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Li Y, Wu Y, Jiang T, Xing H, Xu J, Li C, Ni R, Zhang N, Xiang G, Li L, Li Z, Gan L, Liu Y. Opportunities and challenges of pharmacovigilance in special populations: a narrative review of the literature. Ther Adv Drug Saf 2023; 14:20420986231200746. [PMID: 37780667 PMCID: PMC10540608 DOI: 10.1177/20420986231200746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/22/2023] [Indexed: 10/03/2023] Open
Abstract
The relatively new discipline of pharmacovigilance (PV) aims to monitor the safety of drugs throughout their evolution and is essential to discovering new drug risks. Due to their specific and complex physiology, children, pregnant women, and elderly adults are more prone to adverse drug reactions (ADRs). Additionally, the lack of clinical trial data exacerbates the challenges faced with pharmacotherapy in these populations. Elderly patients tend to have multiple comorbidities often requiring more extensive medication, which adds additional challenges for healthcare professionals (HCPs) in delivering safe and effective pharmacotherapy. Clinical trials often have inherent limitations, including insufficient sample size and limited duration of research; as some ADRs are attributed to long-term use of a drug, these may go undetected during the course of the trial. Therefore, the implementation of PV is key to insuring the safe and effective use of drugs in special populations. We conducted a thorough review of the scientific literature on PV systems across the European Union, the United States, and China. Our review focused on basic physiological characteristics, drug use, and PV for specific populations (children, pregnant women, and the elderly). This article aims to provide a reference for the development of follow-up policies and improvement of existing policies as well as provide insight into drug safety with respect to patients of special populations.
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Affiliation(s)
- Yanping Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Yuanlin Wu
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Tingting Jiang
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Haiyan Xing
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Jing Xu
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Chen Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Rui Ni
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Ni Zhang
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Guiyuan Xiang
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Li Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Ziwei Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Lanlan Gan
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Yao Liu
- Department of Pharmacy, Daping Hospital, Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing 400042, China
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Ciccone V, Ziche M, Spini A, Donnini S. Uncovering Knowledge Gaps in the Safety Profile of Antiangiogenic Drugs in Cancer Patients: Insights from Spontaneous Reporting Systems Studies. Pharmaceuticals (Basel) 2023; 16:867. [PMID: 37375814 DOI: 10.3390/ph16060867] [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: 05/13/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Global repositories of postmarketing safety reports improve understanding of real-life drug toxicities, often not observed in clinical trials. The aim of this scoping review was to map the evidence from spontaneous reporting systems studies (SRSs) of antiangiogenic drugs (AADs) in cancer patients and highlight if the found disproportionality signals of adverse events (AEs) were validated and thus mentioned in the respective Summary of product Characteristics (SmPC). This scoping review was conducted according to PRISMA guidelines for scoping reviews. A knowledge gap on the safety of AADs was found: firstly, several cardiovascular AEs were not mentioned in the SmPCs and no pharmacovigilance studies were conducted despite the well-known safety concerns about these drugs on the cardiovascular system. Second, a disproportionality signal (not validated through causality assessment) of pericardial disease was found in the literature for axitinib with no mention in SmPC of the drug. Despite the exclusion of pharmacoepidemiological studies, we believe that this scoping review, which focuses on an entire class of drugs, could be considered as a novel approach to highlight possible safety concerns of drugs and as a guide for the conduction of a target postmarketing surveillance on AADs.
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Affiliation(s)
- Valerio Ciccone
- Department of Life Sciences, University of Siena, Via Aldo Moro 2, 53100 Siena, Italy
| | - Marina Ziche
- Department of Medicine Surgery and Neuroscience, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Andrea Spini
- Department of Medicine Surgery and Neuroscience, University of Siena, Viale Mario Bracci 16, 53100 Siena, Italy
- Azienda Ospedaliera Universitaria Senese, Viale Mario Bracci 16, 53100 Siena, Italy
| | - Sandra Donnini
- Department of Life Sciences, University of Siena, Via Aldo Moro 2, 53100 Siena, Italy
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3
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Lau DK, Mencel J, Chau I. Safety and efficacy review of aflibercept for the treatment of metastatic colorectal cancer. Expert Opin Drug Saf 2022; 21:589-597. [PMID: 34986714 DOI: 10.1080/14740338.2022.2008905] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Anti-angiogenic drugs are an efficacious class of therapy in the treatment of patients with metastatic colorectal cancer (mCRC). Aflibercept, a vascular endothelial growth factor (VEGF) trap which binds the angiogenic factors VEGF-A, VEGF-B, and placental growth factor (PIGF) is approved in combination with FOLFIRI chemotherapy following progression after an oxaliplatin-containing regimen. AREAS COVERED This report provides a review of the practice-changing clinical studies which have established the use of anti-angiogenic therapy as second-line therapy in mCRC including aflibercept with FOLFIRI (5FU, leucovorin, irinotecan). This review also evaluates aflibercept with other chemotherapy regimens as well as efficacy and safety data from real-world studies. EXPERT OPINION Aflibercept in combination with FOLFIRI chemotherapy is an established safe and efficacious regimen for the treatment of mCRC as second-line chemotherapy. Although several toxicities have been described, the majority are either low grade or manageable by drug cessation and supportive therapies. For optimal outcomes, patient selection and close observation of toxicities is essential.
