Tasaki S, Park J, Tasaki K, Tsuda N, Ushijima K. Olaparib maintenance therapy for platinum-sensitive relapsed ovarian cancer at a single institution: A retrospective study. J Obstet Gynaecol Res 2024; 50:1192-1200. [PMID: 38742699 DOI: 10.1111/jog.15965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/27/2024] [Indexed: 05/16/2024]
Abstract
AIM In this study, we aimed to investigate patient characteristics, efficacy, prognostic factors, and safety of olaparib maintenance therapy for platinum-sensitive recurrent ovarian cancer at our institution. METHODS Patients responding to platinum-based therapy and starting olaparib maintenance therapy for recurrent epithelial ovarian, fallopian tube, or peritoneal cancer at Kurume University Hospital between January 2018 and November 2021 were enrolled in the study. Their data were extracted retrospectively from medical records. RESULTS In all, 50 patients were included. The median (range) age of the patients, follow-up time, and duration of olaparib maintenance therapy were 62 (39-87) years, 21.6 (2.2-45.9) months, and 7.2 (2-45.9) months, respectively. Among the 29 patients tested for homologous recombination (HR) status, 22 (75.9%) were positive for HR deficiency (HRD), 12 (54.5%) of whom had BRCA-positive tumors. The median progression-free survival was 8.9 months (95% confidence interval: 6.2-12.6), and the median overall survival was 27.1 months (95% confidence interval: 22.5-40.3). Multivariate analysis of prognostic factors revealed that HRD was an independent prognostic factor for both progression-free survival and overall survival. The most common adverse event was nausea (any grade, n = 30, 60%), resulting in drug interruption (n = 23, 46%), dose reduction (n = 17, 34%), and discontinuation of treatment (n = 1, 2%). CONCLUSION Olaparib maintenance therapy for recurrent platinum-sensitive ovarian cancer at our institution was effective, with acceptable adverse events. HRD was the most significant prognostic factor for patients with recurrent platinum-sensitive ovarian cancer.
Collapse
Affiliation(s)
- Takahiro Katsuda
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Fukuoka, Japan
| | - Shin Nishio
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Fukuoka, Japan
| | - Shingo Tasaki
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Fukuoka, Japan
| | - Jongmyung Park
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Fukuoka, Japan
| | - Kazuto Tasaki
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Fukuoka, Japan
| | - Naotake Tsuda
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Fukuoka, Japan
| | - Kimio Ushijima
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, Fukuoka, Japan
| |
Collapse
|
3
|
Hong YW, Kuo IM, Kuo WL, Yu CC, Shen SC, Tsai HP, Chu CH, Ho HY, Lo YF, Chen SC, Lin YC, Chien CY, Chou HH. The influence of chronic renal insufficiency on multi-therapeutic modalities for breast cancer: a single-center experience. Breast Cancer 2024; 31:252-262. [PMID: 38150135 PMCID: PMC10901917 DOI: 10.1007/s12282-023-01530-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/25/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Due to the presence of other comorbidities and multi-therapeutic modalities in breast cancer, renally cleared chemotherapeutic regimens may cause nephrotoxicity. The aim of this retrospective study is to compare the chemotherapy types and outcomes in breast cancer patients with or without chronic renal disease. PATIENTS AND METHODS We retrospectively enrolled 62 female patients with breast cancer and underlying late stages (stage 3b, 4, and 5) of chronic kidney disease (CKD) treated from 2000 to 2017. They were propensity score-matched 1:1 with patients in our database with breast cancer and normal renal function (total n = 124). RESULTS The main subtype of breast cancer was luminal A and relatively few patients with renal impairment received chemotherapy and anti-Her-2 treatment. The breast cancer patients with late-stage CKD had a slightly higher recurrent rate, especially at the locally advanced stage. The 5-year overall survival was 90.1 and 71.2% for patients without and with late-stage CKD, but the breast cancer-related mortality rate was 88.9 and 24.1%, respectively. In multivariate analyses, dose-reduced chemotherapy was an independent negative predictor of 5-year recurrence-free survival and late-stage CKD was associated with lower 5-year overall survival rate. CONCLUSIONS Breast cancer patients with late-stage CKD may receive insufficient therapeutic modalities. Although the recurrence-free survival rate did not differ significantly by the status of CKD, patients with breast cancer and late-stage CKD had shorter overall survival time but a lower breast cancer-related mortality rate, indicated that the mortality was related to underlying disease.
Collapse
Affiliation(s)
- Yi-Wen Hong
- Division of General Surgery, Department of Surgery, New Taipei Municipal TuCheng Hospital, No. 6, Sec. 2, Jincheng Rd., Tucheng Dist., New Taipei City, 236, Taiwan
| | - I-Ming Kuo
- Division of General Surgery, Department of Surgery, New Taipei Municipal TuCheng Hospital, No. 6, Sec. 2, Jincheng Rd., Tucheng Dist., New Taipei City, 236, Taiwan.
| | - Wen-Ling Kuo
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Chi-Chang Yu
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Shih-Che Shen
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Hsiu-Pei Tsai
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Chia-Hui Chu
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Hui-Yu Ho
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Yung-Feng Lo
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Shin-Cheh Chen
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Yung-Chang Lin
- Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Ying Chien
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Hsu-Huan Chou
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan.
| |
Collapse
|
4
|
Helwani AM, Al Suleimani YM, Al Baimani K, Abdelrahman AM. Relative dose intensity of taxane-based chemotherapy in breast cancer patients in a tertiary hospital. J Oncol Pharm Pract 2023:10781552231214467. [PMID: 37968875 DOI: 10.1177/10781552231214467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Breast cancer (BC) is the most diagnosed tumor among women worldwide. The aim of this study was to investigate the incidence and causes of low relative dose intensity (RDI) < 85% for taxane-based chemotherapy regimens used in the treatment of BC in Sultan Qaboos University Hospital (SQUH). METHODS This was a retrospective study that included 303 BC patients, treated with taxane-based chemotherapy protocols at SQUH. RDI was calculated for each chemotherapy regimen and causes and predictors of low RDI < 85% were identified. Prophylactic and therapeutic supportive measures for certain toxicities were studied. RESULTS 50.8% of the patients had neoadjuvant chemotherapy, 38% had adjuvant chemotherapy, and 11.2% of patients were given palliative treatment. AC-T and AC-THP were the most used regimens (40.3% and 17.2%). Mean RDI of used taxane-based chemotherapy regimens was 93.4%. Dose delays, dose reductions, and treatment discontinuation occurred in 36.6%, 14.8%, and 11.5%, respectively. Thirty-eight patients (12.5%) had low RDI < 85% which was reduced to 9.9% after the use of an alternative taxane. Age and chemotherapy intent were significant risk factors. 83.8% received primary granulocyte colony stimulating factor. CONCLUSION An optimal RDI greater than 85% was achieved in most cases. Furthermore, prophylactic and therapeutic supportive measures were widely used.
Collapse
Affiliation(s)
- Amira M Helwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Yousuf M Al Suleimani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Khalid Al Baimani
- Department of Medicine, Sultan Qaboos Comprehensive Cancer Center, Muscat, Sultanate of Oman
| | - Aly M Abdelrahman
- Department of Pharmacology & Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
| |
Collapse
|
5
|
Jeon Y, Yang DH, Oh SJ, Park JH, Kim JA, Kim SY, Choi CW, Lee WS, Kim IH, Mun YC, Min GJ, Eom KS, Cho SG. Effectiveness of pegfilgrastim prophylaxis in preventing febrile neutropenia during R-FC chemoimmunotherapy for chronic lymphocytic leukemia: A multicenter prospective phase II study. Front Oncol 2023; 13:998014. [PMID: 37056335 PMCID: PMC10086440 DOI: 10.3389/fonc.2023.998014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundA chemotherapy of rituximab, fludarabine and cyclophosphamide (R-FC) has been accepted as a promising frontline chemotherapy in selected patients with chronic lymphocytic leukemia (CLL). Although R-FC regimen is a relatively dose-dense regimen and neutropenia incidence is more than 50%, primary prophylactic pegfilgrastim was not fully recommended in the clinical field. Therefore, the study evaluated the prophylactic effectiveness of pegfilgrastim to reduce the incidence of febrile neutropenia associated with R-FC of patients with CLL.Patients and methodsA single-arm, multicenter, prospective phase II study was designed to assess the efficacy of prophylactic pegfilgrastim. Thirty-four CLL patients were enrolled and analyzed for neutropenia and other related factors, and comparative analysis was performed with historical cohort.ResultsCompared with our historical cohort, incidence of grade 3-4 neutropenia and febrile neutropenia was remarkably reduced during any cycle of chemotherapy (14.7% vs. 48.2% of study cohort vs. historical cohort during C1, 5.9% vs. 65.8% during C2, 12.9% vs. 80.6% during C3, 10% vs. 84.6% during C4, 3.4% vs. 83.6% during C5, and 10.7% vs. 85.7% during C6, p <0.001). Also, cumulative incidence of disrupted chemotherapy was noticeably reduced in study cohort on any cycles of R-FC regimen (8.8% vs. 22.2% of study cohort vs. historical cohort on C2, 9.7% vs. 25.2% on C3, 13.4% vs. 26.9% on C4, 13.8% vs. 45.2% on C5, 17.9% vs. 47.3% on C6, p=0.007). In addition, treatment-related mortality was 5.9%, which significantly reduced compared to 9.6% of our historical cohort (HR 0.64, 95% CI 0.42–0.79, P = 0.032).ConclusionPrimary prophylactic pegfilgrastim is effective in the prevention of neutropenia/febrile neutropenia, and infection-related mortality during R-FC regimen in patients with CLL.
Collapse
Affiliation(s)
- Youngwoo Jeon
- Lymphoma & Cell Therapy-Research Center, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Institute for Translational Research and Molecular Imaging, The Catholic University of Korea, Seoul, Republic of Korea
| | - Duk-Hwan Yang
- Department of Hematology-Oncology, Chonnam National University, Hwasun Hospital, Hwasun, Republic of Korea
| | - Suk-Joong Oh
- Department of Hematology and Oncology, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Jin-Hee Park
- Department of Hematology and Oncology, Cachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jung-Ah Kim
- Department of Hematology and Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
| | - Sung-Young Kim
- Department of Hematology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Chul-Won Choi
- Department of Hematology and Oncology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Won-Sik Lee
- Department of Internal Medicine, Hemato-Oncology, Inje University, Busan Paik Hospital, Busan, Republic of Korea
| | - In-Ho Kim
- Department of Hematology and Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yeung-Chul Mun
- Department of Hematology and Oncology, Ewha Woman’s University, Mok-dong Medical Center, Seoul, Republic of Korea
| | - Gi June Min
- Division of Lymphoma-Myeloma, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Seong Eom
- Division of Lymphoma-Myeloma, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok-Goo Cho
- Lymphoma & Cell Therapy-Research Center, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Institute for Translational Research and Molecular Imaging, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Lymphoma-Myeloma, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- *Correspondence: Seok-Goo Cho,
| |
Collapse
|
6
|
Rosenzweig MQ, Mazanec SR. Racial Differences in Breast Cancer Therapeutic Toxicity: Implications for Practice. Cancer Epidemiol Biomarkers Prev 2023; 32:157-158. [PMID: 36744310 PMCID: PMC11229706 DOI: 10.1158/1055-9965.epi-22-1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 02/07/2023] Open
Abstract
Disparities in treatment intensity can contribute to racial disparities in overall breast cancer survival. A natural extension of measuring racial disparities in treatment intensity is consideration of the distribution of treatment toxicities, symptoms, and distress that lead to chemotherapy dose reductions, holds or early termination. There is growing evidence that therapeutic toxicity during early-stage breast cancer treatment may be greater among Black women than White. Important components of symptom management involve the communication of symptoms, the self-care abilities of the patient, the patient's perception of the clinical encounter, and the patient centeredness of the clinical encounter. Racial differences in the symptom reporting, the clinical "reception" and response to symptoms, the prescribed management, and the patient adherence to symptom management requires further investigation. Further research must also consider the structural inequities, as well as institutional and interpersonal racism that contribute to racial differences in cancer symptom burden leading to potential decreases in dose intensity of potentially life-saving early cancer treatment. See related article by Hu et al., p. 167.
Collapse
Affiliation(s)
| | - Susan R. Mazanec
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
7
|
Pati S, Irfan W, Jameel A, Ahmed S, Shahid RK. Obesity and Cancer: A Current Overview of Epidemiology, Pathogenesis, Outcomes, and Management. Cancers (Basel) 2023; 15:485. [PMID: 36672434 PMCID: PMC9857053 DOI: 10.3390/cancers15020485] [Citation(s) in RCA: 138] [Impact Index Per Article: 138.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Obesity or excess body fat is a major global health challenge that has not only been associated with diabetes mellitus and cardiovascular disease but is also a major risk factor for the development of and mortality related to a subgroup of cancer. This review focuses on epidemiology, the relationship between obesity and the risk associated with the development and recurrence of cancer and the management of obesity. METHODS A literature search using PubMed and Google Scholar was performed and the keywords 'obesity' and cancer' were used. The search was limited to research papers published in English prior to September 2022 and focused on studies that investigated epidemiology, the pathogenesis of cancer, cancer incidence and the risk of recurrence, and the management of obesity. RESULTS About 4-8% of all cancers are attributed to obesity. Obesity is a risk factor for several major cancers, including post-menopausal breast, colorectal, endometrial, kidney, esophageal, pancreatic, liver, and gallbladder cancer. Excess body fat results in an approximately 17% increased risk of cancer-specific mortality. The relationship between obesity and the risk associated with the development of cancer and its recurrence is not fully understood and involves altered fatty acid metabolism, extracellular matrix remodeling, the secretion of adipokines and anabolic and sex hormones, immune dysregulation, and chronic inflammation. Obesity may also increase treatment-related adverse effects and influence treatment decisions regarding specific types of cancer therapy. Structured exercise in combination with dietary support and behavior therapy are effective interventions. Treatment with glucagon-like peptide-1 analogues and bariatric surgery result in more rapid weight loss and can be considered in selected cancer survivors. CONCLUSIONS Obesity increases cancer risk and mortality. Weight-reducing strategies in obesity-associated cancers are important interventions as a key component of cancer care. Future studies are warranted to further elucidate the complex relationship between obesity and cancer with the identification of targets for effective interventions.
