1
|
Rujkijyanont P, Inaba H. Diagnostic and treatment strategies for pediatric acute lymphoblastic leukemia in low- and middle-income countries. Leukemia 2024; 38:1649-1662. [PMID: 38762553 DOI: 10.1038/s41375-024-02277-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/20/2024]
Abstract
The survival rate of children and adolescents with acute lymphoblastic leukemia (ALL), the most common pediatric cancer, has improved significantly in high-income countries (HICs), serving as an excellent example of how humans can overcome catastrophic diseases. However, the outcomes in children with ALL in low- and middle-income countries (LMICs), where approximately 80% of the global population live, are suboptimal because of limited access to diagnostic procedures, chemotherapeutic agents, supportive care, and financial assistance. Although the implementation of therapeutic strategies in resource-limited countries could theoretically follow the same path of improvement as modeled in HICs, intensification of chemotherapy may simply result in increased toxicities. With the advent of genetic diagnosis, molecular targeted therapy, and immunotherapy, the management of ALL is changing dramatically in HICs. Multidisciplinary collaborations between institutions in LMICs and HICs will provide access to strategies that are suitable for institutions in LMICs, enabling them to minimize toxicities while improving outcomes. This article summarizes important aspects of the diagnosis and treatment of pediatric ALL that were mostly developed in HICs but that can be realistically implemented by institutions in countries with limited resources through resource-adapted multidisciplinary collaborations.
Collapse
Affiliation(s)
- Piya Rujkijyanont
- Division of Hematology-Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Hiroto Inaba
- Leukemia/Lymphoma Division, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.
| |
Collapse
|
2
|
Gómez-De León A, Noyola-Pérez A, Gil-Flores L, Malhotra H, Musteata V, El-Beshlawy A, Tadjoedin H, Pavlovsky C, Cortes J. Bringing global hematology research to the forefront. Blood Adv 2024; 8:3607-3611. [PMID: 38739717 PMCID: PMC11279253 DOI: 10.1182/bloodadvances.2023011873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Affiliation(s)
- Andrés Gómez-De León
- Department of Hematology, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Andrés Noyola-Pérez
- Department of Hematology, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Lourdes Gil-Flores
- Department of Hematology, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Hemant Malhotra
- Department of Medical Oncology, Sri Ram Cancer Center, Mahatma Gandhi Medical College Hospital, Jaipur, India
| | - Vasile Musteata
- N. Testemitanu State University of Medicine and Pharmacy, Discipline of Hematology, Institute of Oncology, Department of Hematology, Chisinau, Republic of Moldova
| | | | - Hilman Tadjoedin
- Department of Internal Medicine, Dharmais National Cancer Center, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Carolina Pavlovsky
- Department of Hematology and Research, Fundación de Lucha Contra la Leucemia, Buenos Aires, Argentina
| | - Jorge Cortes
- Division of Hematology/Oncology, Department of Medicine, Georgia Cancer Center at Augusta University, Augusta, GA
| |
Collapse
|
3
|
Briercheck E, Pyle D, Adams C, Atun R, Booth C, Dent J, Garcia-Gonzalez P, Ilbawi A, Jazieh AR, Kerr D, Knaul F, Kobayashi E, Lim C, Maza M, Milner D, Navarro MF, O'Brien M, Rodriguez-Galindo C, Sullivan R, Torode J, Vokes E, Gralow J. Unification of Efforts to Improve Global Access to Cancer Therapeutics: Report From the 2022/2023 Access to Essential Cancer Medicines Stakeholder Summit. JCO Glob Oncol 2024; 10:e2300256. [PMID: 38781548 DOI: 10.1200/go.23.00256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/06/2023] [Accepted: 03/24/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE There is an urgent need to improve access to cancer therapy globally. Several independent initiatives have been undertaken to improve access to cancer medicines, and additional new initiatives are in development. Improved sharing of experiences and increased collaboration are needed to achieve substantial improvements in global access to essential oncology medicines. METHODS The inaugural Access to Essential Cancer Medicines Stakeholder Meeting was organized by ASCO and convened at the June 2022 ASCO Annual Meeting in Chicago, IL, with two subsequent meetings, Union for International Cancer Control World Cancer Congress held in Geneva, Switzerland, in October 2022 and at the ASCO Annual Meeting in June of 2023. Invited stakeholders included representatives from cancer institutes, physicians, researchers, professional societies, the pharmaceutical industry, patient advocacy organizations, funders, cancer organizations and foundations, policy makers, and regulatory bodies. The session was moderated by ASCO. Past efforts and current and upcoming initiatives were initially discussed (2022), updates on progress were provided (2023), and broad agreement on resulting action steps was achieved with participants. RESULTS Summit participants recognized that while much work was ongoing to enhance access to cancer therapeutics globally, communication and synergy across projects and organizations could be enhanced by providing a platform for collaboration and shared expertise. CONCLUSION The summit resulted in new cross-stakeholder insights and planned collaboration addressing barriers to accessing cancer medications. Specific actions and timelines for implementation and reporting were established.
