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De Oliveira Brandao C, Lewis S, Sandschafer D, Crawford J. Two decades of pegfilgrastim: what have we learned? Where do we go from here? Curr Med Res Opin 2023; 39:707-718. [PMID: 36976784 DOI: 10.1080/03007995.2023.2196197] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Chemotherapy-induced febrile neutropenia (FN) is a medical emergency that may occur in patients with malignancies receiving myelosuppressive chemotherapy. FN requires early therapeutic intervention since it is associated with increased hospitalizations and high mortality risk of 5%-20%. FN-related hospitalizations are higher in patients with myeloid malignancies than in those with solid tumors due to the myelotoxicity of chemotherapy regimens and the compromised bone marrow function. FN increases the burden of cancer by causing chemotherapy dose reductions and delays. The administration of the first granulocyte colony-stimulating factor (G-CSF), filgrastim, reduced the incidence and duration of FN in patients undergoing chemotherapy. Filgrastim later evolved into pegfilgrastim, which has a longer half-life than filgrastim and was associated with a lower rate of severe neutropenia, chemotherapy dose reduction, and treatment delay. Nine million patients have received pegfilgrastim since its approval in early 2002. The pegfilgrastim on-body injector (OBI) is an innovative device facilitating the time-released auto-injection of pegfilgrastim approximately 27 hours after chemotherapy, as clinically recommended for the prevention of FN, thus eliminating the need for a next-day hospital visit. Since its introduction in 2015, one million patients with cancer have received pegfilgrastim using the OBI. Subsequently, the device has been approved in the United States (US), European Union, Latin America, and Japan, with studies and a postmarketing commitment demonstrating device reliability. A recent prospective observational study conducted in the US demonstrated that the OBI substantially improved the adherence to and compliance with clinically recommended pegfilgrastim therapy; patients receiving pegfilgrastim via the OBI experienced a lower incidence of FN than those receiving alternatives for FN prophylaxis. This review discusses the evolution of G-CSFs leading to the development of the OBI, current recommendations for G-CSF prophylaxis in the clinic, continued evidence supporting next-day pegfilgrastim administration, and improvements in patient care made possible with the OBI.
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Affiliation(s)
| | - Sandra Lewis
- Global Research & Development, Amgen Inc., Thousand Oaks, CA, USA
| | | | - Jeffrey Crawford
- Medical Oncology, Division of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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Edelsberg J, Weycker D, Bensink M, Bowers C, Lyman GH. Prophylaxis of febrile neutropenia with colony-stimulating factors: the first 25 years. Curr Med Res Opin 2020; 36:483-495. [PMID: 31834830 DOI: 10.1080/03007995.2019.1703665] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Filgrastim prophylaxis, both primary and secondary, was rapidly incorporated into clinical practice in the 1990s. When pegfilgrastim became available in 2002, it quickly replaced filgrastim as the colony-stimulating factor (CSF) of choice for prophylaxis. Use of prophylaxis increased markedly in the first decade of this century and has stabilized during the present decade. Data concerning real-world CSF prophylactic practice patterns are limited but suggest that both primary and secondary prophylaxis are common, and that use is frequently inappropriate according to guidelines. The extent of inappropriate use is controversial, as are issues concerning the cost-effectiveness of prophylaxis versus no prophylaxis and the cost-effectiveness of primary prophylaxis versus secondary prophylaxis. Nevertheless, CSF prophylaxis is firmly established as a valuable adjunct to chemotherapy and will almost certainly continue to be widely used for the foreseeable future. In this article, we chronicle the use and impact of CSF prophylaxis in US patients receiving myelosuppressive chemotherapy for non-myeloid malignancies. We emphasize the interplay of expert opinion, clinical evidence, and economic factors in shaping the use of CSFs in clinical practice over time, and, with the recent introduction of new CSF agents and options, we aim to provide useful clinical and economic information for healthcare decision makers.