Collapse
Affiliation(s)
- Sukanya Pati
- College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | | | - Ahmad Jameel
- College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Shahid Ahmed
- College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
- Saskatoon Cancer Center, Saskatchewan Cancer Agency, Saskatoon, SK S7N 4H4, Canada
| | - Rabia K. Shahid
- College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| |
Collapse
|
8
|
Sedrak MS, Sun CL, Ji J, Cohen HJ, Gross CP, Tew WP, Klepin HD, Wildes TM, Dotan E, Freedman RA, O'Connor T, Chow S, Fenton MA, Moy B, Chapman AE, Dale W, Katheria V, Kuderer NM, Lyman GH, Magnuson A, Muss HB. Low-Intensity Adjuvant Chemotherapy for Breast Cancer in Older Women: Results From the Prospective Multicenter HOPE Trial. J Clin Oncol 2023; 41:316-326. [PMID: 36455189 PMCID: PMC9839299 DOI: 10.1200/jco.22.01440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/26/2022] [Accepted: 10/14/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Older women with high-risk early breast cancer (EBC) benefit from adjuvant chemotherapy, but their treatment is frequently complicated by toxic side effects, resulting in dose reductions and delays. This makes it challenging for oncologists to maintain a relative dose intensity (RDI) ≥ 85%, as recommended for optimal curative-intent treatment. Understanding which women are at risk of receiving suboptimal RDI may inform treatment discussions and guide early, targeted supportive care or geriatric comanagement interventions. METHODS This was a prespecified secondary analysis of the HOPE trial, which enrolled women age ≥ 65 years with EBC initiating neoadjuvant or adjuvant chemotherapy. RDI was calculated as the ratio of delivered to planned chemotherapy dose intensity. The primary outcome was low RDI, defined as RDI < 85%. Multivariable logistic regression with stepwise selection was used to evaluate the association between baseline variables (demographic, clinical, and geriatric assessment) and low RDI. Survival probability was estimated using the Kaplan-Meier method, and the log-rank test was used to compare overall survival. RESULTS Three hundred twenty-two patients (median age at diagnosis, 70 years; range, 65-86 years) were included. The median follow-up was 4 years. Sixty-six patients (21%) had a low RDI. Age ≥ 76 years (odds ratio [OR], 2.57; 95% CI, 1.12 to 5.91; P = .03), lower performance status (OR, 4.32; 95% CI, 1.98 to 9.42; P < .001), and use of anthracycline-based or cyclophosphamide, methotrexate, and fluorouracil regimens (OR, 3.47; 95% CI, 1.71 to 7.05; P < .001) were associated with low RDI. The 5-year overall survival probability was 0.80 versus 0.91 in patients with RDI < 85 versus ≥ 85%, respectively (log-rank P = .02). CONCLUSION One in five older patients with EBC treated with standard chemotherapy received low RDI and had inferior survival outcomes. Older patients at risk for low RDI should be identified and targeted upfront before initiating chemotherapy.
Collapse
Affiliation(s)
- Mina S. Sedrak
- Center for Cancer and Aging, City of Hope, Duarte, CA
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
| | - Can-Lan Sun
- Center for Cancer and Aging, City of Hope, Duarte, CA
- Department of Supportive Care Medicine, City of Hope, Duarte, CA
| | - Jingran Ji
- Department of Medical Oncology & Therapeutics Research, City of Hope, Duarte, CA
| | - Harvey J. Cohen
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Cary P. Gross
- Department of Medicine, Yale School of Medicine, New Haven, CT
| | - William P. Tew
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heidi D. Klepin
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Tanya M. Wildes
- Department of Medical Oncology, Nebraska Medicine, Omaha, NE
| | - Efrat Dotan
- Department of Hematology Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Rachel A. Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Tracey O'Connor
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Selina Chow
- Department of Medicine, University of Chicago, Chicago, IL
| | | | - Beverly Moy
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Andrew E. Chapman
- Department of Medical Oncology, Sidney Kimmel Cancer Center/Jefferson Health, Philadelphia, PA
| | - William Dale
- Center for Cancer and Aging, City of Hope, Duarte, CA
- Department of Supportive Care Medicine, City of Hope, Duarte, CA
| | - Vani Katheria
- Center for Cancer and Aging, City of Hope, Duarte, CA
- Department of Supportive Care Medicine, City of Hope, Duarte, CA
| | | | - Gary H. Lyman
- Department of Medicine, University of Washington, Seattle, WA
| | - Allison Magnuson
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Hyman B. Muss
- Department of Medicine, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| |
Collapse
|
9
|
Hatse S, Serena M, Vulsteke C, Punie K, Neven P, Smeets A, Laenen A, Wildiers H. Impact of baseline telomere length on survival and chemotherapy related toxicity in breast cancer patients receiving (neo)adjuvant anthracycline containing chemotherapy. Transl Oncol 2022; 26:101551. [PMID: 36219936 PMCID: PMC9558049 DOI: 10.1016/j.tranon.2022.101551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/09/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this study is to assess baseline mean leukocyte telomere length (TL) as a potential predictive factor for chemotherapy toxicity and a prognostic marker for long-term outcome in early breast cancer (BC) patients. METHODS 445 BC patients were selected, diagnosed between 2007 and 2010 with early BC and treated with (neo)adjuvant fluorouracil, epirubicin and cyclophosphamide (FEC) or with FEC and Docetaxel (FEC-D). RT-qPCR was performed on germline DNA samples collected at diagnosis before any treatment, to measure mean leukocyte TL. Uni- and multivariable logistic regression or Cox proportional hazard regression analyses were carried out to assess correlation between baseline TL and toxicity parameters (derived from the medical chart) or longer-term outcome. RESULTS Baseline TL correlated with age as expected (p = 0.005), but not with febrile neutropenia (n = 97), left ventricular ejection fraction >10% decrease (n = 17) nor other toxicity endpoints measured (all p > 0.05). TL was neither associated with overall survival, breast cancer specific survival or distant disease-free survival (all p > 0.05). CONCLUSIONS Baseline TL is not associated with chemotherapy-related toxicity nor long-term outcome in BC patients.
Collapse
Affiliation(s)
- Sigrid Hatse
- Department of Oncology, Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium
| | - Marta Serena
- Department of Oncology, Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium
| | - Christof Vulsteke
- Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Kevin Punie
- Department of Oncology, Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium; Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium; Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Neven
- Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Ann Smeets
- Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Interuniversity Centre for Biostatistics and Statistical Bioinformatics, Leuven, Belgium
| | - Hans Wildiers
- Department of Oncology, Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium; Department of General Medical Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium; Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium.
| |
Collapse
|
10
|
Rožman S, Novaković B, Gorenjec N, Novaković S. Treatment outcomes and relative dose intensity of chemotherapy in patients with advanced Hodgkin lymphoma. Oncol Lett 2022; 24:320. [PMID: 35949614 PMCID: PMC9353858 DOI: 10.3892/ol.2022.13440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/27/2022] [Indexed: 11/21/2022] Open
Abstract
The present retrospective study was undertaken to investigate the association of relative dose intensity (RDI) with the outcome of patients with advanced stage Hodgkin lymphoma (HL) receiving ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and escalated BEACOPP regimens (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone). A total of 114 patients with HL treated between 2004 and 2013 were enrolled for evaluation. The association of variables with overall survival (OS) and progression-free survival (PFS) was analysed using univariate and multivariate Cox proportional hazards models. The median age of patients was 39 years, and the majority were male and had stage IV disease. A total of 54 patients received ABVD and 60 received BEACOPP chemotherapy with 24 and four deaths, respectively. Patients in the BEACOPP group were significantly younger with lower Charlson comorbidity index (CCI) and better performance status in comparison with the ABVD group, making the comparison of groups not possible. In the ABVD group, RDI was not significantly associated with OS (P=0.590) or PFS (P=0.354) in a multivariate model where age was controlled. The low number of events prevented this analysis in the BEACOPP group. The age of patients was strongly associated with both OS and PFS; all statistically significant predictors for OS and PFS from univariate analyses (chemotherapy regimen, CCI, RDI, performance status) lost their effect in multivariate analyses where age was controlled. Based on these observations, it was concluded that RDI was not associated with OS or PFS after age is controlled, neither in all patients combined nor in the ABVD group.
Collapse
Affiliation(s)
- Samo Rožman
- Pharmacy Department, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | - Barbara Novaković
- The Department of Lymphoma Treatment, Division of Medical Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | - Nina Gorenjec
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Srdjan Novaković
- Department of Molecular Diagnostics, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| |
Collapse
|
11
|
Musta E, van Geloven N, Anninga J, Gelderblom H, Fiocco M. Short-term and long-term prognostic value of histological response and intensified chemotherapy in osteosarcoma: a retrospective reanalysis of the BO06 trial. BMJ Open 2022; 12:e052941. [PMID: 35537786 PMCID: PMC9092180 DOI: 10.1136/bmjopen-2021-052941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Cure rate models accounting for cured and uncured patients, provide additional insights into long and short-term survival. We aim to evaluate the prognostic value of histological response and chemotherapy intensification on the cure fraction and progression-free survival (PFS) for the uncured patients. DESIGN Retrospective analysis of a randomised controlled trial, MRC BO06 (EORTC 80931). SETTING Population-based study but proposed methodology can be applied to other trial designs. PARTICIPANTS A total of 497 patients with resectable highgrade osteosarcoma, of which 118 were excluded because chemotherapy was not started, histological response was not reported, abnormal dose was reported or had disease progression during treatment. INTERVENTIONS Two regimens with the same anticipated cumulative dose (doxorubicin 6×75 mg/m2/week; cisplatin 6×100 mg/m2/week) over different time schedules: every 3 weeks in regimen-C and every 2 weeks in regimen-DI. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome is PFS computed from end of treatment because cure, if it occurs, may happen at any time during treatment. A mixture cure model is used to study the effect of histological response and intensified chemotherapy on the cure status and PFS for the uncured patients. RESULTS Histological response is a strong prognostic factor for the cure status (OR 3.00, 95% CI 1.75 to 5.17), but it has no clear effect on PFS for the uncured patients (HR 0.78, -95% CI 0.53 to 1.16). The cure fractions are 55% (46%-63%) and 29% (22%-35%), respectively, among patients with good and poor histological response (GR, PR). The intensified regimen was associated with a higher cure fraction among PR (OR 1.90, 95% CI 0.93 to 3.89), with no evidence of effect for GR (OR 0.78, 95% CI 0.38 to 1.59). CONCLUSIONS Accounting for cured patients is valuable in distinguishing the covariate effects on cure and PFS. Estimating cure chances based on these prognostic factors is relevant for counselling patients and can have an impact on treatment decisions. TRIAL REGISTRATION NUMBER ISRCTN86294690.
Collapse
Affiliation(s)
- Eni Musta
- Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, The Netherlands
| | - Nan van Geloven
- Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
| | - Jakob Anninga
- Department of Solid Tumours, Princess Máxima Centre, Utrecht, The Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marta Fiocco
- Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
- Department of Solid Tumours, Princess Máxima Centre, Utrecht, The Netherlands
- Mathematical Institute, Leiden University, Leiden, The Netherlands
| |
Collapse
|
12
|
Mir O, Ferrua M, Fourcade A, Mathivon D, Duflot-Boukobza A, Dumont S, Baudin E, Delaloge S, Malka D, Albiges L, Pautier P, Robert C, Planchard D, de Botton S, Scotté F, Lemare F, Abbas M, Guillet M, Puglisi V, Di Palma M, Minvielle E. Digital remote monitoring plus usual care versus usual care in patients treated with oral anticancer agents: the randomized phase 3 CAPRI trial. Nat Med 2022; 28:1224-1231. [PMID: 35469070 DOI: 10.1038/s41591-022-01788-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/16/2022] [Indexed: 01/02/2023]
Abstract
Strategies that individualize the care of cancer patients receiving oral anticancer agents offer opportunities to improve treatment adherence and patient care. However, the impact of digital remote monitoring systems in this setting has not been evaluated. Here, we report the results of a phase 3 trial (CAPRI, NCT02828462) to assess the impact of a nurse navigator-led program on treatment delivery for patients with metastatic cancer. Patients receiving approved oral anticancer agents were randomized (1:1) to an intervention combining a nurse navigator-led follow-up system and a web portal-smartphone application on top of usual care, or to usual symptom monitoring at the discretion of the treating oncologist, for a duration of 6 months. The primary objective included optimization of the treatment dose. Secondary objectives were grade ≥3 toxicities, patient experience, rates and duration of hospitalization, response and survival, and quality of life. In 559 evaluable patients the relative dose intensity was higher in the experimental arm (93.4% versus 89.4%, P = 0.04). The intervention improved the patient experience (Patient Assessment of Chronic Illness Care score, 2.94 versus 2.67, P = 0.01), reduced the days of hospitalization (2.82 versus 4.44 days, P = 0.02), and decreased treatment-related grade ≥3 toxicities (27.6% versus 36.9%, P = 0.02). These findings show that patient-centered care through remote monitoring of symptoms and treatment may improve patient outcomes and experience.