Collapse
Affiliation(s)
- Edward Briercheck
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Doug Pyle
- American Society of Clinical Oncology, Alexandria, VA
| | - Cary Adams
- Union for International Cancer Control, Geneva, Switzerland
| | - Rifat Atun
- Department of Global Health and Population, Harvard University, Boston, MA
| | - Christopher Booth
- Division of Cancer Care and Epidemiology, Queen's University, Kingston, Canada
| | | | | | - Andre Ilbawi
- Cancer Programme, World Health Organization, Geneva, Switzerland
| | | | - David Kerr
- Nuffield Department of Clinical Laboratory Sciences, Oxford University, Oxford, United Kingdom
| | - Felicia Knaul
- Department of Public Health Sciences, University of Miami, Miami, FL
| | | | | | | | - Danny Milner
- Union for International Cancer Control, Geneva, Switzerland
| | | | | | | | - Richard Sullivan
- Institute of Cancer Policy, King's College London, London, United Kingdom
| | - Julie Torode
- Institute of Cancer Policy, King's College London, London, United Kingdom
| | - Everett Vokes
- Department of Medicine, University of Chicago, Chicago, IL
| | - Julie Gralow
- American Society of Clinical Oncology, Alexandria, VA
| |
Collapse
|
4
|
Briercheck EL, Wrigglesworth JM, Garcia-Gonzalez I, Scheepers C, Ong MC, Venkatesh V, Stevenson P, Annamalay AA, Coffey DG, Anderson AB, Garcia-Gonzalez P, Wagner MJ. Treatment Access for Gastrointestinal Stromal Tumor in Predominantly Low- and Middle-Income Countries. JAMA Netw Open 2024; 7:e244898. [PMID: 38568688 PMCID: PMC10993077 DOI: 10.1001/jamanetworkopen.2024.4898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/01/2024] [Indexed: 04/05/2024] Open
Abstract
Importance Gastrointestinal stromal tumor (GIST) is a rare cancer treated with the tyrosine kinase inhibitors imatinib mesylate or sunitinib malate. In general, in low- and middle-income countries (LMICs), access to these treatments is limited. Objective To describe the demographic characteristics, treatment duration, and survival of patients with GIST in LMICs treated with imatinib and sunitinib through The Max Foundation programs. Design, Setting, and Participants This retrospective database cohort analysis included patients in 2 access programs administered by The Max Foundation: the Glivec International Patient Assistance Program (GIPAP), from January 1, 2001, to December 31, 2016, and the Max Access Solutions (MAS) program, January 1, 2017, to October 12, 2020. Sixty-six countries in which The Max Foundation facilitates access to imatinib and sunitinib were included. Participants consisted of patients with approved indications for imatinib, including adjuvant therapy in high-risk GIST by pathologic evaluation of resected tumor or biopsy-proven unresectable or metastatic GIST. All patients were reported to have tumors positive for CD117(c-kit) by treating physicians. A total of 9866 patients received treatment for metastatic and/or unresectable disease; 2100 received adjuvant imatinib; 49 received imatinib from another source and were only included in the sunitinib analysis; and 53 received both imatinib and sunitinib through The Max Foundation programs. Data were analyzed from October 13, 2020, to January 30, 2024. Main Outcomes and Measures Demographic and clinical information was reported by treating physicians. Kaplan-Meier analysis was used to estimate time to treatment discontinuation (TTD) and overall survival (OS). An imputation-based informed censoring model estimated events for patients lost to follow-up after treatment with adjuvant imatinib. Patients who were lost to follow-up with metastatic or unresectable disease were presumed deceased. Results A total of 12 015 unique patients were included in the analysis (6890 male [57.6%]; median age, 54 [range, 0-100] years). Of these, 2100 patients were treated with imatinib in the adjuvant setting (median age, 54 [range 8-88] years) and 9866 were treated with imatinib for metastatic or unresectable disease (median age, 55 [range, 0-100] years). Male patients comprised 5867 of 9866 patients (59.5%) with metastatic or unresectable disease and 1023 of 2100 patients (48.7%) receiving adjuvant therapy. The median OS with imatinib for unresectable or metastatic disease was 5.8 (95% CI, 5.6-6.1) years, and the median TTD was 4.2 (95% CI, 4.1-4.4) years. The median OS with sunitinib for patients with metastatic or unresectable GIST was 2.0 (95% CI, 1.5-2.5) years; the median TTD was 1.5 (95% CI, 1.0-2.1) years. The 10-year OS rate in the adjuvant setting was 73.8% (95% CI, 67.2%-81.1%). Conclusions and Relevance In this cohort study of patients with GIST who were predominantly from LMICs and received orally administered therapy through the GIPAP or MAS programs, outcomes were similar to those observed in high-resource countries. These findings underscore the feasibility and relevance of administering oral anticancer therapy to a molecularly defined population in LMICs, addressing a critical gap in cancer care.
Collapse
Affiliation(s)
- Edward Lloyd Briercheck
- Division of Hematology, University of Washington, Seattle
- now with Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | | | | | | | | | - Philip Stevenson
- Division of Clinical Biostatistics, Fred Hutchinson Cancer Center, Seattle, Washington
| | | | | | - Aparna B. Anderson
- Bill & Melinda Gates Medical Research Institute, Cambridge, Massachusetts
| | | | - Michael J. Wagner
- now with Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Oncology, University of Washington, Seattle
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| |
Collapse
|
5
|
Gopal S. The case for prioritizing malignant hematology services in low- and middle-income countries. Semin Hematol 2023; 60:189-191. [PMID: 37723025 PMCID: PMC10840687 DOI: 10.1053/j.seminhematol.2023.08.005] [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: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/20/2023]
Abstract
A clear case for can be made for prioritizing malignant hematology services in low- and middle-income countries based on large public health burden, convincing demonstrations of cure and control, innovation opportunities with likely worldwide implications, and sizable returns on investment for health systems and societies. We must now ensure that need and opportunity are matched by commensurate levels of investment and attention.
