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Shen J, Zhao J, Jin G, Li H, Jiang Y, Wu Y, Gao J, Chen F, Li J, Wang W, Li Q. A prospective randomized controlled clinical trial investigating the efficacy of low-dose olanzapine in preventing nausea and vomiting associated with oxaliplatin-based and irinotecan-based chemotherapy. J Cancer Res Clin Oncol 2024; 150:283. [PMID: 38806870 PMCID: PMC11133208 DOI: 10.1007/s00432-024-05712-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/18/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE The aim of this study is to assess the clinical efficacy of a 5 mg dosage of olanzapine in preventing chemotherapy-induced nausea and vomiting (CINV) associated with moderately emetogenic chemotherapy (MEC) among female patients diagnosed with gastrointestinal tract tumors. METHODS Patients undergoing the oxaliplatin/irinotecan chemotherapy regimen were enrolled in this prospective controlled study. The olanzapine group received a 5 mg dosage of olanzapine along with palonosetron and dexamethasone, while the control group received a standard two-combination regimen consisting of dexamethasone and palonosetron. The primary endpoints included the total protection (TP) rates for the entire age group and the subgroup aged 60 years and above. Secondary endpoints encompassed the total protection rates during the acute and delayed phases within the two age brackets, as well as the total control (TC) rates and complete remission (CR) rates across all three phases (total, acute, and delayed). Additionally, the study involved the assessment of quality of life and the collection of adverse events associated with the interventions. RESULTS 1) Regarding the primary endpoint, the total phase TP rates within both the entire age group and the age group exceeding 60 years demonstrated superiority in the olanzapine group when compared to the control group (66.7% vs 37.25%, P = 0.003; 68.8% vs 44.4%, P = 0.044). 2) In terms of secondary endpoints, the olanzapine group exhibited superior acute phase TP rates in both age brackets when compared to the control group (P < 0.05). The olanzapine group also demonstrated higher delayed-phase TP rates, TC rates across all three phases, and CR rates within the two age brackets, although the differences were not statistically significant (P > 0.05). Furthermore, the quality of life in the olanzapine group surpassed that of the control group for both age brackets (P < 0.05), characterized by enhanced appetite and a higher incidence of drowsiness in the patients treated with olanzapine when compared to those in the control group (P < 0.05). CONCLUSION Olanzapine can enhance CINV induced by MEC regimen in female patients across all age groups, including the elderly, and therefore improve the quality of life for these patients. CLINICAL TRIAL REGISTRATION https://www.chictr.org.cn/index.html , identifier: ChiCTR20000368269, 25/08/2020.
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Affiliation(s)
- Jing Shen
- Ordos Clinical College, Baotou Medical College, Ordos, 017000, China
| | - Juan Zhao
- Department of Medical Oncology, Ordos Central Hospital, 23th Yijinhuoluo Western Road, Dongsheng District, Ordos, 017000, China
| | - Gaowa Jin
- Department of Medical Oncology, Ordos Central Hospital, 23th Yijinhuoluo Western Road, Dongsheng District, Ordos, 017000, China
| | - Hui Li
- Department of Medical Oncology, Ordos Central Hospital, 23th Yijinhuoluo Western Road, Dongsheng District, Ordos, 017000, China
| | - Ying Jiang
- Department of Medical Oncology, Ordos Central Hospital, 23th Yijinhuoluo Western Road, Dongsheng District, Ordos, 017000, China
| | - Yungaowa Wu
- Department of Medical Oncology, Ordos Central Hospital, 23th Yijinhuoluo Western Road, Dongsheng District, Ordos, 017000, China
| | - Jiali Gao
- Department of Medical Oncology, Ordos Central Hospital, 23th Yijinhuoluo Western Road, Dongsheng District, Ordos, 017000, China
| | - Feng Chen
- Department of Medical Oncology, Ordos Central Hospital, 23th Yijinhuoluo Western Road, Dongsheng District, Ordos, 017000, China
| | - Jiaxuan Li
- Ordos Clinical College, Inner Mongolia Medical University, Ordos, 017000, China
| | - Wenjuan Wang
- Department of Medical Oncology, Ordos Central Hospital, 23th Yijinhuoluo Western Road, Dongsheng District, Ordos, 017000, China.
| | - Quanfu Li
- Department of Medical Oncology, Ordos Central Hospital, 23th Yijinhuoluo Western Road, Dongsheng District, Ordos, 017000, China.