Collapse
Affiliation(s)
- Olivier Mir
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France. .,Division of Interdisciplinary Patients Care Pathways (DIOPP), Gustave Roussy, Villejuif, France.
| | - Marie Ferrua
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - Aude Fourcade
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - Delphine Mathivon
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France.,Division of Interdisciplinary Patients Care Pathways (DIOPP), Gustave Roussy, Villejuif, France
| | - Adeline Duflot-Boukobza
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France.,Division of Interdisciplinary Patients Care Pathways (DIOPP), Gustave Roussy, Villejuif, France
| | - Sarah Dumont
- Division of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Eric Baudin
- Department of Endocrine Oncology, Gustave Roussy, Villejuif, France
| | | | - David Malka
- Division of Cancer Medicine, Gustave Roussy, Villejuif, France
| | | | | | - Caroline Robert
- Division of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - David Planchard
- Division of Cancer Medicine, Gustave Roussy, Villejuif, France
| | | | - Florian Scotté
- Division of Interdisciplinary Patients Care Pathways (DIOPP), Gustave Roussy, Villejuif, France
| | - François Lemare
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - May Abbas
- Division of Interdisciplinary Patients Care Pathways (DIOPP), Gustave Roussy, Villejuif, France
| | - Marilène Guillet
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France
| | - Vanessa Puglisi
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France.,Division of Interdisciplinary Patients Care Pathways (DIOPP), Gustave Roussy, Villejuif, France
| | - Mario Di Palma
- Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France.,Division of Interdisciplinary Patients Care Pathways (DIOPP), Gustave Roussy, Villejuif, France
| | - Etienne Minvielle
- Division of Interdisciplinary Patients Care Pathways (DIOPP), Gustave Roussy, Villejuif, France.,i3-Centre de Recherche en Gestion, Institut Interdisciplinaire de l'Innovation (UMR 9217), École polytechnique, Palaiseau, France
| |
Collapse
|
13
|
Prophylactic use of pegfilgrastim enables the management of severe neutropenia without dose delays in patients with metastatic colorectal cancer treated with TAS‑102 plus bevacizumab. Mol Clin Oncol 2022; 16:103. [PMID: 35463210 PMCID: PMC9022083 DOI: 10.3892/mco.2022.2536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 03/01/2022] [Indexed: 12/02/2022] Open
Abstract
Combined treatment with bevacizumab and trifluridine/tipiracil (TAS-102) leads to an increased chance of survival in patients with refractory metastatic colorectal cancer (mCRC); however, this treatment is associated with an increased frequency of severe neutropenia (number of neutrophils <1,000), which should ideally be managed without dose delays. The present study provided a retrospective review of 35 patients with mCRC, and aimed to elucidate the benefits of prophylactic pegfilgrastim for the treatment of severe neutropenia. Patients received TAS-102 (35 mg/m2) orally twice daily on days 1-5 and 8-12 of each 28-day treatment cycle, along with intravenous bevacizumab (5 mg/kg) on days 1 and 15. Moreover, the patients received 3.6 mg pegfilgrastim on day 15 of each cycle. The incidence of adverse events (AEs), disease control rate (DCR), progression-free survival (PFS) and overall survival (OS) were assessed. In the first and subsequent cycles, 23 and 12 patients, respectively, received pegfilgrastim. The most common AE experienced was grade 3/4 neutropenia (8 patients; 22.9%). Among these 8 patients, 6 (17.1%) and 3 (8.6%) exhibited neutropenia prior to receiving pegfilgrastim or following discontinuation of pegfilgrastim administration, respectively. Moreover, 1 individual among these 8 patients (2.9%) demonstrated grade 3 neutropenia both prior to receiving pegfilgrastim and following discontinuation of pegfilgrastim. A total of 2 patients (5.7%) exhibited grade 3 bone pain, which prevented sustainable administration of pegfilgrastim and resulted in grade 3 neutropenia. Dose delays and dose reduction of TAS-102 due to neutropenia were required in 5 (14.3%) and 2 (5.7%) patients, respectively, during the treatment period. None of the patients exhibited severe neutropenia during chemotherapy after pegfilgrastim administration, thereby preventing dose delays and dose reduction of TAS-102. The relative dose intensity was 96.8% (65.0-100.0%), and the DCR was 54.3%. The median PFS and median OS were 4.4 and 14.9 months, respectively. In conclusion, prophylactic pegfilgrastim may facilitate the management of severe neutropenia without dose delays in patients with mCRC treated with TAS-102 plus bevacizumab.
Collapse
|
14
|
Hirata A, Miyashita K, Tanaka T, Hirata K, Narazaki T, Utsunomiya H, Ohno H, Nakashima E, Tachikawa Y, Choi I, Taguchi K, Suehiro Y. Serum immunoglobulin G as a discriminator of infection in follicular lymphoma patients undergoing chemotherapy with bendamustine in combination with rituximab. Hematology 2022; 27:384-395. [PMID: 35344477 DOI: 10.1080/16078454.2022.2051863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Chemotherapy, including bendamustine, usually causes lymphocytopaenia and hypogammaglobulinaemia as side effects in patients with haematological malignancies. Therefore, the possibility has been considered that these immunological adverse events induced by bendamustine may lead to infectious diseases. However, lymphocytopaenia and/or hypogammaglobulinaemia have not yet been shown to have a statistically significant association with infection in cancer patients who receive bendamustine. METHODS We retrospectively studied 27 patients with relapsed or refractory indolent follicular lymphoma who were treated with bendamustine and rituximab (BR). In order to elucidate relationships between immune-related laboratory parameters (i.e. peripheral blood leukocyte, neutrophil, lymphocyte and immunoglobulin G [IgG]) and infectious events, receiver operating characteristic (ROC) curve and multivariate logistic regression analyses were performed. RESULTS Infectious diseases occurred in 11 patients (11/27, 41%), including 3 (3/27, 11%) with severe diseases. The area under the ROC curve (AUC) showed that the lowest IgG level during and after BR discriminated infectious events (cut-off value, 603 mg/dL) with 81.8% sensitivity and 68.8% specificity (AUC, 0.76; 95% CI, 0.52-0.90). Furthermore, a multivariate regression analysis revealed that the minimal serum IgG value during and after BR therapy was the only variable that was significantly associated with infection (odds ratio, 8.29; 95% CI, 1.19-57.62; p value, 0.03). CONCLUSION Serum IgG ≤603 mg/dL during and after BR therapy was independently associated with an increased risk of infection. The monitoring of serum IgG during chemotherapy may help to predict the development of infection in blood cancer patients undergoing chemotherapy with bendamustine in combination with rituximab.
Collapse
Affiliation(s)
- Akie Hirata
- Department of Clinical Laboratory Medicine, NHO Kyushu Cancer Center, Fukuoka, Japan.,Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | - Kaname Miyashita
- Department of Hematology, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Takafumi Tanaka
- Department of Hematology, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Kiyoko Hirata
- Department of Cell Therapy, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Taisuke Narazaki
- Department of Hematology, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Hayato Utsunomiya
- Department of Cell Therapy, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Hirofumi Ohno
- Department of Cell Therapy, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Eriko Nakashima
- Department of Hematology, NHO Kyushu Cancer Center, Fukuoka, Japan
| | | | - Ilseung Choi
- Department of Hematology, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Kenichi Taguchi
- Department of Clinical Laboratory Medicine, NHO Kyushu Cancer Center, Fukuoka, Japan
| | - Youko Suehiro
- Department of Hematology, NHO Kyushu Cancer Center, Fukuoka, Japan.,Department of Cell Therapy, NHO Kyushu Cancer Center, Fukuoka, Japan
| |
Collapse
|
15
|
Dellapasqua S, Trillo Aliaga P, Munzone E, Bagnardi V, Pagan E, Montagna E, Cancello G, Ghisini R, Sangalli C, Negri M, Mazza M, Iorfida M, Cardillo A, Sciandivasci A, Bianco N, De Maio AP, Milano M, Campennì GM, Sansonno L, Viale G, Morra A, Leonardi MC, Galimberti V, Veronesi P, Colleoni M. Pegylated Liposomal Doxorubicin (Caelyx®) as Adjuvant Treatment in Early-Stage Luminal B-like Breast Cancer: A Feasibility Phase II Trial. Curr Oncol 2021; 28:5167-5178. [PMID: 34940072 PMCID: PMC8700739 DOI: 10.3390/curroncol28060433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Adjuvant chemotherapy for Luminal B-like breast cancers usually includes anthracycline-based regimens. However, some patients are reluctant to receive chemotherapy because of side-effects, especially alopecia, and ask for a “less intensive” or personalized approach. Patients and methods: We conducted a phase II feasibility trial to evaluate pegylated liposomal doxorubicin (PLD, Caelyx®) as adjuvant chemotherapy. Patients who received surgery for pT1–3, any N, and luminal B-like early-stage breast cancer (EBC) candidates for adjuvant chemotherapy were included. PLD was administered intravenously at 20 mg/m2 biweekly for eight courses. Endocrine therapy was given according to menopausal status. Trastuzumab was administered in HER2-positive disease. The primary endpoint was to evaluate the feasibility of this regimen, defined as the ability of a patient to achieve a relative dose intensity (RDI) of at least 85% of the eight cycles of treatment. Secondary endpoints included adverse events (AEs), tolerability, breast cancer-free survival, disease-free survival, and overall survival. Results: From March 2016 to July 2018, 63 patients were included in the trial. Median age was 49 years (range: 33–76), with mostly pre- and peri-menopausal (65%) and stage I–II (94%). Only 5% of patients had HER2-positive EBC. Median RDI was 100% (range: 12.5–100%; interquartile range, IQR: 87.5–100%). The proportion of patients meeting the primary endpoint was 84% (95% confidence interval, CI: 73–92%). Overall, 55 out of 63 enrolled patients completed treatment (87%, 95% CI: 77–94%). Most common AEs were palmar-plantar erythrodysesthesia (12.2%), fatigue (10.4%), and mucositis (8.5%). Only 13% of patients had G3 AEs. None had alopecia. After a median follow-up of 3.9 years (range: 0.3–4.7) two distant events were observed, and all patients were alive at the date of last visit. Conclusions: The trial successfully met its primary endpoint: the regimen was feasible and well tolerated and could be considered for further evaluation as a treatment option for patients with contraindications to standard anthracyclines or requiring a personalized, less intensive approach.
Collapse
Affiliation(s)
- Silvia Dellapasqua
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
- Correspondence: ; Tel.: +39-02-57-489-502
| | - Pamela Trillo Aliaga
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Elisabetta Munzone
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy; (V.B.); (E.P.)
| | - Eleonora Pagan
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy; (V.B.); (E.P.)
| | - Emilia Montagna
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Giuseppe Cancello
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Raffaella Ghisini
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Claudia Sangalli
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Mara Negri
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Manuelita Mazza
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Monica Iorfida
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Anna Cardillo
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Angela Sciandivasci
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Nadia Bianco
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Ana Paula De Maio
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Monica Milano
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Giuseppe Maria Campennì
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Loredana Sansonno
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| | - Giuseppe Viale
- Department of Pathology, European Institute of Oncology IRCCS and University of Milan, 20141 Milan, Italy;
| | - Anna Morra
- Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.M.); (M.C.L.)
| | - Maria Cristina Leonardi
- Division of Radiotherapy, European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.M.); (M.C.L.)
| | - Viviana Galimberti
- Division of Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (V.G.); (P.V.)
| | - Paolo Veronesi
- Division of Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (V.G.); (P.V.)
| | - Marco Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy; (P.T.A.); (E.M.); (E.M.); (G.C.); (R.G.); (C.S.); (M.N.); (M.M.); (M.I.); (A.C.); (A.S.); (N.B.); (A.P.D.M.); (M.M.); (G.M.C.); (L.S.); (M.C.)
| |
Collapse
|
16
|
Yates JWT, Fairman DA. How translational modeling in oncology needs to get the mechanism just right. Clin Transl Sci 2021; 15:588-600. [PMID: 34716976 PMCID: PMC8932697 DOI: 10.1111/cts.13183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 11/28/2022] Open
Abstract
Translational model‐based approaches have played a role in increasing success in the development of novel anticancer treatments. However, despite this, significant translational uncertainty remains from animal models to patients. Optimization of dose and scheduling (regimen) of drugs to maximize the therapeutic utility (maximize efficacy while avoiding limiting toxicities) is still predominately driven by clinical investigations. Here, we argue that utilizing pragmatic mechanism‐based translational modeling of nonclinical data can further inform this optimization. Consequently, a prototype model is demonstrated that addresses the required fundamental mechanisms.
Collapse
Affiliation(s)
| | - David A Fairman
- Clinical Pharmacology, Modelling and Simulation, GSK, Stevenage, UK
| |
Collapse
|
17
|
Rastogi S, Kalaiselvan V, Ali S, Ahmad A, Guru SA, Sarwat M. Efficacy and Safety of Filgrastim and Its Biosimilars to Prevent Febrile Neutropenia in Cancer Patients: A Prospective Study and Meta-Analysis. BIOLOGY 2021; 10:biology10101069. [PMID: 34681169 PMCID: PMC8533340 DOI: 10.3390/biology10101069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/07/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023]
Abstract
Simple Summary Febrile neutropenia is the serious side-effect associated with myelosuppressive chemotherapy. Filgrastim, the first granulocyte colony-stimulating factor (G-CSF) was approved by the Food and Drug Administration for the treatment of neutropenia. Subsequently, pegfilgrastim (long-acting G-CSF) and filgrastim biosimilars were developed to have comparable efficacy to filgrastim. Therefore, it is necessary to produce a systematic review and meta-analysis that provides evidence that filgrastim is more efficacious than placebo/no-treatment, as it provides evidence on the comparable efficacy of filgrastim versus pegfilgrastim and biosimilar filgrastim. Abstract Background: The aim of this review and meta-analysis was to identify, assess, meta-analyze and summarize the comparative effectiveness and safety of filgrastim in head-to-head trials with placebo/no treatment, pegfilgrastim (and biosimilar filgrastim to update advances in the field. Methods: The preferred reporting items for systematic reviews and meta-analyses PRISMA statement were applied, and a random-effect model was used. Primary endpoints were the rate and duration of grade 3 or 4 neutropenia, and an incidence rate of febrile neutropenia. Secondary endpoints were time to absolute neutrophil count ANC recovery, depth of ANC nadir (lowest ANC), neutropenia-related hospitalization and other neutropenia-related complications. For filgrastim versus biosimilar filgrastim comparison, the primary efficacy endpoint was the mean difference in duration of severe neutropenia DSN. Results: A total of 56 studies were considered that included data from 13,058 cancer patients. The risk of febrile neutropenia in filgrastim versus placebo/no treatment was not statistically different. The risk ratio for febrile neutropenia was 0.58, a 42% reduction in favor of filgrastim. The most reported adverse event with FIL was bone pain. For pegfilgrastim versus filgrastim, no statistically significant difference was noted. The risk ratio was 0.90 (95% CI 0.67 to 1.12). The overall difference in duration of severe neutropenia between filgrastim and biosimilar filgrastim was not statistically significant. The risk ratio was 1.03 (95% CI 0.93 to 1.13). Conclusions: Filgrastim was effective and safe in reducing febrile neutropenia and related complications, compared to placebo/no treatment. No notable differences were found between pegfilgrastim and filgrastim in terms of efficacy and safety. However, a similar efficacy profile was observed with FIL and its biosimilars.
Collapse
Affiliation(s)
- Shruti Rastogi
- Indian Pharmacopoeia Commission, Ministry of Health & Family Welfare, Government of India, Sector-23, Raj Nagar, Ghaziabad 201002, Uttar Pradesh, India; (S.R.); (V.K.)
