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van Eijk E, van der Spek YM, van Deudekom FJA, van den Bos F, Mooijaart SP, Trompet S. Temporal changes in characteristics and external validity of randomized controlled trials in older people from 2012 to 2019. BMC Geriatr 2023; 23:324. [PMID: 37226093 DOI: 10.1186/s12877-023-04018-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/04/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Older individuals are often underrepresented in clinical trials. In 2012 only 7% of RCT's specifically studied older people and their geriatric characteristics were poorly reported. The aim of this review was to investigate temporal changes in characteristics and external validity of randomized controlled trials in older people from 2012 to 2019. METHODS PubMed was searched for randomized clinical trials (RCTs) published in 2019. Firstly, the proportion of RCTs specially designed for older people were determined by the following criteria: a reported mean age of ≥ 70 years or a lower age cutoff of ≥ 55. Secondly, the trials with a majority of older people, defined by a reported mean age of ≥ 60 years, were screened for reporting of geriatric assessments. Both parts were compared with identical reviews performed in 2012. RESULTS From a 10% random sample, 1446 RCTs were included in this systematic review. First, 8% of trials were specifically designed for older people in 2019 compared to 7% in 2012. Secondly, 25% of the trials included a majority of older people in 2019, compared to 22% in 2012. Thirdly, in 52% of these trials in 2019 one or more of the geriatric assessments were reported compared to 34% in 2012. CONCLUSIONS Although in 2019 the proportion of published RCTs specifically designed for older people remains low, more characteristics on geriatric assessments were reported compared to 2012. Continued efforts should be paid to increase both the number and the validity of trials for older people.
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Affiliation(s)
- Estelle van Eijk
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands
| | - Yanna M van der Spek
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands
| | | | - Frederiek van den Bos
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands
| | - Simon P Mooijaart
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands
- LUMC Center for Medicine for Older People, Leiden, The Netherlands
| | - Stella Trompet
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands.
- LUMC Center for Medicine for Older People, Leiden, The Netherlands.
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Gómez-Palomo F, Sánchez González JV, Bernal Gómez A, Pérez Ardavín J, Ruíz Cerdá JL. Impact of aging on the incidence and mortality of urological cancers: 20-year projection in Spain. Actas Urol Esp 2022; 46:268-274. [PMID: 35551891 DOI: 10.1016/j.acuroe.2021.10.004] [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: 04/06/2021] [Accepted: 10/22/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION In 2020, 282,421 new cases of cancer were diagnosed in Spain, and urological neoplasms (UN) were among the most frequent ones. Cancer treatment in eldery people is challenging due to fragility and comorbidities of these patients. To meet the needs of treating UN in the eldery, it is necessary to optimize healthcare resources, for which a deep analysis of cancer registries becomes mandatory. The objective of this work was to provide a detailed analysis of the incidence and mortality of UN in Spanish people over 65 years old in the last year 2020, as well as the estimates for the year 2040. MATERIAL AND METHODS Incidence and mortality estimates were obtained from the GLOBOCAN database. The urological neoplasms that were included were: testicle, bladder, penis, kidney and prostate. RESULTS In 2020, 63,278 cases of UN were diagnosed in Spain. Most UN were much more frequent among patients >65 years old, except for testicular cancers. For the year 2040, an incidence increase of 41.5% is estimated, reaching 89,507 new cases of UN per year, with approximately 3 out of 4 patients being over 65 years old. Deaths in people over 65 will increase by 60.15% in 2040. CONCLUSION In the next two decades, it is expected that new cases UN in people over 65 years will increase above 50%. For Healthcare systems to face it, greater financial and human resources, as well as multidisciplinary teams with experience and geriatric training will be necessary.