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Affiliation(s)
- David K Lau
- Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Justin Mencel
- Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Ian Chau
- Gastrointestinal and Lymphoma Unit, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
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Yang Y, Xu L, Wang D, Hui B, Li X, Zhou Y, Chen X, Gu Y. Anti-PD-1 and regorafenib induce severe multisystem adverse events in microsatellite stability metastatic colorectal cancer: a case report. Immunotherapy 2021; 13:1317-1323. [PMID: 34369830 DOI: 10.2217/imt-2020-0327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
There exists a dilemma in the treatment of microsatellite stability (MSS) metastatic colorectal cancer (mCRC) owing to limited therapeutic options. Based on the promising results of the REGONIVO trial, combination of anti-PD-1 and regorafenib could be applicable for this kind of patients. Here we first report a case of an MSS mCRC patient who received sinitilimab plus regorafenib as third-line treatment and suffered severe multisystem treatment-related adverse events including Grade 3 myocarditis, myositis, myasthenia gravis, dermatitis, hepatitis, etc. Fortunately, all these adverse events have been reversed with administration of corticosteroids. Though evidence of tumor shrinkage was not found, CEA levels markedly decreased. Therefore, anti-PD-1 plus regorafenib might be optional for the MSS mCRC patients which requires special caution in the clinical practice.
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Affiliation(s)
- Yuchen Yang
- Department of Oncology & Cancer Rehabilitation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.,The First Clinical College of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Lingyan Xu
- Department of Oncology & Cancer Rehabilitation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.,The First Clinical College of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Danping Wang
- The First Clinical College of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.,Department of Oncology, Nantong First People's Hospital, the Second Affiliated Hospital of Nantong University, 6 North Road Hai'er Xiang, Nantong, 226001, Jiangsu, China
| | - Bingqing Hui
- Department of Oncology & Cancer Rehabilitation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.,The First Clinical College of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Xiaofei Li
- Department of Oncology & Cancer Rehabilitation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.,The First Clinical College of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Yirui Zhou
- Department of Oncology & Cancer Rehabilitation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.,The First Clinical College of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Xiaofeng Chen
- Department of Oncology & Cancer Rehabilitation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Yanhong Gu
- Department of Oncology & Cancer Rehabilitation Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
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Effect of Synchronous Versus Sequential Regimens on the Pharmacokinetics and Biodistribution of Regorafenib with Irradiation. Pharmaceutics 2021; 13:pharmaceutics13030386. [PMID: 33805831 PMCID: PMC8035703 DOI: 10.3390/pharmaceutics13030386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 02/07/2023] Open
Abstract
This study was performed to evaluate the interaction between conventional or high-dose radiotherapy (RT) and the pharmacokinetics (PK) of regorafenib in concurrent or sequential regimens for the treatment of hepatocellular carcinoma. Concurrent and sequential in vitro and in vivo studies of irradiation and regorafenib were designed. The interactions of RT and regorafenib in vitro were examined in the human hepatoma Huh-7, HA22T and Hep G2 cell lines. The RT–PK phenomenon and biodistribution of regorafenib under RT were confirmed in a free-moving rat model. Regorafenib inhibited the viability of Huh-7 cells in a dose-dependent manner. Apoptosis in Huh-7 cells was enhanced by RT followed by regorafenib treatment. In the concurrent regimen, RT decreased the area under the concentration versus time curve (AUC)regorafenib by 74% (p = 0.001) in the RT2 Gy × 3 fraction (f’x) group and by 69% (p = 0.001) in the RT9 Gy × 3 f’x group. The AUCregorafenib was increased by 182.8% (p = 0.011) in the sequential RT2Gy × 1 f’x group and by 213.2% (p = 0.016) in the sequential RT9Gy × 1 f’x group. Both concurrent regimens, RT2Gy × 3 f’x and RT9Gy × 3 f’x, clearly decreased the biodistribution of regorafenib in the heart, liver, lung, spleen and kidneys, compared to the control (regorafenib × 3 d) group. The concurrent regimens, both RT2Gy × 3 f’x and RT9Gy × 3 f’x, significantly decreased the biodistribution of regorafenib, compared with the control group. The PK of regorafenib can be modulated both by off-target irradiation and stereotactic body radiation therapy (SBRT).