Collapse
Affiliation(s)
- Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD.
| |
Collapse
|
6
|
Schuh A. Special edition of the Seminars in Hematology series on Global Hematology Care. Semin Hematol 2023; 60:179-181. [PMID: 37838581 DOI: 10.1053/j.seminhematol.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Affiliation(s)
- Anna Schuh
- Department of Oncology, University of Oxford, Oxford, UK.
| |
Collapse
|
7
|
Hailu S, Kinde S, Cross M, Tsegaye A, Kelemu T, Seifu D, Alemayehu D, Tarekegn A, Jabessa G, Abeje D, Abebe M, Sherif A, Tadesse F, Platzbecker U, Howe R, Gebremedhin A. Estimating prognostic relevant cutoff values for a multiplex PCR detecting BCR::ABL1 in chronic myeloid leukemia patients on tyrosine kinase inhibitor therapy in resource-limited settings. Ann Hematol 2023:10.1007/s00277-023-05254-x. [PMID: 37212909 DOI: 10.1007/s00277-023-05254-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/23/2023] [Indexed: 05/23/2023]
Abstract
The prognosis of chronic myeloid leukemia (CML) on tyrosine kinase inhibitor (TKI) treatment is based on the quantification of BCR::ABL1 fusion gene transcript copy number, harmonized by an international scale (IS) based on TaqMan-based real-time quantitative PCR (qRT-PCR). In Ethiopia, as in most low- and middle-income countries (LMICs), access to standard diagnostic, follow-up, and prognostic tools is very limited, and it has been challenging to strictly follow international guidelines. This seriously compromises clinical outcome, despite the availability of TKIs through the Glivec International Patient Assistance Program (GIPAP). Multiplex PCR (mpx-PCR), conventionally regarded as a "screening tool," offers a potential solution to this problem. A total of 219 samples from confirmed CML patients were assayed. In reference to qRT-PCR, the AUC of ROC curve for mpx-PCR was 0.983 (95% CI: 0.957 to 0.997). At the optimum cut-off value, equivalent to BCR::ABL1 (IS) transcript copy number of 0.6%, the specificity and sensitivity were 93% and 95%, respectively, with 94% accuracy. Albeit the sensitivity and accuracy of mpx-PCR decrease below the optimum cutoff of 0.6% (IS), the specificity at 0.1% (IS) was 100%, making it an attractive means to rule-out relapse and drug non-adherence at later stages of treatment, which is particularly an issue in a low income setting. We conclude that the relative simplicity and low cost of mpx-PCR and prognostic relevant cutoff values (0.1-0.6% IS) should allow its use in peripheral clinics and thus maximize the positive impact of TKIs made available through GIPAP in most LMICs.
Collapse
Affiliation(s)
- Saifu Hailu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Madda Walabu University, Bale Robe, Ethiopia
| | - Samuel Kinde
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- Leipzig University Hospital, Leipzig, Germany.
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
| | | | - Aster Tsegaye
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tsehayneh Kelemu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Seifu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Azeb Tarekegn
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Gutema Jabessa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Desalegn Abeje
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Markos Abebe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Abdulaziz Sherif
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Rawleigh Howe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Amha Gebremedhin
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
8
|
Integrating Single-Cell Transcriptome and Network Analysis to Characterize the Therapeutic Response of Chronic Myeloid Leukemia. Int J Mol Sci 2022; 23:ijms232214335. [PMID: 36430822 PMCID: PMC9695508 DOI: 10.3390/ijms232214335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Abstract
Chronic myeloid leukemia (CML) is a myeloproliferative disease characterized by a unique BCR-ABL fusion gene. Tyrosine kinase inhibitors (TKIs) were developed to target the BCR-ABL oncoprotein, inhibiting its abnormal kinase activity. TKI treatments have significantly improved CML patient outcomes. However, the patients can develop drug resistance and relapse after therapy discontinues largely due to intratumor heterogeneity. It is critical to understand the differences in therapeutic responses among subpopulations of cells. Single-cell RNA sequencing measures the transcriptome of individual cells, allowing us to differentiate and analyze individual cell populations. Here, we integrated a single-cell RNA sequencing profile of CML stem cells and network analysis to decipher the mechanisms of distinct TKI responses. Compared to normal hematopoietic stem cells, a set of genes that were concordantly differentially expressed in various types of stem cells of CML patients was revealed. Further transcription regulatory network analysis found that most of these genes were directly controlled by one or more transcript factors and the genes have more regulators in the cells of the patients who responded to the treatment. The molecular markers including a known drug-resistance gene and novel gene signatures for treatment response were also identified. Moreover, we combined protein-protein interaction network construction with a cancer drug database and uncovered the drugs that target the marker genes directly or indirectly via the protein interactions. The gene signatures and their interacted proteins identified by this work can be used for treatment response prediction and lead to new strategies for drug resistance monitoring and prevention. Our single-cell-based findings offered novel insights into the mechanisms underlying the therapeutic response of CML.
