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Pharmacoepidemiology for oncology clinical practice: Foundations, state of the art and perspectives. Therapie 2022; 77:229-240. [DOI: 10.1016/j.therap.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/23/2021] [Indexed: 11/20/2022]
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Liu Q, Zhou Z, Luo X, Yi L, Peng L, Wan X, Tan C, Zeng X. First-Line ICI Monotherapies for Advanced Non-small-cell Lung Cancer Patients With PD-L1 of at Least 50%: A Cost-Effectiveness Analysis. Front Pharmacol 2022; 12:788569. [PMID: 34992538 PMCID: PMC8724566 DOI: 10.3389/fphar.2021.788569] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 12/06/2021] [Indexed: 12/25/2022] Open
Abstract
Objective: Three immune checkpoint inhibitors (ICIs), pembrolizumab, atezolizumab and cemiplimab, have been successively approved as first-line treatments for advanced non-small-cell lung cancer (NSCLC) patients with programmed cell death ligand 1(PD-L1) expression of at least 50%. This study was designed to compare the cost-effectiveness of these three novel therapies in this patient population. Material and Methods: Using Markov model and network meta-analysis, we conducted separate cost-effectiveness analyses for cemiplimab, pembrolizumab and atezolizumab among advanced NSCLC patients with PD-L1 of at least 50% from the United States health care sector perspective. Health states included progression-free survival, progressive disease, end-stage disease, and death. Clinical efficacy and safety data were derived from phase III clinical trials and health state utilities and costs data were collected from published resources. Two scenario analyses were conducted to assess the impact of varying subsequent anticancer therapies on the cost-effectiveness of these 3 ICIs and cost-effectiveness of pembrolizumab combined with chemotherapy versus these 3 first-line ICI monotherapies. Results: In base case analysis, cemiplimab compared with pembrolizumab was associated with a gain of 0.44 quality-adjusted life-years (QALYs) and an increased cost of $23,084, resulting in an incremental cost-effectiveness ratio (ICER) of $52,998/QALY; cemiplimab compared with atezolizumab was associated with a gain of 0.13 QALYs and a decreased cost of $104,642, resulting in its dominance of atezolizumab. The first scenario analysis yielded similar results as our base case analysis. The second scenario analysis founded the ICERs for pembrolizumab plus chemotherapy were $393,359/QALY, $190,994/QALY and $33,230/QALY, respectively, compared with cemiplimab, pembrolizumab and atezolizumab. Conclusion: For advanced NSCLC patients with PD-L1 of at least 50%, cemiplimab was a cost-effective option compared with pembrolizumab and a dominant alternative against atezolizumab. Our scenario analysis results supported the cemiplimab plus chemotherapy as a second-line therapy and suggested an extended QALY but overwhelming cost linking to pembrolizumab plus chemotherapy.
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Affiliation(s)
- Qiao Liu
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Xia Luo
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lidan Yi
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Liubao Peng
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaomin Wan
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chongqing Tan
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaohui Zeng
- Department of Nuclear Medicine/PET Image Center, The Second Xiangya Hospital of Central South University, Changsha, China
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Wang LT, Lee YW, Bai CH, Chiang HC, Wang HH, Yen BL, Yen ML. A Rapid and Highly Predictive in vitro Screening Platform for Osteogenic Natural Compounds Using Human Runx2 Transcriptional Activity in Mesenchymal Stem Cells. Front Cell Dev Biol 2021; 8:607383. [PMID: 33537299 PMCID: PMC7849832 DOI: 10.3389/fcell.2020.607383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/03/2020] [Indexed: 12/27/2022] Open
Abstract
The rapid aging of worldwide populations had led to epidemic increases in the incidence of osteoporosis (OP), but while treatments are available, high cost, adverse effects, and poor compliance continue to be significant problems. Naturally occurring plant-based compounds including phytoestrogens can be good and safe candidates to treat OP, but screening for osteogenic capacity has been difficult to achieve, largely due to the requirement of using primary osteoblasts or mesenchymal stem cells (MSCs), the progenitors of osteoblasts, to conduct time-consuming in vitro and in vivo osteogenic assay. Taking advantage of MSC osteogenic capacity and utilizing a promoter reporter assay for Runx2, the master osteogenesis transcription factor, we developed a rapid in vitro screening platform to screen osteogenic small molecules including natural plant-based compounds. We screened eight plant-derived compounds from different families including flavonoids, polyphenolic compounds, alkaloids, and isothiocyanates for osteogenic capacity using the human RUNX2-promoter luciferase reporter (hRUNX2-luc) transduced into the mouse MSC line, C3H10T1/2, with daidzein-a well-studied osteogenic phytoestrogen-as a positive control. Classical in vitro and in vivo osteogenesis assays were performed using primary murine and human bone marrow MSCs (BMMSCs) to validate the accuracy of this rapid screening platform. Using the MSC/hRUNX2-luc screening platform, we were able not only to shorten the selection process for osteogenic compounds from 3∼4 weeks to just a few days but also simultaneously perform comparisons between multiple compounds to assess relative osteogenic potency. Predictive analyses revealed nearly absolute correlation of the MSC/hRUNX2-luc reporter platform to the in vitro classical functional assay of mineralization using murine BMMSCs. Validation using human BMMSCs with in vitro mineralization and in vivo osteogenesis assays also demonstrated nearly absolute correlation to the MSC/hRUNX2-luc reporter results. Our findings therefore demonstrate that the MSC/hRUNX2 reporter platform can accurately, rapidly, and robustly screen for candidate osteogenic compounds and thus be relevant for therapeutic application in OP.
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Affiliation(s)
- Li-Tzu Wang
- Department of Obstetrics and Gynecology, National Taiwan University (NTU) Hospital and College of Medicine, Taipei, Taiwan
| | - Yu-Wei Lee
- Regenerative Medicine Research Group, Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hui-Chun Chiang
- Department of Obstetrics and Gynecology, National Taiwan University (NTU) Hospital and College of Medicine, Taipei, Taiwan
| | - Hsiu-Huan Wang
- Regenerative Medicine Research Group, Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan, Taiwan
| | - B. Linju Yen
- Regenerative Medicine Research Group, Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan, Taiwan
- Department of Obstetrics and Gynecology, Cathay General Hospital Shiji, New Taipei City, Taiwan
| | - Men-Luh Yen
- Department of Obstetrics and Gynecology, National Taiwan University (NTU) Hospital and College of Medicine, Taipei, Taiwan
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Schirrmacher V, Sprenger T, Stuecker W, Van Gool SW. Evidence-Based Medicine in Oncology: Commercial Versus Patient Benefit. Biomedicines 2020; 8:biomedicines8080237. [PMID: 32717895 PMCID: PMC7460025 DOI: 10.3390/biomedicines8080237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022] Open
Abstract
At times of personalized and individualized medicine the concept of randomized- controlled clinical trials (RCTs) is being questioned. This review article explains principles of evidence-based medicine in oncology and shows an example of how evidence can be generated independently from RCTs. Personalized medicine involves molecular analysis of tumor properties and targeted therapy with small molecule inhibitors. Individualized medicine involves the whole patient (tumor and host) in the context of immunotherapy. The example is called Individualized Multimodal Immunotherapy (IMI). It is based on the individuality of immunological tumor-host interactions and on the concept of immunogenic tumor cell death (ICD) induced by an oncolytic virus. The evidence is generated by systematic data collection and analysis. The outcome is then shared with the scientific and medical community. The priority of big pharma studies is commercial benefit. Methods used to achieve this are described and have damaged the image of RCT studies in general. A critical discussion is recommended between all partners of the medical health system with regard to the conduct of RCTs by big pharma companies. Several clinics and institutions in Europe try to become more independent from pharma industry and to develop their own modern cancer therapeutics. Medical associations should include references to such studies from personalized and individualized medicine in their guidelines.