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Casarotto E, Noize P, Gouverneur A, Berdaï D, Bégaud B, Levy‐Bachelot L, Molimard M. Overview of French databases available for studying anticancer drugs in real‐life setting. Fundam Clin Pharmacol 2020; 35:76-85. [DOI: 10.1111/fcp.12592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/15/2020] [Accepted: 07/27/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Emilie Casarotto
- Univ. Bordeaux, INSERM, BPH, U1219 Bordeaux F‐33000 France
- MSD France Puteaux F‐92800 France
| | - Pernelle Noize
- Univ. Bordeaux, INSERM, BPH, U1219 Bordeaux F‐33000 France
- Service de Pharmacologie médicale Pôle de Santé Publique CHU de Bordeaux Bordeaux F‐33000 France
| | - Amandine Gouverneur
- Univ. Bordeaux, INSERM, BPH, U1219 Bordeaux F‐33000 France
- Service de Pharmacologie médicale Pôle de Santé Publique CHU de Bordeaux Bordeaux F‐33000 France
| | - Driss Berdaï
- Service de Pharmacologie médicale Pôle de Santé Publique CHU de Bordeaux Bordeaux F‐33000 France
| | - Bernard Bégaud
- Univ. Bordeaux, INSERM, BPH, U1219 Bordeaux F‐33000 France
| | | | - Mathieu Molimard
- Univ. Bordeaux, INSERM, BPH, U1219 Bordeaux F‐33000 France
- Service de Pharmacologie médicale Pôle de Santé Publique CHU de Bordeaux Bordeaux F‐33000 France
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Lessons to be Learnt from Real-World Studies on Immune-Related Adverse Events with Checkpoint Inhibitors: A Clinical Perspective from Pharmacovigilance. Target Oncol 2020; 15:449-466. [PMID: 32725437 PMCID: PMC7434791 DOI: 10.1007/s11523-020-00738-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The advent of immune checkpoint inhibitors (ICIs) caused a paradigm shift both in drug development and clinical practice; however, by virtue of their mechanism of action, the excessively activated immune system results in a multitude of off-target toxicities, the so-called immune-related adverse events (irAEs), requiring new skills for timely diagnosis and a multidisciplinary approach to successfully manage the patients. In the recent past, a plethora of large-scale pharmacovigilance analyses have characterized various irAEs in terms of spectrum and clinical features in the real world. This review aims to summarize and critically appraise the current landscape of pharmacovigilance studies, thus deriving take-home messages for oncologists. A brief primer to study design, conduction, and data interpretation is also offered. As of February 2020, 30 real-world postmarketing studies have characterized multiple irAEs through international spontaneous reporting systems, namely WHO Vigibase and the US FDA Adverse Event Reporting System. The majority of studies investigated a single irAE and provided new epidemiological evidence about class-specific patterns of irAEs (i.e. anti-cytotoxic T-lymphocyte antigen 4 [CTLA-4] versus anti-programmed cell death 1 [PD-1] receptor, and its ligand [PD-L1]), kinetics of appearance, co-occurrences (overlap) among irAEs, and fatality rate. Oncologists should be aware of both strengths and limitations of these pharmacovigilance analyses, especially in terms of data interpretation. Optimal management (including rechallenge), predictivity of irAEs (as potential biomarkers of effectiveness), and comparative safety of ICIs (also in terms of combination regimens) represent key research priorities for next-generation real-world studies.
