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Seifu Y, Mt-Isa S, Duke K, Gamalo-Siebers M, Wang W, Dong G, Kolassa J. Design of paediatric trials with benefit-risk endpoints using a composite score of adverse events of interest (AEI) and win-statistics. J Biopharm Stat 2023; 33:696-707. [PMID: 36545791 DOI: 10.1080/10543406.2022.2153202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022]
Abstract
A fundamental problem in the regulatory evaluation of a therapy is assessing whether the benefit outweighs the associated risks. This work proposes designing a trial that assesses a composite endpoint consisting of benefit and risk, hence, making the core of the design of the study, to assess benefit and risk. The proposed benefit risk measure consists of efficacy measure(s) and a risk measure that is based on a composite score obtained from pre-defined adverse events of interest (AEI). This composite score incorporates full aspects of adverse events of interest (i.e. the incidence, severity, and duration of the events). We call this newly proposed score the AEI composite score. After specifying the priorities between the components of the composite endpoint, a win-statistic (i.e. win ratio, win odds, or net benefit) is used to assess the difference between treatments in this composite endpoint. The power and sample size requirements of such a trial design are explored via simulation. Finally, using Dupixent published adult study results, we show how we can design a paediatric trial where the primary outcome is a composite of prioritized outcomes consisting of efficacy endpoints and the AEI composite score endpoint. The resulting trial design can potentially substantially reduce sample size compared to a trial designed to assess the co-primary efficacy endpoints, therefore it may address the challenge of slow enrollment and patient availability for paediatric studies.
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Affiliation(s)
- Yodit Seifu
- GBDS, Bristol-Myers Squibb, Berkeley Heights, New Jersey, USA
| | | | - Kyle Duke
- Department of Statistics, North Caroline State University, Raleigh, North Carolina
| | | | - William Wang
- BARDS, Merck & Co. Inc, Kenilworth, New Jersey, USA
| | | | - John Kolassa
- Department of Statistics, Rutgers, the State University of NJ, Piscataway, New Jersey, USA
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Escudero-Vilaplana V, Revuelta-Herrero JL, Collado-Borrell R, Marzal-Alfaro B, Gimenez-Manzorro A, Herranz-Alonso A, Sanjurjo-Saez M. Oral antineoplastic agents: assessment of safety and dose adjustments in clinical practice. Expert Opin Drug Saf 2019; 18:861-868. [PMID: 31282227 DOI: 10.1080/14740338.2019.1641197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Although the safety profile of oral antineoplastic agents (OAAs) is better than that of classic chemotherapy, the rate of severe adverse events (AEs) is high. The objective was to assess the reasons for adjustments to treatment with OAAs during the first 100 days of treatment. Methods: The authors performed a prospective observational study of cancer outpatients who initiated OAAs between November 2015 and October 2017. Dose reductions and treatment interruptions were closely followed-up during the first 100 days after the beginning of treatment with an OAA. The authors described the different safety profile of different OAA classes. Results: The authors included 443 patients (31 different OAA assessed), of whom 53.0% required their OAA to be adjusted during the first 100 days of treatment. A total of 151 patients required dose reductions and/or interruptions of OAAs owing to AEs. The authors identified 203 AEs in these patients. Treatment with sorafenib, lower ECOG performance status, and first-line treatment were associated with a higher proportion of treatment adjustments due to AEs. Conclusion: These results in clinical practice could be a first approach to help healthcare professionals to design patient monitoring programs by identifying priority patients and drugs, and remarks the importance of pharmacovigilance in OAAs.
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Affiliation(s)
- Vicente Escudero-Vilaplana
- a Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón , Madrid , Spain
| | - Jose Luis Revuelta-Herrero
- a Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón , Madrid , Spain
| | - Roberto Collado-Borrell
- a Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón , Madrid , Spain
| | - Belen Marzal-Alfaro
- a Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón , Madrid , Spain
| | - Alvaro Gimenez-Manzorro
- a Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón , Madrid , Spain
| | - Ana Herranz-Alonso
- a Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón , Madrid , Spain
| | - María Sanjurjo-Saez
- a Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón , Madrid , Spain
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Wei D, Wu G, Zheng Y, Chen F, Lu J, Wang Y, He D, Wang H, Wang Z, Chen P, Wang Y, Wang Z, Ye Y, Zhu Z, Yuan J. Efficacy of sorafenib adjuvant therapy in northwestern Chinese patients with non-metastatic renal-cell carcinoma after nephrectomy: A multicenter retrospective study. Medicine (Baltimore) 2019; 98:e14237. [PMID: 30702581 PMCID: PMC6380792 DOI: 10.1097/md.0000000000014237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Recent studies have confirmed the efficacy of sorafenib for patients with advanced renal cell carcinoma; however, its efficacy and safety as an adjuvant therapy in patients with non-metastatic and loco-regional renal cell carcinoma after surgery remains controversial. Thus, the aim of the present retrospective study was to evaluate the efficacy of adjuvant sorafenib therapy in such patients from 8 centers in northwestern China that were treated from August 2009 to December 2016.After surgery, the patients (n = 48) received oral sorafenib for 3 months. The control group (n = 48) comprised patients that underwent the same surgery from December 2009 to June 2016 but without adjuvant therapy who were matched 1:1 with the sorafenib group with respect to sex, age, pathological findings, disease stage and grade, operation time, and surgical procedure. The primary outcome compared between the groups was disease-free survival. Adverse events were also recorded to evaluate the safety of sorafenib. The influence of patients' characteristics and laboratory tests on recurrence was analyzed using unconditional logistic regression.Overall, the demographic characteristics of the 2 groups were similar. There was no significant difference in the rate of recurrence (8.3% for sorafenib patients and 6.2% for the matched patients, P = .66) or median disease-free survival between the 2 groups (hazard ratio = 1.561, 95% confidence interval = 0.349-6.987, P = .56). In multiple logistic regression analysis, increased blood urea nitrogen (BUN) emerged as an independent predictor of recurrence risk (P = .02).These results indicate that postoperative sorafenib adjuvant therapy did not achieve the expected beneficial effect, pointing to the need for further studies to evaluate its utility in such cases.
