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Qin S, Li J, Bai Y, Deng Y, Yang L, Xu RH, Zhong H, Chen Z, Pan H, Guo W, Shu Y, Xu J, Peng C, Chen Y, Li H, Wang N, Guo X, Peng M, Fan S, Shen L. Quality-adjusted survival in patients with metastatic colorectal cancer treated with fruquintinib in the FRESCO trial. Future Oncol 2021; 17:1923-1931. [PMID: 33563040 DOI: 10.2217/fon-2020-1215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Aim: To assess whether the survival benefit of fruquintinib is quality-adjusted. Materials & methods: Data of 416 metastatic colorectal cancer patients from the Phase III FRESCO trial were used. The Quality-adjusted Time Without Symptoms or Toxicity (Q-TWiST) analysis assessed the quality-adjusted survival benefit of fruquintinib versus placebo, accounting for freedom from symptomatic disease and from severe side effects of treatment. Results: Fruquintinib significantly improved patients' Q-TWiST (difference: 2.23 [1.41, 3.04] months) versus placebo. The Q-TWiST gain was 28.3% in the base case and ranged from 16.7 to 39.9% in the threshold analysis, favoring fruquintinib. The Q-TWiST benefit was observed in fruquintinib-treated patients regardless of prior targeted therapy. Conclusion: Fruquintinib provides a clinically meaningful quality-adjusted survival benefit versus placebo as a third-line treatment for metastatic colorectal cancer patients.
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Affiliation(s)
- Shukui Qin
- Department of Medical Oncology, Cancer Center of Jinling Hospital, Nanjing, 210029, China
| | - Jin Li
- Tongji University East Hospital, Department of Medical Oncology, Shanghai, 200120, China
| | - Yuxian Bai
- Harbin Medical University Cancer Hospital, Department of Medical Oncology, Harbin, 120081, China
| | - Yanhong Deng
- Department of Medical Oncology, The Sixth Hospital Affiliated to Sun Yat-Sen University, Guangzhou, 510655, China
| | - Lei Yang
- Nantong Tumor Hospital, Department of medical oncology, Nantong, 226361, China
| | - Rui-Hua Xu
- Department of Medical Oncology, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Haijun Zhong
- Zhejiang Cancer Hospital, Department of Medical Oncology, Hangzhou, 310022, China
| | - Zhendong Chen
- Second Hospital of Anhui Medical University, Department of Medical Oncology, Hefei, 230601, China
| | - Hongming Pan
- Sir Run Run Shaw Hospital, Department of Medical Oncology, Hangzhou, 310020, China
| | - Weijian Guo
- Fudan University Shanghai Cancer Center, Shanghai Medical College, Department of Medical Oncology, Shanghai, 200032, China
| | - Yongqian Shu
- Jiangsu Provincial Hospital, Department of Medical Oncology, Nanjing, 210029, China
| | - Jianming Xu
- 307th Hospital of Chinese PLA-The Affiliated Hospital of Military Medical Sciences, Department of Medical Oncology, Beijing, 100071, China
| | - Cike Peng
- Eli Lilly & Company China Affiliate, Lilly China Drug Development & Medical Affairs Center, Shanghai, 200041, China
| | - Yun Chen
- Eli Lilly & Company China Affiliate, Lilly China Drug Development & Medical Affairs Center, Shanghai, 200041, China
| | - Hongyan Li
- Eli Lilly & Company China Affiliate, Lilly China Drug Development & Medical Affairs Center, Shanghai, 200041, China
| | - Ning Wang
- Eli Lilly & Company China Affiliate, Lilly China Drug Development & Medical Affairs Center, Shanghai, 200041, China
| | - Xiaojun Guo
- Hutchison MediPharma Ltd, Shanghai, 201203, China
| | - Mengye Peng
- Hutchison MediPharma Ltd, Shanghai, 201203, China
| | - Songhua Fan
- Hutchison MediPharma Ltd, Shanghai, 201203, China
| | - Lin Shen
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis & Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, 100048, China
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Model-Based Cost-Effectiveness Analysis of Panitumumab Plus FOLFIRI for the Second-Line Treatment of Patients with Wild-Type Ras Metastatic Colorectal Cancer. Adv Ther 2020; 37:847-859. [PMID: 31902066 DOI: 10.1007/s12325-019-01214-y] [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: 10/24/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The NCT00339183 trial demonstrated that adding panitumumab to fluorouracil, leucovorin and irinotecan (FOLFIRI) as a second-line therapy of wild-type RAS metastatic colorectal cancer (mCRC) increases the median progression-free survival (PFS). Nevertheless, panitumumab is not yet approved in China, and the costs and outcomes of the therapy are still unclear. We estimated the cost-effectiveness of this intervention from the perspective of Chinese health care systems by constructing two pricing scenarios for panitumumab. Scenario 1: Pricing is based on the price of a similar product (cetuximab) in China. Scenario 2: We estimated the value-based price. METHODS A partitioned survival model was created based on the results of the NCT00339183 trial, which evaluated panitumumab plus FOLFIRI versus FOLFIRI. The model simulated the disease progression. We calculated medical costs from the perspectives of the Chinese health care systems. The primary outcome measures were costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). RESULTS In scenario 1, compared with FOLFIRI alone, FOLFIRI with panitumumab arm had an ICER of ¥1,539,988/QALY. The most influential factors were the mean overall survival (OS), utility before progression and cost of panitumumab. The probability of panitumumab plus FOLFIRI being cost-effective in China was 0% when the willingness-to-pay (WTP) threshold was ¥193,932/QALY. In scenario 2, when the cost of panitumumab was assumed to be ¥4032.61 or ¥5218.96 per cycle, the ICERs approximated the WTP thresholds of ¥193,932/QALY or ¥420,633/QALY, respectively. In this value-based pricing scenario, panitumumab plus FOLFIRI is estimated to be cost-effective. CONCLUSION We construct two pricing scenarios in China. In scenario 1, panitumumab plus FOLFIRI as a second-line therapy of mCRC provided an incremental benefit, but simultaneously increased costs (at the current price) even further. In scenario 2, when the value-based price was adopted, panitumumab plus FOLFIRI was estimated to be cost-effective. Our study establishes a pricing framework for new anticancer drugs to reflect the economics of drugs. TRIAL REGISTRATION NUMBER NCT00339183.