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Affiliation(s)
| | | | | | | | - Gary H Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
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3
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Neugut AI, Zhong X, Lebwohl B, Hillyer GC, Accordino MK, Wright JD, Kiran RP, Hershman DL. Adherence to colonoscopy at 1 year following resection of localized colon cancer: a retrospective cohort study. Therap Adv Gastroenterol 2018; 11:1756284818765920. [PMID: 35154382 PMCID: PMC8832335 DOI: 10.1177/1756284818765920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 02/01/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND For patients with stages I-III colon cancer who have undergone surgical resection, guidelines recommend surveillance colonoscopy at 1 year. However, limited data exist on adherence and associated factors. We aimed to determine the rate of adherence to surveillance colonoscopy at 1 year among nonmetastatic colon cancer patients who underwent resection and factors associated with adherence. METHODS In this population-based retrospective cohort study, the Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used. We identified patients with stages I-III colon cancer who underwent surgical resection and survived >3 years without recurrence (no chemotherapy after 8 months) from 2002-2011. Our primary outcome was a colonoscopy claim 10-15 months after resection. We used multivariable regression analysis to assess associations between sociodemographic and clinical factors and receipt of timely colonoscopy. RESULTS Among 28,732 patients who survived >3 years without recurrence, 7967 (28%) did not undergo colonoscopy; 12,033 (42%) had it at one year, with 3159 (11%) before 10 months and 5573 (19%) after 15 months. Decreased adherence was associated with older age; being male versus female; being black or Hispanic versus white; higher tumor stage; left-sided tumors versus right sided; and increased comorbidities. Chemotherapy receipt was associated with increased adherence (odds ratio 2.06; 95% confidence interval 1.88-2.24). CONCLUSIONS In a large population-based sample of individuals aged ⩾ 65 years, only 42% of colon cancer survivors underwent 1-year surveillance colonoscopy. Demographic and clinical factors were associated with adherence.
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Affiliation(s)
- Alfred I. Neugut
- Department of Medicine, Columbia University, New
York, USA,Department of Epidemiology, Columbia University,
New York, USA,Herbert Irving Comprehensive Cancer Center,
Columbia University, New York, USA
| | - Xiaobo Zhong
- Department of Biostatistics, Columbia
University, New York, USA
| | | | - Grace C. Hillyer
- Deparment of Epidemiology, Columbia University,
New York, USA,Herbert Irving Comprehensive Cancer Center,
Columbia University, New York, USA
| | - Melissa K. Accordino
- Department of Medicine, Columbia University, New
York, USA,Herbert Irving Comprehensive Cancer Center,
Columbia University, New York, USA
| | - Jason D. Wright
- Department of Epidemiology, Columbia
University, New York, USA,Herbert Irving Comprehensive Cancer Center,
Columbia University, New York, USA,Department of Obstetrics and Gynecology,
Columbia University, New York, USA
| | - Ravi P. Kiran
- Department of Epidemiology, Columbia
University, New York, USA,Herbert Irving Comprehensive Cancer Center,
Columbia University, New York, USA,Department of Surgery, Columbia University, New
York, USA
| | - Dawn L. Hershman
- Department of Medicine, Columbia University,
New York, USA,Department of Epidemiology, Columbia
University, New York, USA,Herbert Irving Comprehensive Cancer Center,
Columbia University, New York, USA
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4
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Use of Hematopoietic Growth Factors in Elderly Lung Cancer Patients Receiving Chemotherapy: A SEER-Medicare-based Study. Am J Clin Oncol 2017; 40:66-74. [PMID: 25068470 DOI: 10.1097/coc.0000000000000104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Hematopoietic growth factors (HGFs) are essential for successful completion of chemotherapy in lung cancer patients. However, because of their adverse effects, clinical guidelines recommend their use in only selective clinical scenarios. This study, for the first time, explores patient characteristics and temporal trends associated with HGF utilization among elderly lung cancer patients receiving chemotherapy. METHODS This is a retrospective analysis of the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data containing 80,940 patients, aged 65 years and older, diagnosed with stage I to IV lung cancer between 1992 and 2009, and who received chemotherapy. Descriptive statistics and logistic regressions were used to examine the characteristics associated with 2 types of HGFs-colony stimulating factors (CSFs) and erythropoiesis-stimulating agents (ESAs). RESULTS Twenty-five percent of the patients received CSFs and 42% received ESAs. Temporal variations were most predictive of HGF utilization, with an increase from 2.6% in 1992 to 47.3% in 2009 for CSFs and 1.3% to 30.5% for ESAs. Higher chemotherapy-based risk profiles increased the odds of HGF receipt 2 to 3 times (P<0.0001). Even after controlling for relevant clinical characteristics, unexplained sociodemographic associations persisted, suggesting lack of compliance with HGF guidelines. CONCLUSIONS There has been a significant increase in the use of HGFs over time. Although chemotherapy-based risk profiles were significant predictors of HGF receipt, the study results suggest possible lack of compliance with treatment guidelines, which should be investigated. Given the high cost of HGFs, future studies are also needed to determine cost-effectiveness of these drugs among lung cancer patients.