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Sprenger T, Schirrmacher V, Stücker W, van Gool SW. Position paper: new insights into the immunobiology and dynamics of tumor-host interactions require adaptations of clinical studies. Expert Rev Anticancer Ther 2020; 20:639-646. [PMID: 32600076 DOI: 10.1080/14737140.2020.1785874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Prospective double-blind placebo-controlled randomized clinical trials (RCTs) are considered standard for the proof of the efficacy of oncologic therapies. Molecular methods have provided new insights into tumor biology and led to the development of targeted therapies. Due to the increasing complexity of molecular tumor characteristics and of the individuality of specific anti-tumor immune reactivity, RCTs are unfortunately only of limited use. AREAS COVERED The historical methods of drug research and approval and the related practices of reimbursement by statutory and private health insurance companies are being questioned. New, innovative methods for the documentation of evidence in personalized medicine will be addressed. Possible perspectives and new approaches are discussed, in particular with regard to glioblastoma. EXPERT OPINION Highly specialized translational oncology groups like the IOZK can contribute to medical progress and quick transfer 'from bench to bedside.' Their contribution should be acknowledged and taken into account more strongly in the development of guidelines and the reimbursement of therapy costs. Methodological plurality should be encouraged.
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Diaz-Garelli F, Strowd R, Lawson VL, Mayorga ME, Wells BJ, Lycan TW, Topaloglu U. Workflow Differences Affect Data Accuracy in Oncologic EHRs: A First Step Toward Detangling the Diagnosis Data Babel. JCO Clin Cancer Inform 2020; 4:529-538. [PMID: 32543899 PMCID: PMC7331128 DOI: 10.1200/cci.19.00114] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Diagnosis (DX) information is key to clinical data reuse, yet accessible structured DX data often lack accuracy. Previous research hints at workflow differences in cancer DX entry, but their link to clinical data quality is unclear. We hypothesized that there is a statistically significant relationship between workflow-describing variables and DX data quality. METHODS We extracted DX data from encounter and order tables within our electronic health records (EHRs) for a cohort of patients with confirmed brain neoplasms. We built and optimized logistic regressions to predict the odds of fully accurate (ie, correct neoplasm type and anatomic site), inaccurate, and suboptimal (ie, vague) DX entry across clinical workflows. We selected our variables based on correlation strength of each outcome variable. RESULTS Both workflow and personnel variables were predictive of DX data quality. For example, a DX entered in departments other than oncology had up to 2.89 times higher odds of being accurate (P < .0001) compared with an oncology department; an outpatient care location had up to 98% fewer odds of being inaccurate (P < .0001), but had 458 times higher odds of being suboptimal (P < .0001) compared with main campus, including the cancer center; and a DX recoded by a physician assistant had 85% fewer odds of being suboptimal (P = .005) compared with those entered by physicians. CONCLUSION These results suggest that differences across clinical workflows and the clinical personnel producing EHR data affect clinical data quality. They also suggest that the need for specific structured DX data recording varies across clinical workflows and may be dependent on clinical information needs. Clinicians and researchers reusing oncologic data should consider such heterogeneity when conducting secondary analyses of EHR data.
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Affiliation(s)
- Franck Diaz-Garelli
- University of North Carolina at Charlotte, Charlotte, NC
- Wake Forest School of Medicine, Winston Salem, NC
| | - Roy Strowd
- Wake Forest School of Medicine, Winston Salem, NC
| | - Virginia L. Lawson
- University of North Carolina at Charlotte, Charlotte, NC
- Wake Forest School of Medicine, Winston Salem, NC
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Abstract
Pragmatic or practice-oriented comparative effectiveness trials may be conducted to fill the evidence gaps that are revealed after the private sector has performed the trials needed for bringing their product to the market. A tool of increasing importance to identify such evidence gaps is resulting from health technology assessments (HTA) whereby the data derived from clinical research are examined in a systematic manner with reference to effect, safety, as well as additional parameters. Practice-oriented trials are informative for healthcare decision makers, practice-changing and may even be cost-saving for the healthcare payers. There are however only a limited number of funding sources for such trials. Public and private healthcare payers should stimulate the conduct of practice-oriented trials in their effort to maximize patient benefit within the limitation of the available resources. Pragmatic randomized trials can be performed at low cost when based on existing coded electronic health records and as well health registries. Public health decision makers are increasingly taking advantage of results from health technology assessments to support priority setting. In accordance with this it would appear reasonable that decision makers should get more involved in priority setting and funding also in the field of clinical research in order to provide further evidence needed for assessments, reassessments, and subsequent qualified decisions and resource allocations in health care. A closer dialogue and collaboration between the clinical research and HTA communities would facilitate a more efficient utilization of such opportunities.
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Nevens H, Harrison J, Vrijens F, Verleye L, Stocquart N, Marynen E, Hulstaert F. Budgeting of non-commercial clinical trials: development of a budget tool by a public funding agency. Trials 2019; 20:714. [PMID: 31829233 PMCID: PMC6907219 DOI: 10.1186/s13063-019-3900-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/08/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Investigator-led multicentre randomised trials are essential to generate evidence on the optimal use of medical interventions. These non-commercial trials are often hampered by underfunding, which may lead to difficulties in gathering a team with the necessary expertise, a delayed trial start, slow recruitment and even early trial discontinuation. As a new public funder of pragmatic clinical trials, the KCE Trials programme was committed to correctly pay all trial activities in order to assure timely delivery of high-quality trial results. As no appropriate trial budget tool was readily publicly available that took into account the costs for the sponsor as well as the costs for participating sites, we developed a tool to make the budgeting of a clinical trial efficient, transparent and fair across applicants. METHODS All trial-related activities of the sponsor and sites were categorised, and cost drivers were identified. All elements were included in a spreadsheet tool allowing the sponsor team to calculate in detail the various activities of a clinical trial and to appreciate the budget impact of specific cost drivers, e.g. a delay in recruitment. Hourly fees by role were adapted from published data. Fixed amounts per activity were developed when appropriate. RESULTS This publicly available tool has already been used for 17 trials funded since the start of the KCE Trials programme in 2016, and it continues to be used and improved. This budget tool is used together with additional risk-reducing measures such as a multistep selection process with advance payments, a recruitment feasibility check by sponsor and funder, a close monitoring of study progress and a milestone-based payment schedule with the last payment made when the manuscript is submitted. CONCLUSIONS The budget tool helps the KCE Trials programme to answer relevant research questions in a timely way, within budget and with high quality, a necessary condition to achieve impact of this programme for patients, clinical practice and healthcare payers.