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Clinical Pharmacokinetics and Pharmacodynamics of the Epidermal Growth Factor Receptor Inhibitor Panitumumab in the Treatment of Colorectal Cancer. Clin Pharmacokinet 2019; 57:455-473. [PMID: 28853050 PMCID: PMC5856878 DOI: 10.1007/s40262-017-0590-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite progress in the treatment of metastatic colorectal cancer (mCRC) in the last 15 years, it is still a condition with a relatively low 5-year survival rate. Panitumumab, a fully human monoclonal antibody directed against the epidermal growth factor receptor (EGFR), is able to prolong survival in patients with mCRC. Panitumumab is used in different lines of therapy in combination with chemotherapy, and as monotherapy for the treatment of wild-type (WT) RAS mCRC. It is administered as an intravenous infusion of 6 mg/kg every 2 weeks and has a t½ of approximately 7.5 days. Elimination takes place via two different mechanisms, and immunogenicity rates are low. Only RAS mutations have been confirmed as a negative predictor of efficacy with anti-EGFR antibodies. Panitumumab is generally well tolerated and has a manageable toxicity profile, despite a very high prevalence of dermatologic side effects. This article presents an overview of the clinical pharmacokinetics and pharmacodynamics of panitumumab, including a description of the studies that led to its approval in the different lines of therapy of mCRC.
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Impact of Trabectedin Interruption and Subsequent Rechallenge on Progression in Patients With Advanced Soft Tissue Sarcoma. Am J Clin Oncol 2018; 41:1094-1100. [DOI: 10.1097/coc.0000000000000430] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Solem CT, Kwon Y, Shah RM, Aly A, Botteman MF. Systematic review and benchmarking of Quality-Adjusted Time Without Symptoms or Toxicity (Q-TWiST) in oncology. Expert Rev Pharmacoecon Outcomes Res 2018; 18:245-253. [PMID: 29402128 DOI: 10.1080/14737167.2018.1434414] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/26/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The Quality-Adjusted Time Without Symptoms or Toxicity (Q-TWiST) has been used to evaluate the clinical benefits and risks of oncology treatments. However, limited information is available to interpret and contextualize Q-TWiST results. AREAS COVERED A systematic review of Q-TWiST literature was conducted to provide contextualizing benchmarks for future studies. 51 articles with 81 unique Q-TWiST comparisons were identified. The mean (95% CI) and median absolute Q-TWiST gains for treatment versus control arms were 2.78 (1.82-3.73) months and 2.20 months across all cancers, respectively. The mean (median) relative Q-TWiST gains were 7.8% (7.2%) across all cancers. Most (88%) studies reported positive gains. The percentage of studies with relative Q-TWiST gains ≥10% (ie, clinically important difference) and ≥15% (ie, clearly clinically important difference) were 40.0% and 22.7%, respectively EXPERT COMMENTARY The relevance of Q-TWiST in assessing net clinical benefits of cancer therapy has not diminished, despite an arguably low number of published studies. The interest in such assessment is highlighted by the recent emergence of oncology value frameworks. The Q-TWiST should be compelling to clinicians as it integrates clinical information (ie, toxicity, relapse/progression, and survival) and patient preferences for each of these states into a single meaningful index.