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Zhang F, LingHu R, Zhan X, Li R, Feng F, Gao X, Zhao L, Yang J. Efficacy, safety and proper dose analysis of PEGylated granulocyte colony-stimulating factor as support for dose-dense adjuvant chemotherapy in node positive Chinese breast cancer patients. Oncotarget 2017; 8:80020-80028. [PMID: 29108384 PMCID: PMC5668117 DOI: 10.18632/oncotarget.18145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 04/29/2017] [Indexed: 01/16/2023] Open
Abstract
For high-risk breast cancer patients with positive axillary lymph nodes, dose-dense every-two-week epirubicin/cyclophosphamide-paclitaxel (ddEC-P) regimen is the optimal postoperative adjuvant therapy. However, this regimen is limited by the grade 3/4 neutropenia and febrile neutropenia (FN). There is an urgent need to explore the efficacy, safety and proper dosage of PEGylated granulocyte colony-stimulating factor (PEG-G-CSF) as support for ddEC-P in Chinese breast cancer patients with positive axillary lymph nodes. Prospectively, 40 women with stage IIIA to IIIC breast cancer received ddEC-P ± trastuzumab as adjuvant treatment. PEG-G-CSF was injected subcutaneously in a dose of 6 mg or 3 mg on the 2th day of each treatment cycle. With administration of PEG-G-CSF, all of the 40 patients completed 8 cycles of ddEC-P ± trastuzumab regimen without dose reductions or treatment delays. Moreover, no FN cases were observed. Further analysis showed that the proper dosage of PEG-G-CSF was 6 mg for ddEC treatment, and 3 mg for ddP treatment. PEG-G-CSF exhibits advantages compared with G-CSF in convenient of administration and tolerance for high risk Chinese breast cancer patients. More importantly, the proper dose of PEG-G-CSF for high risk Chinese breast cancer patients during ddEC-P chemotherapy may be 6 mg for ddEC treatment and 3 mg for ddP treatment.
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Affiliation(s)
- Fan Zhang
- Department of Oncology, PLA General Hospital Cancer Center, Institute of Geriatric, PLA General Hospital and Beijing Key Laboratory of Cell Engineering & Antibody, Beijing, China
| | - RuiXia LingHu
- Department of Oncology, PLA General Hospital Cancer Center, Institute of Geriatric, PLA General Hospital and Beijing Key Laboratory of Cell Engineering & Antibody, Beijing, China
| | - XingYang Zhan
- Department of Oncology, PLA General Hospital Cancer Center, Institute of Geriatric, PLA General Hospital and Beijing Key Laboratory of Cell Engineering & Antibody, Beijing, China
| | - Ruisheng Li
- Research Center for Clinical and Translational Medicine, PLA 302 Hospital, Beijing, China
| | - Fan Feng
- Department of Pharmacy, General Hospital of Shenyang Military Command, Shenyang, China
| | - Xudong Gao
- Department of Gastroenterology, PLA 302 Hospital, Beijing, China
| | - Lei Zhao
- Department of Oncology, PLA General Hospital Cancer Center, Institute of Geriatric, PLA General Hospital and Beijing Key Laboratory of Cell Engineering & Antibody, Beijing, China.,National Clinical Research Center for Normal Aging and Geriatric & The Key Laboratory of Normal Aging and Geriatric, PLA General Hospital and Second Military Medical University, Shanghai, China
| | - Junlan Yang
- Department of Oncology, PLA General Hospital Cancer Center, Institute of Geriatric, PLA General Hospital and Beijing Key Laboratory of Cell Engineering & Antibody, Beijing, China
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6
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Costs matter: The impact of disclosing treatment costs and provider profit on patients’ decisions. J Cancer Policy 2017. [DOI: 10.1016/j.jcpo.2016.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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7
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Vijayvergia N, Li T, Wong YN, Hall MJ, Cohen SJ, Dotan E. Chemotherapy use and adoption of new agents is affected by age and comorbidities in patients with metastatic colorectal cancer. Cancer 2016; 122:3191-3198. [PMID: 27379436 DOI: 10.1002/cncr.30077] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 04/11/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND The treatment of metastatic colorectal cancer (mCRC) has changed substantially in the last 2 decades, but to the authors' knowledge, the effect of age and comorbidities on chemotherapy use has not been well studied to date. METHODS Patients with mCRC who were being treated with 5-fluorouracil (5-FU)-based chemotherapy between January 1995 to December 2009 were studied using the LifeLink Health Plan Claims Database. The cohort was divided into older (aged >70 years) and younger (aged ≤70 years) patients. The Charlson Comorbidity Index (CCI) was used to assess comorbidity burden. The Wilcoxon and chi-square tests were used in univariate and logistic regression in multivariate analyses. RESULTS A total of 16,087 patients were identified, with 24% of the patients who were receiving chemotherapy being aged >70 years. The percentage of patients with a CCI >1 receiving chemotherapy increased over time (14% in 1996 vs 40% after 