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Chai Y, Liu JL, Zhang S, Li N, Xu DQ, Liu WJ, Fu RJ, Tang YP. The effective combination therapies with irinotecan for colorectal cancer. Front Pharmacol 2024; 15:1356708. [PMID: 38375031 PMCID: PMC10875015 DOI: 10.3389/fphar.2024.1356708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Colorectal cancer is the third most common type of cancer worldwide and has become one of the major human disease burdens. In clinical practice, the treatment of colorectal cancer has been closely related to the use of irinotecan. Irinotecan combines with many other anticancer drugs and has a broader range of drug combinations. Combination therapy is one of the most important means of improving anti-tumor efficacy and overcoming drug resistance. Reasonable combination therapy can lead to better patient treatment options, and inappropriate combination therapy will increase patient risk. For the colorectal therapeutic field, the significance of combination therapy is to improve the efficacy, reduce the adverse effects, and improve the ease of treatment. Therefore, we explored the clinical advantages of its combination therapy based on mechanism or metabolism and reviewed the rationale basis and its limitations in conducting exploratory clinical trials on irinotecan combination therapy, including the results of clinical trials on the combination potentiation of cytotoxic drugs, targeted agents, and herbal medicine. We hope that these can evoke more efforts to conduct irinotecan in the laboratory for further studies and evaluations, as well as the possibility of more in-depth development in future clinical trials.
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Affiliation(s)
- Yun Chai
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Jing-Li Liu
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Shuo Zhang
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao SAR, China
| | - Na Li
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao SAR, China
| | - Ding-Qiao Xu
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Wen-Juan Liu
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Rui-Jia Fu
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Yu-Ping Tang
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
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Li Y, Hu M, Zhang Z, Chu M, Xu R, Liu L, Dong W, Yang M, Zhang R. Cost-effectiveness analysis of continuing bevacizumab plus chemotherapy versus chemotherapy alone after first progression of metastatic colorectal cancer. Cancer Med 2024; 13:e6904. [PMID: 38186268 PMCID: PMC10807607 DOI: 10.1002/cam4.6904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/06/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Continuation of bevacizumab plus second-line chemotherapy has significantly improved overall and progression-free survival in patients with metastatic colorectal cancer (mCRC). However, the cost-effectiveness of such high cost therapy is still uncertain in China; so this analysis was performed to evaluate the cost-effectiveness of these treatment options from the Chinese health care system perspective. METHODS A cost-effectiveness analysis was conducted using data from the ML18147 trial (ClinicalTrials.gov identifier NCT00700102) by modeling a partitioned survival model. Main evaluation indicators were quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) with a willingness to pay (WTP) threshold of $38,201 per QALY. One-way and probabilistic sensitivity analyses were conducted to assess the robustness and stability of the model. Subgroup and scenario analyses were also performed to make our study more relevant. RESULTS Bevacizumab plus chemotherapy increased 0.12 QALYs and an incremental cost of $22,761.62 compared with chemotherapy, resulting in an ICER of $188,904.09 per QALY. The model was most sensitive to the utility of progression-free survival and the cost of bevacizumab. Compared with chemotherapy, bevacizumab plus chemotherapy had a 0% cost-effectiveness probability, and no cost-effectiveness in subgroups at the WTP threshold of $38,201 per QALY. The scenario analysis found that bevacizumab biosimilar gained an ICER of $126,397.38 per QALY when assuming the cost of drugs was calculated at the most affordable price. CONCLUSIONS At the WTP threshold of $38,201 per QALY, continuation of bevacizumab plus chemotherapy is unlikely considered cost-effective for patients after first progression of mCRC.