Collapse
|
9
|
Erfani P, Bates M, Garcia-Gonzalez P, Milner DA, Rebbeck TR, Ruhangaza D, Shulman LN, Fadelu T. Leveraging Molecular Diagnostic Technologies to Close the Global Cancer Pathology Gap. JCO Glob Oncol 2022; 8:e2200182. [PMID: 36252158 PMCID: PMC9812500 DOI: 10.1200/go.22.00182] [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] [Indexed: 11/06/2022] Open
Abstract
Integrating context-appropriate molecular diagnostics into LMIC cancer programs is essential to reduce inequities.![]()
Collapse
Affiliation(s)
| | - Michael Bates
- Medical and Scientific Affairs, Oncology, Cepheid, Sunnyvale, CA
| | | | - Dan A. Milner
- American Society for Clinical Pathology, Chicago, IL,Harvard TH Chan School of Public Health, Boston, MA
| | | | | | | | - Temidayo Fadelu
- Harvard Medical School, Boston, MA,Dana-Farber Cancer Institute, Boston, MA,Temidayo Fadelu, MD, MPH, Dana‐Farber Cancer Institute, 450 Brookline Ave, MA-1B-17, Boston, MA 02215; Twitter: @temidayo; e-mail:
| |
Collapse
|
10
|
Patikorn C, Taychakhoonavudh S, Sakulbumrungsil R, Ross-Degnan D, Anantachoti P. Financing Strategies to Facilitate Access to High-Cost Anticancer Drugs: A Systematic Review of the Literature. Int J Health Policy Manag 2022; 11:1625-1634. [PMID: 34814670 PMCID: PMC9808218 DOI: 10.34172/ijhpm.2021.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 09/21/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Each country manages access to anticancer drugs differently due to variations in the structure and financing of the health system, but a summary of the various strategies used is absent. This study aimed to review and summarize financing strategies implemented across countries to facilitate access to high-cost anticancer drugs. METHODS We conducted a systematic review of articles referenced in PubMed, Embase, and Web of Science through May 12, 2021. Articles published in the English language from 2000 that describe strategies implemented in different countries to facilitate access to high-cost anticancer drugs were included. Letters, news articles, and proposed strategies were excluded. Quality assessment was not performed as we aimed to summarize the strategies. Data were analyzed by thematic analysis. A review protocol was registered at PROSPERO (CRD42018068616). RESULTS The review included 204 studies from 176 countries. Three themes of financing strategies were identified: (1) Basic pharmaceutical reimbursement and pricing policies, (2) Alternative funding strategies specific to high-cost drugs, and (3) Financial assistance for individual patients. Access in most countries depends mainly on basic pharmaceutical reimbursement policies (165 of 176 countries). Apart from that, high-income countries (HICs) tended to use funding strategies targeting high-cost drugs (72% of HICs vs 0%-24% of the rest), such as managed entry agreements (MEAs) or dedicated funds for high-cost drugs. In contrast, lower-income countries tended to implement financial assistance programs for cancer patients as a tool to increase access (32% of HICs vs 62%-79% of the rest). CONCLUSION Many countries have implemented a combination of strategies to increase access to high-cost anticancer drugs. Most low- and middle-income countries utilized placement of anticancer drugs on a national list of essential medicines and patient assistance programs (PAPs) to facilitate access, while many HICs implemented a broader range of strategies.
Collapse
Affiliation(s)
- Chanthawat Patikorn
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Suthira Taychakhoonavudh
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Rungpetch Sakulbumrungsil
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, Boston, MA, USA
| | - Puree Anantachoti
- Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
11
|
Stukan I, Gryzik M, Hoser G, Want A, Grabowska-Pyrzewicz W, Zdioruk M, Napiórkowska M, Cieślak M, Królewska-Golińska K, Nawrot B, Basak G, Wojda U. Novel Dicarboximide BK124.1 Breaks Multidrug Resistance and Shows Anticancer Efficacy in Chronic Myeloid Leukemia Preclinical Models and Patients' CD34 +/CD38 - Leukemia Stem Cells. Cancers (Basel) 2022; 14:cancers14153641. [PMID: 35892900 PMCID: PMC9332833 DOI: 10.3390/cancers14153641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Chemotherapy is a first line treatment in many cancer types, but the constant exposition to chemotherapeutics often leads to therapy resistance. An example is chronic myeloid leukemia that, due to the use of tyrosine kinase inhibitors such as imatinib, remains manageable, however incurable. Overall, 20–25% of imatinib responders develop secondary resistance, and among them, 20–40% is due to mechanisms such as expression of P-glycoprotein (MDR1) or leukemia stem cells’ mechanisms of survival and cancer regrowth. This study provides the first evidence from animal and cellular models that this resistance can be overcome with the novel dicarboximide BK124.1. The compound causes no visible toxicity in mice, and has proper pharmacokinetics for therapeutic applications. It was efficient against both multidrug resistant CML blasts and CD34+/CD38− leukemia stem cells coming from CML patients. Future development of BK124.1 could offer curative treatment of CML and of other cancers resistant or intolerant to current chemotherapy. Abstract The search is ongoing for new anticancer therapeutics that would overcome resistance to chemotherapy. This includes chronic myeloid leukemia, particularly suitable for the studies of novel anticancer compounds due to its homogenous and well-known genetic background. Here we show anticancer efficacy of novel dicarboximide denoted BK124.1 (C31H37ClN2O4) in a mouse CML xenograft model and in vitro in two types of chemoresistant CML cells: MDR1 blasts and in CD34+ patients’ stem cells (N = 8) using immunoblotting and flow cytometry. Intraperitoneal administration of BK124.1 showed anti-CML efficacy in the xenograft mouse model (N = 6) comparable to the commonly used imatinib and hydroxyurea. In K562 blasts, BK124.1 decreased the protein levels of BCR-ABL1 kinase and its downstream effectors, resulting in G2/M cell cycle arrest and apoptosis associated with FOXO3a/p21waf1/cip1 upregulation in the nucleus. Additionally, BK124.1 evoked massive apoptosis in multidrug resistant K562-MDR1 cells (IC50 = 2.16 μM), in CD34+ cells from CML patients (IC50 = 1.5 µM), and in the CD34+/CD38− subpopulation consisting of rare, drug-resistant cancer initiating stem cells. Given the advantages of BK124.1 as a potential chemotherapeutic and its unique ability to overcome BCR-ABL1 dependent and independent multidrug resistance mechanisms, future development of BK124.1 could offer a cure for CML and other cancers resistant to present drugs.