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Affiliation(s)
- Di Wei
- Department of Urology, Xijing Hospital, Fourth Military Medical University
| | - Guojun Wu
- Department of Urology, Xijing Hospital, Fourth Military Medical University
| | - Yu Zheng
- Department of Urology, Xijing Hospital, Fourth Military Medical University
| | - Fubao Chen
- Department of Urology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region
| | - Jingyi Lu
- Department of Urology, Xinjiang karamay Central Hospital, Karamay, Xinjiang Uyghur Autonomous Region
| | - Yangmin Wang
- Department of Urology, General Hospital of Lanzhou Military Area Command of Chinese PLA, Lanzhou, Gansu Province
| | - Dalin He
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University
| | - He Wang
- Department of Urology, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province
| | - Zhiping Wang
- Department of Urology, The Second Affiliated Hospital of Lanzhou University, Lanzhou, Gansu Province
| | - Peng Chen
- Department of Urology, Affiliated Tumor Hospital of Xinjang Medical University
| | - Yujie Wang
- Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uyghur Autonomous Region, China
| | - Zhiyong Wang
- Department of Urology, Xijing Hospital, Fourth Military Medical University
| | - Yongli Ye
- Department of Urology, Xijing Hospital, Fourth Military Medical University
| | - Zheng Zhu
- Department of Urology, Xijing Hospital, Fourth Military Medical University
| | - Jianlin Yuan
- Department of Urology, Xijing Hospital, Fourth Military Medical University
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Kakiuchi S, Yakushijin K, Sakai R, Kawaguchi K, Higashime A, Kurata K, Ichikawa H, Nagao S, Rikitake J, Kiyota N, Matsuoka H, Minami H. Discontinuation of sorafenib can lead to the emergence of FLT3-ITD-positive acute myeloid leukemia. J Oncol Pharm Pract 2018; 25:2010-2015. [PMID: 30514174 DOI: 10.1177/1078155218816768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 69-year-old woman who had been diagnosed with unresectable papillary thyroid cancer was referred to our hospital. We initially treated her with sorafenib, but she subsequently developed erythema multiforme, which was suspected to be a drug rush due to sorafenib; therefore, sorafenib was discontinued. At the time of discontinuation, immature blast cells were detected in her peripheral blood. Approximately two weeks later, her skin rash improved substantially, but the proportion of blasts in the peripheral blood increased. We performed a bone marrow examination, and she was diagnosed with FLT3-ITD-positive acute myeloid leukemia. FLT3-ITD expression is found in 20-25% of AML and is a known independent poor prognostic factor. To overcome the poor prognosis associated with FLT3-ITD, molecular drugs targeting FLT3-ITD are attracting much attention. Sorafenib, a multi-kinase inhibitor, also has an effect on FLT3-ITD. Although primary disease flares after tyrosine kinase inhibitor discontinuation have been reported, this is the first report to describe discontinuation of sorafenib treatment as a potential trigger of FLT3-ITD-positive acute myeloid leukemia in papillary thyroid cancer.