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Affiliation(s)
- Yulian Li
- Department of PharmacyThe Second Affiliated Hospital of Army Medical UniversityChongqingPeople's Republic of China
| | - Min Hu
- Department of PharmacyThe Second Affiliated Hospital of Army Medical UniversityChongqingPeople's Republic of China
| | - Zhe Zhang
- Department of PharmacyThe Second Affiliated Hospital of Army Medical UniversityChongqingPeople's Republic of China
| | - Mingming Chu
- Department of PharmacyThe Second Affiliated Hospital of Army Medical UniversityChongqingPeople's Republic of China
| | - Rufu Xu
- Department of PharmacyThe Second Affiliated Hospital of Army Medical UniversityChongqingPeople's Republic of China
| | - Lulu Liu
- Department of PharmacyThe Second Affiliated Hospital of Army Medical UniversityChongqingPeople's Republic of China
| | - Wenxing Dong
- Department of PharmacyThe Second Affiliated Hospital of Army Medical UniversityChongqingPeople's Republic of China
| | - Mengmeng Yang
- Department of PharmacyThe Second Affiliated Hospital of Army Medical UniversityChongqingPeople's Republic of China
| | - Rong Zhang
- Department of PharmacyThe Second Affiliated Hospital of Army Medical UniversityChongqingPeople's Republic of China
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Liu T, Liu S, Guan S, Tai Y, Jin Y, Dong M. Cost-effectiveness analysis of pembrolizumab versus chemotherapy for microsatellite instability-high or mismatch repair-deficient metastatic colorectal cancer. J Chemother 2023; 35:745-752. [PMID: 36591729 DOI: 10.1080/1120009x.2022.2162220] [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: 09/27/2022] [Revised: 12/07/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023]
Abstract
The aim of this study was to assess the cost-effectiveness of pembrolizumab versus chemotherapy for metastatic colorectal cancer (mCRC) patients with mismatch-repair deficiency or microsatellite instability-high (dMMR/MSI-H) in China. A partitioned survival model was constructed to determine the costs and effects of pembrolizumab and chemotherapy based on KEYNOTE-177 trial outcomes data. Health outcomes were measured in quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). The Chinese health service system perspective was considered. A willing-to-pay threshold was set at 35,832 USD/QALY, which was three times the gross domestic product (GDP) per capita of China in 2021. We examined the robustness of the model in the one-way and probabilistic sensitivity analysis. Pembrolizumab was associated with better health outcomes than chemotherapy (5.30 vs 3.37 QALYs). Compared with chemotherapy, the pembrolizumab strategy yielded an incremental cost of $16 032.57, which resulted in an ICER of $8285 per QALY. The cost of pembrolizumab and chemotherapy had the largest impact on the ICER. The parameters with less influence on the ICER were utility values of the Post-PFS state. Compared to chemotherapy, pembrolizumab had the economic advantage as the first-line treatment of mCRC patients with dMMR/MSI-H in China.
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Affiliation(s)
- Tong Liu
- Department of Pharmacy, Harbin Medical University Cancer Hospital, Harbin, China
| | - Shuang Liu
- Department of Pharmacy, Harbin Medical University Cancer Hospital, Harbin, China
| | - Shangwei Guan
- Department of Pharmacy, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yu Tai
- Department of Pharmacy, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yao Jin
- Department of Pharmacy, Harbin Medical University Cancer Hospital, Harbin, China
| | - Mei Dong
- Department of Pharmacy, Harbin Medical University Cancer Hospital, Harbin, China
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Xie Q, Luo Y, Peng X. Cost-effectiveness analysis of pembrolizumab for patients with advanced esophageal cancer at PD-L1 combined positive score ≥10. J Comp Eff Res 2022; 11:1095-1103. [PMID: 36043412 DOI: 10.2217/cer-2021-0165] [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: 11/21/2022] Open
Abstract
Aim: Due to the high price of pembrolizumab, it is still unknown whether the use of pembrolizumab for advanced esophageal cancer would be a cost-effective option for patients whose PD-L1 combined positive score is ≥10. Methods: A Markov simulation model was performed based on clinical trial KEYNOTE-181. Incremental cost-effectiveness ratios were calculated to compare the two treatments. Results: The total costs were US$193,575.60 and $8789.24 for pembrolizumab and chemotherapy treatment, respectively. The pembrolizumab group produced 0.93 quality-adjusted life years (QALYs), while the chemotherapy group produced 0.58 QALYs. Thus, patients in the pembrolizumab group spent an additional US$184,786.36 and produced 0.35 QALYs more than the chemotherapy group, which resulted in an incremental cost-effectiveness ratio of US$527,961.03 per QALY. Conclusion: For patients with advanced esophageal cancer whose PD-L1 combined positive score is ≥10, pembrolizumab is not a cost-effective second-line therapy versus chemotherapy from the US payer perspective.
