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Muñoz C, Tai X, Arias J, Eisen A, Chaudhry M, Gavura S, Chan KKW. Comparative Effectiveness and Safety of Trastuzumab Biosimilars to Herceptin for Adjuvant Treatment of HER2+ Breast Cancer. Curr Oncol 2024; 31:1633-1644. [PMID: 38534957 PMCID: PMC10969053 DOI: 10.3390/curroncol31030124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Ontario publicly funds reference trastuzumab (Herceptin) and four biosimilar trastuzumab products for adjuvant treatment of HER2+ breast cancer. We assessed the real-world safety and effectiveness of biosimilar trastuzumab compared to Herceptin for adjuvant treatment of patients with HER2+ breast cancer. Methods: This was a population-based, retrospective study comparing the safety and effectiveness of biosimilar trastuzumab and Herceptin for neoadjuvant/adjuvant treatment of HER2+ breast cancer from 2016 to 2021. Treatment patients started biosimilar trastuzumab from November 2019 to June 2021; historical comparator patients started Herceptin from June 2016 to October 2019. Safety outcomes death within 30 days of last dose of trastuzumab, direct hospitalization, emergency department visit leading to hospitalization, early treatment discontinuation, and in-patient admission for congestive heart failure were measured using logistic/negative binomial regression. Overall survival (OS) was measured using Kaplan-Meier methods and Cox proportional hazards regression. Propensity score matching was applied. Results: From June 2016 to 2021, 5071 patients with breast cancer were treated with neoadjuvant/adjuvant trastuzumab. The rate of direct hospitalization (RR: 0.85, 95% CI: 0.74-0.98, p-value: 0.032) was significantly lower in biosimilar compared to Herceptin patients. OS (log-rank test p = 0.98) and risk of mortality (HR: 1.29, 95% CI: 0.72-2.30, p-value = 0.39) did not significantly differ between treatment groups. Conclusions: Biosimilar trastuzumab demonstrated similar safety and effectiveness to Herceptin. The findings can help improve confidence in and use of biosimilars and demonstrate the value of real-world evidence generation for supporting biosimilar implementations and reassessments.
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Affiliation(s)
- Caroline Muñoz
- Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, ON M5G 2L3, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada
| | - Xiaochen Tai
- Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, ON M5G 2L3, Canada
| | - Jessica Arias
- Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, ON M5G 2L3, Canada
| | - Andrea Eisen
- Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, ON M5G 2L3, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M3, Canada
| | - Munaza Chaudhry
- Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, ON M5G 2L3, Canada
| | - Scott Gavura
- Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, ON M5G 2L3, Canada
| | - Kelvin K. W. Chan
- Ontario Health (Cancer Care Ontario), 525 University Ave, Toronto, ON M5G 2L3, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M3, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
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Muirhead R, Aggarwal A. Real World Data - Does it Cut the Mustard or Should We Take it With a Pinch of Salt? Clin Oncol (R Coll Radiol) 2023; 35:15-19. [PMID: 36272863 DOI: 10.1016/j.clon.2022.09.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/16/2022] [Accepted: 09/26/2022] [Indexed: 01/05/2023]
Affiliation(s)
- R Muirhead
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - A Aggarwal
- Department of Clinical Oncology, Guy's & St Thomas' NHS Trust, London, UK; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Risk of Thromboembolic Events and Major Adverse Cardiovascular Events Following Antivascular Endothelial Growth Factor Therapy in Patients with Colorectal Cancer. Cancers (Basel) 2022; 15:cancers15010009. [PMID: 36612005 PMCID: PMC9817700 DOI: 10.3390/cancers15010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Antivascular endothelial growth factor (anti-VEGF) therapy has been a standard treatment for patients with metastatic colorectal cancer. However, the risk of thromboembolic events and cardiovascular events associated with this therapy remains controversial. We assessed whether anti-VEGF therapy increases the risk of thromboembolic events or major adverse cardiovascular events (MACEs) in patients with colorectal cancer based on real-world evidence. This retrospective cohort study was designed using linked 2009-2016 nationwide databases, including the Taiwan Cancer Registry, the National Health Insurance Research Database, and Taiwan's National Death Index. In total, 189,708 patients newly diagnosed as having advanced colorectal cancer from 2009 to 2016 were identified and categorized into the anti-VEGF and comparator groups through age, sex, clinical stage, and diagnosis date (within 180 days) matching. Propensity score matching was further performed to balance the baseline characteristics between the two groups. The Kaplan-Meier method was used to create the cumulative incidence curves of thromboembolic events and MACEs, and log-rank tests were used to compare the differences in Kaplan-Meier curves. Competing hazard ratios (HRs) for thromboembolic events and MACEs were estimated using the Fine-Gray method when considering the competing event of death. Statistical analysis was performed using two-tailed tests with a significance level of 0.05. In total, 4635 patients were included in both the anti-VEGF group and comparator group. The risk of thromboembolic events and MACEs did not differ significantly between the two groups. After propensity score matching, the adjusted HR for MACEs or thromboembolic events was 1.040, which for MACEs was 0.989, and that for thromboembolic events was 1.028. The competing HR for MACEs or thromboembolic events was 0.921, which for MACEs, was 0.862, and that for thromboembolic events was 0.908. In conclusion, patients with advanced colorectal cancer who received anti-VEGF therapy did not exhibit significantly higher risks of thromboembolic events and MACEs than those without anti-VEGF therapy. Our study provides real-world evidence regarding the safety of anti-VEGF therapy in Asian patients with advanced colorectal cancer.