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Affiliation(s)
- Caitlyn T Solem
- a Real-World Evidence and Data Analytics , Pharmerit International , Bethesda , MD , USA
| | - Youngmin Kwon
- a Real-World Evidence and Data Analytics , Pharmerit International , Bethesda , MD , USA
| | - Ruchit M Shah
- a Real-World Evidence and Data Analytics , Pharmerit International , Bethesda , MD , USA
| | - Abdalla Aly
- a Real-World Evidence and Data Analytics , Pharmerit International , Bethesda , MD , USA
| | - Marc F Botteman
- a Real-World Evidence and Data Analytics , Pharmerit International , Bethesda , MD , USA
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6
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Lin JH, Lin D, Xu L, Wang Q, Hu HH, Xu HP, He ZY. The association between clinical prognostic factors and epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) efficacy in advanced non-small-cell lung cancer patients: a retrospective assessment of 94 cases with EGFR mutations. Oncotarget 2018; 8:3412-3421. [PMID: 27926500 PMCID: PMC5356891 DOI: 10.18632/oncotarget.13787] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/22/2016] [Indexed: 11/25/2022] Open
Abstract
Objective This study aimed to examine the association of clinical prognostic factors with epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) efficacy in advanced non-small-cell lung cancer (NSCLC) patients. Methods The demographic and clinical characteristics of 94 patients with stage IV NSCLC were retrospectively reviewed, and the association between clinical factors and EGFR-TKIs efficacy was evaluated. Results Of the 94 stage IV NSCLC patients enrolled in this study, a 74.5% objective response rate (ORR) and 97.9% disease control rate (DCR) were observed for EGFR-TKIs treatment, and a higher ORR was seen in patients with 0 and 1 ECOG scores than those with 2 or greater scores (P = 0.049). The subjects had a median PFS of 11 months and a median OS of 31 months after EGFR-TKIs treatment. ECOG score and timing of targeted therapy were factors affecting PFS, and ECOG score, smoking status and brain metastasis were factors affecting OS. In addition, ECOG score was an independent prognostic factor for PFS in stage IV NSCLC patients, and the patients with EGFR 19del mutation had a longer PFS than those with exon 21 L855R mutation (P = 0.003), while ECOG score and brain metastasis were independent prognostic factors for OS. Conclusions The results of this study demonstrate that EGFR-TKI therapy results in survival benefits for EGFR-mutant advanced NSCLC patients, regardless of gender, smoking history, pathologic type, type of EGFR mutations, brain metastasis and timing of targeted therapy. ECOG score is an independent prognostic factor for PFS, and ECOG score and brain metastasis are independent prognostic factors for OS in advanced NSCLC patients.
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Affiliation(s)
- Jing-Hui Lin
- Department of Thoracic Medical Oncology, Fujian Provincial Cancer Hospital & Cancer Hospital Affiliated to Fujian Medical University, Fuzhou 350014, Fujian Province, China.,Group of Lung Cancer Treatment, Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou 350014, Fujian Province, China
| | - Dong Lin
- Department of Thoracic Medical Oncology, Fujian Provincial Cancer Hospital & Cancer Hospital Affiliated to Fujian Medical University, Fuzhou 350014, Fujian Province, China.,Group of Lung Cancer Treatment, Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou 350014, Fujian Province, China
| | - Ling Xu
- Department of Thoracic Medical Oncology, Fujian Provincial Cancer Hospital & Cancer Hospital Affiliated to Fujian Medical University, Fuzhou 350014, Fujian Province, China.,Group of Lung Cancer Treatment, Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou 350014, Fujian Province, China
| | - Qiang Wang
- Department of Thoracic Medical Oncology, Fujian Provincial Cancer Hospital & Cancer Hospital Affiliated to Fujian Medical University, Fuzhou 350014, Fujian Province, China.,Group of Lung Cancer Treatment, Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou 350014, Fujian Province, China
| | - Hui-Hua Hu
- Department of Thoracic Medical Oncology, Fujian Provincial Cancer Hospital & Cancer Hospital Affiliated to Fujian Medical University, Fuzhou 350014, Fujian Province, China.,Group of Lung Cancer Treatment, Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou 350014, Fujian Province, China
| | - Hai-Peng Xu
- Department of Thoracic Medical Oncology, Fujian Provincial Cancer Hospital & Cancer Hospital Affiliated to Fujian Medical University, Fuzhou 350014, Fujian Province, China.,Group of Lung Cancer Treatment, Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou 350014, Fujian Province, China
| | - Zhi-Yong He
- Department of Thoracic Medical Oncology, Fujian Provincial Cancer Hospital & Cancer Hospital Affiliated to Fujian Medical University, Fuzhou 350014, Fujian Province, China.,Group of Lung Cancer Treatment, Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou 350014, Fujian Province, China
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Wilson MK, Friedlander ML, Joly F, Oza AM. A Systematic Review of Health-Related Quality of Life Reporting in Ovarian Cancer Phase III Clinical Trials: Room to Improve. Oncologist 2018; 23:203-213. [PMID: 29118265 PMCID: PMC5813744 DOI: 10.1634/theoncologist.2017-0297] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/21/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Epithelial ovarian cancer (OC) remains a significant cause of morbidity and mortality for women worldwide. Patients may experience a multitude of disease- and treatment-related symptoms that can impact quality of life (QOL) and should be measured and reported in clinical trials. This systematic review investigated the adequacy of reporting of QOL in randomized phase III trials in OC in both the first-line and recurrent disease setting. MATERIALS AND METHODS A systematic review of MEDLINE and EMBASE identified randomized clinical trials of systemic therapy in OC from 1980 to 2014. The