- Amity Institute of Pharmacy, Amity University, Noida 201301, Uttar Pradesh, India
| | - Vivekananda Kalaiselvan
- Indian Pharmacopoeia Commission, Ministry of Health & Family Welfare, Government of India, Sector-23, Raj Nagar, Ghaziabad 201002, Uttar Pradesh, India; (S.R.); (V.K.)
| | - Sher Ali
- School of Basic Sciences and Research, Department of Life Sciences, Sharda University, Greater Noida 201310, Uttar Pradesh, India;
| | - Ajaz Ahmad
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Sameer Ahmad Guru
- Lurie Children’s Hospital, Department of Pediatric Surgery, Northwestern University, Chicago, IL 60611, USA;
| | - Maryam Sarwat
- Amity Institute of Pharmacy, Amity University, Noida 201301, Uttar Pradesh, India
- Correspondence: or
| |
Collapse
|
18
|
Van Belle H, Hurvitz SA, Gilbar PJ, Wildiers H. Systematic review and meta-analysis of febrile neutropenia risk with TCH(P) in HER2-positive breast cancer. Breast Cancer Res Treat 2021; 190:357-372. [PMID: 34533681 DOI: 10.1007/s10549-021-06387-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 09/06/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Docetaxel, carboplatin and trastuzumab, with or without pertuzumab (TCH(P)), has become the preferred (neo)adjuvant regimen for HER2-positive breast cancer. However, its associated febrile neutropenia (FN) risk is unclear: pivotal studies reported FN risks < 10%, but in clinical practice, a high FN rate (> 20%) was observed. This systematic review and meta-analysis determine the FN risk associated with TCH(P) and the indication for primary prophylactic granulocyte colony-stimulating factor (PP G-CSF). METHODS The MEDLINE, Embase, Web of Science and Cochrane databases were searched for full-text English articles reporting the FN incidence in early breast cancer patients receiving (neo)adjuvant TCH(P). The primary endpoint was the pooled crude FN incidence in patients treated without PP G-CSF using the random effects method. Secondary endpoints were the FN risk with PP G-CSF support, age-related differences in FN and differences in risk with TCH versus TCHP. RESULTS Seventeen studies were included in the systematic review. The pooled estimates of FN incidences were 27.6% (95% CI 18.6 to 37.1) in patients who did not receive PP G-CSF (primary meta-analysis, 9 studies, n = 889) versus 5.0% (95% CI 2.6 to 8.0) in patients administered PP G-CSF (secondary meta-analysis, 7 studies, n = 445). Two studies reported non-significant age-related differences in FN. The risk comparison between TCH and TCHP was inconclusive. CONCLUSIONS The crude FN risk associated with (neo)adjuvant TCH(P) is over 20%, the upper limit above which the international guidelines unanimously advise PP G-CSF administration. G-CSF prophylaxis effectively reduces FN risk and should become the standard of care with (neo)adjuvant TCH(P).
Collapse
Affiliation(s)
| | - Sara A Hurvitz
- David Geffen School of Medicine, University of California Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Peter J Gilbar
- Cancer Care Services, Toowoomba Hospital, Toowoomba, Australia.,Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Australia
| | - Hans Wildiers
- Department of General Medical Oncology and Multidisciplinary Breast Centre, University Hospitals Leuven, Leuven Cancer Institute, Herestraat 49, 3000, Leuven, Belgium. .,Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, Leuven, Belgium.
| |
Collapse
|
19
|
Poncelet A, Verschelden G, Colard M, Hildebrand M, Hites M, Yin N, Michel C, Grimaldi D, De Wilde V. Worsening of COVID-19 after chemotherapy in patients considered to have recovered from a SARS-CoV-2 infection. Leuk Lymphoma 2021; 63:253-255. [PMID: 34521312 DOI: 10.1080/10428194.2021.1978086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Arthur Poncelet
- Departement of Hematology, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Gil Verschelden
- Clinic of Infectious Disease, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Martin Colard
- Departement of Hematology, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Hildebrand
- Department of Internal Medicine, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Maya Hites
- Clinic of Infectious Disease, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Yin
- Department of Microbiology, Laboratoire hospitalier universitaire de Bruxelles (LHUB-ULB)- Université libre de Bruxelles, Brussels, Belgium
| | - Charlotte Michel
- Department of Microbiology, Laboratoire hospitalier universitaire de Bruxelles (LHUB-ULB)- Université libre de Bruxelles, Brussels, Belgium
| | - David Grimaldi
- Departement of Intensive Care, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Virginie De Wilde
- Departement of Hematology, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
20
|
Impact of R-CHOP dose intensity on survival outcomes in diffuse large B-cell lymphoma: a systematic review. Blood Adv 2021; 5:2426-2437. [PMID: 33961018 DOI: 10.1182/bloodadvances.2021004665] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/26/2021] [Indexed: 12/20/2022] Open
Abstract
The dilemma of whether to treat elderly patients with diffuse large B-cell lymphoma (DLBCL) with a full or reduced dose intensity (DI) of R-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone+rituximab) is often faced by clinicians. We conducted a systematic review assessing the impact of R-CHOP DI on DLBCL survival outcomes, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols (PRISMA-P) guidelines. We searched MEDLINE, EMBASE, and Cochrane CENTRAL for studies with ≥100 patients treated with R-CHOP/R-CHOP-like therapies published from January 2002 through November 2020. Studies were included if they reported the impact of R-CHOP DI on survival outcomes. We screened records, extracted data, and reviewed all the studies for quality and statistical appraisal. Of 380 screened records, 13 studies including 5188 patients were reviewed. DI was often calculated as the ratio of the cumulative delivered dose of prespecified drug(s) to the cumulative planned dose multiplied by a time-correction factor. Lower DI (intended or relative) was associated with inferior survival in 7 of 9 studies reporting crude survival analyses. Multivariable analysis using DI as a covariate was performed in 10 studies. Six showed an association (P < .05) with adjustment for other covariates, and 4 did not. Most studies and those larger studies of higher quality showed poorer outcomes associated with reduced DI. In subgroups aged ≥80 years, survival was not consistently affected by reduced DI. DI-specific randomized trials are warranted, but these data support full-dose R-CHOP in elderly and fit patients aged <80 years with DLBCL, but not in those aged ≥80 years, where dose-reduced R-CHOP does not appear to compromise survival.
Collapse
|
21
|
Metz M, Semsek D, Rogmans G, Hutzschenreuter U, Fietz T, Harde J, Zacharias S, Hielscher C, Lorenz A, Zahn MO, Guth D, Liebers S, Berghorn M, Grebhardt S, Matillon CD, Egerer G, Potthoff K. Patient, nurse, and physician preferences: final results of the CONVENIENCE study evaluating pegfilgrastim prophylaxis via pre-filled syringe or on-body injector in cancer patients. Support Care Cancer 2021; 29:6633-6643. [PMID: 33956213 PMCID: PMC8464571 DOI: 10.1007/s00520-021-06230-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/15/2021] [Indexed: 11/25/2022]
Abstract
Purpose The on-body injector (OBI) automatically delivers pegfilgrastim the day after chemotherapy (CTx), thus eliminating the need of return visits to the medical office for guideline-compliant pegfilgrastim administration. The CONVENIENCE study aimed to evaluate patient, nurse, and physician preferences as well as health economics for pegfilgrastim administration either with OBI or manually using a pre-filled syringe (PS). Methods Patients with early breast cancer, receiving two or three weekly anthracycline/cyclophosphamide or three weekly taxane-based CTx, and patients with Non-Hodgkin lymphoma (NHL) receiving first-line R-CHOP-14 or -21 were randomized 1:1 to receive both pegfilgrastim application forms for four consecutive CTx cycles in an alternating sequence starting either with OBI or PS. Primary endpoint was patient preference, assessed by questionnaires. Results A total of 308 patients were evaluable in the per-protocol analysis. Patients slightly preferred OBI over PS (OBI, n = 133, 43.2%; vs. PS, n = 111, 36.0%; p-value = 0.159), while study nurses slightly preferred PS (n = 19, 46.3%) over OBI (n = 18, 43.9%) and physicians clearly preferred PS (n = 24, 58.8%) over OBI (n = 15, 36.6%). Among patients with preference for OBI, saving of time was their major reason for preference (53.4%). Pegfilgrastim was administered 24–72 h after each CTx cycle in 97.6% of OBI and 63.1% of PS applications. Conclusion The OBI was slightly preferred by patients and saving time was the major reason for their preference. PS was physicians’ most preferable choice and slightly preferred by nurses. Using OBI, pegfilgrastim was almost always administered within the time period recommended by current guidelines, while it was often not applied as specified using PS. Trial registration No: ClinicalTrials.gov No. NCT03619993. Registered on June 25, 2018
Collapse
Affiliation(s)
| | - Dieter Semsek
- Praxis für interdisziplinäre Onkologie & Hämatologie, Freiburg im Breisgau, Germany
| | - Gunther Rogmans
- ZAGO- Zentrum für ambulante gynäkologische Onkologie, Krefeld, Germany
| | | | - Thomas Fietz
- Schwerpunktpraxis für Hämatologie und Internistische Onkologie, Gastroenterologie, Singen, Germany
| | | | | | | | - Andreas Lorenz
- Gynäkologische Onkologie, Frauenarztpraxis Dr. Lorenz, Hildburghausen, Germany
| | - Mark-Oliver Zahn
- Überörtliche Berufsausübungsgemeinschaft MVZ Onkologische Kooperation Harz, Goslar, Germany
| | - Dagmar Guth
- Gynäkologische Onkologie, Praxis Dr. med. Dagmar Guth, Plauen, Germany
| | | | | | | | | | - Gerlinde Egerer
- Universitätsklinikum Heidelberg, Klinik Für Hämatologie, Onkologie, Rheumatologie, Heidelberg, Germany
| | | |
Collapse
|
22
|
Yokoyama M, Kusano Y, Inoue N, Nishimura N, Mishima Y, Nukada T, Hatake K, Terui Y. Factors for the optimal selection of granulocyte colony-stimulating factor preparations and predictors for R-CHOP dose reductions/delays among patients with non-Hodgkin B-cell lymphoma (STOP FN in NHL 2 subanalysis). BMC Cancer 2021; 21:358. [PMID: 33823836 PMCID: PMC8025521 DOI: 10.1186/s12885-021-08068-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 03/18/2021] [Indexed: 11/28/2022] Open
Abstract
Background A classification tree was used to analyze background factors for granulocyte colony-stimulating factor (G-CSF) preparation selection for febrile neutropenia (FN) prophylaxis in Japanese patients with non-Hodgkin B-cell lymphoma receiving the first R-CHOP cycle. Methods This was a subanalysis of the retrospective observational study STOP FN in NHL 2 (UMIN000029534). Patient characteristics, changes in neutrophil count, incidence and severity of neutropenia, and risk factors for dose reduction/delay of R-CHOP were assessed by G-CSF formulation. Results Among 234 patients in cycle 1, 25.6% received no G-CSF preparation, 52.1% received daily G-CSF, and 22.2% received pegfilgrastim. Pegfilgrastim use was most frequent among patients aged ≥ 80 years, while that of daily G-CSF was most frequent in patients with lymphocyte count (LC) < 1000 cells/μL. Changes in neutrophil count were more marked with pegfilgrastim compared with daily G-CSF and no G-CSF. Relevant factors for G-CSF preparation selection in the first R-CHOP cycle were age ≥ 80 years and LC < 1000 cells/μL; for chemotherapy dose reduction were FN onset in cycle 1 and female sex; and for dose delay was hemoglobin (< 12 g/dL). After cycle 2 and onward, pegfilgrastim use increased markedly (72.6%) compared with cycle 1 (22.2%), with significantly greater proportions continuing pegfilgrastim use and switching from daily G-CSF. Conclusion Relevant factors for G-CSF preparation selection were age ≥ 80 years and LC < 1000 cells/μL. The use of pegfilgrastim increased markedly after cycle 2. These results may be useful for selecting appropriate G-CSF preparations in the first R-CHOP cycle. Trial registration UMIN000029534; registered on 13 October 2017, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000033733. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08068-0.
Collapse
Affiliation(s)
- Masahiro Yokoyama
- Division of Hematology Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Yoshiharu Kusano
- Division of Hematology Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Norihito Inoue
- Division of Hematology Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Noriko Nishimura
- Division of Hematology Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yuko Mishima
- Division of Hematology Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | | | - Kiyohiko Hatake
- Department of Hematology, International University of Health and Welfare, Tokyo, Japan
| | - Yasuhito Terui
- Division of Hematology Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| |
Collapse
|
23
|
Ise M, Matsuda K, Shimura A, Masamoto Y, Kurokawa M. Primary prophylaxis with pegfilgrastim during the first cycle of R-CHOP to avoid reduction of dose intensity in elderly patients. Int J Hematol 2021; 113:823-831. [PMID: 33738702 DOI: 10.1007/s12185-021-03118-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
The long-term effects of pegfilgrastim administered in the first cycle of chemotherapy in day-to-day practice remain unclear. We retrospectively identified 114 patients aged ≥ 70 years with diffuse large B-cell lymphoma who received a rituximab-cyclophosphamide-doxorubicin-vincristine-prednisolone (R-CHOP) regimen in our institution. Twenty-six patients received pegfilgrastim (pegfilgrastim group); of the 88 patients scheduled to receive conventional granulocyte-colony stimulating factor (G-CSF) when their neutrophil count decreased (neut-adjusted-G group), conventional G-CSF was ultimately administered to 57. During the first cycle of R-CHOP, the incidence of febrile neutropenia was lower in the pegfilgrastim group than in the neut-adjusted-G group (0% vs. 18%, p = 0.020). Throughout all cycles, a higher proportion of patients exhibited sustained relative dose intensity (≥ 80%) in the pegfilgrastim group than in the neut-adjusted-G group (25% vs. 4.0%, p = 0.008). A lower proportion of patients received a reduced dose in the second cycle in the pegfilgrastim group than in the neut-adjusted-G group (0% vs. 10%, p = 0.116). Although the differences were not significant, the pegfilgrastim group showed higher progression-free survival and overall survival than the neut-adjusted-G group. Adequate prevention of febrile neutropenia using pegfilgrastim during the first cycle of R-CHOP may contribute to avoidance of dose intensity reduction in all cycles.