2004; P<.05). Older patients were less likely to receive treatment with >2 agents compared with younger patients (15% vs.22% and 11% vs.16%, respectively, in 2003 and 2009; P<.001). After approval by the US Food and Drug Administration in 1998, the use of irinotecan was lower in older compared with younger patients, a difference that resolved by 2002 (15% vs 38% [P<.05]; 62% in both groups [P = .9], respectively). Similarly, oxaliplatin was used more frequently in younger patients in 2003 (22% vs 15%; P<.05), with a decrease in this difference noted by 2009 (64% vs 60%; P = .95). On multivariate analysis, older age (odds ratio, 0.65; P<.001) and a CCI >1 (odds ratio, 0.84; P<.001) were found to be associated with a lower likelihood of receiving combination chemotherapy. CONCLUSIONS In this commercially insured population, the percentage of older patients treated for mCRC was low, and the rate of chemotherapy adoption was found to lag behind that of younger patients. However, the percentage of older patients with comorbidities receiving therapy increased over time. Cancer 2016;122:3191-8. © 2016 American Cancer Society.
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Affiliation(s)
- Namrata Vijayvergia
- Department of Hematology and Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania.
| | - Tianyu Li
- Department of Biostatistics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
| | - Yu-Ning Wong
- Department of Hematology and Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
| | - Michael J Hall
- Department of Hematology and Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
| | - Steven J Cohen
- Department of Hematology and Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
| | - Efrat Dotan
- Department of Hematology and Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania
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8
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Lambertini M, Poggio F, Vaglica M, Blondeaux E, Del Mastro L. News on the medical treatment of young women with early-stage HER2-negative breast cancer. Expert Opin Pharmacother 2016; 17:1643-55. [DOI: 10.1080/14656566.2016.1199685] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino, IST, Genova, Italy
- BrEAST Data Centre, Department of Medicine, Institut Jules Bordet, and l’Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Francesca Poggio
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino, IST, Genova, Italy
| | - Marina Vaglica
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino, IST, Genova, Italy
| | - Eva Blondeaux
- Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino, IST, Genova, Italy
| | - Lucia Del Mastro
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino, IST, Genova, Italy
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9
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Smith TJ, Bohlke K, Lyman GH, Carson KR, Crawford J, Cross SJ, Goldberg JM, Khatcheressian JL, Leighl NB, Perkins CL, Somlo G, Wade JL, Wozniak AJ, Armitage JO. Recommendations for the Use of WBC Growth Factors: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2015; 33:3199-212. [PMID: 26169616 DOI: 10.1200/jco.2015.62.3488] [Citation(s) in RCA: 573] [Impact Index Per Article: 63.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To update the 2006 American Society of Clinical Oncology guideline on the use of hematopoietic colony-stimulating factors (CSFs). METHODS The American Society of Clinical Oncology convened an Update Committee and conducted a systematic review of randomized clinical trials, meta-analyses, and systematic reviews from October 2005 through September 2014. Guideline recommendations were based on the review of the evidence by the Update Committee. RESULTS Changes to previous recommendations include the addition of tbo-filgrastim and filgrastim-sndz, moderation of the recommendation regarding routine use of CSFs in older patients with diffuse aggressive lymphoma, and addition of recommendations against routine dose-dense chemotherapy in lymphoma and in favor of high-dose-intensity chemotherapy in urothelial cancer. The Update Committee did not address recommendations regarding use of CSFs in acute myeloid leukemia or myelodysplastic syndromes in adults. RECOMMENDATIONS Prophylactic use of CSFs to reduce the risk of febrile neutropenia is warranted when the risk of febrile neutropenia is approximately 20% or higher and no other equally effective and safe regimen that does not require CSFs is available. Primary prophylaxis is recommended for the prevention of febrile neutropenia in patients who are at high risk on the basis of age, medical history, disease characteristics, and myelotoxicity of the chemotherapy regimen. Dose-dense regimens that require CSFs should only be used within an appropriately designed clinical trial or if supported by convincing efficacy data. Current recommendations for the management of patients exposed to lethal doses of total-body radiotherapy, but not doses high enough to lead to certain death as a result of injury to other organs, include the prompt administration of CSFs.