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Affiliation(s)
- Hilde Nevens
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium.
| | - Jillian Harrison
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - France Vrijens
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - Leen Verleye
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - Nelle Stocquart
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - Elisabeth Marynen
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
| | - Frank Hulstaert
- Belgian Healthcare Knowledge Centre - KCE, Kruidtuinlaan 55, 1000, Brussel, Belgium
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Durán CE, Elseviers M, Vander Stichele R, Rottey S, Granja P, Christiaens T. Policies influencing access to new targeted oncologic drugs in Ecuadorian hospitals: an interrupted time series analysis. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2019. [DOI: 10.1111/jphs.12317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Carlos E. Durán
- Heymans Institute of Pharmacology Ghent University GhentBelgium
| | | | | | - Sylvie Rottey
- Heymans Institute of Pharmacology Ghent University GhentBelgium
- Drug Research Unit GhentGhent University Hospital GhentBelgium
- Department of Medical Oncology Ghent University Hospital Ghent Belgium
| | - Patricia Granja
- Faculty of Medicine Universidad Mayor de San Simón Cochabamba Bolivia
- Public Health Institute Catholic University of Ecuador Quito Ecuador
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Agrawal S, Woźniak M, Łuc M, Makuch S, Pielka E, Agrawal AK, Wietrzyk J, Banach J, Gamian A, Pizon M, Ziółkowski P. Insulin enhancement of the antitumor activity of chemotherapeutic agents in colorectal cancer is linked with downregulating PIK3CA and GRB2. Sci Rep 2019; 9:16647. [PMID: 31719636 PMCID: PMC6851401 DOI: 10.1038/s41598-019-53145-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 06/21/2019] [Indexed: 12/22/2022] Open
Abstract
The present state of cancer chemotherapy is unsatisfactory. New anticancer drugs that marginally improve the survival of patients continue to be developed at an unsustainably high cost. The study aimed to elucidate the effects of insulin (INS), an inexpensive drug with a convincing safety profile, on the susceptibility of colon cancer to chemotherapeutic agents: 5-fluorouracil (FU), oxaliplatin (OXA), irinotecan (IRI), cyclophosphamide (CPA) and docetaxel (DOC). To examine the effects of insulin on cell viability and apoptosis, we performed an in vitro analysis on colon cancer cell lines Caco-2 and SW480. To verify the results, we performed in vivo analysis on mice bearing MC38 colon tumors. To assess the underlying mechanism of the therapy, we examined the mRNA expression of pathways related to the signaling downstream of insulin receptors (INSR). Moreover, we performed Western blotting to confirm expression patterns derived from the genetic analysis. For the quantification of circulating tumor cells in the peripheral blood, we used the maintrac method. The results of our study show that insulin-pretreated colon cancer cells are significantly more susceptible to commonly used chemotherapeutics. The apoptosis ratio was also enhanced when INS was administered complementary to the examined drugs. The in vivo study showed that the combination of INS and FU resulted in significant inhibition of tumor growth and reduction of the number of circulating tumor cells. This combination caused a significant downregulation of the key signaling substrates downstream of INSR. The results indicate that the downregulation of PIK3CA (phosphatidylinositol 3-kinase catalytic subunit alpha), which plays a critical role in cell signaling and GRB2 (growth factor receptor-bound protein 2), a regulator of cell proliferation and differentiation may be responsible for the sensitizing effect of INS. These findings were confirmed at protein levels by Western blotting. In conclusion, these results suggest that INS might be potentially applied to clinical use to enhance the therapeutic effectiveness of chemotherapeutic drugs. The findings may become a platform for the future development of new and inexpensive strategies for the clinical chemotherapy of tumors.
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Affiliation(s)
- Siddarth Agrawal
- Department of Pathology, Wroclaw Medical University, Wroclaw, Poland.
| | - Marta Woźniak
- Department of Pathology, Wroclaw Medical University, Wroclaw, Poland
| | - Mateusz Łuc
- Department of Pathology, Wroclaw Medical University, Wroclaw, Poland
| | - Sebastian Makuch
- Department of Pathology, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa Pielka
- Department of Pathology, Wroclaw Medical University, Wroclaw, Poland
| | - Anil Kumar Agrawal
- 2nd Department and Clinic of General and Oncological Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Joanna Wietrzyk
- Department of Experimental Oncology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Joanna Banach
- Department of Experimental Oncology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland
| | - Andrzej Gamian
- Department of Biochemistry, Wroclaw Medical University, Wroclaw, Poland
| | - Monika Pizon
- Transfusion Center Bayreuth, Kurpromenade 2, 95448, Bayreuth, Germany
| | - Piotr Ziółkowski
- Department of Pathology, Wroclaw Medical University, Wroclaw, Poland
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Chamberlain C, Sullivan R. Weighing false hope in population anticancer drug decision making. Ann Oncol 2019; 30:10-11. [PMID: 30462161 DOI: 10.1093/annonc/mdy508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- C Chamberlain
- Population Health Sciences, University of Bristol, Bristol.
| | - R Sullivan
- Institute of Cancer Policy, Kings Health Partners Integrated Cancer Centre, London, UK
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12
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Ma CKK, Danta M, Day R, Ma DDF. Dealing with the spiralling price of medicines: issues and solutions. Intern Med J 2018; 48:16-24. [PMID: 29068529 DOI: 10.1111/imj.13652] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 10/11/2017] [Accepted: 10/19/2017] [Indexed: 11/30/2022]
Abstract
Escalating cost of medicines is rapidly becoming a serious threat to patients and health systems. This trend has been documented to impact patient outcomes adversely. As clinicians and tax payers, it is our responsibility to be aware of the potential detrimental effects spiralling costs have on our patients, our community and our health system and to mitigate these effects by exposing this issue to our respective professional societies, representatives of the pharmaceutical companies that we interact with, government regulatory bodies and to patients who we are caring for. Only through understanding and constructive actions will we be able to provide the best quality of care to our patients and continue to enjoy universal healthcare in our country.