adequacy of reporting QOL was evaluated with respect to adherence to established guidelines on reporting QOL in clinical trials and the recent recommendations on the inclusion of patient-reported outcomes in clinical trials from the Fifth Ovarian Cancer Consensus Conference. RESULTS Of 3,247 abstracts, 35 studies, including 24,664 patients, met inclusion criteria. Twenty-two trials (63%) were in the first-line setting, with 13 (37%) in the recurrent setting. The inclusion of QOL assessments increased from 2% (1980s) to 62% (2010+). Quality of life was a co-primary endpoint in only one trial.Minimal clinically important differences in QOL were defined in eight trials (23%), with results included in the abstract in 37% and article in 86%. Compliance was reported in 26 trials (74%), with 13 trials (37%) reporting specifically how they dealt with missing data. Only seven trials reported the reasons for missing data (20%).Group results were published in 29 trials (83%), with 6 (17%) reporting individual patient results. Results were more commonly reported as a mean overall score (21 trials; 60%), with specific domain scores in only 9 trials (26%). No studies reported QOL beyond progression or included predefined context-specific endpoints based on objectives of treatment (i.e., palliation/cure/maintenance) and the patient population. Duration of benefit of palliative chemotherapy was reported in only one study. CONCLUSION Inclusion and reporting of QOL as a trial endpoint has improved in phase III trials in OC, but there are still significant shortfalls that need to be addressed in future trials. IMPLICATIONS FOR PRACTICE The impact of treatment on quality of life (QOL) is an important consideration in patients with ovarian cancer for whom treatment is often given with palliative intent. Both the disease and treatment impact a patient's QOL and require careful evaluation in clinical trials. Matching the QOL questions to the patient population of interest is critical. Similar rigor to that used to assess progression-based endpoints is essential to guide clinical decisions. This systematic review demonstrated that although the inclusion and reporting of QOL as a trial endpoint has improved in phase III trials there are still significant shortfalls that need to be addressed in future trials.
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Affiliation(s)
- Michelle K Wilson
- Department of Medical Oncology, Auckland City Hospital, Auckland, New Zealand
| | | | - Florence Joly
- Department of Medical Oncology, Centre Francois Baclesse, Universite Basse Normandie, INSERM U1086, Caen, France
| | - Amit M Oza
- Princess Margaret Cancer Centre, Toronto, Canada
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Management of adverse events during treatment of gastrointestinal cancers with epidermal growth factor inhibitors. Crit Rev Oncol Hematol 2017; 114:102-113. [PMID: 28477738 DOI: 10.1016/j.critrevonc.2017.03.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 12/17/2022] Open
Abstract
The epidermal growth factor receptor (EGFR) is involved in development and progression of some gastrointestinal cancers, and is targeted by monoclonal antibodies (mAbs) and tyrosine kinase inhibitors (TKIs) used to treat these conditions. Targeted agents are generally better tolerated than conventional chemotherapy, but have characteristic toxicities that can affect adherence, dosing, and outcomes. Skin conditions are the most common toxicities associated with EGFR inhibitors, particularly papulopustular rash. Other common toxicities include mucosal toxicity, electrolyte imbalances (notably hypomagnesaemia), and diarrhoea, while the chimaeric mAb cetuximab is also associated with increased risk of infusion reactions. With appropriate prophylaxis, the incidence and severity of these events can be reduced, while management strategies tailored to the patient and the degree of toxicity can help to ensure continuation of anti-cancer therapy. Here, we review the main toxicities associated with EGFR-inhibiting mAbs and TKIs in patients with gastrointestinal cancers, and provide recommendations for prophylaxis and treatment.
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Husson O, Jones RL. Q-TWiST: What really matters to the cancer patient? Cancer 2017; 123:2200-2202. [PMID: 28294292 DOI: 10.1002/cncr.30662] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/10/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Olga Husson
- Royal Marsden Hospital/Institute of Cancer Research, London, United Kingdom.,Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Robin L Jones
- Royal Marsden Hospital/Institute of Cancer Research, London, United Kingdom
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Jeong K, Cairns J. Systematic review of health state utility values for economic evaluation of colorectal cancer. HEALTH ECONOMICS REVIEW 2016; 6:36. [PMID: 27541298 PMCID: PMC4991979 DOI: 10.1186/s13561-016-0115-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 08/12/2016] [Indexed: 05/30/2023]
Abstract
Cost-utility analyses undertaken to inform decision making regarding colorectal cancer (CRC) require a set of health state utility values (HSUVs) so that the time CRC patients spend in different health states can be aggregated into quality-adjusted life-years (QALY). This study reviews CRC-related HSUVs that could be used in economic evaluation and assesses their advantages and disadvantages with respect to valuation methods used and CRC clinical pathways. Fifty-seven potentially relevant studies were identified which collectively report 321 CRC-related HSUVs. HSUVs (even for similar health states) vary markedly and this adds to the uncertainty regarding estimates of cost-effectiveness. There are relatively few methodologically robust HSUVs that can be directly used in economic evaluations concerned with CRC. There is considerable scope to develop new HSUVs which improve on those currently available either by expanded collection of generic measures or by making greater use of condition-specific data, for example, using mapping algorithms.