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Affiliation(s)
- Qian Xie
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, ChinaChina
| | - Yaxin Luo
- West China School of Public Health & West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, China
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Chu X, Xue P, Zhu S. Management of chemotherapy dose intensity for metastatic colorectal cancer (Review). Oncol Lett 2022; 23:141. [PMID: 35340557 PMCID: PMC8931773 DOI: 10.3892/ol.2022.13261] [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: 11/02/2021] [Accepted: 02/14/2022] [Indexed: 12/24/2022] Open
Abstract
Chemotherapy dose intensity is a momentous parameter of antitumor clinical medication. In certain clinical trials, the actual application dose of the chemotherapeutic drugs is frequently different from the prescribed dose. The chemotherapy dose intensity completed in different trials is also variable, which has an impact on the treatment efficacy, disease prognosis and patient safety. When these agents are tested in the population, chemotherapy reduction and delay or failure to complete the planned cycle constantly occur due to age, performance status, adverse reactions and other reasons, resulting in the modification of the chemotherapy dose intensity. The present review analyzed the correlation between the chemotherapy dose intensity and the incidence of adverse reactions, the treatment efficacy and disease prognosis in clinical trials of metastatic colorectal cancer. Moreover, the clinical applications of chemotherapy dose intensity were discussed. Based on individual differences, the present review analyzed the clinical trials that examined the efficacy of the chemotherapy dose intensity in different patient populations. The conclusions suggested that different populations require a specific dose intensity to reduce treatment toxicity without affecting the curative effect.
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Affiliation(s)
- Xuelei Chu
- Department of Oncology, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing 100102, P.R. China
| | - Peng Xue
- Department of Oncology, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing 100102, P.R. China
| | - Shijie Zhu
- Department of Oncology, Wangjing Hospital Affiliated to China Academy of Chinese Medical Sciences, Beijing 100102, P.R. China
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Hatamluyi B, Sadeghian R, Sany SBT, Alipourfard I, Rezayi M. Dual-signaling electrochemical ratiometric strategy for simultaneous quantification of anticancer drugs. Talanta 2021; 234:122662. [PMID: 34364470 DOI: 10.1016/j.talanta.2021.122662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/13/2021] [Accepted: 06/24/2021] [Indexed: 12/12/2022]
Abstract
A novel and unique ratiometric electrochemical sensing strategy for highly reliable and selective simultaneous quantification of Irinotecan (IRI) and 5-Fluorouracil (5-FU) has been developed based on Pd-Au/MWCNT-rGO nanocomposite. Introduction of Pd-Au/MWCNT-rGO significantly improved the speed of electron transport, specific surface area, and electrical catalytic ability of sensing system due to synergistic effect of Pd-Au bimetallic nanoparticles and MWCNT-rGO hybrid structure. The assay strategy was based on the use of ferrocene (Fc) as reference electroactive substance and IRI and 5-FU as analytes with three oxidation peaks at different potentials (Fc at +0.20 V, IRI at +0.58 V, and 5-FU at +1.17 V). The oxidation peak currents of the IRI and 5-FU were gradually enhanced while that of Fc remained almost constant with continuous adding of IRI and 5-FU. By using IIRI/IFc and I5-FU/IFc signals as output, the designed ratiometric system showed good performance with a wide linear range of 0.05-40 μM for IRI and 0.05-75 μM for 5-FU and low detection limit of 0.0061 μM and 0.0094 μM for IRI and 5-FU, respectively. This study proved that ratiometric strategy is able to eliminate disturbance caused by the sensing environment and possess high sensitivity, reproducibility, stability, and selectivity toward anticancer drugs detection, over potential interferents as well as opens a new procedure for reliable and selective simultaneous analysis of other analytes.
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Affiliation(s)
- Behnaz Hatamluyi
- Department of Pharmacology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran; Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reihaneh Sadeghian
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Seyedeh Belin Tavakoly Sany
- Department of Health Education and Health Promotion, Social Determinants of Health Research Center, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Iraj Alipourfard
- Institute of Biology, Biotechnology and Environmental Protection, Faculty of Natural Sciences, University of Silesia, Katowice, Poland
| | - Majid Rezayi
- Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Medical Biotechnology and Nanotechnology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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