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Affiliation(s)
- Chun K K Ma
- Department of Haematology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Danta
- St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Department of Gastroenterology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Richard Day
- St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - David D F Ma
- Department of Haematology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Giacalone NJ, Milani N, Rawal B, Catalano PJ, Nguyen PL, Schoenfeld JD, Tishler RB, Margalit DN. Funding Support and Principal Investigator Leadership of Oncology Clinical Trials Using Radiation Therapy. Int J Radiat Oncol Biol Phys 2018; 102:34-43. [PMID: 29970311 DOI: 10.1016/j.ijrobp.2018.05.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 05/15/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Sources of funding and principal investigator (PI) leadership for clinical trials using radiation therapy (RT) are not well characterized but are important mediators of innovation, particularly because funding for trials from the National Institutes of Health (NIH) has decreased and industry funding has increased. We sought to determine characteristics of trials using RT that are associated with industry funding, NIH funding, and radiation oncologist (RO) PI leadership. METHODS AND MATERIALS www.ClinicalTrials.gov was queried for all open, interventional trials that administered RT. Logistic regression was used to identify associations between trial characteristics, receipt of funding type (NIH, industry, or other), and PI leadership. RESULTS The authors identified 1469 oncology trials, of which 41% were based in the United States, 56% were based internationally, and 3% were based in the United States and internationally. Of these, 22% were RT monotherapy, 53% were bimodality (40% RT + drug, 13% RT + surgery), and 24% were trimodality. Although ROs led 60% of all trials, industry-sponsored trials were significantly less likely to have RO PIs (35% RO vs 65% non-RO PI; adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.28-0.73), to fund trials that did not incorporate drug therapy (aOR, 0.19; 95% CI, 0.10-0.35), or to fund phase III trials (aOR, 0.25; 95% CI, 0.11-0.60) because industry-sponsored trials favored smaller phase I trials. NIH-funded trials were not associated with PI type and, although not statistically significant, favored larger phase III trials (unadjusted OR, 2.06; 95% CI, 0.99-4.29). ROs were less likely to lead trials incorporating drug therapy (aOR, 0.30; 95% CI, 0.22-0.41). CONCLUSIONS ROs are less likely than other specialties to lead trials that use RT in combination with drug therapy or surgery and more likely to lead trials supported by nonindustry, non-NIH funding. This suggests a need for ROs to lead multimodality trials and to consider opportunities to interact with industry. As NIH resources decrease, alternative funding is needed to support innovation, particularly in in RT-alone trials.
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Affiliation(s)
- Nicholas J Giacalone
- Harvard Radiation Oncology Program, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nastaran Milani
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Bhupendra Rawal
- Department of Biostatistics & Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Paul J Catalano
- Department of Biostatistics & Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Roy B Tishler
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Danielle N Margalit
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts.
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14
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Gross CP, Gluck AR. Soaring Cost of Cancer Treatment: Moving Beyond Sticker Shock. J Clin Oncol 2018; 36:305-307. [DOI: 10.1200/jco.2017.76.0488] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Cary P. Gross
- Cary P. Gross, Yale School of Medicine, Yale University, New Haven, CT; and Abbe R. Gluck, Yale Law School, Yale University, New Haven, CT
| | - Abbe R. Gluck
- Cary P. Gross, Yale School of Medicine, Yale University, New Haven, CT; and Abbe R. Gluck, Yale Law School, Yale University, New Haven, CT
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Matsumoto T, Hatakeyama S, Ookubo T, Mitsuzuka K, Narita S, Inoue T, Yamashita S, Narita T, Koie T, Kawamura S, Tochigi T, Tsuchiya N, Habuchi T, Arai Y, Ohyama C. Cost-effectiveness comparison between neoadjuvant chemohormonal therapy and extended pelvic lymph node dissection in high-risk prostate cancer patients treated with radical prostatectomy: a multi-institutional analysis. Med Oncol 2017; 34:190. [PMID: 29090390 DOI: 10.1007/s12032-017-1050-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/23/2017] [Indexed: 12/19/2022]
Abstract
The aim of the present study was to assess the cost-effectiveness of extended pelvic lymph node dissection (ePLND) compared to neoadjuvant chemohormonal therapy using gonadotropin-releasing hormone agonist/antagonist and estramustine. We retrospectively analyzed data within Michinoku Urological Cancer Study Group database containing 2971 PC patients treated with radical prostatectomy (RP) at four institutes between July 1996 and July 2017. We identified 237 and 403 high-risk patients who underwent RP and ePLND (ePLND group), and neoadjuvant chemohormonal therapy followed by RP and limited PLND (neoadjuvant group), respectively. The oncological outcomes and cost-effectiveness were compared between groups. Medical cost calculation focused on PC-related medication and adjuvant radiotherapy. Biochemical recurrence-free and overall survival rates in the neoadjuvant group were significantly higher than those in the ePLND group. Significantly higher number of patients progressed to castration-resistant PC in the ePLND group than in the neoadjuvant group. Background-adjusted multivariate Cox regression analysis using inverse probability of treatment weighting (IPTW) revealed that neoadjuvant chemohormonal therapy independently reduced the risk of biochemical recurrence after RP. The 5-year cost per person was significantly higher in the ePLND group than in the neoadjuvant group. Although the present study was retrospective, neoadjuvant chemohormonal therapy followed by RP as a concurrent strategy has potential to improve oncological outcome and cost-effectiveness.
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Affiliation(s)
- Teppei Matsumoto
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan.
| | - Teppei Ookubo
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koji Mitsuzuka
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shintaro Narita
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Takamitsu Inoue
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shinichi Yamashita
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takuma Narita
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan
| | - Takuya Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan
| | | | - Tatsuo Tochigi
- Department of Urology, Miyagi Cancer Center, Natori, Japan
| | - Norihiko Tsuchiya
- Department of Urology, Yamagata University Graduate School of Medicine, Yamagata, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoichi Arai
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan
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Araujo RLC, Herman P, Riechelmann RP. Recurrence-free survival as a putative surrogate for overall survival in phase III trials of curative-intent treatment of colorectal liver metastases: Systematic review. World J Clin Oncol 2017; 8:266-272. [PMID: 28638797 PMCID: PMC5465017 DOI: 10.5306/wjco.v8.i3.266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 04/05/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To verify whether recurrence-free survival (RFS) surrogates overall survival (OS) in phase III trials for resectable colorectal liver metastases (CRLM).
METHODS MEDLINE, EMBASE, and Scopus databases were consulted. Eligible studies were phase III trials testing any type of systemic therapy (neoadjuvant, adjuvant or perioperative) added to surgery in patients with resectable CRLM. A linear regression model based on hazard ratios (HR) of OS and RFS was performed.
RESULTS Of 3059 studies, 5 phase III trials (1162 patients) were included for analyses. A linear regression weighted by each trial was used to estimate the association between each HR and RFS. The originated formula was: OS HR = (0.93 × RFS HR) + 0.14; with RFS 95%CI (0.48-1.38), with P = 0.007.
CONCLUSION This association suggests that RFS could work as a putative surrogate endpoint of OS in this population, avoiding bigger, longer and more resource-consuming trials. The OS could be assumed based on RFS and our model could be useful to better estimate sample size calculations of phase III trials of CRLM aiming for OS.
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Lauer MS, Gordon D, Wei G, Pearson G. Efficient design of clinical trials and epidemiological research: is it possible? Nat Rev Cardiol 2017; 14:493-501. [PMID: 28447664 DOI: 10.1038/nrcardio.2017.60] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Randomized clinical trials and large-scale, cohort studies continue to have a critical role in generating evidence in cardiovascular medicine; however, the increasing concern is that ballooning costs threaten the clinical trial enterprise. In this Perspectives article, we discuss the changing landscape of clinical research, and clinical trials in particular, focusing on reasons for the increasing costs and inefficiencies. These reasons include excessively complex design, overly restrictive inclusion and exclusion criteria, burdensome regulations, excessive source-data verification, and concerns about the effect of clinical research conduct on workflow. Thought leaders have called on the clinical research community to consider alternative, transformative business models, including those models that focus on simplicity and leveraging of digital resources. We present some examples of innovative approaches by which some investigators have successfully conducted large-scale, clinical trials at relatively low cost. These examples include randomized registry trials, cluster-randomized trials, adaptive trials, and trials that are fully embedded within digital clinical care or administrative platforms.