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Affiliation(s)
- Kim Jeong
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - John Cairns
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
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Freeman K, Connock M, Cummins E, Gurung T, Taylor-Phillips S, Court R, Saunders M, Clarke A, Sutcliffe P. Fluorouracil plasma monitoring: systematic review and economic evaluation of the My5-FU assay for guiding dose adjustment in patients receiving fluorouracil chemotherapy by continuous infusion. Health Technol Assess 2016; 19:1-321, v-vi. [PMID: 26542268 DOI: 10.3310/hta19910] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND 5-Fluorouracil (5-FU) is a chemotherapy used in colorectal, head and neck (H&N) and other cancers. Dose adjustment is based on body surface area (BSA) but wide variations occur. Pharmacokinetic (PK) dosing is suggested to bring plasma levels into the therapeutic range to promote fewer side effects and better patient outcomes. We investigated the clinical effectiveness and cost-effectiveness of the My5-FU assay for PK dose adjustment to 5-FU therapy. OBJECTIVES To systematically review the evidence on the accuracy of the My5-FU assay compared with gold standard methods [high-performance liquid chromatography (HPLC) and liquid chromatography-mass spectrometry (LC-MS)]; the effectiveness of My5-FU PK dosing compared with BSA; the effectiveness of HPLC and/or LC-MS compared with BSA; the generalisability of published My5-FU and PK studies; costs of using My5-FU; to develop a cost-effectiveness model. DATA SOURCES We searched MEDLINE, EMBASE, Science Citation Index and other databases between January and April 2014. METHODS Two reviewers independently screened titles and abstracts with arbitration and consensus agreement. We undertook quality assessment. We reconstructed Kaplan-Meier plots for progression-free survival (PFS) and overall survival (OS) for comparison of BSA and PK dosing. We developed a Markov model to compare My5-FU with BSA dosing which modelled PFS, OS and adverse events, using a 2-week cycle over a 20 year time horizon with a 3.5% discount rate. Health impacts were evaluated from the patient perspective, while costs were evaluated from the NHS and Personal Social Services perspective. RESULTS A total of 8341 records were identified through electronic searches and 35 and 54 studies were included in the clinical effectiveness and cost-effectiveness reviews respectively. There was a high apparent correlation between My5-FU, HPLC and LC-MS/mass spectrometer but upper and lower limits of agreement were -18% to 30%. Median OS were estimated as 19.6 [95% confidence interval (CI) 17.0 to 21.0] months for PK versus 14.6 (95% CI 14.1 to 15.3) months for BSA for 5-FU+folinic acid (FA); and 27.4 (95% CI 23.2 to 38.8) months for PK versus 20.6 (95% CI 18.4 to 22.9) months for BSA for FOLFOX6 in metastatic colorectal cancer (mCRC). PK versus BSA studies were generalisable to the relevant populations. We developed cost-effectiveness models for mCRC and H&N cancer. The base case assumed a cost per My5-FU assay of £ 61.03. For mCRC for 12 cycles of a oxaliplatin in combination with 5-fluorouracil and FA (FOLFOX) regimen, there was a quality-adjusted life-year (QALY) gain of 0.599 with an incremental cost-effectiveness ratio of £ 4148 per QALY. Probabilistic and scenario analyses gave similar results. The cost-effectiveness acceptability curve showed My5-FU to be 100% cost-effective at a threshold of £ 20,000 per QALY. For H&N cancer, again, given caveats about the poor evidence base, we also estimated that My5-FU is likely to be cost-effective at a threshold of £ 20,000 per QALY. LIMITATIONS Quality and quantity of evidence were very weak for PK versus BSA dosing for all cancers with no randomised controlled trials (RCTs) using current regimens. For H&N cancer, two studies of regimens no longer in use were identified. CONCLUSIONS Using a linked evidence approach, My5-FU appears to be cost-effective at a willingness to pay of £ 20,000 per QALY for both mCRC and H&N cancer. Considerable uncertainties remain about evidence quality and practical implementation. RCTs are needed of PK versus BSA dosing in relevant cancers.