Collapse
Affiliation(s)
- Iga Stukan
- Laboratory of Preclinical Testing of Higher Standard, Nencki Institute of Experimental Biology of Polish Academy of Sciences, 3 Pasteur Street, 02-093 Warsaw, Poland; (I.S.); (M.G.); (G.H.); (A.W.); (W.G.-P.); (M.Z.)
| | - Marek Gryzik
- Laboratory of Preclinical Testing of Higher Standard, Nencki Institute of Experimental Biology of Polish Academy of Sciences, 3 Pasteur Street, 02-093 Warsaw, Poland; (I.S.); (M.G.); (G.H.); (A.W.); (W.G.-P.); (M.Z.)
| | - Grażyna Hoser
- Laboratory of Preclinical Testing of Higher Standard, Nencki Institute of Experimental Biology of Polish Academy of Sciences, 3 Pasteur Street, 02-093 Warsaw, Poland; (I.S.); (M.G.); (G.H.); (A.W.); (W.G.-P.); (M.Z.)
- Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Andrew Want
- Laboratory of Preclinical Testing of Higher Standard, Nencki Institute of Experimental Biology of Polish Academy of Sciences, 3 Pasteur Street, 02-093 Warsaw, Poland; (I.S.); (M.G.); (G.H.); (A.W.); (W.G.-P.); (M.Z.)
| | - Wioleta Grabowska-Pyrzewicz
- Laboratory of Preclinical Testing of Higher Standard, Nencki Institute of Experimental Biology of Polish Academy of Sciences, 3 Pasteur Street, 02-093 Warsaw, Poland; (I.S.); (M.G.); (G.H.); (A.W.); (W.G.-P.); (M.Z.)
| | - Mikolaj Zdioruk
- Laboratory of Preclinical Testing of Higher Standard, Nencki Institute of Experimental Biology of Polish Academy of Sciences, 3 Pasteur Street, 02-093 Warsaw, Poland; (I.S.); (M.G.); (G.H.); (A.W.); (W.G.-P.); (M.Z.)
| | - Mariola Napiórkowska
- Department of Biochemistry, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Marcin Cieślak
- Centre of Molecular and Macromolecular Studies, Polish Academy of Sciences, 90-363 Lodz, Poland; (M.C.); (K.K.-G.); (B.N.)
| | - Karolina Królewska-Golińska
- Centre of Molecular and Macromolecular Studies, Polish Academy of Sciences, 90-363 Lodz, Poland; (M.C.); (K.K.-G.); (B.N.)
| | - Barbara Nawrot
- Centre of Molecular and Macromolecular Studies, Polish Academy of Sciences, 90-363 Lodz, Poland; (M.C.); (K.K.-G.); (B.N.)
| | - Grzegorz Basak
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Urszula Wojda
- Laboratory of Preclinical Testing of Higher Standard, Nencki Institute of Experimental Biology of Polish Academy of Sciences, 3 Pasteur Street, 02-093 Warsaw, Poland; (I.S.); (M.G.); (G.H.); (A.W.); (W.G.-P.); (M.Z.)
- Correspondence: ; Tel.: +48-22-5892-578
| |
Collapse
|
12
|
Morgan J, DeBoer RJ, Bigirimana JB, Nguyen C, Ruhangaza D, Paciorek A, Mugabo F, Villaverde C, Nsabimana N, Bihizimana P, Umwizerwa A, Lehmann LE, Shulman LN, Shyirambere C. A Ten-Year Experience of Treating Chronic Myeloid Leukemia in Rural Rwanda: Outcomes and Insights for a Changing Landscape. JCO Glob Oncol 2022; 8:e2200131. [PMID: 35839427 PMCID: PMC9812457 DOI: 10.1200/go.22.00131] [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] [Indexed: 01/07/2023] Open
Abstract
PURPOSE In describing our ten-year experience with treating chronic myeloid leukemia (CML) as part of the Glivec Patient Assistance Program (GIPAP) in rural Rwanda, we evaluate (1) patient characteristics and treatment outcomes, (2) resource-adapted management strategies, and (3) the impact of diagnostic capacity development. METHODS We retrospectively reviewed all patients with BCR-ABL-positive CML enrolled in this GIPAP program between 2009 and 2018. Clinical data were analyzed using descriptive statistics, Kaplan-Meier methods, proportional hazards regression, and the Kruskal-Wallis test. RESULTS One hundred twenty-four patients were included. The median age at diagnosis was 34 (range 8-81) years. On imatinib, 91% achieved complete hematologic response (CHR) after a median of 49 days. Seven (6%) and 12 (11%) patients had primary and secondary imatinib resistance, respectively. The 3-year overall survival was 80% (95% CI, 72 to 87) for the cohort, with superior survival in imatinib responders compared with those with primary and secondary resistance. The median time from imatinib initiation to CHR was 59 versus 38 days (P = .040) before and after in-country diagnostic testing, whereas the median time to diagnosis (P = .056) and imatinib initiation (P = .170) was not significantly different. CONCLUSION Coupling molecular diagnostics with affordable access to imatinib within a comprehensive cancer care delivery program is a successful long-term strategy to treat CML in resource-constrained settings. Our patients are younger and have higher rates of imatinib resistance compared with historic cohorts in high-income countries. High imatinib resistance rates highlight the need for access to molecular monitoring, resistance testing, and second-generation tyrosine kinase inhibitors, as well as systems to support drug adherence. Hematologic response is an accurate resource-adapted predictor of survival in this setting. Local diagnostic capacity development has allowed for continuous, timely CML care delivery in Rwanda.