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Affiliation(s)
- Michael S Lauer
- National Institutes of Health Office of Extramural Research, One Center Drive, Building 1, Room 144, Bethesda, Maryland 20892, USA
| | - David Gordon
- Division of Cardiovascular Sciences of the National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, 8th Floor, Bethesda, Maryland 20892, USA
| | - Gina Wei
- Division of Cardiovascular Sciences of the National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, 8th Floor, Bethesda, Maryland 20892, USA
| | - Gail Pearson
- Division of Cardiovascular Sciences of the National Heart, Lung, and Blood Institute, 6701 Rockledge Drive, 8th Floor, Bethesda, Maryland 20892, USA
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18
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The high price of anticancer drugs: origins, implications, barriers, solutions. Nat Rev Clin Oncol 2017; 14:381-390. [DOI: 10.1038/nrclinonc.2017.31] [Citation(s) in RCA: 208] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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19
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Zheng Z, Han X, Guy GP, Davidoff AJ, Li C, Banegas MP, Ekwueme DU, Yabroff KR, Jemal A. Do cancer survivors change their prescription drug use for financial reasons? Findings from a nationally representative sample in the United States. Cancer 2017; 123:1453-1463. [PMID: 28218801 DOI: 10.1002/cncr.30560] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/03/2016] [Accepted: 11/04/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is limited evidence from nationally representative samples about changes in prescription drug use for financial reasons among cancer survivors in the United States. METHODS The 2011 to 2014 National Health Interview Survey was used to identify adults who reported ever having been told they had cancer (cancer survivors; n = 8931) and individuals without a cancer history (n = 126,287). Measures of changes in prescription drug use for financial reasons included: 1) skipping medication doses, 2) taking less medicine, 3) delaying filling a prescription, 4) asking a doctor for lower cost medication, 5) buying prescription drugs from another country, and 6) using alternative therapies. Multivariable logistic regression analyses were controlled for demographic characteristics, number of comorbid conditions, interactions between cancer history and number of comorbid conditions, and health insurance coverage. Main analyses were stratified by age (nonelderly, ages 18-64 years; elderly, ages ≥65 years) and time since diagnosis (recently diagnosed, <2 years; previously diagnosed, ≥2 years). RESULTS Among nonelderly individuals, both recently diagnosed (31.6%) and previously diagnosed (27.9%) cancer survivors were more likely to report any change in prescription drug use for financial reasons than those without a cancer history (21.4%), with the excess percentage changes for individual measures ranging from 3.5% to 9.9% among previously diagnosed survivors and from 2.6% to 2.7% among recently diagnosed survivors (P < .01). Elderly cancer survivors and those without a cancer history had comparable rates of changes in prescription drug use for financial reasons. CONCLUSIONS Nonelderly cancer survivors are particularly vulnerable to changes in prescription drug use for financial reasons, suggesting that targeted efforts are needed. Cancer 2017;123:1453-1463. © 2016 American Cancer Society.
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Affiliation(s)
- Zhiyuan Zheng
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia.,University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Gery P Guy
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy J Davidoff
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Chunyu Li
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - K Robin Yabroff
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Ahmedin Jemal
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
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20
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Neyt M, Christiaens T, Demotes J, Walley T, Hulstaert F. Publicly funded practice-oriented clinical trials: of importance for healthcare payers. J Comp Eff Res 2016; 5:551-560. [PMID: 27595308 DOI: 10.2217/cer-2016-0018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Many questions of relevance to patients/society are not answered by industry-sponsored clinical trials. We consider whether there are benefits to governments in funding practice-oriented clinical trials. METHODOLOGY A literature search including publications on institutions' websites was performed and supplemented with information gathered from (inter)national stakeholders. RESULTS Areas were identified where public funding of clinical trials is of importance for society, such as head-to-head comparisons or medical areas where companies have no motivation to invest. The available literature suggests publicly funded research programs could provide a positive return on investment. The main hurdles (e.g., sufficient funding and absence of equipoise) and success factors (e.g., selection of research questions and research infrastructure) for the successful conduct of publicly funded trials were identified. CONCLUSION Governments should see public funding of pragmatic practice-oriented clinical trials as a good opportunity to improve the selection and quality of treatments and stimulate efficient use of limited resources.
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Affiliation(s)
- Mattias Neyt
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | - Thierry Christiaens
- Ghent University, Belgium.,Belgian Centre for Pharmacotherapeutic Information (BCFI), Belguim
| | - Jacques Demotes
- European Clinical Research Infrastructure Network (ECRIN), Paris, France
| | - Tom Walley
- University of Liverpool, UK.,National Institute for Health Research (NIHR), UK
| | - Frank Hulstaert
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
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21
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Maratea D, Fadda V, Trippoli S, Messori A. Economic analysis of not running tenders for recombinant Factor VIII procurement: a simplified analysis to estimate an otherwise unknown pharmacoeconomic index. Eur J Hosp Pharm 2016; 23:219-223. [PMID: 31156852 DOI: 10.1136/ejhpharm-2015-000728] [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: 06/02/2015] [Revised: 11/17/2015] [Accepted: 11/23/2015] [Indexed: 11/04/2022] Open
Abstract
Background Two approaches to the procurement of recombinant Factor VIII products are used by health systems: (A) the most common approach where acquisition tenders are not carried out; (B) the approach tested in the UK in which procurement is based on tenders. The respective cost-effectiveness is not known. Objective To estimate the incremental cost-effectiveness ratio (ICER) for the comparison A vs B. Methods The analysis evaluated: (i) Factor VIII cost with/without tenders; (ii) inhibitor development caused by switching between products; (iii) clinical and economic consequences of inhibitors. Information on these items was obtained from a literature search. Because of the scarce evidence available on some items, our analysis considered the 'most favourable' scenario-that is, some extreme though reasonable assumptions were adopted that were intentionally biased towards improving the ICER of the no-tender option. Results and discussion We estimated an ICER for A vs B of £486 409 (€657 139; £1=€1.351) per quality-adjusted life year (QALY). Since pharmacoeconomic thresholds are ∼£30 000 per QALY, our results indicate that the cost-effectiveness of acquisition strategies that avoid tenders is prohibitive. Because of the simplified nature of our analysis, this estimate is preliminary. Conclusions The 'true' ICER of A vs B remains unknown, but its value is likely to be even worse than the unfavourable ICER of £486 409 (€657 139) per QALY.