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Affiliation(s)
- Seiji Kakiuchi
- Division of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Hyogo, Japan.,Department of Hematology, Yodogawa Christian Hospital, Osaka, Osaka, Japan
| | - Kimikazu Yakushijin
- Division of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Rina Sakai
- Division of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Koji Kawaguchi
- Division of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Ako Higashime
- Division of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Keiji Kurata
- Division of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Hiroya Ichikawa
- Division of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Shigeki Nagao
- Division of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Hyogo, Japan.,Division of Hematology, Department of Internal Medicine, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan
| | - Junpei Rikitake
- Division of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Hyogo, Japan.,Department of Hematology, Yodogawa Christian Hospital, Osaka, Osaka, Japan
| | - Naomi Kiyota
- Division of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Hiroshi Matsuoka
- Division of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Hironobu Minami
- Division of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Hyogo, Japan
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Soldatos TG, Taglang G, Jackson DB. In Silico Profiling of Clinical Phenotypes for Human Targets Using Adverse Event Data. High Throughput 2018; 7:ht7040037. [PMID: 30477159 PMCID: PMC6306940 DOI: 10.3390/ht7040037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/09/2018] [Accepted: 11/19/2018] [Indexed: 12/19/2022] Open
Abstract
We present a novel approach for the molecular transformation and analysis of patient clinical phenotypes. Building on the fact that drugs perturb the function of targets/genes, we integrated data from 8.2 million clinical reports detailing drug-induced side effects with the molecular world of drug-target information. Using this dataset, we extracted 1.8 million associations of clinical phenotypes to 770 human drug-targets. This collection is perhaps the largest phenotypic profiling reference of human targets to-date, and unique in that it enables rapid development of testable molecular hypotheses directly from human-specific information. We also present validation results demonstrating analytical utilities of the approach, including drug safety prediction, and the design of novel combination therapies. Challenging the long-standing notion that molecular perturbation studies cannot be performed in humans, our data allows researchers to capitalize on the vast tomes of clinical information available throughout the healthcare system.
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Affiliation(s)
| | - Guillaume Taglang
- Molecular Health GmbH, Kurfuersten Anlage 21, 69115 Heidelberg, Germany.
| | - David B Jackson
- Molecular Health GmbH, Kurfuersten Anlage 21, 69115 Heidelberg, Germany.
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Chiriac A, Coros MF, Podoleanu C, Stolnicu S. Grade III hand-foot skin reaction induced by sorafenib. An Bras Dermatol 2017; 92:590-591. [PMID: 28954127 PMCID: PMC5595625 DOI: 10.1590/abd1806-4841.20176631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 01/14/2017] [Indexed: 01/12/2023] Open
Affiliation(s)
- Anca Chiriac
- Department of Dermatology, Apollonia University - Iasi, Romania.,Department of Dermatology, Institute of Macromolecular Chemistry "Petru Poni" - Iasi, Romania.,Department of Dermatology, Nicolina Medical Center - Iasi, Romania
| | - Marius Florin Coros
- Department of Surgery, University of Medicine and Pharmacy of Targu Mures - Mures, Romania
| | - Cristian Podoleanu
- Department of Cardiology, University of Medicine and Pharmacy of Targu Mures - Mures, Romania
| | - Simona Stolnicu
- Department of Pathology, University of Medicine and Pharmacy of Targu Mures - Mures, Romania
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Huo Z, Yu S, Hong S, Cao X, Xiu L, Liao Z, Li Y, Xiao H. A systematic review and meta-analysis of the risk of diarrhea associated with vandetanib treatment in carcinoma patients. Onco Targets Ther 2016; 9:3621-31. [PMID: 27382300 PMCID: PMC4920236 DOI: 10.2147/ott.s96830] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background and purpose Vandetanib is a promising anticancer targeted agent for treating advanced carcinomas, such as non-small-cell lung cancer, small-cell lung cancer, breast cancer, malignant glioma, hepatocellular cancer, and unresectable, locally advanced, or metastatic medullary thyroid cancer. However, diarrhea is a frequently reported adverse event. The incidence of vandetanib-associated diarrhea varies extensively in different study populations and has not been carefully estimated. This systematic review and meta-analysis of clinical trials aims to figure out the overall risks of all-grade and high-grade diarrhea during vandetanib treatment and get a better understanding of its prediction and management. Materials and methods A comprehensive search was performed in EMBASE, PubMed, and Cochrane Library for clinical trials studying vandetanib and diarrhea prior to April 2015. Eligible articles were selected according to the inclusion criteria. Data were extracted to calculate the summary incidence of all-grade and high-grade diarrhea caused by vandetanib treatment. Results Thirteen clinical trials that involved 3,264 patients were included in this meta-analysis. The overall incidences of all-grade and high-grade diarrhea caused by vandetanib treatment were 52.1% (95% confidence interval [CI], 48.3%–55.8%) and 5.6% (95% CI, 4.4%–76.7%), respectively. The risk ratios of the all-grade and high-grade diarrhea for vandetanib arm versus control arm were 1.932 (95% CI, 1.746–2.138; P<0.001) and 3.190 (95% CI, 2.061–4.938; P<0.001), respectively. Studies with small-cell lung cancer demonstrated the highest incidence of all-grade diarrhea (78.85%) and high-grade diarrhea (17.31%), whereas the lowest incidences of all-grade (42.11%) and high-grade (2.67%) diarrhea are seen in patients with hepatocellular carcinoma and non-small-cell lung cancer, respectively. Conclusion Our findings demonstrate that the administration of vandetanib leads to a significantly increased risk of diarrhea, which varies in different carcinoma patients. Early recognition and timely management may be key factors to avoid dose reduction, drug interruption, and drug discontinuation, which is significant to maximize the treatment benefits.
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Affiliation(s)
- Zijun Huo
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Shuang Yu
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Shubin Hong
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Xiaopei Cao
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Lingling Xiu
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Zhihong Liao
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Yanbing Li
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Haipeng Xiao
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
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