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Affiliation(s)
- F Gómez-Palomo
- Departamento de Urología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - J V Sánchez González
- Departamento de Urología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - A Bernal Gómez
- Departamento de Urología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J Pérez Ardavín
- Departamento de Urología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J L Ruíz Cerdá
- Departamento de Urología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Impacto del envejecimiento sobre la incidencia y mortalidad de los cánceres urológicos: proyección a 20 años en España. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Winer A, Handorf E, Dotan E. Dosing Schedules of Gemcitabine and nab-Paclitaxel for Older Adults With Metastatic Pancreatic Cancer. JNCI Cancer Spectr 2021; 5:pkab074. [PMID: 34532641 PMCID: PMC8438244 DOI: 10.1093/jncics/pkab074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/04/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background Gemcitabine and nab-paclitaxel (GA) is a first-line treatment for patients with metastatic pancreatic cancer (mPDAC). The traditional dosing schedule of GA is days 1, 8, and 15 of a 28-day cycle. Frequently, older adults are given a modified dosing schedule using 2 doses per cycle because of toxicity. We retrospectively analyzed treatment patterns and outcomes of older adults with mPDAC given these 2 dosing schedules. Methods Patients 65 years or older with mPDAC treated with GA in a nationwide real-world database between January 1, 2014, and May 31, 2019, were included. Demographic, disease, and treatment information were collected. Patients were grouped by dosing at treatment initiation (traditional vs modified dosing schedules). Endpoints were time on treatment (TOT) and overall survival (OS) in patients receiving at least 2 cycles. All statistical tests were 2-sided. Results 1317 patients were included (traditional dosing schedule: n = 842; modified dosing schedule: n = 475). Median age at diagnosis was 72 and 73 years for traditional and modified dosing schedules, respectively (P < .001), but sex, race, and performance status were not statistically significantly different. The median TOT and OS were better for the traditional vs modified dosing schedule (unadjusted median TOT, first-line = 4.18 vs 3.26 mo, P =.04; OS = 9.44 vs 7.63 mo, P =.003). Conclusion In this real-world cohort, treatment of older mPDAC patients with a modified dosing schedule of GA resulted in shorter TOT and worse OS vs a traditional dosing schedule. With the caveats of potential confounding that exist in a nonrandomized retrospective database, these results suggest that dose intensity may be important, and prospective studies are necessary to ensure we treat our patients most effectively.
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Affiliation(s)
- Arthur Winer
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Elizabeth Handorf
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Efrat Dotan
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Kaufman PA, Hurvitz SA, O'Shaughnessy J, Mason G, Yardley DA, Brufsky AM, Rugo HS, Cobleigh M, Swain SM, Tripathy D, Morris A, Antao V, Li H, Jahanzeb M. Baseline characteristics and first-line treatment patterns in patients with HER2-positive metastatic breast cancer in the SystHERs registry. Breast Cancer Res Treat 2021; 188:179-190. [PMID: 33641083 DOI: 10.1007/s10549-021-06103-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 01/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Systemic Therapies for HER2-Positive Metastatic Breast Cancer Study (SystHERs, NCT01615068) was a prospective, observational disease registry designed to identify treatment patterns and clinical outcomes in patients with HER2-positive metastatic breast cancer (MBC) in real-world treatment settings. METHODS SystHERs enrolled patients aged ≥ 18 years with recently diagnosed HER2-positive MBC. Treatment regimens and clinical management were determined by the treating physician. In this analysis, patients were compared descriptively by first-line treatment, age, or race. Multivariate logistic regression was used to examine the associations between baseline variables and treatment selections. Clinical outcomes were assessed in patients treated with trastuzumab (Herceptin [H]) + pertuzumab (Perjeta [P]). RESULTS Patients were enrolled from June 2012 to June 2016. As of February 22, 2018, 948 patients from 135 US treatment sites had received first-line treatment, including HP (n = 711), H without P (n = 175), or no H (n = 62) (with or without chemotherapy and/or hormonal therapy). Overall, 68.7% received HP + taxane and 9.3% received H without P + taxane. Patients aged < 50 years received HP (versus H without P) more commonly than those ≥ 70 years (odds ratio 4.20; 95% CI, 1.62-10.89). Chemotherapy was less common in patients ≥ 70 years (68.2%) versus those < 50 years (88.0%) or 50-69 years (87.4%). Patients treated with HP had median overall survival of 53.8 months and median progression-free survival of 15.8 months. CONCLUSIONS Our analysis of real-world data shows that most patients with HER2-positive MBC received first-line treatment with HP + taxane. However, older patients were less likely to receive dual HER2-targeted therapy and chemotherapy.