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Affiliation(s)
- Thomas J Smith
- Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE
| | - Kari Bohlke
- Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE
| | - Gary H Lyman
- Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE
| | - Kenneth R Carson
- Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE
| | - Jeffrey Crawford
- Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE
| | - Scott J Cross
- Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE
| | - John M Goldberg
- Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE
| | - James L Khatcheressian
- Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE
| | - Natasha B Leighl
- Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE
| | - Cheryl L Perkins
- Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE
| | - George Somlo
- Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE
| | - James L Wade
- Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE
| | - Antoinette J Wozniak
- Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE
| | - James O Armitage
- Thomas J. Smith, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Kari Bohlke, American Society of Clinical Oncology, Alexandria; Scott J. Cross, Virginia Oncology Associates, Norfolk; James L. Khatcheressian, Virginia Cancer Institute, Richmond, VA; Gary H. Lyman, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; Kenneth R. Carson, Washington University, St Louis, MO; Jeffrey Crawford, Duke Medicine, Durham, NC; John M. Goldberg, University of Miami Miller School of Medicine, Miami, FL; Natasha B. Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Cheryl L. Perkins, patient representative, Dallas, TX; George Somlo, City of Hope National Medical Center, Duarte, CA; James L. Wade, Cancer Care Specialists of Central Illinois, Decatur, IL; Antoinette J. Wozniak, Karmanos Cancer Institute, Detroit, MI; and James O. Armitage, University of Nebraska Medical Center, Omaha, NE
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10
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Wright JD, Tergas AI, Ananth CV, Burke WM, Hou JY, Chen L, Neugut AI, Richards CA, Hershman DL. Quality and Outcomes of Treatment of Hypercalcemia of Malignancy. Cancer Invest 2015; 33:331-9. [PMID: 26068056 DOI: 10.3109/07357907.2015.1047506] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Using a nationwide database, 4,874 patients with hypercalcemia of malignancy were identified. The in-hospital mortality rate was 6.8%. Overall, 1,971 (40.4%) patients received pamidronate and 1,399 (28.7%) received zoledronic acid during hospitalization. Calcitonin was utilized in 1,337 (27.4%) patients while glucocorticoids were administered to 1,311 (26.9%). Use of contraindicated medications was noted in 136 (2.8%) patients who received thiazide diuretics and 12 (0.2%) who received lithium. Tumor site, presence of bone metastases, and severity of illness were predictors of treatment. There was no association between treatment with bisphosphonates, calcitonin, or glucocorticoids and morbidity or mortality.
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Affiliation(s)
- Jason D Wright
- a Department of Obstetrics and Gynecology , Columbia University , New York , USA.,b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , USA.,c New York Presbyterian Hospital , New York , USA
| | - Ana I Tergas
- a Department of Obstetrics and Gynecology , Columbia University , New York , USA.,b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , USA.,c New York Presbyterian Hospital , New York , USA.,d Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , USA
| | - Cande V Ananth
- a Department of Obstetrics and Gynecology , Columbia University , New York , USA.,d Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , USA
| | - William M Burke
- a Department of Obstetrics and Gynecology , Columbia University , New York , USA.,b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , USA.,c New York Presbyterian Hospital , New York , USA
| | - June Y Hou
- a Department of Obstetrics and Gynecology , Columbia University , New York , USA.,b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , USA.,c New York Presbyterian Hospital , New York , USA
| | - Ling Chen
- a Department of Obstetrics and Gynecology , Columbia University , New York , USA
| | - Alfred I Neugut
- b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , USA.,c New York Presbyterian Hospital , New York , USA.,d Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , USA .,e Department of Medicine, College of Physicians and Surgeons , Columbia University , New York , USA
| | - Catherine A Richards
- d Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , USA
| | - Dawn L Hershman
- b Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons , Columbia University , New York , USA.,c New York Presbyterian Hospital , New York , USA.,d Department of Epidemiology, Mailman School of Public Health , Columbia University , New York , USA .,e Department of Medicine, College of Physicians and Surgeons , Columbia University , New York , USA
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11
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Maroongroge S, Kim SP, Mougalian S, Johung K, Decker RH, Soulos PR, Long JB, Gross CP, Yu JB. The cost of cancer-related physician services to Medicare. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2015; 88:107-14. [PMID: 26029009 PMCID: PMC4445432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Although physician services represent a substantial portion of cancer care costs, little is known about trends in the costs of physician cancer services in the fee-for-service Medicare program. We analyzed aggregated data from all Part B Medicare claims for physician and supplier services attributed to cancer patients from 1999 to 2012 to characterize how billing and payments have changed over time for the most common cancer types. Billing and expenditure data are from the Medicare Statistical Supplement, and age-adjusted incidence data are from SEER. Physician services for cancer patients grew from $7.6 billion in 1999 to $12.3 billion in 2012 (60 percent increase). Reimbursements for physician and supplier services for cancer treatment in Medicare Part B beneficiaries steadily grew from 1999 to 2005 and then plateaued through 2012, led by a decrease in reimbursements for prostate cancer care. These trends may reflect shifts toward hospital-based care or changes in aggressiveness of care.