Collapse
Affiliation(s)
- Jennifer Morgan
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC,Jennifer Morgan, MD, Lineberger Comprehensive Cancer Center, University of North Carolina, 170 Manning Dr, CB #7305, Chapel Hill, NC 27599; e-mail:
| | - Rebecca J. DeBoer
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | | | | | | | - Alan Paciorek
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | - Fred Mugabo
- Republic of Rwanda Ministry of Health, Burera District, Rwanda
| | | | | | | | - Aline Umwizerwa
- Partners In Health/Inshuti Mu Buzima, Burera District, Rwanda
| | | | | | | |
Collapse
|
13
|
Sharma R, Jani C. Mapping incidence and mortality of leukemia and its subtypes in 21 world regions in last three decades and projections to 2030. Ann Hematol 2022; 101:1523-1534. [PMID: 35536353 DOI: 10.1007/s00277-022-04843-6] [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: 11/13/2021] [Accepted: 04/05/2022] [Indexed: 11/28/2022]
Abstract
This study examines the burden of leukemia and its subtypes at the global, regional, and national levels in 21 world regions and 204 countries in the last three decades. The estimates of incidence, deaths, and age-standardized rates of leukemia for 21 regions and 204 countries for 1990-2019 were extracted from the Global Burden of Disease 2019 study. Average annual percentage change in 1990-2019 for 21 regions was utilized for projecting leukemia burden in 2030. Globally, there were 643,579 [586,980-699,729] incident cases and 334,592 [306,818-360,214] deaths in 2019 due to leukemia, up from 474,924 [388,559-560,550] cases and 263,263 [233,664-298,696] deaths in 1990. Between 1990 and 2019, the age-standardized incidence rate (ASIR) decreased from 9.6 [8.1-11.0] in 1990 to 8.2 [7.5-8.9] per 100,000 person-years in 2019, and the age-standardized mortality rate (ASMR) decreased from 5.8/100,000 [5.2-6.4] in 1990 to 4.3/100,000 [3.9-4.6] in 2019. Between 1990 and 2019, the ASIR decreased in majority of regions except Western Europe and high-income Asia Pacific, whereas the ASMR decreased in all 21 regions. In 2019, country-wise, the ASIR varied from 3.0/100,000 [2.3-3.7] in Palau to 35.1/100,000 [26.4-47.2] in San Marino and the ASMR spanned from 2.3/100,000 [1.7-2.8] in San Marino to 15.8/100,000 [12.0-20.4] in Syria. As per our projections, globally, there will be 720,168 incident cases and 367,804 deaths due to leukemia in 2030. Substantial improvements have been witnessed in leukemia mortality rates in all regions, especially high-income regions and countries. Health care policies focusing on diagnostic improvements, cancer registration, and newer therapeutics at reduced cost or with insurance coverage are needed in low and middle-income countries.
Collapse
Affiliation(s)
- Rajesh Sharma
- University School of Management and Entreprenuership, Delhi Technological University, East Delhi Campus, Room No. 305, Vivek Vihar Phase II, Delhi, 110095, India.
| | - Chinmay Jani
- Mount Aubrun Hospital, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
14
|
Aliu P, Sarp S, Reichenbach R, Behr S, Fitzsimmons P, Shamlajee M, Kola SP, Nunes Radimerski S, Scosyrev E. International Country-Level Trends, Factors, and Disparities in Compassionate Use Access to Unlicensed Products for Patients With Serious Medical Conditions. JAMA HEALTH FORUM 2022; 3:e220475. [PMID: 35977322 PMCID: PMC9012970 DOI: 10.1001/jamahealthforum.2022.0475] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/11/2022] [Indexed: 12/28/2022] Open
Abstract
Importance Compassionate use (CU) is a treatment option for patients with serious or life-threatening medical conditions that provides access to locally unlicensed medications (generally free of charge) when all available treatment options have been exhausted and enrollment in a clinical trial is not possible. Objective To examine the disparity in CU access observed across countries and explore the key driving factors. Design Settings and Participants This study analyzed all Novartis CU requests (for individual/named patients and cohort programs) received between January 1, 2018, and December 31, 2020, and investigated selected country-specific factors for association with request activity. Data analysis was performed from February 2021 to February 2022. Main Outcomes and Measures Country-specific request activity was quantified using request counts and rates per million population and examined in stratified and multivariable analyses (negative-binomial regression) for association with the following covariates: existence of local CU regulations and their public availability, clinical trial activity, population size, and gross domestic product. Results During the 36-month observation period, 31 711 CU requests were received from 110 countries, 23 194 (73%) of which came from only 10 high-income countries. All high-income countries combined accounted for 27 612 (87%) of all requests, while lower-middle-income and low-income countries contributed only 1021 (3%). Of all requests, 29 870 (94%) were from countries with CU regulations made publicly available on the internet, and higher request activity was demonstrated in countries conducting more clinical trials. Presence and public availability of CU regulations, population size, gross domestic product, and clinical trial activity were independently associated with the CU request activity in multivariable analysis. Conclusions and Relevance In this cohort study analyzing Novartis CU requests over a 3-year period, existence and public availability of CU regulations and local clinical trial activity were positively associated with higher CU request rates. The analysis also identified an association between macroeconomic factors and CU request activity, despite the generally free provision of unlicensed therapeutic products. Similar analyses of other comparable experiences are needed to supplement these initial observations. Ultimately, better understanding of factors associated with CU request activity would translate into improved early access to novel lifesaving products for patients with unmet medical needs around the world.