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Affiliation(s)
- Peter A Kaufman
- Breast Oncology, Division of Hematology/Oncology, University of Vermont Cancer Center, University of Vermont Medical Center, 89 Beaumont Avenue, Burlington, VT, 05405, USA.
| | - Sara A Hurvitz
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Joyce O'Shaughnessy
- Department of Medical Oncology, Baylor University Medical Center, Texas Oncology and US Oncology, Dallas, TX, USA
| | - Ginny Mason
- Inflammatory Breast Cancer Research Foundation, West Lafayette, IN, USA
| | - Denise A Yardley
- Breast Cancer Research Program, Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, TN, USA
| | - Adam M Brufsky
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hope S Rugo
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Melody Cobleigh
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Sandra M Swain
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Debu Tripathy
- MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Anne Morris
- Genentech, Inc., South San Francisco, CA, USA
| | | | - Haocheng Li
- F. Hoffmann-La Roche, Mississauga, ON, Canada
| | - Mohammad Jahanzeb
- Florida Precision Oncology, a Division of 21st Century Oncology, Boca Raton, FL, USA
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Merchant SJ, Kong W, Gyawali B, Hanna T, Chung W, Nanji S, Patel SV, Booth CM. Effectiveness of Trastuzumab in Routine Clinical Practice: A Population-based Study of Patients with HER-2-positive Oesophageal, Gastroesophageal and Gastric Cancer. Clin Oncol (R Coll Radiol) 2020; 33:202-207. [PMID: 32747152 DOI: 10.1016/j.clon.2020.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 06/16/2020] [Accepted: 07/15/2020] [Indexed: 01/25/2023]
Abstract
AIMS In the pivotal Trastuzumab for Gastric Cancer (ToGA) trial, trastuzumab improved median survival in patients with advanced HER-2-positive gastric and gastroesophageal cancer from 11.1 to 13.8 months; however, its effectiveness in routine clinical practice has not been evaluated. Our objective was to evaluate the uptake and outcomes of trastuzumab in a population-based cohort of patients with oesophageal, gastroesophageal and gastric cancer in Ontario, Canada. MATERIALS AND METHODS The Ontario Cancer Registry and linked treatment records were used to identify all patients with oesophageal, gastroesophageal and gastric cancer treated with trastuzumab during 2012-2017. Outcomes were analysed from the time of first trastuzumab cycle and included a primary outcome (survival) and secondary outcomes (uptake, delivery, 30-day hospital admission and 30-day mortality). Trends over the study period and survival were evaluated. RESULTS In total, 476 patients with oesophageal, gastroesophageal and gastric cancer received trastuzumab during the study period. The mean age was 62 years, 78% (370/476) were male, and 65% (312/476) had gastric cancer. The annual number of patients receiving trastuzumab increased over the study period (53 in 2012 and 101 in 2017). The median number of cycles of trastuzumab delivered was six. Thirty-day hospital admission and mortality rates were 17% and 4%, respectively. The median overall survival was 282 days (9.3 months). CONCLUSIONS The median survival of patients treated with trastuzumab for advanced oesophageal, gastroesophageal and gastric cancer in routine practice is substantially less than that observed in the pivotal clinical trial. Studies of comparative effectiveness using real-world data offer insight into outcomes achieved in routine practice.
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Affiliation(s)
- S J Merchant
- Department of Surgery, Queen's University, Kingston, Ontario, Canada.
| | - W Kong
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | - B Gyawali
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | - T Hanna
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | - W Chung
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - S Nanji
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - S V Patel
- Department of Surgery, Queen's University, Kingston, Ontario, Canada
| | - C M Booth
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
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