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Affiliation(s)
| | - Simon P. Kim
- University Hospital Case Western Reserve Medical Center, Case Western Reserve University, Urology Institute, Cleveland, Ohio,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, Connecticut
| | - Sarah Mougalian
- Yale School of Medicine, New Haven, Connecticut,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, Connecticut
| | - Kimberly Johung
- Yale School of Medicine, New Haven, Connecticut,Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Roy H. Decker
- Yale School of Medicine, New Haven, Connecticut,Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Pamela R. Soulos
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, Connecticut
| | - Jessica B. Long
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, Connecticut
| | - Cary P. Gross
- Yale School of Medicine, New Haven, Connecticut,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, Connecticut
| | - James B. Yu
- Yale School of Medicine, New Haven, Connecticut,Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, Connecticut,To whom all correspondence should be addressed: James B. Yu, Department of Therapeutic Radiology, Yale School of Medicine, HRT 138, 333 Cedar St., New Haven, CT 06520; Tele: 203-785-5703; Fax: 203-785-4622;
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12
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Zhang W, Jiang Z, Wang L, Li C, Xia J. An open-label, randomized, multicenter dose-finding study of once-per-cycle pegfilgrastim versus daily filgrastim in Chinese breast cancer patients receiving TAC chemotherapy. Med Oncol 2015; 32:147. [PMID: 25820754 DOI: 10.1007/s12032-015-0537-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 02/13/2015] [Indexed: 11/28/2022]
Abstract
A chemotherapy regimen of docetaxel, doxorubicin and cyclophosphamide (TAC) has been accepted as a standard care because of their superior clinical benefit in early-stage breast cancer patients, but with a higher risk of neutropenia. Pegfilgrastim is a once-per-cycle therapy for prophylactic neutrophil support and neutropenia prevention. There was still a lack of direct evidences for finding an optimal fixed dose of pegfilgrastim in Chinese breast cancer patients receiving TAC regimen. An open-label, randomized, phase II study was designed to compare the effects of pegfilgrastim with filgrastim. Eighteen centers in China enrolled 171 eligible female breast cancer patients with cycles of TAC chemotherapy treatment, randomized into four arms, received a single subcutaneous injection of pegfilgrastim (60, 100 or 120 µg/kg) per chemotherapy cycle or daily subcutaneous injections of filgrastim 5 µg/kg 24 h after chemotherapy. Efficacy and safety were analyzed. In ITT population, the mean duration of grade 3+ neutropenia (neutrophil count <1.0 × 10(9)/l) was 2.09, 1.53 and 1.73 days in patients who received pegfilgrastim 60, 100 and 120 µg/kg/cycle, respectively, and 1.69 days in patients who received 5 µg/kg/day filgrastim (P = 0.043). The incidence of grade 3+ neutropenia was 76, 83 and 74 % for doses of pegfilgrastim and 90 % for filgrastim (P = 0.409). The results for febrile neutropenia, time to neutrophil recovery and neutrophil profile were also not significantly different between arms. The safety profiles of pegfilgrastim and filgrastim were similar. A single dose of 100 µg/kg once-per-cycle administration of pegfilgrastim provided neutrophil support and a safety profile comparable to daily subcutaneous injections of filgrastim in Chinese breast cancer patients receiving TAC chemotherapy.