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8
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Aparicio T, Canouï-Poitrine F, Caillet P, François E, Cudennec T, Carola E, Albrand G, Bouvier AM, Petri C, Couturier B, Phelip JM, Bengrine-Lefevre L, Paillaud E. Treatment guidelines of metastatic colorectal cancer in older patients from the French Society of Geriatric Oncology (SoFOG). Dig Liver Dis 2020; 52:493-505. [PMID: 32029404 DOI: 10.1016/j.dld.2019.12.145] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several guidelines dedicated to metastatic colorectal cancer (mCRC) are available. Since 2013 no recent guidelines are specifically dedicated to older patients and based on a systematic review. MATERIALS AND METHODS A multidisciplinary Task Force with digestive oncologists, geriatricians and methodologists from the SoFOG was formed in 2016 to update recommendations on medical treatment of mCRC based on a systematic review of publications from 2000 to 2018. Search strategy has followed a standardized protocol from the formulation of clinical questions and definition of a search algorithm to the selection of complete articles for recommendations. RESULTS The four selected key questions were: For which older patients with mCRC can we considered: (1) Any chemotherapy, (2) Mono or poly-chemotherapy, (3) Anti-angiogenic therapy, (4) Other targeted therapy. Main recommendations for older patients are: (1) Omission of chemotherapy should be discussed with a geriatrician for patients with severe comorbidities, advanced dementia, uncontrolled psychiatric disorder or severe loss of autonomy. (2) If tumor response is not the main aim, a mono-chemotherapy with 5-fluorouracil combined with bevacizumab is recommended as first-line. (3) For patients with symptoms related to metastases or with a planned metastasis ablation, a doublet chemotherapy combined with bevacizumab or anti-EGFR antibody in the context of a RAS wild type tumor is recommended as first-line. Preliminary data suggest that regorafenib may be used, in its registered indication, in patients under 80 with a performance status of 0 and no autonomy alterations and that trifluridine-tipiracil may be used with a tight supervising of hematological function.
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Affiliation(s)
- Thomas Aparicio
- Department of Gastroenterology and Digestive Oncology, Saint Louis Hospital, AP-HP, University of Paris, Paris, France.
| | - Florence Canouï-Poitrine
- Clinical Epidemiology and Ageing Unit, Henri Mondor Hospital, APHP, EA 7376, CEpiA- IMRB, University of Paris-Est, Créteil, France
| | - Philippe Caillet
- Department of Geriatry, Georges Pompidou Hospital, APHP, University of Paris, Paris, France
| | - Eric François
- Department of Medical Oncology, Antoine-Lacassagne Center, University Côte d'Azur, Nice, France
| | - Tristan Cudennec
- Department of Geriatry, Ambroise Paré Hospital, APHP, University Versailles - Saint Quentin, Boulogne-Billancourt, France
| | - Elisabeth Carola
- Department of Medical Oncology, Public Sud de l'Oise Hospital, Creil, France
| | - Gilles Albrand
- Department of Geriatry, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Anne-Marie Bouvier
- Digestive Cancer Registry of Burgundy, INSERM UMR1231 EPICAD University of Burgundy Franche Comté, Dijon, France
| | - Camille Petri
- Clinical Epidemiology and Ageing Unit, Henri Mondor Hospital, APHP, EA 7376, CEpiA- IMRB, University of Paris-Est, Créteil, France
| | - Bérengère Couturier
- Clinical Epidemiology and Ageing Unit, Henri Mondor Hospital, APHP, EA 7376, CEpiA- IMRB, University of Paris-Est, Créteil, France
| | - Jean-Marc Phelip
- Department of Gastroenterology and Digestive Oncology, Saint-Etienne Hospital, University Jean Monnet, Saint-Priest-en-Jarez, France
| | | | - Elena Paillaud
- Department of Geriatry, Georges Pompidou Hospital, APHP, University of Paris, Paris, France
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Chau I, Fakih M, García-Alfonso P, Linke Z, Ruiz Casado A, Marques EP, Picard P, Celanovic M, Cartwright T. Safety and Effectiveness of Aflibercept + Fluorouracil, Leucovorin, and Irinotecan (FOLFIRI) for the Treatment of Patients with Metastatic Colorectal Cancer (mCRC) in Current Clinical Practice: OZONE Study. Cancers (Basel) 2020; 12:cancers12030657. [PMID: 32168980 PMCID: PMC7139359 DOI: 10.3390/cancers12030657] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/27/2020] [Accepted: 03/06/2020] [Indexed: 02/06/2023] Open
Abstract
For patients with metastatic colorectal cancer (mCRC) that have failed a first-line oxaliplatin-based regimen, the preferred treatment option is an irinotecan-based regimen. This prospective, observational, noncomparative, post-authorization safety study (OZONE) evaluated the safety and effectiveness of aflibercept plus fluorouracil, leucovorin, and irinotecan (FOLFIRI) in patients with mCRC treated in daily practice after failure of an oxaliplatin-based regimen. Patients were grouped by age, renal impairment, hepatic impairment, race, number, and type of prior anticancer therapy. Of 766 treated patients enrolled, 59.5% were male, 94.8% had an Eastern Cooperative Oncology Group performance status of 0–1, all received previous chemotherapy (97.8% including oxaliplatin), and 58.6% had prior exposure to bevacizumab. At least one grade ≥ 3 treatment-emergent adverse event (TEAE) was reported in 68.3% of patients. Neutropenia, hypertension, diarrhea, and asthenia were the most frequently occurring grade ≥ 3 TEAEs. Antivascular endothelial growth factor class events were infrequent. Subgroup analyses did not reveal major differences in the safety profile according to age, renal and hepatic status, race, or prior anticancer therapy. For the total population, median overall survival was 12.5 months, median progression-free survival was 6.1 months, and overall response rate was 16.3%. Aflibercept in combination with FOLFIRI is a safe and efficacious regimen administered in current clinical practice to patients with mCRC previously treated with oxaliplatin. The study results, conducted in real-world clinical practice with a less selected patient population, are aligned with the VELOUR (NCT00561470) trial and no new safety issues were identified.