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Affiliation(s)
- Dario Maratea
- HTA Unit, ESTAV Toscana Centro, Regional Health Service, Firenze, Italy
| | - Valeria Fadda
- HTA Unit, ESTAV Toscana Centro, Regional Health Service, Firenze, Italy
| | - Sabrina Trippoli
- HTA Unit, ESTAV Toscana Centro, Regional Health Service, Firenze, Italy
| | - Andrea Messori
- HTA Unit, ESTAV Toscana Centro, Regional Health Service, Firenze, Italy
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Guazzelli A, Hussain M, Krstic-Demonacos M, Mutti L. Tremelimumab for the treatment of malignant mesothelioma. Expert Opin Biol Ther 2015; 15:1819-29. [DOI: 10.1517/14712598.2015.1116515] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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23
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Bertolini F, Sukhatme VP, Bouche G. Drug repurposing in oncology--patient and health systems opportunities. Nat Rev Clin Oncol 2015; 12:732-42. [PMID: 26483297 DOI: 10.1038/nrclinonc.2015.169] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In most countries, healthcare service budgets are not likely to support the current explosion in the cost of new oncology drugs. Repurposing the large arsenal of approved, non-anticancer drugs is an attractive strategy to offer more-effective options to patients with cancer, and has the substantial advantages of cheaper, faster and safer preclinical and clinical validation protocols. The potential benefits are so relevant that funding of academically and/or independently driven preclinical and clinical research programmes should be considered at both national and international levels. To date, successes in oncology drug repurposing have been limited, despite strong evidence supporting the use of many different drugs. A lack of financial incentives for drug developers and limited drug development experience within the non-profit sector are key reasons for this lack of success. We discuss these issues and offer solutions to finally seize this opportunity in the interest of patients and societies, globally.
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Affiliation(s)
- Francesco Bertolini
- Laboratory of Hematology-Oncology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Vikas P Sukhatme
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | - Gauthier Bouche
- Anticancer Fund, 1853 Strombeek-Bever, Brussels 1853, Belgium
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24
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Differences in cancer drug assessment between Spain and the United Kingdom. Eur J Cancer 2015; 51:1843-52. [DOI: 10.1016/j.ejca.2015.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 04/27/2015] [Accepted: 04/30/2015] [Indexed: 11/18/2022]
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25
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Patanè S. Is there a role for quinazoline-based α (1)-adrenoceptor antagonists in cardio-oncology? Cardiovasc Drugs Ther 2015; 28:587-8. [PMID: 25230599 DOI: 10.1007/s10557-014-6552-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Salvatore Patanè
- Cardiologia Ospedale San Vincenzo - Taormina (Me) Azienda Sanitaria Provinciale di Messina, Contrada Sirina, 98039, Taormina, ME, Italy, patane-@libero.it
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26
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Rugo HS, Barry WT, Moreno-Aspitia A, Lyss AP, Cirrincione C, Leung E, Mayer EL, Naughton M, Toppmeyer D, Carey LA, Perez EA, Hudis C, Winer EP. Randomized Phase III Trial of Paclitaxel Once Per Week Compared With Nanoparticle Albumin-Bound Nab-Paclitaxel Once Per Week or Ixabepilone With Bevacizumab As First-Line Chemotherapy for Locally Recurrent or Metastatic Breast Cancer: CALGB 40502/NCCTG N063H (Alliance). J Clin Oncol 2015; 33:2361-9. [PMID: 26056183 DOI: 10.1200/jco.2014.59.5298] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We compared nab-paclitaxel or ixabepilone once per week to paclitaxel with bevacizumab as first-line therapy for patients with advanced breast cancer (BC) to evaluate progression-free survival (PFS) for nab-paclitaxel or ixabepilone versus paclitaxel. PATIENTS AND METHODS Eligible patients were age ≥ 18 years with chemotherapy-naive advanced BC. Patients were randomly assigned to bevacizumab with paclitaxel 90 mg/m(2) (arm A), nab-paclitaxel 150 mg/m(2) (arm B), or ixabepilone 16 mg/m(2) (arm C), once per week for 3 of 4 weeks. Planned enrollment was 900 patients, which would give 88% power to detect a hazard ratio of 0.73. RESULTS In all, 799 patients were enrolled, and 783 received treatment (97% received bevacizumab). Arm C was closed for futility at the first interim analysis (n = 241), and arm A (n = 267) and arm B (n = 275) were closed for futility at the second interim analysis. Median PFS for paclitaxel was 11 months, ixabepilone was inferior to paclitaxel (PFS, 7.4 months; hazard ratio, 1.59; 95% CI, 1.31 to 1.93; P < .001), and nab-paclitaxel was not superior to paclitaxel (PFS, 9.3 months; hazard ratio, 1.20; 95% CI, 1.00 to 1.45; P = .054). Results were concordant with overall survival; time to treatment failure was significantly shorter in both experimental arms v paclitaxel. Hematologic and nonhematologic toxicity, including peripheral neuropathy, was increased with nab-paclitaxel, with more frequent and earlier dose reductions. CONCLUSION In patients with chemotherapy-naive advanced BC, ixabepilone once per week was inferior to paclitaxel, and nab-paclitaxel was not superior with a trend toward inferiority. Toxicity was increased in the experimental arms, particularly for nab-paclitaxel. Paclitaxel once per week remains the preferred palliative chemotherapy in this setting.
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Affiliation(s)
- Hope S Rugo
- Hope S. Rugo, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Erica L. Mayer and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Alvaro Moreno-Aspitia and Edith A. Perez, Mayo Clinic, Jacksonville, FL; Alan P. Lyss, Heartland Cancer Research Community Clinical Oncology Program; Michael Naughton, Washington University School of Medicine, St Louis, MO; Constance Cirrincione and Eleanor Leung, Alliance Statistics and Data Center, Duke University, Durham; Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Deborah Toppmeyer, Cancer Institute of New Jersey, New Brunswick, NJ; and Clifford Hudis, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - William T Barry
- Hope S. Rugo, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Erica L. Mayer and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Alvaro Moreno-Aspitia and Edith A. Perez, Mayo Clinic, Jacksonville, FL; Alan P. Lyss, Heartland Cancer Research Community Clinical Oncology Program; Michael Naughton, Washington University School of Medicine, St Louis, MO; Constance Cirrincione and Eleanor Leung, Alliance Statistics and Data Center, Duke University, Durham; Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Deborah Toppmeyer, Cancer Institute of New Jersey, New Brunswick, NJ; and Clifford Hudis, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alvaro Moreno-Aspitia
- Hope S. Rugo, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Erica L. Mayer and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Alvaro Moreno-Aspitia and Edith A. Perez, Mayo Clinic, Jacksonville, FL; Alan P. Lyss, Heartland Cancer Research Community Clinical Oncology Program; Michael Naughton, Washington University School of Medicine, St Louis, MO; Constance Cirrincione and Eleanor Leung, Alliance Statistics and Data Center, Duke University, Durham; Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Deborah Toppmeyer, Cancer Institute of New Jersey, New Brunswick, NJ; and Clifford Hudis, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alan P Lyss