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Affiliation(s)
| | - Martin Connock
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Tara Gurung
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Rachel Court
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Mark Saunders
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK
| | - Aileen Clarke
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Paul Sutcliffe
- Warwick Medical School, University of Warwick, Coventry, UK
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Skin toxicity and quality of life during treatment with panitumumab for RAS wild-type metastatic colorectal carcinoma: results from three randomised clinical trials. Qual Life Res 2016; 25:2645-2656. [PMID: 27083443 PMCID: PMC5010834 DOI: 10.1007/s11136-016-1288-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 12/19/2022]
Abstract
Purpose Epidermal growth factor receptor inhibitors such as panitumumab are associated with characteristic skin toxicities. We summarise data from three panitumumab clinical trials to investigate the potential impact of skin toxicity on quality of life (QoL) in patients with metastatic colorectal cancer (mCRC). Methods The studies were randomised, open-label trials comparing standard treatment (first-line FOLFOX4 [n = 456], second-line FOLFIRI [n = 381], or best supportive care [n = 114]) with or without panitumumab in adults with KRAS/NRAS (RAS) wild-type mCRC. QoL was assessed using the EuroQoL 5-domain health state index (HSI) and overall health rating (OHR) measures. Impact of skin toxicity on changes in QoL scores was estimated using a linear mixed-effects model. Worst skin toxicity was defined in separate models as a subgroup variable or as a measure over time. Results Regardless of analysis method, there were no statistically significant differences between the panitumumab and comparator arms in any of the studies in terms of change in HSI or OHR scores. There were no statistically significant differences in QoL outcomes between patients with worst skin toxicity grade <3 and those with grade ≥3. In addition, there were no statistically significant differences between the panitumumab and comparator arms in subgroups of patients with worst skin toxicity of grade <3 and ≥3. Conclusions Addition of panitumumab to chemotherapy in RAS wild-type mCRC has no statistically significant negative effect on overall QoL, despite skin toxicity. Skin toxicity of worst grade ≥3 appeared to have similar impact on QoL as skin toxicity of grade <3. Electronic supplementary material The online version of this article (doi:10.1007/s11136-016-1288-4) contains supplementary material, which is available to authorized users.
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Higa GM, Sypult C. Molecular Biology and Clinical Mitigation of Cancer Treatment-Induced Neuropathy. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2016; 10:27-34. [PMID: 27081324 PMCID: PMC4820064 DOI: 10.4137/cmo.s32810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 02/21/2016] [Accepted: 02/22/2016] [Indexed: 01/12/2023]
Abstract
Disruption of microtubule function is the antitumor mechanism of several classes of drugs used to treat cancer today. However, the significant beneficial effect on tumor outcomes is frequently counterbalanced by neurotoxic complications. Despite an abundance of scientific data, our under-standing of the biological mechanisms underlying this toxic reaction remains unclear, further hindering attempts to identify and develop effective preventive strategies. The primary goals of this review are to: (1) provide insight regarding the biology of the microtubule, (2) analyze the molecular and biochemical pathways that may be involved in the development of neurotoxicity, and (3) propose a unifying concept linking drug-induced neuropathy, microtubule dysfunction, and vitamin D.
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Affiliation(s)
- Gerald M Higa
- Professor of Clinical Pharmacy, Clinical Professor of Medicine, Schools of Pharmacy and Medicine, West Virginia University, Morgantown, WV, USA
| | - Corbin Sypult
- Doctor of Pharmacy Student, School of Pharmacy, West Virginia University, Morgantown, WV, USA
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Bogart E, Jouin A, Béhal H, Duhamel A, Filleron T, Kramar A. Analysis of survival adjusted for quality of life using the Q-TWiST function: Interface in R. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 125:79-87. [PMID: 26652976 DOI: 10.1016/j.cmpb.2015.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/21/2015] [Accepted: 11/08/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The analysis of treatment effects in clinical trials usually focus on efficacy and safety in separate descriptive statistical analyses. The Q-TWiST (Quality adjusted Time Without Symptoms and Toxicity) method has been proposed by Gelber in the 90s to enable a statistical comparison between two groups with a graphical representation by incorporating benefit and risk into a single analysis. Although the method has been programmed in SAS, it is rarely used. The availability of the method in the freely software environment system like R would greatly enhanced the accessibility by researchers. The objective of this paper is to present a program for Q-TWiST analyses within R software environment. METHODS The qtwist function was developed in order to estimate and compare Q-TWiST for two groups. Two individual patient data files are required used for input: one for visits and one for follow-up. Q-TWiST is obtained as a sum of time spent in three health states: period in toxicity (TOX), period without relapse and toxicity (TWiST) and period in relapse (REL), weighted by associated utility scores restricted to median overall survival for example. The bootstrap method is used for testing statistical significance. Threshold analysis and gain functions allow a group comparison for different utility values. RESULTS Input data is checked for consistency. Descriptive statistics and mean durations for each health state are provided, allowing statistical comparisons. Graphical results are presented in a PDF file. The use of the function is illustrated with data from a simulated data set and a randomized clinical trial. CONCLUSIONS qtwist is an easy to use R function, allowing a quality adjusted survival analysis with the Q-TWiST method.