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Affiliation(s)
- Ian Chau
- The Royal Marsden NHS Foundation Trust, London and Surrey, Sutton SM2 5PT, UK
- Correspondence: ; Tel.: +44-208-915-6196
| | - Marwan Fakih
- City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA;
| | | | - Zdenĕk Linke
- University Hospital Motol, 150 06 Prague 5, Czech Republic;
| | - Ana Ruiz Casado
- Hospital Universitario Puerta de Hierro-Majadahonda, 28222 Majadahonda, Spain;
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10
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Toxicities with Immune Checkpoint Inhibitors: Emerging Priorities From Disproportionality Analysis of the FDA Adverse Event Reporting System. Target Oncol 2020; 14:205-221. [PMID: 30927173 DOI: 10.1007/s11523-019-00632-w] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs), including antibodies targeting cytotoxic T-lymphocyte associated protein 4 (CTLA4) and programmed cell death 1 or its ligand (PD1/PDL1), elicit different immune-related adverse events (irAEs), but their global safety is incompletely characterized. OBJECTIVE The aim of this study was to characterize the spectrum, frequency, and clinical features of ICI-related adverse events (AEs) reported to the FDA Adverse Event Reporting System (FAERS). PATIENTS AND METHODS AEs from FAERS (up to June 2018) recording ICIs (ipilimumab, nivolumab, pembrolizumab, atezolizumab, avelumab, durvalumab) as suspect were extracted. Comprehensive disproportionality analyses were performed through the reporting odds ratio (ROR) with 95% confidence interval (95% CI), using other oncological drugs as comparison. An overview of systematic reviews (OoSRs) was also undertaken to identify irAEs with consistent positive associations. RESULTS ICIs were recorded in 47,266 reports, submitted mainly by consumers receiving monotherapy with anti-PD1/PDL1 drugs. Three areas of toxicity emerged from both disproportionality analysis and the OoSRs (32 studies): endocrine (N = 2863; ROR = 6.91; 95% CI 6.60-7.23), hepatobiliary (2632; 1.33; 1.28-1.39), and respiratory disorders (7240; 1.04; 1.01-1.06). Different reporting patterns emerged for anti-CTLA4 drugs (e.g., hypophysitis, adrenal insufficiency, hypopituitarism, and prescribed overdose) and anti-PD1/PDL1 agents (e.g., pneumonitis, cholangitis, vanishing bile duct syndrome, tumor pseudoprogression, and inappropriate schedule of drug administration). No increased reporting emerged when comparing combination with monotherapy regimens, but multiple hepatobiliary/endocrine/respiratory irAEs were recorded. CONCLUSIONS This parallel approach through contemporary post-marketing analysis and OoSRs confirmed that ICIs are associated with a multitude of irAEs, with different reporting patterns between anti-CTLA4 and anti-PD1/PDL1 medications. Close clinical monitoring is warranted to early diagnose and timely manage irAEs, especially respiratory, endocrine, and hepatic toxicities, which warrant further characterization; patient- and drug-related risk factors should be assessed through analytical pharmaco-epidemiological studies and prospective multicenter registries.