- Hope S. Rugo, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Erica L. Mayer and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Alvaro Moreno-Aspitia and Edith A. Perez, Mayo Clinic, Jacksonville, FL; Alan P. Lyss, Heartland Cancer Research Community Clinical Oncology Program; Michael Naughton, Washington University School of Medicine, St Louis, MO; Constance Cirrincione and Eleanor Leung, Alliance Statistics and Data Center, Duke University, Durham; Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Deborah Toppmeyer, Cancer Institute of New Jersey, New Brunswick, NJ; and Clifford Hudis, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Constance Cirrincione
- Hope S. Rugo, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Erica L. Mayer and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Alvaro Moreno-Aspitia and Edith A. Perez, Mayo Clinic, Jacksonville, FL; Alan P. Lyss, Heartland Cancer Research Community Clinical Oncology Program; Michael Naughton, Washington University School of Medicine, St Louis, MO; Constance Cirrincione and Eleanor Leung, Alliance Statistics and Data Center, Duke University, Durham; Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Deborah Toppmeyer, Cancer Institute of New Jersey, New Brunswick, NJ; and Clifford Hudis, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eleanor Leung
- Hope S. Rugo, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Erica L. Mayer and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Alvaro Moreno-Aspitia and Edith A. Perez, Mayo Clinic, Jacksonville, FL; Alan P. Lyss, Heartland Cancer Research Community Clinical Oncology Program; Michael Naughton, Washington University School of Medicine, St Louis, MO; Constance Cirrincione and Eleanor Leung, Alliance Statistics and Data Center, Duke University, Durham; Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Deborah Toppmeyer, Cancer Institute of New Jersey, New Brunswick, NJ; and Clifford Hudis, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Erica L Mayer
- Hope S. Rugo, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Erica L. Mayer and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Alvaro Moreno-Aspitia and Edith A. Perez, Mayo Clinic, Jacksonville, FL; Alan P. Lyss, Heartland Cancer Research Community Clinical Oncology Program; Michael Naughton, Washington University School of Medicine, St Louis, MO; Constance Cirrincione and Eleanor Leung, Alliance Statistics and Data Center, Duke University, Durham; Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Deborah Toppmeyer, Cancer Institute of New Jersey, New Brunswick, NJ; and Clifford Hudis, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael Naughton
- Hope S. Rugo, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Erica L. Mayer and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Alvaro Moreno-Aspitia and Edith A. Perez, Mayo Clinic, Jacksonville, FL; Alan P. Lyss, Heartland Cancer Research Community Clinical Oncology Program; Michael Naughton, Washington University School of Medicine, St Louis, MO; Constance Cirrincione and Eleanor Leung, Alliance Statistics and Data Center, Duke University, Durham; Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Deborah Toppmeyer, Cancer Institute of New Jersey, New Brunswick, NJ; and Clifford Hudis, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Deborah Toppmeyer
- Hope S. Rugo, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Erica L. Mayer and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Alvaro Moreno-Aspitia and Edith A. Perez, Mayo Clinic, Jacksonville, FL; Alan P. Lyss, Heartland Cancer Research Community Clinical Oncology Program; Michael Naughton, Washington University School of Medicine, St Louis, MO; Constance Cirrincione and Eleanor Leung, Alliance Statistics and Data Center, Duke University, Durham; Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Deborah Toppmeyer, Cancer Institute of New Jersey, New Brunswick, NJ; and Clifford Hudis, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lisa A Carey
- Hope S. Rugo, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Erica L. Mayer and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Alvaro Moreno-Aspitia and Edith A. Perez, Mayo Clinic, Jacksonville, FL; Alan P. Lyss, Heartland Cancer Research Community Clinical Oncology Program; Michael Naughton, Washington University School of Medicine, St Louis, MO; Constance Cirrincione and Eleanor Leung, Alliance Statistics and Data Center, Duke University, Durham; Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Deborah Toppmeyer, Cancer Institute of New Jersey, New Brunswick, NJ; and Clifford Hudis, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Edith A Perez
- Hope S. Rugo, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Erica L. Mayer and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Alvaro Moreno-Aspitia and Edith A. Perez, Mayo Clinic, Jacksonville, FL; Alan P. Lyss, Heartland Cancer Research Community Clinical Oncology Program; Michael Naughton, Washington University School of Medicine, St Louis, MO; Constance Cirrincione and Eleanor Leung, Alliance Statistics and Data Center, Duke University, Durham; Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Deborah Toppmeyer, Cancer Institute of New Jersey, New Brunswick, NJ; and Clifford Hudis, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Clifford Hudis
- Hope S. Rugo, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Erica L. Mayer and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Alvaro Moreno-Aspitia and Edith A. Perez, Mayo Clinic, Jacksonville, FL; Alan P. Lyss, Heartland Cancer Research Community Clinical Oncology Program; Michael Naughton, Washington University School of Medicine, St Louis, MO; Constance Cirrincione and Eleanor Leung, Alliance Statistics and Data Center, Duke University, Durham; Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Deborah Toppmeyer, Cancer Institute of New Jersey, New Brunswick, NJ; and Clifford Hudis, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eric P Winer
- Hope S. Rugo, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; William T. Barry, Alliance Statistics and Data Center, Dana-Farber Cancer Institute; Erica L. Mayer and Eric P. Winer, Dana-Farber Cancer Institute, Boston, MA; Alvaro Moreno-Aspitia and Edith A. Perez, Mayo Clinic, Jacksonville, FL; Alan P. Lyss, Heartland Cancer Research Community Clinical Oncology Program; Michael Naughton, Washington University School of Medicine, St Louis, MO; Constance Cirrincione and Eleanor Leung, Alliance Statistics and Data Center, Duke University, Durham; Lisa A. Carey, University of North Carolina, Chapel Hill, NC; Deborah Toppmeyer, Cancer Institute of New Jersey, New Brunswick, NJ; and Clifford Hudis, Memorial Sloan Kettering Cancer Center, New York, NY
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Patanè S. Insights into cardio-oncology: Polypharmacology of quinazoline-based α 1-adrenoceptor antagonists. World J Cardiol 2015; 7:238-242. [PMID: 26015856 PMCID: PMC4438465 DOI: 10.4330/wjc.v7.i5.238] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 12/28/2014] [Accepted: 02/02/2015] [Indexed: 02/06/2023] Open
Abstract
New uses of cardiovascular drugs with proven experience are emerging, including for treating cancer. Quinazoline is a compound made up of two fused six member simple aromatic rings, benzene and pyrimidine rings, with several biological effects. Cardiologists first used quinazoline-based α1-adrenoceptor antagonists prazosin, doxazosin, and terazosin; currently available data support their use as safe, well tolerated, and effective add-on therapy in uncontrolled hypertension with additional favourable metabolic effects. Recent findings highlight the anticancer effects of quinazoline-based α1-adrenoceptor antagonists, indicating that they may have a significant role in uncontrolled hypertensive cancer patients without signs of ischemia.