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Affiliation(s)
- Emilie Bogart
- Methodology and Biostatistics Unit, Centre Oscar Lambret, Lille and SIRIC ONCOLille, France.
| | - Anaïs Jouin
- Methodology and Biostatistics Unit, Centre Oscar Lambret, Lille and SIRIC ONCOLille, France
| | - Hélène Béhal
- Methodology and Biostatistics Unit, EA2694, UDSL2, Univ Lille Nord de France, CHRU Lille and SIRIC ONCO Lille, France
| | - Alain Duhamel
- Methodology and Biostatistics Unit, EA2694, UDSL2, Univ Lille Nord de France, CHRU Lille and SIRIC ONCO Lille, France
| | - Thomas Filleron
- Institut Claudius Regaud, IUCT-O, Bureau des Essais Cliniques, Cellule Biostatistique, Toulouse F-31059, France
| | - Andrew Kramar
- Methodology and Biostatistics Unit, Centre Oscar Lambret, Lille and SIRIC ONCOLille, France
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15
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Bentley TGK, Schroeder BE, Schnabel CA, Erlander MG, Hsiao WC, Ortendahl JD, Broder MS. Cost effectiveness of a 92-gene assay for the diagnosis of metastatic cancer. J Med Econ 2014; 17:527-37. [PMID: 24689556 DOI: 10.3111/13696998.2014.909817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To estimate the clinical and economic trade-offs involved in using a molecular assay (92-gene assay, CancerTYPE ID) to aid in identifying the primary site of difficult-to-diagnose metastatic cancers and to explore whether the 92-gene assay can be used to standardize the diagnostic process and costs for clinicians, patients, and payers. METHODS Four decision-analytic models were developed to project the lifetime clinical and economic impact of incorporating the 92-gene assay compared with standard care alone. For each model, total and incremental costs, life-years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and the proportion of patients treated correctly versus incorrectly were projected from the payer perspective. Model inputs were based on published literature, analyses of SEER (Surveillance Epidemiology and End RESULTS) data, publicly available data, and interviews with clinical experts. RESULTS In all four models, the 92-gene assay increased the proportion of patients treated correctly, decreased the proportion of patients treated with empiric therapy, and increased quality-adjusted survival. In the primary model, the ICER was $50,273/QALY; thus, the 92-gene assay is therefore cost effective when considering a societal willingness-to-pay threshold of $100,000/QALY. These findings were robust across sensitivity analyses. CONCLUSIONS Use of the 92-gene assay for diagnosing metastatic tumors of uncertain origin is associated with reduced misdiagnoses, increased survival, and improved quality of life. Incorporating the assay into current practice is a cost-effective approach to standardizing diagnostic methods while improving patient care. Limitations of this analysis are the lack of data availability and resulting modeling simplifications, although sensitivity analyses showed these to not be key drivers of results.
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Affiliation(s)
- Tanya G K Bentley
- Partnership for Health Analytic Research LLC , Beverly Hills, CA , USA
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16
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Tate WR, Skrepnek GH. Quality-adjusted time without symptoms or toxicity (Q-TWiST): patient-reported outcome or mathematical model? A systematic review in cancer. Psychooncology 2014; 24:253-61. [PMID: 24917078 DOI: 10.1002/pon.3595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 05/09/2014] [Accepted: 05/16/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Successful cancer treatment is defined as an increase in overall survival and/or progression-free survival. Despite their importance, these metrics omit patient quality of life. Quality-adjusted time without symptoms or toxicity (Q-TWiST) was developed to adjust survival gained, accounting for quality of life. The purpose of this systematic review was to assess the methods reported in cancer literature to determine Q-TWiST values and how these are currently translated to the clinic. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used to conduct a systematic review of studies indexed on MEDLINE and Web of Science through April 2013. Cancer studies that measured Q-TWiST either as a primary outcome or retrospectively and determined utility coefficients from a patient population were identified, and their methods reviewed to determine how the utility coefficient was calculated. Additionally, other relevant factors such as definitions of health states and significant findings were collected and summarized. RESULTS Out of 284 studies, 11 were identified that calculated patient-defined utility coefficients. Several methods to determine utility coefficients were reported, and multiple definitions of health state toxicity were applied. Of these studies, seven reported significant differences (p < 0.05) in quality-adjusted survival. No studies, however, directly discussed the clinical relevance of their findings. CONCLUSIONS Currently, Q-TWiST is utilized as a mathematical theory rather than a clinical tool. Standardization of terminology plus reliability and validity testing of determining both utility coefficients and time frame definitions must be performed before Q-TWiST can become clinically useful to physicians and patients alike for making treatment decisions.