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11
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Carrato A, Benavides M, Massutí B, Ferreiro-Monteagudo R, García Alfonso P, Falcó E, Reboredo M, Cano T, Gallego J, Viéitez JM, Layos L, Salud A, Polo E, Dotor E, Durán-Ogalla G, Rodriguez-Garrote M, Calvo A, Grande E, Aranda E. First-line single-agent regorafenib in frail patients with metastatic colorectal cancer: a pilot phase II study of the Spanish Cooperative Group for the Treatment of Digestive Tumours (TTD). BMC Cancer 2019; 19:533. [PMID: 31159765 PMCID: PMC6547483 DOI: 10.1186/s12885-019-5753-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/27/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Treatment of frail patients with advanced colorectal cancer (CRC) is controversial. This pilot phase II trial aimed to assess the efficacy and safety of regorafenib when administered in first-line to frail patients with advanced CRC. METHODS Frail patients without prior advanced colorectal cancer treatment were included in the study. Definition of frailty was defined per protocol based on dependency criteria, presence of chronic comorbid pathologies and/or geriatric features. MAIN OBJECTIVE to assess progression-free survival (PFS) rate at 6 months. Treatment consisted of 28-day cycles of orally administered regorafenib 160 mg/day (3 weeks followed by 1 week rest). RESULTS Forty-seven patients were included in the study. Median age was 81 years (range 63-89). Frailty criteria: dependency was observed in 26 patients (55%), comorbidities in 27 (57%) and geriatric features in 18 (38%). PFS rate at 6 months was 45% (95% confidence interval [CI] 30-60]. Median PFS was 5.6 months (95%CI 2.7-8.4). Median overall survival (OS) was 16 months (95%CI 7.8-24). Complete response, partial response and stable disease were observed in one, two and 21 patients respectively (objective response rate 6.4%; disease control rate 51%). Thirty-nine patients (83%) experienced grade 3-4 adverse events (AEs). The most common grade 3-4 AEs were hypertension (15 patients; 32%), asthenia (14; 30%), hypophosphatemia (6; 13%); diarrhea (4; 8%), hand-foot-skin reaction (4; 8%). There were two toxic deaths (4.2%) (grade 5 rectal bleeding and death not further specified). Dose reduction was required in 26 patients (55%) and dose-delays in 13 patients (28%). CONCLUSIONS The study did not meet the pre-specified boundary of 55% PFS rate at 6 months. Toxicity observed (83% patients experienced grade 3 and 4 AEs) preclude its current use in clinical practice on this setting. Disease control rate and overall survival results are interesting and might warrant further investigation to identify those who benefit from this approach. TRIAL REGISTRATION This trial was prospectively registered at EudraCT ( 2013-000236-94 ). Date of trial registration: April 9th, 2013.
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Affiliation(s)
- A. Carrato
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERONC, Alcala University, Ctra. De Colmenar Viejo, km 9,100, 28034 Madrid, Spain
| | - M. Benavides
- Hospital Regional Universitario Virgen de la Victoria, Málaga, Spain
| | - B. Massutí
- Hospital General Universitario de Alicante, Alicante, Spain
| | - R. Ferreiro-Monteagudo
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERONC, Alcala University, Ctra. De Colmenar Viejo, km 9,100, 28034 Madrid, Spain
| | | | - E. Falcó
- Hospital Son Llatzer, Mallorca, Spain
| | - M. Reboredo
- Complejo Hospitalario Universitario A Coruña, La Coruña, Spain
| | - T. Cano
- Hospital Universitario Reina Sofia, IMIBIC, University of Córdoba, CIBERONC, Instituto de Salud Carlos III, Córdoba, Spain
| | - J. Gallego
- Hospital General Universitario de Elche, Alicante, Spain
| | - J. M. Viéitez
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - L. Layos
- Hospital Germans Trias i Pujol, ICO, Badalona, Spain
| | - A. Salud
- Hospital de Lleida Arnau de Vilanova, Lérida, Spain
| | - E. Polo
- Hospital Miguel Servet, Zaragoza, Spain
| | - E. Dotor
- Corporació Sanitària Parc Taulí, Barcelona, Spain
| | - G. Durán-Ogalla
- Hospital Regional Universitario Virgen de la Victoria, Málaga, Spain
| | - M. Rodriguez-Garrote
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERONC, Alcala University, Ctra. De Colmenar Viejo, km 9,100, 28034 Madrid, Spain
| | - A. Calvo
- Hospital Gregorio Marañón, Madrid, Spain
| | - E. Grande
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERONC, Alcala University, Ctra. De Colmenar Viejo, km 9,100, 28034 Madrid, Spain
| | - E. Aranda
- Hospital Universitario Reina Sofia, IMIBIC, University of Córdoba, CIBERONC, Instituto de Salud Carlos III, Córdoba, Spain
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12