Collapse
Affiliation(s)
- Masataka Ise
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kensuke Matsuda
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Arika Shimura
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yosuke Masamoto
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mineo Kurokawa
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. .,Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, Tokyo, Japan.
| |
Collapse
|
24
|
Timmins HC, Li T, Goldstein D, Trinh T, Mizrahi D, Harrison M, Horvath LG, Friedlander M, Kiernan MC, Park SB. The impact of obesity on neuropathy outcomes for paclitaxel- and oxaliplatin-treated cancer survivors. J Cancer Surviv 2021; 16:223-232. [DOI: 10.1007/s11764-021-01012-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/17/2021] [Indexed: 12/27/2022]
|
25
|
Gebremariam A, Assefa M, Addissie A, Worku A, Dereje N, Abreha A, Tigeneh W, Pace LE, Kantelhardt EJ, Jemal A. Delayed initiation of adjuvant chemotherapy among women with breast cancer in Addis Ababa, Ethiopia. Breast Cancer Res Treat 2021; 187:877-882. [PMID: 33599864 DOI: 10.1007/s10549-021-06131-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Chemotherapy within 90 days following surgery for non-metastatic breast cancer is the standard of care. There are no data, however, on the extent of time to initiation of chemotherapy (TTC) in Africa settings, including Ethiopia. METHODS A total of 223 women with stage I-III breast cancer treated with surgery and adjuvant chemotherapy during 2017-2019 in Addis Ababa, Ethiopia, were included in the analysis. Based on information from medical records, we calculated TTC from date of surgery and completion of planned chemotherapy, with TTC > 90 days considered delayed and receipt of 85% of planned therapy as complete. Multivariable Poisson regression with robust variance was used to assess whether TTC > 90 days was associated with sociodemographic or clinical factors. RESULTS The median TTC was 63 days. Chemotherapy initiation was delayed in 30% (95% CI 24.4-36.6%) of patients, with the risk significantly higher in low-income women. For example, the risk of delay in women with lowest quartile family monthly income group (US$ < 61) was 3.98 (95% CI 1.67-9.46) higher than in those women with highest quartile family income group (US$ > 194). Remarkably, adjuvant chemotherapy was completed in 95% of patients. CONCLUSIONS A staggering one-in-three women with breast cancer in Addis Ababa, Ethiopia, delay to initiation of adjuvant chemotherapy, with the delay more common in low-income women and yet with remarkably high degree of treatment adherence. These findings underscore the need for public policy to expand health care to low-income population to improve breast cancer care and other health outcomes in the country.
Collapse
Affiliation(s)
- Alem Gebremariam
- Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Tigray, Adigrat, Ethiopia. .,Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Mathewos Assefa
- Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nebiyu Dereje
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Aynalem Abreha
- Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Lydia E Pace
- Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Eva Johanna Kantelhardt
- Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle-Wittenberg, Halle, Germany
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| |
Collapse
|
26
|
Mizrahi D, Park SB, Li T, Timmins HC, Trinh T, Au K, Battaglini E, Wyld D, Henderson RD, Grimison P, Ke H, Geelan-Small P, Marker J, Wall B, Goldstein D. Hemoglobin, Body Mass Index, and Age as Risk Factors for Paclitaxel- and Oxaliplatin-Induced Peripheral Neuropathy. JAMA Netw Open 2021; 4:e2036695. [PMID: 33587134 PMCID: PMC7885037 DOI: 10.1001/jamanetworkopen.2020.36695] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating adverse effect of neurotoxic cancer treatments including taxanes and platinum agents. Limited knowledge exists of potential prechemotherapy factors associated with CIPN development. OBJECTIVE To identify the association of pretreatment blood-based and clinical factors with CIPN persistence in patients who received paclitaxel or oxaliplatin. DESIGN, SETTING, AND PARTICIPANTS This cohort study assessed pretreatment blood-based clinical factors and demographic characteristics of 333 patients treated with paclitaxel and oxaliplatin chemotherapy at urban multicenter cancer clinics and academic institutions in Australia between September 2015 and February 2020. Comprehensive neuropathy assessments were undertaken 3 to 12 months posttreatment. Posttreatment CIPN severity was compared with blood-based factors within 30 days prior to commencing chemotherapy. Data were analyzed between March and December 2020. EXPOSURES Paclitaxel or oxaliplatin chemotherapy. MAIN OUTCOMES AND MEASURES CIPN was measured using composite neurological grading scales, nerve conduction studies, and assessments of fine motor skills (grooved pegboard test), sensory function (grating orientation test and 2-point discrimination), and patient-reported outcomes. Independent samples t tests and Mann-Whitney U tests with post hoc Bonferroni correction were used to compare CIPN between patients according to blood-based factor normative ranges. Linear regression was used to identify blood-based and clinical associations with CIPN development. RESULTS The study included 333 participants (266 [79.9%] women; median [interquartile range] age, 58 [18] years) who were consecutively recruited and referred (228 treated with paclitaxel, 105 treated with oxaliplatin; 138 [41.4%] with breast cancer, 83 [24.9%] with colorectal cancer). Most participants had grade 1 CIPN or higher (238 [71.5%] participants). Participants with low hemoglobin pretreatment had worse CIPN posttreatment (median [IQR] composite neurological grading scale score, 5 [2-8] vs 4 [1-6]; P = .002; grooved pegboard mean [SD] time, 84.2 [28.7] vs 72.9 [21.1] seconds; P = .002; grating orientation task, 4.8 [2.8] vs 3.9 [1.8] mm; P = .03; 2-point discrimination, 45% vs 28%; P = .01), with no other impairments outside normative ranges associated with CIPN. In the multivariable model, several factors were associated with worse CIPN (F4,315 = 18.6; P < .001; r2 = .19) including for lower hemoglobin (β = -0.47; 95% CI, -0.73 to -0.21; P < .001), higher body mass index (β = 0.08; 95% CI, 0.02 to 0.12; P = .007), older age (β = 0.08; 95% CI, 0.06 to 0.11; P < .001), and female sex (β = -1.08; 95% CI, -1.76 to -0.16; P = .01). CONCLUSIONS AND RELEVANCE The results of this cohort study suggest that participants with low pretreatment hemoglobin, higher body mass index, older age, and female sex were more likely to develop paclitaxel- or oxaliplatin-induced CIPN posttreatment. Future research should investigate prospectively whether these risk factors are associated with a higher incidence of CIPN development.
Collapse
Affiliation(s)
- David Mizrahi
- Prince of Wales Clinical School, UNSW Medicine, University of New South Wales Sydney, Sydney, Australia
| | - Susanna B. Park
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Tiffany Li
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | | | - Terry Trinh
- Prince of Wales Clinical School, UNSW Medicine, University of New South Wales Sydney, Sydney, Australia
| | - Kimberley Au
- Prince of Wales Clinical School, UNSW Medicine, University of New South Wales Sydney, Sydney, Australia
| | - Eva Battaglini
- Prince of Wales Clinical School, UNSW Medicine, University of New South Wales Sydney, Sydney, Australia
| | - David Wyld
- Royal Brisbane and Women’s Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Robert D. Henderson
- Royal Brisbane and Women’s Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Peter Grimison
- Chris O’Brien Lifehouse, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Helen Ke
- Chris O’Brien Lifehouse, Sydney, Australia
| | - Peter Geelan-Small
- Mark Wainwright Analytical Centre, University of New South Wales, Kensington, Australia
| | - Julie Marker
- The Australasian Gastro-Intestinal Trials Group Consumer Advisory Panel, Sydney, Australia
| | - Brian Wall
- The Australasian Gastro-Intestinal Trials Group Consumer Advisory Panel, Sydney, Australia
| | - David Goldstein
- Prince of Wales Clinical School, UNSW Medicine, University of New South Wales Sydney, Sydney, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| |
Collapse
|
27
|
Nyrop KA, Damone EM, Deal AM, Carey LA, Lorentsen M, Shachar SS, Williams GW, Brenizer AT, Wheless A, Muss HB. Obesity, comorbidities, and treatment selection in Black and White women with early breast cancer. Cancer 2020; 127:922-930. [PMID: 33284988 DOI: 10.1002/cncr.33288] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND This study investigates obesity and comorbidity in Black and White women with early breast cancer (stages I-III) and their potential impact on treatment decisions for patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) tumors. METHODS In this retrospective chart review, comparisons of frequencies for Black and White patients were calculated with the Fisher exact test. Log binomial regression was used to estimate prevalence ratios (PRs) with 95% confidence intervals for total and individual comorbidities, and multivariable modeling was used to estimate PRs adjusted for age and body mass index (BMI). RESULTS In a sample of 548 patients, 26% were Black, and 74% were White. Sixty-two percent of Black patients and 32% of White patients were obese (BMI ≥ 30 kg/m2 ; P < .0001). Seventy-five percent of Black patients and 87% of White patients had HR+ tumors (P = .001). Significant intergroup differences were seen for 2 or more total comorbidities (62% of Blacks vs 47% of Whites; P = .001), 2 or more obesity-related comorbidities (33% vs 10%; P < .0001), hypertension (60% vs 32%; P < .0001), diabetes mellitus (23% vs 6%; P < .0001), hypercholesterolemia or hyperlipidemia (28% vs 18%; P = .02), and hypothyroidism (4% vs 11%; P = .012). In women with HR+/HER2- tumors, there were no intergroup differences in treatment decisions regarding the type of surgery, chemotherapy regimen, radiation, or endocrine treatment despite significant differences in the prevalence of obesity and comorbidities. CONCLUSIONS This study documents significant disparities between Black and White women with early breast cancer with regard to high rates of obesity, overall comorbidities, and obesity-related comorbidities, and it highlights the prevalence of competing risks that may complicate outcomes in breast cancer.
Collapse
Affiliation(s)
- Kirsten A Nyrop
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily M Damone
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lisa A Carey
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael Lorentsen
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Grant W Williams
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Addison Tucker Brenizer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amy Wheless
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hyman B Muss
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
28
|
Febrile neutropenia and role of prophylactic granulocyte colony-stimulating factor in docetaxel and cyclophosphamide chemotherapy for breast cancer. Support Care Cancer 2020; 29:3507-3512. [PMID: 33146835 DOI: 10.1007/s00520-020-05868-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Febrile neutropenia (FN) incidence during docetaxel and cyclophosphamide (TC) chemotherapy, known as a high-risk regimen, differs among countries. The role of prophylactic granulocyte colony-stimulating factor (G-CSF) in FN is unclear. This study aimed to investigate FN frequency and relative dose intensity (RDI) of TC chemotherapy in patients with breast cancer and identify the correct population requiring prophylactic G-CSF. METHODS In total, 205 patients with breast cancer were scheduled for TC chemotherapy (docetaxel/cyclophosphamide 75/600 mg/m2, every 3 weeks, 4 cycles) as adjuvant chemotherapy. Trastuzumab (8 mg/kg; continued with 6 mg/kg) was administrated intravenously for human epidermal growth factor receptor 2 (HER2)-positive cancer. Fifty-five patients received primary prophylactic measures (G-CSF: 20 and antibiotics: 35). We investigated the frequency of FN and hospitalization, RDI, and the factors related to FN, adverse events, hospitalization, and RDI. RESULTS FN occurred in 70 patients (35.7%). FN incidence was noted in 41.1% without any prophylactic measures and in 5.0% with prophylactic G-CSF. In multivariate analysis, the independent risk factors of FN were older age (≥ 60 years, P = 0.017) and without primary prophylactic G-CSF (P = 0.011). Eleven patients (5.6%) were hospitalized of which 8 (72.7%) were elderly. The median RDIs of docetaxel and cyclophosphamide were 96.7% and 99.7%, respectively. CONCLUSION FN frequency during TC chemotherapy was high, and primary prophylactic G-CSF reduced FN incidence. Primary prophylactic G-CSF is an effective therapy for preventing FN during TC chemotherapy. However, prophylactic G-CSF should be considered for elderly patients based on the low hospitalization rate and the high RDI.
Collapse
|
29
|
Narasimhulu DM, McGree ME, Weaver AL, Jatoi A, LeBrasseur NK, Glaser GE, Langstraat CL, Block MS, Kumar A. Frailty is a determinant of suboptimal chemotherapy in women with advanced ovarian cancer. Gynecol Oncol 2020; 158:646-652. [PMID: 32518016 DOI: 10.1016/j.ygyno.2020.05.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/27/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the relationship between frailty and chemotherapy delivery among women with epithelial ovarian cancer (EOC). METHODS We included women who underwent primary debulking surgery (PDS) for stage IIIC/IV EOC between 1/2/2003 and 12/30/2011, received adjuvant chemotherapy at our institution, and had data available to calculate a frailty deficit index. Frailty was defined as a frailty deficit index ≥0.15. Relative dose intensity (RDI) of chemotherapy was calculated as the percentage of the standard dose that was administered, and compared between frail and non-frail using the Wilcoxon rank-sum test. RESULTS Failure to receive chemotherapy following PDS was twice as common among frail vs. non-frail women (26.7% vs 14.2%, p = 0.001). Of the 169 women who received chemotherapy at our institution, 17.2% (29/169) were frail. Frail women were older (mean, 67.9 vs 62.3 years, p = 0.01), had higher BMI (mean, 29.6 vs 25.7 kg/m2, p = 0.003), and were less likely to complete 6 cycles of chemotherapy (75.9 vs. 93.6%, p = 0.008). Using an RDI cutoff of 85%, frail women were less likely to have adequate doses of carboplatin (15.8 vs. 66.2%, p < 0.001) and paclitaxel (57.9 vs. 80.5%, p = 0.07) despite no differences in dose delays (34.5 vs. 42.1%), dose reductions (65.5 vs. 68.6%), and severe neutropenia (44.8 vs. 39.3%). After adjusting for age, frailty was associated with shorter progression-free (HR 1.58, 95% CI: 0.99-2.50) and overall survival (HR 2.14, 95% CI: 1.35-3.41). CONCLUSION Frail women with EOC were less likely to receive chemotherapy or the optimal dose of chemotherapy after PDS despite no evidence of treatment-related toxicity. Frail EOC patients demonstrated shorter progression-free and overall survival. Further studies are needed to explore the association between frailty, chemotherapy, and survival.