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Affiliation(s)
- Wei Zhang
- Department of Health Statistics, School of Preventive Medicine, Fourth Military Medical University, No. 169 Changle West Road, Xi'an, 710032, Shaanxi, China
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13
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Dinkelspiel HE, Tergas AI, Zimmerman LA, Burke WM, Hou JY, Chen L, Hillyer G, Neugut AI, Hershman DL, Wright JD. Use and duration of chemotherapy and its impact on survival in early-stage ovarian cancer. Gynecol Oncol 2015; 137:203-9. [PMID: 25703674 DOI: 10.1016/j.ygyno.2015.02.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/13/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Although 5-year survival for early-stage ovarian cancer is favorable, prognosis at recurrence is poor, necessitating appropriate initial management. We examined the patterns of care and the impact of the duration of chemotherapy on survival for women with early-stage ovarian cancer. METHODS We used the SEER-Medicare database to identify women ≥ 65 years of age with stage I ovarian cancer diagnosed from 1992 to 2009. Patients were categorized as low-risk (non-clear cell histology, stage IA or IB, grade 1 or 2) or high-risk (clear cell histology, grade 3, or stage IC). We used multivariable logistic regression models to determine predictors of chemotherapy use and duration and Cox proportional hazards models to evaluate the effect of chemotherapy use and duration on survival. RESULTS We identified 1394 patients. Among low-risk patients, 32.9% received adjuvant chemotherapy and the use of chemotherapy increased with time. Among high-risk patients, 71.9% received adjuvant chemotherapy; 44.2% had ≤ 3 months of treatment, and 55.8% had > 3 months of treatment. Older patients were less likely to receive chemotherapy, while those with higher stage and grade were more likely to receive chemotherapy (P<0.05 for all). Among high-risk patients, the duration of chemotherapy did not impact overall (HR=0.93, 95% CI, 0.67-1.27) or cancer specific (HR=0.93; 95% CI, 0.61-1.42) survival. CONCLUSIONS Among early-stage ovarian cancer patients, practice patterns are widely divergent. Extended duration chemotherapy does not appear to impact survival for women with high-risk disease.
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Affiliation(s)
- Helen E Dinkelspiel
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA
| | - Ana I Tergas
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - Lilli A Zimmerman
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA
| | - William M Burke
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - June Y Hou
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - Ling Chen
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA
| | - Grace Hillyer
- Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, USA
| | - Alfred I Neugut
- Department of Medicine, Columbia University College of Physicians and Surgeons, USA; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - Dawn L Hershman
- Department of Medicine, Columbia University College of Physicians and Surgeons, USA; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, USA; New York Presbyterian Hospital, USA.
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14
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Adjuvant Docetaxel and Cyclophosphamide (DC) with prophylactic granulocyte colony-stimulating factor (G-CSF) on days 8 &12 in breast cancer patients: a retrospective analysis. PLoS One 2014; 9:e107273. [PMID: 25330205 PMCID: PMC4198090 DOI: 10.1371/journal.pone.0107273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 08/14/2014] [Indexed: 11/23/2022] Open
Abstract
Purpose Four cycles of docetaxel/cyclophosphamide (DC) resulted in superior survival than doxorubicin/cyclophosphamide in the treatment of early breast cancer. The original study reported a 5% incidence of febrile neutropenia (FN) recommending prophylactic antibiotics with no granulocyte colony-stimulating factor (G-CSF) support. The worldwide adoption of this protocol yielded several reports on substantially higher rates of FN events. We explored the use of growth factor (GF) support on days 8 and 12 of the cycle with the original DC protocol. Methods Our study included all consecutive patients with stages I–II breast cancer who were treated with the DC protocol at the Institute of Oncology, Davidoff Center (Rabin Medical Center, Petah Tikva, Israel) from April, 2007 to March, 2012. Patient, tumor characteristics, and toxicity were reported. Results: In total, 123 patients received the DC regimen. Median age was 60 years, (range, 25–81 years). Thirty-three patients (26.8%) were aged 65 years and older. Most of the women (87%) adhered to the planned G-CSF protocol (days 8 &12). 96% of the patients completed the 4 planned cycles of chemotherapy. Six patients (5%) had dose reductions, 6 (5%) had treatment delays due to non-medical reasons. Thirteen patients (10.6%) experienced at least one event of FN (3 patients had 2 events), all requiring hospitalization. Eight patients (6.5%) required additional support with G-CSF after the first chemotherapy cycle, 7 because of FN and one due to neutropenia and diarrhea. In Conclusion Primary prophylactic G-CSF support on days 8 and 12 of the cycle provides a tolerable option to deliver the DC protocol. Our results are in line with other retrospective protocols using longer schedules of GF support.