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Gouverneur A, Bezin J, Jové J, Bosco-Lévy P, Fourrier-Réglat A, Noize P. Treatment Modalities and Survival in Older Adults with Metastatic Colorectal Cancer in Real Life. J Am Geriatr Soc 2019; 67:913-919. [PMID: 30840323 DOI: 10.1111/jgs.15858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Metastatic colorectal cancer (mCRC) is increasingly treated with targeted therapies, but little is known about real-life mCRC treatment in older adults. The aims were to describe the real-life first-line treatment modalities in older adult mCRC patients, to identify factors associated with treatment modalities, and to evaluate survival with regard to treatment modalities. PATIENTS AND METHODS A cohort of mCRC patients aged 65 years and older at diagnosis was identified between 2009 and 2013 using French national healthcare insurance system claims data. Treatment modalities were: treatment with one or more anticancer medication vs best supportive care and, among treated patients, treatment with targeted therapy vs conventional chemotherapy alone. Multivariate logistic regression was used to identify factors associated with treatment by anticancer medication and by targeted therapy. Cox proportional hazards models were used to assess the independent effect of treatment modalities on overall survival while adjusting for baseline covariates identified with logistic regression. RESULTS A total of 503 patients were included with a median age of 78 years (54% were men). Of these, 299 (59%) were treated with anticancer medications. Among treated patients, 131 (44%) received targeted therapy. In multivariate analysis, age 75 years or older, renal failure, malnutrition, and five or more concomitant medications were associated with a lower likelihood of treatment with anticancer medications. Among treated patients, age 75 years or older, history of cancer, lymph node metastases, and a single metastatic site were associated with a lower likelihood of treatment with targeted therapy. Multivariate Cox proportional hazards models found that treatment with any anticancer medication tended to be associated with a lower risk of death; treatment with targeted therapy was not significantly associated. CONCLUSION A more appropriate prescription of anticancer medications in the older adult will require the definition of more explicit criteria to avoid undertreatment. The real benefit of targeted therapies vs conventional chemotherapy alone needs to be confirmed in this population. J Am Geriatr Soc 67:913-919, 2019.
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Affiliation(s)
- Amandine Gouverneur
- Bordeaux Population Health Research Center, team Pharmacoepidemiology, UMR 1219, University of Bordeaux, Inserm, Bordeaux, France.,Pôle de Santé publique, Service de Pharmacologie médicale, CHU de Bordeaux, Bordeaux, France
| | - Julien Bezin
- Bordeaux Population Health Research Center, team Pharmacoepidemiology, UMR 1219, University of Bordeaux, Inserm, Bordeaux, France
| | - Jérémy Jové
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France
| | | | - Annie Fourrier-Réglat
- Bordeaux Population Health Research Center, team Pharmacoepidemiology, UMR 1219, University of Bordeaux, Inserm, Bordeaux, France.,Pôle de Santé publique, Service de Pharmacologie médicale, CHU de Bordeaux, Bordeaux, France.,Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France
| | - Pernelle Noize
- Bordeaux Population Health Research Center, team Pharmacoepidemiology, UMR 1219, University of Bordeaux, Inserm, Bordeaux, France.,Pôle de Santé publique, Service de Pharmacologie médicale, CHU de Bordeaux, Bordeaux, France.,Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France
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13
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Gouverneur A, Coutureau J, Jové J, Rouyer M, Grelaud A, Duc S, Gérard S, Smith D, Ravaud A, Droz C, Bernard MA, Lassalle R, Forrier-Réglat A, Noize P. Patterns of Use, Safety, and Effectiveness of Targeted Therapies in First-Line Treatment of Metastatic Colorectal Cancer According to Age: The STROMBOLI Cohort Study. Clin Colorectal Cancer 2019; 18:e150-e162. [PMID: 30630730 DOI: 10.1016/j.clcc.2018.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Metastatic colorectal cancer (mCRC) is increasingly treated using targeted therapies. Their real-life evaluation is insufficient, especially in elderly and frail patients. The aim was to describe use, safety, and effectiveness of targeted therapies in first-line mCRC treatment according to age. PATIENTS AND METHODS Two field cohorts of patients initiating bevacizumab or cetuximab for first-line mCRC were pooled. Patients characteristics, use, and safety were compared between younger and elderly patients (<75 vs. ≥75 years). Two-year overall survival (OS) and progression-free survival (PFS) were estimated in both age groups using the Kaplan-Meier method adjusted on factors associated with death or progression identified with Cox multivariate modeling. RESULTS Eight hundred patients (n = 411, 51.4% bevacizumab) were included: 498 (62.3%) male, median age 64 years, 118 (14.8%) Eastern Cooperative Oncology Group performance status (ECOG-PS) ≥2. Elderly patients (n = 126, 15.8%) were more often treated with 5-fluorouracil alone than younger. Severe adverse events were equivalent across age groups. ECOG-PS ≥1, abnormal hemoglobin, and abnormal alkaline phosphatases were associated with a higher risk of death; OS adjusted on these factors was similar between elderly and younger patients. ECOG-PS ≥1, lung metastases, abnormal hemoglobin, and abnormal creatinine clearance were associated with a higher risk of progression or death; PFS adjusted on these factors was similar across groups. CONCLUSION Despite treatment adaptations, elderly patients could benefit from targeted therapies as younger without safety warning.