Collapse
Affiliation(s)
- Deepa Maheswari Narasimhulu
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Michaela E McGree
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Amy L Weaver
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Aminah Jatoi
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | - Nathan K LeBrasseur
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
| | - Gretchen E Glaser
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States; Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | - Carrie L Langstraat
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States; Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | - Matthew S Block
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | - Amanika Kumar
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States; Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States.
| |
Collapse
|
30
|
McCall MK, Connolly M, Nugent B, Conley YP, Bender CM, Rosenzweig MQ. Symptom Experience, Management, and Outcomes According to Race and Social Determinants Including Genomics, Epigenomics, and Metabolomics (SEMOARS + GEM): an Explanatory Model for Breast Cancer Treatment Disparity. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:428-440. [PMID: 31392599 PMCID: PMC7245588 DOI: 10.1007/s13187-019-01571-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Even after controlling for stage, comorbidity, age, and insurance status, black women with breast cancer (BC) in the USA have the lowest 5-year survival as compared with all other races for stage-matched disease. One potential cause of this survival difference is the disparity in cancer treatment, evident in many population clinical trials. Specifically, during BC chemotherapy, black women receive less relative dose intensity with more dose reductions and early chemotherapy cessation compared with white women. Symptom incidence, cancer-related distress, and ineffective communication, including the disparity in patient-centeredness of care surrounding patient symptom reporting and clinician assessment, are important factors contributing to racial disparity in dose reduction and early therapy termination. We present an evidence-based overview and an explanatory model for racial disparity in the symptom experience during BC chemotherapy that may lead to a reduction in dose intensity and a subsequent disparity in outcomes. This explanatory model, the Symptom Experience, Management, Outcomes and Adherence according to Race and Social determinants + Genomics Epigenomics and Metabolomics (SEMOARS + GEM), considers essential factors such as social determinants of health, clinician communication, symptoms and symptom management, genomics, epigenomics, and pharmacologic metabolism as contributory factors.
Collapse
Affiliation(s)
- Maura K. McCall
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Mary Connolly
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Bethany Nugent
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Yvette P. Conley
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Catherine M. Bender
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| | - Margaret Q. Rosenzweig
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15261 USA
| |
Collapse
|
31
|
Ruanglertboon W, Sorich MJ, Rowland A, Hopkins AM. Effect of early adverse events resulting in sorafenib dose adjustments on survival outcomes of advanced hepatocellular carcinoma patients. Int J Clin Oncol 2020; 25:1672-1677. [DOI: 10.1007/s10147-020-01698-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/01/2020] [Indexed: 12/23/2022]
|
32
|
Gadisa DA, Assefa M, Tefera GM, Yimer G. Patterns of Anthracycline-Based Chemotherapy-Induced Adverse Drug Reactions and Their Impact on Relative Dose Intensity among Women with Breast Cancer in Ethiopia: A Prospective Observational Study. JOURNAL OF ONCOLOGY 2020; 2020:2636514. [PMID: 32148494 PMCID: PMC7054818 DOI: 10.1155/2020/2636514] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The breast cancer chemotherapy leads to diverse aspects of noxious or unintended adverse drug reactions (ADRs) that cause the relative dose intensity (RDI) reduced to below optimal (i.e., if the percentage of actual dose received per unit time divided by planned dose per unit time is less than 85%). Hence, this prospective observational study was conducted to evaluate chemotherapy-induced ADRs and their impact on relative dose intensity among women with breast cancer in Ethiopia. METHODS The study was conducted with a cohort of 146 patients from January 1 to September 30, 2017, Gregorian Calendar (GC) at the only nationwide oncology center, Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. The ADRs of the chemotherapy were collected using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) (version 4.03). The patients were personally interviewed for subjective toxicities, and laboratory results and supportive measures were recorded at each cycle. SPSS version 22 was used for analysis. RESULTS Grade 3 neutropenia (23 (15.8%)) was the most frequently reported ADR among grade 3 hematological toxicity on cycle 4. However, overall grade fatigue (136 (93.2%)) and grade 3 nausea (31 (21.2%)) were the most frequently reported nonhematological toxicities on cycle 1. The majority of ADRs were reported during the first four cycles except for peripheral neuropathy. Oral antibiotics and G-CSF use (17 (11.6%)) and treatment delay (31 (21.2%)) were frequently reported on cycle 3. Overall, 61 (41.8%) and 42 (28.8%) of study participants experienced dose delay and used G-CSF, respectively, at least once during their enrollment. Of the 933 interventions observed, 95 (10%) cycles were delayed due to toxicities in which neutropenia attributed to the delay of 89 cycles. Forty-four (30.1%) of the patients received overall RDI < 85%. Pretreatment hematological counts were significant predictors (P < 0.05) for the incidence of first cycle hematological toxicities such as neutropenia, anemia, and leukopenia and nonhematological toxicities like vomiting. CONCLUSION Ethiopian women with breast cancer on anthracycline-based AC and AC-T chemotherapy predominantly experienced grade 1 to 3 hematological and nonhematological ADRs, particularly during the first four cycles. Neutropenia was the only toxicity that led to RDI < 85%. Thus, enhancing the utilization of G-CSF and other supportive measures will improve RDI to above 85%.
Collapse
Affiliation(s)
- Diriba Alemayehu Gadisa
- College of Medicine and Health Sciences, Pharmacy Department, Ambo University, Ambo, Ethiopia
| | - Mathewos Assefa
- School of Medicine, College of Health Sciences, Radiotherapy Center, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gosaye Mekonen Tefera
- College of Medicine and Health Sciences, Pharmacy Department, Ambo University, Ambo, Ethiopia
| | - Getnet Yimer
- Ohio State Global One Health Initiative, Office of International Affairs, The Ohio State University, Addis Ababa, Ethiopia
| |
Collapse
|
33
|
Kirkham AA. Supervised, Multimodal Exercise: The Chemotherapy Supportive Therapy That Almost Does It All. Oncologist 2020; 25:3-5. [PMID: 31754070 PMCID: PMC6964116 DOI: 10.1634/theoncologist.2019-0628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/01/2019] [Indexed: 12/16/2022] Open
Abstract
This commentary describes and places the results into context for the recent OptiTrain trial, a three‐arm randomized trial of two different exercise interventions versus usual care on rates of chemotherapy completion, hospitalization, and hematological toxicity.
Collapse
Affiliation(s)
- Amy A. Kirkham
- Department of Biomedical Engineering, University of AlbertaEdmontonCanada
| |
Collapse
|
34
|
Kubouchi K, Shimada K, Yokoe T, Tsutsumi Y. Avoidance and Period-Shortening of Neoadjuvant Chemotherapy Against Triple-Negative Breast Cancer in Stages I and II: Importance of Ki-67 Labeling Index and the Recognition of Apocrine-Type Lesions. Technol Cancer Res Treat 2020; 19:1533033820943246. [PMID: 32677589 PMCID: PMC7370551 DOI: 10.1177/1533033820943246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 06/20/2020] [Accepted: 06/24/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Triple-negative breast cancer encompasses heterogeneous subtypes. Neoadjuvant chemotherapy is ineffective against some triple-negative breast cancers, while others show a favorable prognosis despite chemoresistance. METHODS A total of 51 cases with stages I and II triple-negative breast cancer were analyzed; 34 triple-negative breast cancers treated with neoadjuvant chemotherapy were divided into "good responders" (n = 22), showing therapeutic effect G2b or G3 in surgical specimens, and "poor responders" with therapeutic effect G0, G1a, G1b, and G2a (n = 12). Neoadjuvant chemotherapy was spared in 17 cases (non-neoadjuvant chemotherapy group). Apocrine-type triple-negative breast cancer was defined as triple-negative breast cancer immunoreactive for both androgen receptor and forkhead-box protein A1. Triple-negative breast cancer other than apocrine-type (n = 16) and special types (myoepithelial, medullary, adenoid cystic, and spindle cell carcinomas, n = 6) was categorized as basal-like subtype (n = 29). Prognosis was evaluated in each category. RESULTS Neoadjuvant chemotherapy provoked significant effects against basal-like triple-negative breast cancer with high Ki-67 labeling (≧50%), and tumor-infiltrating lymphocytes predicted high chemosensitivity. Neoadjuvant chemotherapy was avoidable in triple-negative breast cancer of apocrine- and special types showing low (<50%) Ki-67 labeling. Ten (59%) lesions in the non-neoadjuvant chemotherapy group belonged to the apocrine-type. When clinical complete remission shown by contrast-enhanced magnetic resonance imaging was reached in the course of neoadjuvant chemotherapy against basal-like triple-negative breast cancer, the neoadjuvant chemotherapy period was shortened in 14 (64%) of 22 good responders. Disease-free and overall survival rates were excellent in all groups. CONCLUSIONS The following 2 hypothetical proposals should be proven by large-scale clinical trials. Immunohistochemical recognition of apocrine-type triple-negative breast cancer with low Ki-67 labeling is important for avoiding ineffective/unnecessary neoadjuvant chemotherapy. By employing appropriate clinical imaging, period-shortening is achievable in basal-like triple-negative breast cancer with high Ki-67 labeling.
Collapse
Affiliation(s)
| | - Kyosuke Shimada
- Department of Breast Surgery, Kawasaki Municipal Ida Hospital, Kawasaki, Kanagawa, Japan
| | - Takamichi Yokoe
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
- Department of Breast Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Yutaka Tsutsumi
- Diagnostic Pathology Clinic, Pathos Tsutsumi, Nagoya, Aichi, Japan
| |
Collapse
|
35
|
Baig H, Somlo B, Eisen M, Stryker S, Bensink M, Morrow PK. Appropriateness of granulocyte colony-stimulating factor use in patients receiving chemotherapy by febrile neutropenia risk level. J Oncol Pharm Pract 2019; 25:1576-1585. [PMID: 30200842 PMCID: PMC6716357 DOI: 10.1177/1078155218799859] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 08/11/2018] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Inappropriate granulocyte colony-stimulating factor use with myelosuppressive chemotherapy has been reported. Using the Oncology Services Comprehensive Electronic Records electronic medical record database, prophylactic granulocyte colony-stimulating factor (pegfilgrastim/filgrastim) use in cancer patients was assessed by febrile neutropenia risk level. METHODS Patients with nonmetastatic or metastatic breast, head/neck, colorectal, ovarian/gynecologic, lung cancer, or non-Hodgkin's lymphoma who received myelosuppressive chemotherapy from June 2013 to May 2014 were included. Prophylactic granulocyte colony-stimulating factor use with high-risk, intermediate-risk, and low-risk chemotherapy and distribution of National Comprehensive Cancer Network risk factors with intermediate-risk regimens were assessed. RESULTS Overall, 86,189 patients received ∼4.2 million chemotherapy cycles (high risk, 9%; intermediate risk, 48%; low risk, 43%). Prophylactic granulocyte colony-stimulating factor was given in 24% of cycles (high risk, 59%; intermediate risk, 29%; low risk, 11%). For nonmetastatic solid tumors, granulocyte colony-stimulating factor was given in 78% (high risk), 31% (intermediate risk), and 6% (low risk) of cycles. For metastatic solid tumors or non-Hodgkin's lymphoma, granulocyte colony-stimulating factor was given in 50% (high risk), 27% (intermediate risk), and 11% (low risk) of cycles. Among patients receiving intermediate-risk regimens with granulocyte colony-stimulating factor, febrile neutropenia risk factors were identified in 56% (95% confidence interval, 51.1-60.9%) of patients with nonmetastatic solid tumors (n = 400) and in 70% (64.5-73.5%) of patients with metastatic solid tumors or non-Hodgkin's lymphoma (n = 400). CONCLUSION Prophylactic granulocyte colony-stimulating factor use was appropriately highest for high-risk regimens and lowest for low-risk regimens yet still potentially underused in high risk regimens, overused in low-risk regimens, and not appropriately targeted in intermediate-risk regimens, indicating a need for further education on febrile neutropenia risk evaluation and appropriate granulocyte colony-stimulating factor use.
Collapse
|
36
|
Bland KA, Kirkham AA, Bovard J, Shenkier T, Zucker D, McKenzie DC, Davis MK, Gelmon KA, Campbell KL. Effect of Exercise on Taxane Chemotherapy-Induced Peripheral Neuropathy in Women With Breast Cancer: A Randomized Controlled Trial. Clin Breast Cancer 2019; 19:411-422. [PMID: 31601479 DOI: 10.1016/j.clbc.2019.05.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/10/2019] [Accepted: 05/24/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting adverse effect of taxanes. We sought to evaluate the effect of exercise on taxane CIPN in women with breast cancer. PATIENTS AND METHODS Women (n = 27) were randomized to immediate exercise (IE, during taxane chemotherapy) or delayed exercise (DE, after chemotherapy). Supervised aerobic, resistance, and balance training was offered 3 days a week for 8-12 weeks. CIPN symptoms and quality of life were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30 and CIPN20 (scored from 0 to 100). The percentage of participants reporting moderate to severe sensory symptoms ('3/4' or '4/4' for CIPN20 sensory items) was also evaluated, along with clinical sensory testing at the lower limb (vibration sense and pinprick). Taxane treatment adherence, including relative dose intensity, was extracted from patient medical records. Assessments occurred at: baseline (before taxane chemotherapy), pre-cycle 4 (before the final taxane cycle), the end of chemotherapy, and follow-up (10-15 weeks after chemotherapy). RESULTS No differences in the EORTC QLQ CIPN20 symptom scores were detected between groups at any time point. At pre-cycle 4, there was a significant difference between groups in patient-reported moderate to severe numbness in the toes or feet (IE: n = 1, 9%, DE: n = 7, 50%, P = .04) and impaired vibration sense in the feet (IE: n = 2, 18%, DE: n = 10, 83%, P < .01). Overall global health status/quality of life was higher in IE compared to DE at the end of chemotherapy (P = .05), yet both groups had worse CIPN20 sensory (Δ24.3 ± 4.6, P < .01) and motor symptom scores (Δ10.5 ± 1.9, P < .01) relative to baseline. By the end of chemotherapy, no differences between groups were found for moderate to severe numbness in the toes or feet (P = 1.0) or impaired vibration sense in the feet (P = .71). More IE participants received ≥ 85% relative dose intensity (IE: n = 12, 100%, DE: n = 10, 67%, P < .05). CONCLUSION Exercise may attenuate CIPN over the course of taxane chemotherapy and possibly improve taxane adherence in women with breast cancer. These findings, as well as whether exercise can attenuate CIPN by the end of taxane chemotherapy, should be confirmed in larger trials.