Collapse
Affiliation(s)
- Paul Aliu
- Novartis Pharma AG, Basel, Switzerland
| | | | | | | | | | | | | | | | - Emil Scosyrev
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| |
Collapse
|
15
|
DeBoer RJ, Rugo HS, Shulman LN. Reconceptualizing Risk-Benefit Assessment of Novel Cancer Therapies to Expand Global Access and Reduce Worldwide Mortality. JAMA Oncol 2021; 8:203-204. [PMID: 34882172 DOI: 10.1001/jamaoncol.2021.5945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rebecca J DeBoer
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco
| | - Hope S Rugo
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco
| | | |
Collapse
|
16
|
Maheshwari VK, Slader C, Dani N, Gkitzia C, Yuan Q, Xiong T, Liu Y, Viana R. Enabling access to molecular monitoring for chronic myeloid leukemia patients is cost effective in China. PLoS One 2021; 16:e0259076. [PMID: 34695169 PMCID: PMC8544861 DOI: 10.1371/journal.pone.0259076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 10/12/2021] [Indexed: 12/02/2022] Open
Abstract
Objective To determine the cost effectiveness of molecular monitoring in patients with chronic myeloid leukemia in the chronic phase (CML-CP) compared to no molecular monitoring from a Chinese payer perspective. Methods Analyses were conducted using a semi-Markov model with a 50-year time horizon. Population data from multicenter registry-based studies of Chinese patients with CML-CP informed the model. Transition probabilities were based on time-to-event data from the literature. Utility values were obtained from published studies and were assumed to be the same for patients with and without molecular monitoring. Costs were based on values commonly used in the Chinese healthcare system, including drug acquisition, drug administration, follow-up, treatment for disease progression, molecular monitoring, and terminal care costs, and were in the local currency (2020 Chinese Yuan RMB [¥]). Outcomes were total life-years (LYs) and quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratio. Results Molecular monitoring was dominant to no molecular monitoring, with increased LYs (1.52) and QALYs (1.90) and costs savings (¥93,840) over a lifetime compared to no monitoring in discounted analyses. The opportunity of patients that receive molecular monitoring to discontinue treatment during treatment-free remission, an opportunity not afforded to those without molecular monitoring, was the principle driver of this result. Results were similar across multiple clinical scenarios. Particularly, molecular monitoring remained dominant even if the proportion of patients achieving deep molecular response (DMR) was reduced by 10%-30%, or the proportion of patients maintaining DMR for 1 year was reduced by 10%-30% or increased by 10%. Cost savings in these scenarios ranged from ¥62,230 to ¥103,964. Conclusions Overall, this analysis demonstrates that adherence to guideline recommendations of regular molecular monitoring of patients with CML-CP treated with TKIs provides significant clinical benefit that leads to substantial cost savings compared to no molecular monitoring from the perspective of a Chinese payer. In a time where healthcare systems have limited resources to allocate to optimal patient care, investment in molecular monitoring is an ideal choice for improving patient benefits at a reduced cost.
Collapse
Affiliation(s)
| | - Cassandra Slader
- Novartis Pharma AG, Medical Affairs, Basel, Basel Stadt, Switzerland
| | - Nidhi Dani
- Novartis Pharma AG, Value & Access, Basel, Basel Stadt, Switzerland
| | | | - Quan Yuan
- Novartis Oncology, Market Access Strategy, Beijing, China
| | | | - Yu Liu
- Novartis Oncology, Medical Affairs, Beijing, China
| | - Ricardo Viana
- Novartis Pharma AG, Global Value & Access, Oncology, Basel, Basel Stadt, Switzerland
- * E-mail:
| |
Collapse
|
17
|
Hu Y, Li Q, Hou M, Peng J, Yang X, Xu S. Magnitude and Temporal Trend of the Chronic Myeloid Leukemia: On the Basis of the Global Burden of Disease Study 2019. JCO Glob Oncol 2021; 7:1429-1441. [PMID: 34591599 PMCID: PMC8492379 DOI: 10.1200/go.21.00194] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
To map the magnitudes and temporal trends of chronic myeloid leukemia (CML) along with its attributable risk factors, providing the essential foundation for targeted public policies at the national, regional, and global levels. Temporal trend of CML burden and its attributable factors was mapped to guide public health resource allocation.![]()
Collapse
Affiliation(s)
- Yuefen Hu
- Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Qizhao Li
- Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ming Hou
- Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jun Peng
- Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiaorong Yang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Shuqian Xu
- Department of Hematology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| |
Collapse
|
18
|
Kiwumulo HF, Muwonge H, Ibingira C, Kirabira JB, Ssekitoleko RT. A systematic review of modeling and simulation approaches in designing targeted treatment technologies for Leukemia Cancer in low and middle income countries. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:8149-8173. [PMID: 34814293 DOI: 10.3934/mbe.2021404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Virtual experimentation is a widely used approach for predicting systems behaviour especially in situations where resources for physical experiments are very limited. For example, targeted treatment inside the human body is particularly challenging, and as such, modeling and simulation is utilised to aid planning before a specific treatment is administered. In such approaches, precise treatment, as it is the case in radiotherapy, is used to administer a maximum dose to the infected regions while minimizing the effect on normal tissue. Complicated cancers such as leukemia present even greater challenges due to their presentation in liquid form and not being localised in one area. As such, science has led to the development of targeted drug delivery, where the infected cells can be specifically targeted anywhere in the body. Despite the great prospects and advances of these modeling and simulation tools in the design and delivery of targeted drugs, their use by Low and Middle Income Countries (LMICs) researchers and clinicians is still very limited. This paper therefore reviews the modeling and simulation approaches for leukemia treatment using nanoparticles as an example for virtual experimentation. A systematic review from various databases was carried out for studies that involved cancer treatment approaches through modeling and simulation with emphasis to data collected from LMICs. Results indicated that whereas there is an increasing trend in the use of modeling and simulation approaches, their uptake in LMICs is still limited. According to the review data collected, there is a clear need to employ these tools as key approaches for the planning of targeted drug treatment approaches.