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Affiliation(s)
- Wendy R Tate
- College of Pharmacy, The University of Arizona, Tucson, AZ, USA; The University of Arizona Cancer Center, The University of Arizona, Tucson, AZ, USA
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17
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Q-TWiST analysis comparing ipilimumab/dacarbazine vs placebo/dacarbazine for patients with stage III/IV melanoma. Br J Cancer 2013; 109:8-13. [PMID: 23787916 PMCID: PMC3708560 DOI: 10.1038/bjc.2013.298] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: Study CA184024 was a multinational, randomised, double-blind, phase 3 study comparing ipilimumab/dacarbazine (DTIC) vs placebo/DTIC in patients with untreated stage III/IV melanoma, which showed that ipilimumab significantly improves survival in patients with metastatic melanoma. The objective of this analysis was to compare the quality-adjusted survival experience among patients in this trial. Methods: Survival time was partitioned into health states: toxicity, time before progression without toxicity, and relapse until death or end of follow-up. Q-TWiST (quality-adjusted time without symptoms of disease or toxicity of treatment) was calculated as the utility-weighted sum of the mean health state durations. Analyses were repeated over extended follow-up periods. Results: Based on a combination of trial-based and external utility scores, the Q-TWiST difference in this trial was 0.50 months (P=0.0326) favoring ipilimumab after 1 year. The Q-TWiST difference was 1.5 months with 2 years of follow-up (P=0.0091), 2.36 months at 3 years (P=0.005) and 3.28 months at 4 years (P=0.0074). Conclusion: During the first year of study, there was little difference between groups in quality-adjusted survival. However, after 2, 3 and 4 years follow-up for patients with extended survival, the benefits of IPI+DTIC vs PLA+DTIC for advanced melanoma continue to accrue.
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Colon Cancer Liver Metastasis: Addition of Antiangiogenesis or EGFR Inhibitors to Chemotherapy. CURRENT COLORECTAL CANCER REPORTS 2013. [DOI: 10.1007/s11888-012-0148-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Adelstein DJ, Ridge JA, Brizel DM, Holsinger FC, Haughey BH, O'Sullivan B, Genden EM, Beitler JJ, Weinstein GS, Quon H, Chepeha DB, Ferris RL, Weber RS, Movsas B, Waldron J, Lowe V, Ramsey S, Manola J, Yueh B, Carey TE, Bekelman JE, Konski AA, Moore E, Forastiere A, Schuller DE, Lynn J, Ullmann CD. Transoral resection of pharyngeal cancer: summary of a National Cancer Institute Head and Neck Cancer Steering Committee Clinical Trials Planning Meeting, November 6-7, 2011, Arlington, Virginia. Head Neck 2012; 34:1681-703. [PMID: 23015475 PMCID: PMC7721598 DOI: 10.1002/hed.23136] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2012] [Indexed: 11/10/2022] Open
Abstract
Recent advances now permit resection of many pharyngeal tumors through the open mouth, an approach that can greatly reduce the morbidity of surgical exposure. These transoral techniques are being rapidly adopted by the surgical community and hold considerable promise. On November 6-7, 2011, the National Cancer Institute sponsored a Clinical Trials Planning Meeting to address how to further investigate the use of transoral surgery, both in the good prognosis human papillomavirus (HPV)-initiated oropharyngeal cancers, and in those with HPV-unrelated disease. The proceedings of this meeting are summarized.
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Govaert KM, van Kessel CS, Lolkema M, Ruers TJM, Borel Rinkes IHM. Does Radiofrequency Ablation Add to Chemotherapy for Unresectable Liver Metastases? CURRENT COLORECTAL CANCER REPORTS 2012; 8:130-137. [PMID: 22611343 PMCID: PMC3343230 DOI: 10.1007/s11888-012-0122-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In patients with unresectable colorectal liver metastases (CRLM), radiofrequency ablation (RFA) might be a good alternative, whenever possible. In contrast to systemic therapy, the aim of RFA is to achieve complete local tumor control in an attempt to provide long-term survival. In this article we discuss the available evidence regarding the treatment of patients with unresectable CRLM, focusing on RFA in conjunction with modern systemic therapies. We observed that the available evidence in the existing literature is limited, and often consists of level 2 and 3 evidence, thereby hampering any firm conclusions. Nonetheless, RFA seems superior to chemotherapy alone in patients with liver-only disease amenable for RFA. However, the combination of RFA and chemotherapy has been demonstrated to be feasible and safe, lending support to the concept of RFA followed by chemotherapy, in order to reduce local recurrence rates and prolong survival.
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Affiliation(s)
- Klaas M. Govaert
- Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX Utrecht, the Netherlands
| | - Charlotte S. van Kessel
- Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX Utrecht, the Netherlands
| | - Martijn Lolkema
- Department of Medical Oncology, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX Utrecht, the Netherlands
| | - Theo J. M. Ruers
- Department of Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX Amsterdam, the Netherlands
| | - Inne H. M. Borel Rinkes
- Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584CX Utrecht, the Netherlands
- Department of Surgery, University Medical Center Utrecht, Room G04-228, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Identification of a novel marker associated with risk for delayed chemotherapy-induced vomiting. Support Care Cancer 2012; 20:2803-9. [DOI: 10.1007/s00520-012-1402-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 02/03/2012] [Indexed: 10/28/2022]
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