Collapse
Affiliation(s)
- Kelcey A Bland
- Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Amy A Kirkham
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Joshua Bovard
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | | | - David Zucker
- Swedish Cancer Institute, Swedish Medical Center, Seattle, WA
| | - Donald C McKenzie
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Margot K Davis
- Division of Cardiology, Gordon & Leslie Diamond Health Care Centre, University of British Columbia, Vancouver, Canada
| | | | - Kristin L Campbell
- Rehabilitation Sciences, University of British Columbia, Vancouver, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
| |
Collapse
|
37
|
Lancia C, Anninga J, Spitoni C, Sydes MR, Whelan J, Hogendoorn PCW, Gelderblom H, Fiocco M. Method to measure the mismatch between target and achieved received dose intensity of chemotherapy in cancer trials: a retrospective analysis of the MRC BO06 trial in osteosarcoma. BMJ Open 2019; 9:e022980. [PMID: 31152023 PMCID: PMC6549670 DOI: 10.1136/bmjopen-2018-022980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES In cancer studies, the target received dose intensity (tRDI) for any regimen, the intended dose and time for the regimen, is commonly taken as a proxy for achieved RDI (aRDI), the actual individual dose and time for the regimen. Evaluating tRDI/aRDI mismatches is crucial to assess study results whenever patients are stratified on allocated regimen. The manuscript develops a novel methodology to highlight and evaluate tRDI/aRDI mismatches. DESIGN Retrospective analysis of a randomised controlled trial, MRC BO06 (EORTC 80931). SETTING Population-based study but proposed methodology can be applied to other trial designs. PARTICIPANTS A total of 497 patients with resectable high-grade osteosarcoma, of which 19 were excluded because chemotherapy was not started or the estimated dose was abnormally high (>1.25 × prescribed dose). INTERVENTIONS Two regimens with the same anticipated cumulative dose (doxorubicin 6×75 mg/m2/week; cisplatin 6×100 mg/m2/week) over different time schedules: every 3 weeks in regimen-C and every 2 weeks in regimen-DI. PRIMARY AND SECONDARY OUTCOME MEASURES: tRDI distribution was measured across groups of patients derived from k-means clustering of treatment data. K-means creates groups of patients who are aRDI-homogeneous. The main outcome is the proportion of tRDI values in groups of homogeneous aRDI. RESULTS For nearly half of the patients, there is a mismatch between tRDI and aRDI; for 21%, aRDI was closer to the tRDI of the other regimen. CONCLUSIONS For MRC BO06, tRDI did not predict well aRDI. The manuscript offers an original procedure to highlight the presence of and quantify tRDI/aRDI mismatches. Caution is required to interpret the effect of chemotherapy-regimen intensification on survival outcome at an individual level where such a mismatch is present.The study relevance lies in the use of individual realisation of the intended treatment, which depends on individual delays and/or dose reductions reported throughout the treatment. TRIAL REGISTRATION NUMBER ISRCTN86294690.
Collapse
Affiliation(s)
- Carlo Lancia
- Mathematical Institute, Universiteit Leiden, Leiden, The Netherlands
| | - Jakob Anninga
- Department Solid Tumors, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Cristian Spitoni
- Mathematical Institute, Universiteit Utrecht, Utrecht, The Netherlands
- Department of Epidemiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Matthew R. Sydes
- MRC London Hub for Trial Methodology Research, University College London, London, UK
- MRC Clinical Trials Unit, University College London, London, UK
| | - Jeremy Whelan
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Hans Gelderblom
- Clinical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marta Fiocco
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
- Mathematical Institute, Leiden University, Leiden, the Netherlands
| |
Collapse
|
38
|
Ahmed JH, Makonnen E, Yimer G, Seifu D, Bekele A, Assefa M, Aseffa A, Howe R, Fotoohi A, Hassan M, Aklillu E. CYP2J2 ∗7 Genotype Predicts Risk of Chemotherapy-Induced Hematologic Toxicity and Reduced Relative Dose Intensity in Ethiopian Breast Cancer Patients. Front Pharmacol 2019; 10:481. [PMID: 31139078 PMCID: PMC6527746 DOI: 10.3389/fphar.2019.00481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 04/16/2019] [Indexed: 11/13/2022] Open
Abstract
Chemotherapy-induced hematologic toxicity is the primary reasons of dose reductions and/or delays, low relative dose intensity (RDI), and predicts anticancer response. We investigated the incidence and predictors of chemotherapy-induced hematologic toxicities and reduced RDI in Ethiopian breast cancer patients, and implication of pharmacogenetics variations. Breast cancer patients (n = 249) were enrolled prospectively to receive cyclophosphamide based chemotherapy. Hematological toxicity (neutropenia, anemia, and thrombocytopenia) were monitored throughout chemotherapy cycle. The primary and secondary outcomes were incidence of grade 3 or 4 toxicity and reduced RDI, respectively. CYP2B6∗6, CYP3A5∗3, CYP2C9 (∗2,∗3), CYP2C19 (∗2,∗3), CYP2J2∗7, POR∗28, and ABCB1 (rs3842) genotyping were done. Cox proportional hazard and logistic regression were used to estimate risk predictors of toxicity and reduced RDI, respectively. Majority (73.5%) of the patients were < 45 years of age. The incidence of grade 3 or 4 hematological toxicity was 51.0% (95% CI = 44.54–57.46%). Multivariate Cox proportional hazard regression indicated CYP2J2∗7 genotype [Hazard ratio (HR) = 1.82; 95% CI = 1.14–2.90], pretreatment grade 1 leukopenia (HR = 2.75; 95% CI = 1.47–5.15) or grade 1 or 2 neutropenia (HR = 2.75; 95% CI = 1.73–4.35) as significant predictors of hematologic toxicities. The odds of having hematologic toxicities was lower in CYP2C9∗2 or ∗3 carriers (p = 0.024). The prevalence of reduced RDI was 56.6% (95% CI = 50.3–62.9%). Higher risk of reduced RDI was associated with CYP2J2∗7 allele [Adjusted odds ratio (AOR) = 2.79; 95% CI = 1.21–6.46], BMI ≤ 18.4 kg/m2 (AOR = 5.98; 95% CI = 1.36–26.23), baseline grade 1 leukopenia (AOR = 6.09; 95% CI = 1.24–29.98), and baseline neutropenia (AOR = 3.37; 95% CI = 1.41–8.05). The odds of receiving reduced RDI was lower in patients with CYP2B6 ∗6/∗6 genotype (AOR = 0.19; 95% CI = 0.06–0.77). We report high incidence of chemotherapy-induced hematological toxicities causing larger proportion of patients to receive reduced RDI in Ethiopian breast cancer patients. Patients carrying CYP2J2∗7 allele and low baseline blood counts are at a higher risk for chemotherapy-induced hematologic toxicities and receiving reduced RDI, and may require prior support and close follow up during chemotherapy.
Collapse
Affiliation(s)
- Jemal Hussien Ahmed
- Department of Pharmacology, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Pharmacy, Jimma University, Jimma, Ethiopia.,Division of Clinical Pharmacology, Department of Laboratory of Medicine, Karolinska Institutet Huddinge, Stockholm, Sweden
| | - Eyasu Makonnen
- Department of Pharmacology, Addis Ababa University, Addis Ababa, Ethiopia.,Center for Inovative Drug Development and Therapeutic Trials, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getnet Yimer
- Department of Pharmacology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Seifu
- Department of Biochemistry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebe Bekele
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mathewos Assefa
- Department of Oncology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Rawleigh Howe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Alan Fotoohi
- Clinical Pharmacology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Moustapha Hassan
- Department of Laboratory Medicine, Experimental Cancer Medicine, Clinical Research Centre, Karolinska Institutet, Stockholm, Sweden
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory of Medicine, Karolinska Institutet Huddinge, Stockholm, Sweden
| |
Collapse
|
39
|
Lancia C, Anninga JK, Sydes MR, Spitoni C, Whelan J, Hogendoorn PCW, Gelderblom H, Fiocco M. A novel method to address the association between received dose intensity and survival outcome: benefits of approaching treatment intensification at a more individualised level in a trial of the European Osteosarcoma Intergroup. Cancer Chemother Pharmacol 2019; 83:951-962. [PMID: 30879111 PMCID: PMC6458990 DOI: 10.1007/s00280-019-03797-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/08/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE There is lack of consensus on the prognostic value of received high dose intensity in osteosarcoma survivorship. Many studies have not shown a clear survival benefit when dose intensity is increased. The aim of this study is to go beyond chemotherapy intensification by arm-wide escalation of intended dose and/or compression of treatment schedule, while conversely addressing the relationship between treatment intensity and survival at the patient level. The study focusses on the difference in outcome results, based on a novel, progressively more individualised approach to dose intensity. METHODS A retrospective analysis of data from MRC BO06/EORTC 80931 randomised controlled trial for treatment of osteosarcoma was conducted. Three types of post hoc patient groups are formed using the intended regimen: the individually achieved cumulative dose and time on treatment, and the increase of individual cumulative dose over time. Event-free survival is investigated and compared in these three stratifications. RESULTS The strata of intended regimen and achieved treatment yields equivalent results. Received cumulative dose over time produces groups with evident different survivorship characteristics. In particular, it highlights a group of patients with an estimated 3-year event-free survival much larger (more than 10%) than other patient groups. This group mostly contains patients randomised to an intensified regimen. In addition, adverse events reported by that group show the presence of increased preoperative myelotoxicity. CONCLUSIONS The manuscript shows the benefits of analyzing studies by using longitudinal data, e.g. recorded per cycle. This has impact on the drafting of future trials by showing why such a level of detail is needed for both treatment and adverse event data. The novel method proposed, based on cumulative dose received over time, shows that longitudinal treatment data might be used to link survival outcome with drug metabolism. This is particularly valuable when pharmacogenetics data for metabolism of cytotoxic agents are not collected. TRIAL REGISTRATION ISRCTN86294690.
Collapse
Affiliation(s)
- Carlo Lancia
- Mathematical Institute Leiden University, Niels Bohrweg 1, 2333 CA Leiden, The Netherlands
| | - Jakob K. Anninga
- Department Paediatric Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Matthew R. Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL and MRC London Hub for Trials Methodology Research, 90 High Holborn, London, WC1V 6LJ UK
| | - Cristian Spitoni
- Mathematical Institute Utrecht University, Budapestlaan 6, 3584 CD Utrecht, The Netherlands
- Department of Epidemiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Jeremy Whelan
- Department of Oncology, University College London Hospital, 235 Euston Rd, Fitzrovia, London, NW1 2BU UK
| | - Pancras C. W. Hogendoorn
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Marta Fiocco
- Mathematical Institute Leiden University, Niels Bohrweg 1, 2333 CA Leiden, The Netherlands
- Department of Biomedical Data Science, Section Medical Statistics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| |
Collapse
|
40
|
Bland KA, Zadravec K, Landry T, Weller S, Meyers L, Campbell KL. Impact of exercise on chemotherapy completion rate: A systematic review of the evidence and recommendations for future exercise oncology research. Crit Rev Oncol Hematol 2019; 136:79-85. [DOI: 10.1016/j.critrevonc.2019.02.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022] Open
|
41
|
Tjokrowidjaja A, Hovey E, Lewis CR. Let's talk about cytotoxic chemotherapy dosing: unravelling adjustments and off-protocol prescribing. Med J Aust 2019; 210:65-66. [PMID: 30712300 DOI: 10.5694/mja2.12072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Elizabeth Hovey
- Prince of Wales Hospital and Community Health Services, Sydney, NSW.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW
| | - Craig R Lewis
- Prince of Wales Hospital and Community Health Services, Sydney, NSW.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW
| |
Collapse
|
42
|
Araki R, Keira T, Masuda Y, Tanaka T, Yamada H, Hamamoto T. Effects of proton pump inhibitors on severe haematotoxicity induced after first course of pemetrexed/carboplatin combination chemotherapy. J Clin Pharm Ther 2018; 44:276-284. [PMID: 30552862 DOI: 10.1111/jcpt.12788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/19/2018] [Accepted: 11/19/2018] [Indexed: 12/19/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Pemetrexed/carboplatin combination chemotherapy has shown efficacy as a first-line treatment for advanced non-small-cell lung cancer. However, severe haematotoxicity is often observed during this combination chemotherapy. Some studies have suggested that concomitant drugs may be the risk factors for severe adverse events. However, those studies identified the predictive risk factors without paying attention to the relative dose intensities (RDIs) of the anticancer drugs. The objective of this study was to clarify the effects of concomitant drugs on the severe haematotoxicity induced by pemetrexed/carboplatin combination chemotherapy using multiple logistic regression analysis incorporating RDIs of the anticancer drugs. METHODS We retrospectively reviewed the records of 61 patients who had received first-line treatment with this combination chemotherapy at Yamato Municipal Hospital between April 2011 and May 2017. Severe haematotoxicity was defined as grade 3 or 4 according to the Common Terminology Criteria for Adverse Events, version 4.0. To clarify the influence of concomitant drugs on haematotoxicity, we performed multiple logistic regression analysis. RESULTS Among the 61 patients, 18 (29.5%) developed grade 3 or 4 haematotoxicity. Multiple logistic regression analysis showed that body weight <54.5 kg [odds ratio: 5.21, 95% confidence interval (CI): 1.17-23.08, P = 0.030], haemoglobin <12.0 g/dL [odds ratio: 7.13, 95% CI: 1.54-33.11, P = 0.012], and coadministration of proton pump inhibitors (PPIs) [odds ratio: 5.34, 95% CI: 1.06-26.94, P = 0.042] were significantly associated with severe haematotoxicity in patients receiving pemetrexed/carboplatin combination chemotherapy after adjustment using non-steroidal anti-inflammatory drugs and RDIs of the anticancer drugs. WHAT IS NEW AND CONCLUSION Multiple logistic regression analysis incorporating RDIs of the anticancer drugs revealed that low baseline body weight, low baseline haemoglobin level, and coadministration of PPIs were the independent risk factors for predicting severe haematotoxicity induced by pemetrexed/carboplatin combination chemotherapy.