Collapse
Affiliation(s)
| | - Haruna Muwonge
- Department of Medical Physiology, Makerere University, Kampala, Uganda
| | - Charles Ibingira
- Department of Human Anatomy, Makerere University, Kampala, Uganda
| | | | | |
Collapse
|
19
|
Tadesse F, Asres G, Abubeker A, Gebremedhin A, Radich J. Spectrum of BCR-ABL Mutations and Treatment Outcomes in Ethiopian Imatinib-Resistant Patients With Chronic Myeloid Leukemia. JCO Glob Oncol 2021; 7:1187-1193. [PMID: 34292760 PMCID: PMC8457809 DOI: 10.1200/go.21.00058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Despite the successes achieved in chronic myeloid leukemia (CML) with tyrosine kinase inhibitor (TKI) therapy, resistance remains an obstacle. The most common mechanism of resistance is the acquisition of a point mutation in the BCR-ABL kinase domain. Few studies have reported African patients with CML in regard to such mutations. We here report the types of BCR-ABL mutations in Ethiopian imatinib-resistant patients with CML and their outcome.
Collapse
Affiliation(s)
| | - Getahun Asres
- University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Abdulaziz Abubeker
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Amha Gebremedhin
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | | |
Collapse
|
20
|
Bharadwaj M, Vallurupalli M, Huang FW. Global Precision Oncology: A Call to Action on Expanding Access to Targeted Cancer Therapies. Oncologist 2021; 26:353-355. [PMID: 33539588 DOI: 10.1002/onco.13708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/18/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
| | - Mounica Vallurupalli
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Franklin W Huang
- Department of Medicine, University of California-San Francisco School of Medicine, San Francisco, California, USA.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| |
Collapse
|
21
|
Social and Financial Barriers to Optimum TKI Treatment in Patients with Chronic Myeloid Leukemia-A Knowledge-Attitudes-Practices Study from India. Mediterr J Hematol Infect Dis 2021; 13:e2021004. [PMID: 33489043 PMCID: PMC7813279 DOI: 10.4084/mjhid.2021.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/07/2020] [Indexed: 11/08/2022] Open
Abstract
Introduction Outcomes in chronic myeloid leukemia (CML) have vastly improved after introducing tyrosine kinase inhibitors. However, patients in low and middle-income countries (LMICs) face many challenges due to social and financial barriers. Objective This study was conducted to understand socio-economic hindrances, knowledge-attitudes-practices, and assessing nonadherence to treatment in chronic phase CML patients taking imatinib. Materials and Methods Patients of chronic phase CML, aged 15 and above, taking imatinib for six months or more were included in the study. A questionnaire (in the Hindi language) was administered, inquiring about the nature of the disease and its treatment, how imatinib was obtained, drug-taking behavior, and the treatment’s economic and social burden. Nonadherence was assessed by enquiring patients for missed doses since the last hospital visit and for any treatment interruptions of ≥7 days during the entire course of treatment (TIs). Results Four hundred patients were enrolled (median age 37 years, median duration on imatinib 63 months). Patients hailed from 16 different Indian states, and 29.75% had to travel more than 500 kilometers for their hospital visit. Scheduled hospital visits were missed by 14.75%. A third of the patients were unaware of the lifelong treatment duration, and 41.75% were unaware of the risks of discontinuing treatment. Treatment was financed by three different means −61.75% received imatinib via the Glivec International Patient Assistance Program (GIPAP), 14.25% through a cost-reimbursement program, and 24% self-paying. 52.75% of patients felt financially burdened due to the cost of drugs (self-paying patients), cost of investigations, the expenditure of the commute and stay for the hospital visit, and loss of working days due to hospital visits. 41.25% of patients reported missed doses in the last three months, and 9% reported missing >10% doses. 16.5% of patients reported TIs. Nonadherence>10% and TIs were significantly higher in self-paying patients (15.6% and 25% respectively). Conclusion We observed that patient awareness about the disease was suboptimal. Patients felt inconvenienced and financially burdened by the treatment. Nonadherence and treatment interruptions were observed in 41.25% and 16.5%, respectively. These issues were prevalent in self-paying patients.
Collapse
|