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LncRNA SNHG11 enhances bevacizumab resistance in colorectal cancer by mediating miR-1207-5p/ABCC1 axis. Anticancer Drugs 2022; 33:575-586. [PMID: 35324517 DOI: 10.1097/cad.0000000000001289] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Long noncoding RNAs (lncRNAs) have been reported to serve as vital regulators in the chemoresistance of human cancers, including colorectal cancer (CRC). In this study, we aimed to explore the functions of lncRNA small nucleolar RNA host gene 11 (SNHG11) in the resistance of CRC to bevacizumab. Quantitative real-time PCR, western blot assay or immunohistochemistry assay were performed to examine the expression of SNHG11, microRNA-1207-5p (miR-1207-5p), ATP binding cassette subfamily C member 1 (ABCC1) and Ki67. Cell Counting Kit-8 assay was conducted to evaluate bevacizumab resistance and cell viability. 5'-ethynyl-2'-deoxyuridine analysis, flow cytometry analysis and wound-healing assay were conducted for cell proliferation, apoptosis and migration, respectively. Dual-luciferase reporter assay and RNA immunoprecipitation assay were employed to analyze the relations among SNHG11, miR-1207-5p and ABCC1. Murine xenograft model assay was employed to analyze bevacizumab resistance in vivo. The exosomes were observed under transmission electron microscopy. SNHG11 was overexpressed in bevacizumab-resistant CRC tissues and cells. Knockdown of SNHG11 restrained bevacizumab resistance, repressed cell proliferation and migration, and promoted apoptosis in bevacizumab-resistant CRC cells. MiR-1207-5p served as the target of SNHG11 and SNHG11 regulated bevacizumab resistance by targeting miR-1207-5p. ABCC1 was the target gene of miR-1207-5p. Overexpression of miR-1207-5p inhibited bevacizumab resistance and cell progression in bevacizumab-resistant CRC cells, with ABCC1 elevation abrogated the impacts. SNHG11 silencing repressed bevacizumab resistance in vivo. In addition, exosomal SNHG11 was upregulated in bevacizumab-resistant CRC cells. SNHG11 contributes to bevacizumab resistance in CRC depending on the modulation of miR-1207-5p and ABCC1.
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Dai WF, de Oliveira C, Blommaert S, Pataky RE, Tran D, Aurangzeb Z, Kendell C, Folkins C, Somayaji C, Dowden J, Cheung W, Strumpf E, Beca JM, McClure C, Urquhart R, McDonald JT, Alvi R, Turner D, Peacock S, Denburg A, Mercer RE, Muñoz C, Parmar A, Tadrous M, Takhar P, Chan KKW. Mapping Canadian Data Assets to Generate Real-World Evidence: Lessons Learned from Canadian Real-World Evidence for Value of Cancer Drugs (CanREValue) Collaboration's RWE Data Working Group. Curr Oncol 2022; 29:2046-2063. [PMID: 35323365 PMCID: PMC8947246 DOI: 10.3390/curroncol29030165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/02/2022] [Accepted: 03/11/2022] [Indexed: 11/16/2022] Open
Abstract
Canadian provinces routinely collect patient-level data for administrative purposes. These real-world data (RWD) can be used to generate real-world evidence (RWE) to inform clinical care and healthcare policy. The CanREValue Collaboration is developing a framework for the use of RWE in cancer drug funding decisions. A Data Working Group (WG) was established to identify data assets across Canada for generating RWE of oncology drugs. The mapping exercise was conducted using an iterative scan with informant surveys and teleconference. Data experts from ten provinces convened for a total of three teleconferences and two in-person meetings from March 2018 to September 2019. Following each meeting, surveys were developed and shared with the data experts which focused on identifying databases and data elements, as well as a feasibility assessment of conducting RWE studies using existing data elements and resources. Survey responses were compiled into an interim data report, which was used for public stakeholder consultation. The feedback from the public consultation was used to update the interim data report. We found that databases required to conduct real-world studies are often held by multiple different data custodians. Ninety-seven databases were identified across Canada. Provinces held on average 9 distinct databases (range: 8-11). An Essential RWD Table was compiled that contains data elements that are necessary, at a minimal, to conduct an RWE study. An Expanded RWD Table that contains a more comprehensive list of potentially relevant data elements was also compiled and the availabilities of these data elements were mapped. While most provinces have data on patient demographics (e.g., age, sex) and cancer-related variables (e.g., morphology, topography), the availability and linkability of data on cancer treatment, clinical characteristics (e.g., morphology and topography), and drug costs vary among provinces. Based on current resources, data availability, and access processes, data experts in most provinces noted that more than 12 months would be required to complete an RWE study. The CanREValue Collaboration's Data WG identified key data holdings, access considerations, as well as gaps in oncology treatment-specific data. This data catalogue can be used to facilitate future oncology-specific RWE analyses across Canada.