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High-dose intravenous vitamin C combined with cytotoxic chemotherapy in patients with advanced cancer: a phase I-II clinical trial. PLoS One 2015; 10:e0120228. [PMID: 25848948 PMCID: PMC4388666 DOI: 10.1371/journal.pone.0120228] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 01/27/2015] [Indexed: 12/17/2022] Open
Abstract
Background Biological and some clinical evidence suggest that high-dose intravenous vitamin C (IVC) could increase the effectiveness of cancer chemotherapy. IVC is widely used by integrative and complementary cancer therapists, but rigorous data are lacking as to its safety and which cancers and chemotherapy regimens would be the most promising to investigate in detail. Methods and Findings We carried out a phase I-II safety, tolerability, pharmacokinetic and efficacy trial of IVC combined with chemotherapy in patients whose treating oncologist judged that standard-of-care or off-label chemotherapy offered less than a 33% likelihood of a meaningful response. We documented adverse events and toxicity associated with IVC infusions, determined pre- and post-chemotherapy vitamin C and oxalic acid pharmacokinetic profiles, and monitored objective clinical responses, mood and quality of life. Fourteen patients were enrolled. IVC was safe and generally well tolerated, although some patients experienced transient adverse events during or after IVC infusions. The pre- and post-chemotherapy pharmacokinetic profiles suggested that tissue uptake of vitamin C increases after chemotherapy, with no increase in urinary oxalic acid excretion. Three patients with different types of cancer experienced unexpected transient stable disease, increased energy and functional improvement. Conclusions Despite IVC’s biological and clinical plausibility, career cancer investigators currently ignore it while integrative cancer therapists use it widely but without reporting the kind of clinical data that is normally gathered in cancer drug development. The present study neither proves nor disproves IVC’s value in cancer therapy, but it provides practical information, and indicates a feasible way to evaluate this plausible but unproven therapy in an academic environment that is currently uninterested in it. If carried out in sufficient numbers, simple studies like this one could identify specific clusters of cancer type, chemotherapy regimen and IVC in which exceptional responses occur frequently enough to justify appropriately focused clinical trials. Trial Registration ClinicalTrials.gov NCT01050621
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Insights into cardio-oncology: the patient's heavy cancer journey among doubts, controversies and pitfalls. The role of the cardiologist. Int J Cardiol 2014; 178:175-7. [PMID: 25464247 DOI: 10.1016/j.ijcard.2014.10.167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 10/27/2014] [Indexed: 02/07/2023]
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Kim W, Zhang L, Wilton JH, Fetterly G, Mohler JL, Weinberg V, Morse A, Szmulewitz RZ, Friedlander TW, Fong L, Lin AM, Harzstark AL, Molina A, Small EJ, Ryan CJ. Sequential use of the androgen synthesis inhibitors ketoconazole and abiraterone acetate in castration-resistant prostate cancer and the predictive value of circulating androgens. Clin Cancer Res 2014; 20:6269-76. [PMID: 25336698 DOI: 10.1158/1078-0432.ccr-14-1595] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Patients previously treated with ketoconazole were excluded from phase III trials of abiraterone acetate due to potential overlapping mechanism of action. The purpose of this study was to determine the clinical utility of abiraterone and its impact on circulating androgens following ketoconazole. EXPERIMENTAL DESIGN Chemotherapy-naïve patients with progressive metastatic castration-resistant prostate cancer (mCRPC) and prior ketoconazole therapy ≥28 days received abiraterone acetate 1,000 mg daily and prednisone 5 mg twice daily. The primary endpoint was the proportion of patients with PSA response, defined as ≥30% PSA decline at 12 weeks. H0 = 0.30 versus H1 = 0.50 (α = 0.05, power = 0.83). Circulating androgen levels were measured using liquid chromatography tandem mass spectrometry. RESULTS Thirty-nine patients were included in the final analysis. Twenty (51%; 95% confidence interval, 36%-66%) patients had ≥30% PSA decline; the null hypothesis was rejected. Sixteen (41%) had ≥50% PSA decline. Median PFS (progression-free survival) was 16 weeks; median radiographic PFS (rPFS) was 36 weeks. Samples for measurement of baseline androgens were available in 37 patients. The PSA response proportion was 59% in 29 patients with DHEA ≥ limit of quantitation (LOQ), compared with 13% in 8 patients with DHEA < LOQ (P = 0.042). Median PFS was 6 and 16 weeks in DHEA < LOQ and DHEA ≥ LOQ patients, respectively (P = 0.017); median rPFS was 14 and 36 weeks in DHEA < LOQ and DHEA ≥ LOQ patients, respectively (P < 0.001). CONCLUSIONS Abiraterone demonstrates modest clinical efficacy in mCRPC patients previously treated with ketoconazole. Patients with DHEA ≥ LOQ were more likely to demonstrate PSA responses and longer PFS. Analysis of circulating androgens merits further investigation as a biomarker for response to androgen synthesis inhibitor therapy.
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Affiliation(s)
- Won Kim
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California.
| | - Li Zhang
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - John H Wilton
- Department of Medicine, PK/PD Core Resource, Roswell Park Cancer Institute, Buffalo, New York
| | - Gerald Fetterly
- Department of Medicine, PK/PD Core Resource, Roswell Park Cancer Institute, Buffalo, New York
| | - James L Mohler
- Department of Urology, Roswell Park Cancer Institute, Buffalo, New York
| | - Vivian Weinberg
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Allison Morse
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | | | - Terence W Friedlander
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Lawrence Fong
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Amy M Lin
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Andrea L Harzstark
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Arturo Molina
- Janssen Research and Development, Menlo Park, California
| | - Eric J Small
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
| | - Charles J Ryan
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
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Leibowitz-Amit R, Seah JA, Atenafu EG, Templeton AJ, Vera-Badillo FE, Alimohamed N, Knox JJ, Tannock IF, Sridhar SS, Joshua AM. Abiraterone acetate in metastatic castration-resistant prostate cancer: A retrospective review of the Princess Margaret experience of (I) low dose abiraterone and (II) prior ketoconazole. Eur J Cancer 2014; 50:2399-407. [DOI: 10.1016/j.ejca.2014.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/02/2014] [Accepted: 06/05/2014] [Indexed: 10/25/2022]
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Dueñas-Gonzalez A, Coronel J, Cetina L, González-Fierro A, Chavez-Blanco A, Taja-Chayeb L. Hydralazine-valproate: a repositioned drug combination for the epigenetic therapy of cancer. Expert Opin Drug Metab Toxicol 2014; 10:1433-44. [PMID: 25154405 DOI: 10.1517/17425255.2014.947263] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION DNA methylation (DNMTi) and histone deacetylase inhibitors (HDACi) are in development for cancer therapy. So far, four epigenetic drugs are approved for myelodysplastic syndrome (MDS) and cutaneous T-cell lymphoma (CTCL). The combination of hydralazine-valproate (TRANSKRIP(™)) is being repositioned as an oral DNMT and HDAC inhibitor. AREAS COVERED Brief discussion on the current status of epigenetic drugs and studies published on the preclinical and clinical development of the hydralazine-valproate combination. EXPERT OPINION Drug repositioning is a strategy for prompt and cost-efficient drug discovery. There is evidence that combining DNMTi with HDACi would be more efficacious than administering each agent on its own. Hydralazine-valproate is safe when used alone or in combination with chemotherapy or chemoradiation. The fact that both drugs are orally administered is another advantage over current epigenetic drugs. This combination is promising but larger studies are needed. Among these, the randomized Phase III trials in advanced and in locally advanced cervical cancer combined with chemotherapy and cisplatin-radiation respectively, would eventually confirm its efficacy. Studies on MDS and CTCL would also eventually prove the efficacy of hydralazine valproate so that in the coming years hydralazine-valproate could have a role in cancer epigenetic therapy.
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Affiliation(s)
- Alfonso Dueñas-Gonzalez
- Instituto de Investigaciones Biomédicas UNAM/Instituto Nacional de Cancerología Mexico, Unit of Biomedical Research on Cancer , Mexico City , Mexico
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