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Affiliation(s)
- Amandine Gouverneur
- Univ Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Bordeaux, France; Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; CHU de Bordeaux, Pôle de Sante publique, Service de Pharmacologie médicale, Bordeaux, France.
| | - Juliette Coutureau
- Univ Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Bordeaux, France; CHU de Bordeaux, Pôle de Sante publique, Service de Pharmacologie médicale, Bordeaux, France
| | - Jérémy Jové
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; ADERA, Pessac, France
| | - Magali Rouyer
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; ADERA, Pessac, France
| | - Angela Grelaud
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; ADERA, Pessac, France
| | - Sophie Duc
- Service de Gériatrie, CHU Bordeaux, Bordeaux, France
| | | | - Denis Smith
- Service d'Oncologie médicale, CHU Bordeaux, Bordeaux, France
| | - Alain Ravaud
- Service d'Oncologie médicale, CHU Bordeaux, Bordeaux, France
| | - Cécile Droz
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; ADERA, Pessac, France
| | - Marie-Agnès Bernard
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; ADERA, Pessac, France
| | - Régis Lassalle
- Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; ADERA, Pessac, France
| | - Annie Forrier-Réglat
- Univ Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Bordeaux, France; Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; CHU de Bordeaux, Pôle de Sante publique, Service de Pharmacologie médicale, Bordeaux, France
| | - Pernelle Noize
- Univ Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Bordeaux, France; Bordeaux PharmacoEpi, INSERM CIC1401, Bordeaux, France; CHU de Bordeaux, Pôle de Sante publique, Service de Pharmacologie médicale, Bordeaux, France
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14
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Petrioli R, Chirra M, Messuti L, Fiaschi AI, Savelli V, Martellucci I, Francini E. Efficacy and Safety of Regorafenib With 2/1 Schedule for Patients ≥ 75 Years With Metastatic Colorectal Cancer (mCRC) After Failure of 2 Lines of Chemotherapy. Clin Colorectal Cancer 2018; 17:307-312. [PMID: 29548772 DOI: 10.1016/j.clcc.2018.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND In the CORRECT (patients with metastatic COloRectal Cancer treated with REgorafenib or plaCebo after failure of standard Therapy) trial, regorafenib was proven to extend survival of patients with metastatic colorectal cancer (mCRC) that progressed after all available therapies. Grade 3 to 4 toxicity occurred in 54% of patients, and data on the activity and tolerability of regorafenib in elderly patients were scarce. The aim of this study was to evaluate the efficacy and safety of an alternative schedule, 2-week-on treatment and 1 week-off (2/1 schedule), of regorafenib for elderly patients with mCRC. PATIENTS AND METHODS Patients ≥ 75 years with mCRC who progressed after oxaliplatin- and irinotecan-based chemotherapy received regorafenib on a 2/1 schedule. Potentially frail subjects were identified by G8 screening tool and excluded. The 2-month disease-control rate was the primary endpoint, and the secondary endpoints included safety, progression-free survival (PFS), overall survival (OS), and objective response rate. RESULTS Between February 2014 and May 2017, 23 patients with mCRC were recruited at our institution. No partial or complete responses were observed, and the stable disease and disease-control rate were 52.2%. The median PFS was 4.8 months (95% confidence interval, 3.8-6.3 months), and the median OS was 8.9 months (95% confidence interval, 6.9-10.6 months). Adverse events were uncommon, and the most frequent grade 3 toxicity adverse events were hand-foot skin reaction (9%) and fatigue (9%). Toxicity-related dose reductions and discontinuations occurred in 5 and 2 patients, respectively. CONCLUSION Regorafenib administered with a modified 2/1 schedule to patients who were aged ≥ 75 years and non-frail with treatment-refractory mCRC seems to be tolerable and achieve encouraging results in terms of PFS and OS.
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Affiliation(s)
- Roberto Petrioli
- Medical Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.
| | - Martina Chirra
- Medical Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Luciana Messuti
- Medical Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Anna Ida Fiaschi
- Pharmacology Unit, Department of Medicine, University of Siena, Siena, Italy
| | - Vinno Savelli
- Department of Surgery and Bioengineering, Section of Surgery, University of Siena, Siena, Italy
| | - Ignazio Martellucci
- Medical Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
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