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Affiliation(s)
- Wei Fang Dai
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada;
- Canadian Centre for Applied Research in Cancer Control, Canada; (R.E.P.); (J.M.B.); (S.P.); (R.E.M.)
| | - Claire de Oliveira
- Centre for Health Economics and Hull York Medical School, University of York, York YO10 5DD, UK;
- ICES, Toronto, ON M4N 3M5, Canada
| | - Scott Blommaert
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (S.B.); (A.P.)
| | - Reka E. Pataky
- Canadian Centre for Applied Research in Cancer Control, Canada; (R.E.P.); (J.M.B.); (S.P.); (R.E.M.)
- BC Cancer, Vancouver, BC V5Z 1G1, Canada
| | - David Tran
- Saskatchewan Cancer Agency, Regina SK S4W 0G3, Canada; (D.T.); (R.A.)
| | - Zeb Aurangzeb
- CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (Z.A.); (D.T.)
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
| | - Cynthia Kendell
- Department of Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (C.K.); (R.U.)
| | - Chris Folkins
- New Brunswick Institute for Research, Data and Training, University of New Brunswick, Fredericton, NB E3C 1N8, Canada; (C.F.); (C.S.); (J.T.M.)
| | - Chandy Somayaji
- New Brunswick Institute for Research, Data and Training, University of New Brunswick, Fredericton, NB E3C 1N8, Canada; (C.F.); (C.S.); (J.T.M.)
| | - Jeff Dowden
- Cancer Care Program, Eastern Health, St. John’s, NL A1B 3V6, Canada;
| | - Winson Cheung
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada;
| | - Erin Strumpf
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC H3A 2T7, Canada;
| | - Jaclyn M. Beca
- Canadian Centre for Applied Research in Cancer Control, Canada; (R.E.P.); (J.M.B.); (S.P.); (R.E.M.)
- Ontario Health (CCO), Toronto, ON M5G 2L7, Canada; (C.M.); (P.T.)
| | - Carol McClure
- Prince Edward Island Cancer Registry, Government of Prince Edward Island, Charlottetown, PE C1A 9L2, Canada;
| | - Robin Urquhart
- Department of Surgery, Dalhousie University, Halifax, NS B3H 2Y9, Canada; (C.K.); (R.U.)
| | - James Ted McDonald
- New Brunswick Institute for Research, Data and Training, University of New Brunswick, Fredericton, NB E3C 1N8, Canada; (C.F.); (C.S.); (J.T.M.)
| | - Riaz Alvi
- Saskatchewan Cancer Agency, Regina SK S4W 0G3, Canada; (D.T.); (R.A.)
| | - Donna Turner
- CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada; (Z.A.); (D.T.)
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control, Canada; (R.E.P.); (J.M.B.); (S.P.); (R.E.M.)
- BC Cancer, Vancouver, BC V5Z 1G1, Canada
| | - Avram Denburg
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Rebecca E. Mercer
- Canadian Centre for Applied Research in Cancer Control, Canada; (R.E.P.); (J.M.B.); (S.P.); (R.E.M.)