Collapse
Affiliation(s)
- Ryosuke Araki
- Department of Pharmacy, Yamato Municipal Hospital, Kanagawa, Japan.,Laboratory of Applied Therapeutics, Center for Education & Research on Clinical Pharmacy, Showa Pharmaceutical University, Tokyo, Japan
| | - Takayuki Keira
- Department of Pharmacy, St. Marianna University School of Medicine Hospital, Kanagawa, Japan
| | - Yutaka Masuda
- Laboratory of Applied Therapeutics, Center for Education & Research on Clinical Pharmacy, Showa Pharmaceutical University, Tokyo, Japan
| | - Tsuneaki Tanaka
- Department of Pharmacy, St. Marianna University School of Medicine Hospital, Kanagawa, Japan
| | - Hideki Yamada
- Department of Pharmacy, Yamato Municipal Hospital, Kanagawa, Japan
| | - Tomoyuki Hamamoto
- Laboratory of Applied Therapeutics, Center for Education & Research on Clinical Pharmacy, Showa Pharmaceutical University, Tokyo, Japan
| |
Collapse
|
43
|
Denduluri N, Lyman GH, Wang Y, Morrow PK, Barron R, Patt D, Bhowmik D, Li X, Bhor M, Fox P, Dhanda R, Saravanan S, Jiao X, Garcia J, Crawford J. Chemotherapy Dose Intensity and Overall Survival Among Patients With Advanced Breast or Ovarian Cancer. Clin Breast Cancer 2018; 18:380-386. [DOI: 10.1016/j.clbc.2018.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 01/12/2018] [Accepted: 02/08/2018] [Indexed: 02/02/2023]
|
44
|
Ladwa R, Kalas T, Pathmanathan S, Woodward N, Wyld D, Sanmugarajah J. Maintaining Dose Intensity of Adjuvant Chemotherapy in Older Patients With Breast Cancer. Clin Breast Cancer 2018; 18:e1181-e1187. [DOI: 10.1016/j.clbc.2018.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/08/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
|
45
|
Salmon JP, Smakal M, Karanikiotis C, Wojtukiewicz MZ, Omnes Y, DeCosta L, Wetten S, O'Kelly J. Febrile neutropenia (FN) and pegfilgrastim prophylaxis in breast cancer and non-Hodgkin's lymphoma patients receiving high (> 20%) FN-risk chemotherapy: results from a prospective observational study. Support Care Cancer 2018; 27:1449-1457. [PMID: 30259136 DOI: 10.1007/s00520-018-4473-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 09/17/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Prophylaxis for febrile neutropenia (FN) is recommended for the duration of myelosuppressive chemotherapy in high-risk patients; yet, granulocyte-colony-stimulating factor (G-CSF) discontinuation occurs frequently in clinical practice. The objective of this study was to investigate the incidence of FN in real-world settings and the extent and impact of early pegfilgrastim discontinuation. METHODS This prospective, observational study enrolled patients with any-stage non-Hodgkin's lymphoma (NHL) or breast cancer initiating a new chemotherapy course with a high (> 20%) FN risk, with pegfilgrastim in cycle 1. During routine clinical visits, data were collected on FN events, discontinuation of pegfilgrastim (defined as administration of G-CSF other than pegfilgrastim for ≥ 1 cycle) and all G-CSF (and reasons), neutropenic complications and adverse drug reactions (ADRs). RESULTS Overall, 943 patients were enrolled; 844 met the eligibility criteria (full analysis set) and 814 (86%) completed the study. Twenty-eight patients (3%) had 31 FN events (NHL, n = 17; breast cancer, n = 11). Twenty-six patients (3%) discontinued pegfilgrastim. Forty-four patients (5%) discontinued G-CSF. The most common reason for pegfilgrastim discontinuation was physician preference for daily G-CSF (n = 14 [2%]), and for discontinuation of all G-CSFs was reduced FN risk (n = 14 [2%]). Patients who continued G-CSF prophylaxis were less likely to experience neutropenic complications (odds ratio [95% confidence interval]: 0.26 [0.09-0.80]). Suspected ADRs to pegfilgrastim occurred in 43 patients (5%) and serious ADRs in 5 (1%). CONCLUSIONS FN rates were consistent with previous reports with pegfilgrastim in clinical practice. No new ADRs were observed. G-CSF discontinuation was uncommon but appeared to increase the likelihood of neutropenic complications.
Collapse
Affiliation(s)
- Jean Paul Salmon
- Centre Hospitalier Régional de la Citadelle, Medical Oncology, Liège, Belgium.
| | - Martin Smakal
- Nemocnice Hořovice Hospital, Hořovice, Czech Republic
| | | | | | | | | | - Sally Wetten
- Amgen Center for Observational Research, Uxbridge, UK
| | - James O'Kelly
- Amgen Center for Observational Research, Uxbridge, UK
| |
Collapse
|
46
|
Schwartzberg LS, Lal LS, Balu S, Campbell K, Brekke L, Elliott C, Korrer S. Incidence of febrile neutropenia during chemotherapy among patients with nonmyeloid cancer receiving filgrastim vs a filgrastim biosimilar. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:493-500. [PMID: 30214262 PMCID: PMC6126503 DOI: 10.2147/ceor.s168298] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Filgrastim and other granulocyte colony-stimulating factors are recommended to decrease febrile neutropenia (FN) incidence among patients with nonmyeloid cancers undergoing chemotherapy. Data comparing biosimilar filgrastim-sndz with reference filgrastim (filgrastim-ref) are limited outside of clinical trials in the US. Objective To compare the incidence of FN across chemotherapy cycles 1-6 between patients treated with filgrastim-sndz vs filgrastim-ref. Materials and methods This was a retrospective claims analysis of patients with nonmyeloid cancer enrolled in commercial or Medicare Advantage plans from March 2015 to June 2016 and receiving filgrastim-sndz or filgrastim-ref during ≥1 completed chemotherapy cycle. Patients undergoing hematopoietic stem cell transplantation, pregnant patients, and those with missing data were excluded. FN was identified using the diagnosis codes for neutropenia + fever, neutropenia + bacterial/fungal infection, and neutropenia + infection + fever. Equivalence testing for FN incidence at the cycle level across chemotherapy cycles 1-6 was conducted for filgrastim-sndz vs filgrastim-ref after adjusting for baseline characteristics using inverse probability of treatment weighting. Results were considered equivalent if the 90% CIs for between-cohort differences were within ±6.0%. Results The analysis included 3,459 patients (162 filgrastim-sndz and 3,297 filgrastim-ref). Before weighting, the filgrastim-sndz cohort was younger than filgrastim-ref and had a higher proportion of men, a higher proportion with commercial insurance, and lower proportions with granulocyte colony-stimulating factor prophylaxis or metastatic cancer. After weighting, baseline characteristics were similar between cohorts. Adjusted FN incidence was equivalent for filgrastim-sndz vs filgrastim-ref, respectively: neutropenia + fever, 0.81% vs 0.61% (difference [90% CI]=0.20 [-0.57 to 1.56]); neutropenia + infection, 1.21% vs 1.33% (difference [90% CI]=-0.12 [-1.17 to 2.28]); neutropenia + infection + fever, 0.0% vs 0.14% (difference=-0.14; CI not calculated because filgrastim-sndz had 0 events). Conclusion Filgrastim-sndz and filgrastim-ref are statistically equivalent for preventing FN across chemotherapy cycles 1-6 among patients with nonmyeloid cancer.
Collapse
Affiliation(s)
- Lee S Schwartzberg
- West Cancer Center, Memphis, TN, USA.,Division of Hematology and Oncology, University of Tennessee, Memphis, TN, USA
| | - Lincy S Lal
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA,
| | - Sanjeev Balu
- US Clinical Development and Medical Affairs, Sandoz Inc., Princeton, NJ, USA
| | - Kim Campbell
- US Clinical Development and Medical Affairs, Sandoz Inc., Princeton, NJ, USA
| | - Lee Brekke
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA,
| | - Caitlin Elliott
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA,
| | - Stephanie Korrer
- Health Economics and Outcomes Research, Optum, Eden Prairie, MN, USA,
| |
Collapse
|
47
|
Farhi J, Laribi K, Orvain C, Hamel JF, Mercier M, Sutra Del Galy A, Clavert A, Rousselet MC, Tanguy-Schmidt A, Hunault-Berger M, Moles-Moreau MP. Impact of front line relative dose intensity for methotrexate and comorbidities in immunocompetent elderly patients with primary central nervous system lymphoma. Ann Hematol 2018; 97:2391-2401. [PMID: 30091022 DOI: 10.1007/s00277-018-3468-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 07/31/2018] [Indexed: 12/16/2022]
Abstract
Primary central nervous system lymphomas (PCNSL) are non-Hodgkin lymphomas strictly localized to the CNS, occurring mainly in elderly patients with comorbidities. Current treatment in fit patients relies on high-dose methotrexate and high-dose cytarabine. The aim of this study was to evaluate the efficacy and feasibility of this treatment in elderly patients and to assess potential prognostic factors associated with survival. We conducted a retrospective study in two centers between January 2008 and September 2015 including 35 elderly immunocompetent patients who received first-line treatment with high-dose methotrexate. With a median follow-up of 19.8 months (range: 1.7-73.4 months), median overall survival (OS) was 39.5 months (95% confidence interval (95% CI): 18.3-60.7) and median progression-free survival (PFS) was 25.8 months (95% CI: 5.2-46.4). In univariate analysis, administration of high-dose cytarabine and achieving a relative dose intensity for methotrexate > 75% were associated with increased OS (p = 0.006 and p = 0.003, respectively) and PFS (p = 0.003 and p = 0.04, respectively) whereas comorbidities, defined by a CIRS-G score ≥ 8, were associated with decreased OS and PFS (p = 0.02 and p = 0.04, respectively). A high MSKCC score was associated with decreased OS (p = 0.02). In multivariate analysis, administration of high-dose cytarabine was associated with increased OS and PFS (p = 0.02 and p = 0.007, respectively). Comorbidities and relative dose intensity for methotrexate are important for the prognosis of elderly patients with PCNSL. These results must be confirmed in prospective trials.
Collapse
Affiliation(s)
- Jonathan Farhi
- Service des Maladies du Sang, CHU Angers, 4, rue Larrey, 49933, Angers Cedex 9, France. .,Service d'Hématologie Clinique, CH Le Mans, Le Mans, France.
| | - Kamel Laribi
- Service d'Hématologie Clinique, CH Le Mans, Le Mans, France
| | - Corentin Orvain
- Service des Maladies du Sang, CHU Angers, 4, rue Larrey, 49933, Angers Cedex 9, France
| | | | - Mélanie Mercier
- Service des Maladies du Sang, CHU Angers, 4, rue Larrey, 49933, Angers Cedex 9, France
| | | | - Aline Clavert
- Service des Maladies du Sang, CHU Angers, 4, rue Larrey, 49933, Angers Cedex 9, France
| | | | - Aline Tanguy-Schmidt
- Service des Maladies du Sang, CHU Angers, 4, rue Larrey, 49933, Angers Cedex 9, France
| | | | | |
Collapse
|
48
|
Kohei N, Sugiyama K, Chihara I, Muro Y, Imamura M, Nishio Y, Yoshimura K. Impact of relative dose intensity in gemcitabine-cisplatin chemotherapy for metastatic urothelial carcinoma. SAGE Open Med 2018; 6:2050312118783011. [PMID: 30013781 PMCID: PMC6041858 DOI: 10.1177/2050312118783011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/21/2018] [Indexed: 01/01/2023] Open
Abstract
Objectives To evaluate the impact of relative dose intensity for gemcitabine-cisplatin chemotherapy in patients with metastatic urothelial carcinoma. Methods We retrospectively reviewed the medical records of 18 patients with metastatic urothelial carcinoma, who received gemcitabine-cisplatin regimen as the first-line chemotherapy between 2009 and 2015. The doses of gemcitabine and cisplatin were reduced or the intervals between treatment cycles were prolonged according to the treatment efficacy and adverse events during the first and second cycles. The individually optimal relative dose intensity was set as the actual dose per the standard dose in the first and second cycles. From the third course onward, patients received the gemcitabine-cisplatin chemotherapy with the same relative dose intensity. Overall survival was compared with the groups according to the value of relative dose intensity. Results The median age was 72.5 (range, 56-79) years and 15 men and 3 women were enrolled in the study. The median number of cycles of first-line gemcitabine-cisplatin chemotherapy was 8 (range, 2-17), and the median survival time from initiation of first-line chemotherapy was 20.1 (range, 3.5-32.8) months. The total median relative dose intensity of gemcitabine-cisplatin chemotherapy was 56.1%. The median survival time of 10 patients in the group with the relative dose intensity of less than 60% was significantly longer than that of 8 patients in the group with the relative dose intensity of more than 60% (19.2 and 11.0 months, respectively, p = 0.04). Conclusion Individual low relative dose intensity management in the first-line gemcitabine-cisplatin chemotherapy may be an acceptable option for patients with metastatic urothelial carcinoma.
Collapse
Affiliation(s)
- Naoki Kohei
- Department of Urology, Shizuoka General Hospital, Shizuoka, Japan
| | - Kyohei Sugiyama
- Department of Urology, Shizuoka General Hospital, Shizuoka, Japan
| | - Ichiro Chihara
- Department of Urology, Shizuoka General Hospital, Shizuoka, Japan
| | - Yusuke Muro
- Department of Urology, Shizuoka General Hospital, Shizuoka, Japan
| | - Masaaki Imamura
- Department of Urology, Shizuoka General Hospital, Shizuoka, Japan
| | - Yasunori Nishio
- Department of Urology, Shizuoka General Hospital, Shizuoka, Japan
| | - Koji Yoshimura
- Department of Urology, Shizuoka General Hospital, Shizuoka, Japan
| |
Collapse
|
49
|
Abstract
High BMI is associated with an increased risk of breast cancer in post-menopausal women but poorer outcomes in all age groups. The underlying mechanism is likely to be multi-factorial. Patients with a high BMI may present later due to body habitus. Some studies have also indicated an increased incidence of biologically adverse features, including a higher frequency of oestrogen receptor (ER negative) tumours, in obese patients. Obese patients have a higher frequency of surgical complications, potentially delaying systemic therapies, and reports suggest that chemotherapy and endocrine therapy are less effective in patients with BMI ≥30 kg/m2.High BMI is generally interpreted as excess adiposity and a World Cancer Research Fund report judged that the associations between BMI and incidence of breast cancer were due to body fatness. However, BMI cannot distinguish lean mass from fat mass, or characterise body fat distribution. Most chemotherapy drugs are dosed according to calculated body surface area (BSA). Patients with a similar BSA or BMI may have wide variations in their distribution of adipose tissue and skeletal muscle (body composition); however, few studies have looked at the effect of this on chemotherapy tolerance or effectiveness. Finally, adjuvant treatments for breast cancer can themselves result in body composition changes.Research is required to fully understand the biological mechanisms by which obesity influences cancer behaviour and the impact of obesity on treatment effectiveness and tolerance so that specific management strategies can be developed to improve the prognosis of this patient group.
Collapse
|
50
|
Hirasawa K, Okamoto I, Motohashi R, Sato H, Takase S, Agata A, Takeda A, Tsukahara K. The efficiency and adverse events of radiotherapy with cetuximab for Japanese head and neck cancer patients. Auris Nasus Larynx 2017; 44:724-728. [DOI: 10.1016/j.anl.2017.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/09/2016] [Accepted: 01/06/2017] [Indexed: 01/08/2023]
|