- Ontario Health (CCO), Toronto, ON M5G 2L7, Canada; (C.M.); (P.T.)
| | - Caroline Muñoz
- Ontario Health (CCO), Toronto, ON M5G 2L7, Canada; (C.M.); (P.T.)
| | - Ambica Parmar
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (S.B.); (A.P.)
| | - Mina Tadrous
- Women’s College Hospital, Toronto, ON M5S 1B2, Canada;
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M53 3M2, Canada
| | - Pam Takhar
- Ontario Health (CCO), Toronto, ON M5G 2L7, Canada; (C.M.); (P.T.)
| | - Kelvin K. W. Chan
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada;
- Canadian Centre for Applied Research in Cancer Control, Canada; (R.E.P.); (J.M.B.); (S.P.); (R.E.M.)
- ICES, Toronto, ON M4N 3M5, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (S.B.); (A.P.)
- Ontario Health (CCO), Toronto, ON M5G 2L7, Canada; (C.M.); (P.T.)
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Dai WF, Craig E, Fraser B, Chambers A, Mai H, Brown MB, Earle CC, Evans WK, Geirnaert M, Taylor M, Trudeau M, Sperber D, Beca JM, Denburg A, Mercer RE, Parmar A, Tadrous M, Takhar P, Chan KKW. Building a National Reassessment Process for Oncology Drugs: Lessons Learned by the Canadian Real-World Evidence for Value of Cancer Drugs (CanREValue) Collaboration through a Simulated Reassessment Exercise. Curr Oncol 2021; 28:4645-4654. [PMID: 34898572 PMCID: PMC8628679 DOI: 10.3390/curroncol28060392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
The CanREValue Collaboration established the Reassessment & Uptake Working Group to develop a preliminary process to reassess funded cancer drugs in Canada. A simulated exercise was conducted to evaluate the proposed reassessment process using a real-world case. We invited 32 attendees including representatives from Health Canada and Health Technology Assessment (HTA) agencies, along with payers, clinicians, academics, and patient representatives. A case was developed using a real-world study on a publicly funded cancer drug. In facilitated group sessions, participants were asked to deliberate upon the evidence presented in the case to issue reassessment recommendations. Several themes were identified through the deliberation discussions. While the generalizability of real-world evidence (RWE) is perceived as a strength, trust in the RWE depends largely on the source of the real-world data. The attendees suggested several improvements to the proposed reassessment process including evidence requirement for reassessment, recommendation categories, and a priori study protocols. This exercise generated important insights on the evidence required for conducting reassessment and considerations for improvements of the proposed reassessment process. Building upon lessons from this exercise, future work would continue to refine the reassessment process as part of the overall CanREValue framework.
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Affiliation(s)
- Wei Fang Dai
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada;
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
| | - Erica Craig
- New Brunswick Cancer Network, Fredericton, NB E3B 5G8, Canada;
| | - Brent Fraser
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON K1S 5S8, Canada; (B.F.); (A.C.); (H.M.)
| | - Alex Chambers
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON K1S 5S8, Canada; (B.F.); (A.C.); (H.M.)
| | - Helen Mai
- Canadian Agency for Drugs and Technologies in Health, Ottawa, ON K1S 5S8, Canada; (B.F.); (A.C.); (H.M.)
| | - M. Bryson Brown
- Philosophy Department, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada;
| | - Craig C. Earle
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (C.C.E.); (M.T.); (A.P.)
| | - William K. Evans
- Department of Oncology, McMaster University, Hamilton, ON L8S 4L8, Canada;
- Ontario Health (CCO), Toronto, ON M5G 2L3, Canada;
| | | | | | - Maureen Trudeau
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (C.C.E.); (M.T.); (A.P.)
| | - Daniel Sperber
- Pan-Canadian Pharmaceutical Alliance, Toronto, ON M5S 2B1, Canada;
| | - Jaclyn M. Beca
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
- Ontario Health (CCO), Toronto, ON M5G 2L3, Canada;
| | - Avram Denburg
- The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Rebecca E. Mercer
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
- Ontario Health (CCO), Toronto, ON M5G 2L3, Canada;
| | - Ambica Parmar
- Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; (C.C.E.); (M.T.); (A.P.)
| | - Mina Tadrous
- Women’s College Hospital, Toronto, ON M53 1B2, Canada;
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M53 3M2, Canada
| | - Pam Takhar
- Ontario Health (CCO), Toronto, ON M5G 2L3, Canada;
| | - Kelvin K. W. Chan
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada;
- Canadian Centre for Applied Research in Cancer Control, Toronto, ON M5G 2L3, Canada; (J.M.B.); (R.E.M.)
- Ontario Health (CCO), Toronto, ON M5G 2L3, Canada;
- Correspondence: ; Tel.: +1-416-480-4928
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