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Dotan E, Li T, Hall MJ, Meropol NJ, Beck JR, Wong YN. Oncologists' response to new data regarding the use of epidermal growth factor receptor inhibitors in colorectal cancer. J Oncol Pract 2014; 10:308-14. [PMID: 25052499 DOI: 10.1200/jop.2014.001439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although initially approved for metastatic colorectal cancer (mCRC) tumors with epidermal growth factor receptor (EGFR) overexpression, the use of anti-EGFR antibodies is now restricted to wild-type KRAS tumors. Little is known about prescribers' response to new clinical data, practice guidelines, and US Food and Drug Administration (FDA) label change with regard to the use of anti-EGFR antibodies in clinical practice. METHODS Commercially insured patients with mCRC who received second-line therapy between 2004 and 2010 were identified by dusing the LifeLink Health Plan Claims Database. We calculated the fraction of patients receiving anti-EGFR antibody in 2-month intervals. χ(2) tests were used to compare treatment rates at four time points: time 1: June 2008, ASCO presentation of clinical data; time 2: February 2009, ASCO guidelines publication; time 3: August 2009, FDA label change; time 4: April 2010 to 8 months after FDA label change. RESULTS Five thousand eighty-nine patients received second-line therapy; of these, 2,599 patients received an anti-EGFR antibody. Median age was 60 years (range, 20 to 97), with 57% male sex. The majority of patients (59.4%) received an anti-EGFR antibody at time 1, with significant decrease at each of the subsequent time points (time 2: 46.2% [P = .019]; time 3: 35.2% [P < .001]; Time 4: 16.2% [P < .001]). Multivariable logistic regression did not show any affect of age, sex, comorbidities, or region of the country on this pattern. CONCLUSIONS The use of anti-EGFR antibodies for mCRC decreased after the presentation of clinical trial data, ASCO guidelines publication, and FDA label change. These data suggest that oncologists respond rapidly to new evidence and professional guidelines, and readily incorporate predictive biomarkers into clinical practice.
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Affiliation(s)
- Efrat Dotan
- Fox Chase Cancer Center, Philadelphia, PA; and University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Tianyu Li
- Fox Chase Cancer Center, Philadelphia, PA; and University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Michael J Hall
- Fox Chase Cancer Center, Philadelphia, PA; and University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Neal J Meropol
- Fox Chase Cancer Center, Philadelphia, PA; and University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | - J Robert Beck
- Fox Chase Cancer Center, Philadelphia, PA; and University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
| | - Yu-Ning Wong
- Fox Chase Cancer Center, Philadelphia, PA; and University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
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Moylan EJ, Connell LC, O'Reilly S. Are dose-dense and triplet chemotherapy regimens optimal adjuvant therapy in the majority of women with node-positive early breast cancer? J Clin Oncol 2014; 32:605-6. [PMID: 24419118 DOI: 10.1200/jco.2013.53.6771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kamioner D, Fruehauf S, Maloisel F, Cals L, Lepretre S, Berthou C. Study design: two long-term observational studies of the biosimilar filgrastim Nivestim™ (Hospira filgrastim) in the treatment and prevention of chemotherapy-induced neutropenia. BMC Cancer 2013; 13:547. [PMID: 24237790 PMCID: PMC3832750 DOI: 10.1186/1471-2407-13-547] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 10/29/2013] [Indexed: 12/24/2022] Open
Abstract
Background Nivestim™ (filgrastim) is a follow-on biologic agent licensed in the EU for the treatment of neutropenia and febrile neutropenia induced by myelosuppressive chemotherapy. Nivestim™ has been studied in phase 2 and 3 clinical trials where its efficacy and safety was found to be similar to its reference product, Neupogen®. Follow-on biologics continue to be scrutinised for safety. We present a design for two observational phase IV studies that are evaluating the safety profile of Nivestim™ for the prevention and treatment of febrile neutropenia (FN) in patients treated with cytotoxic chemotherapy in general clinical practice. Methods/Design The NEXT (Tolérance de Nivestim chez les patiEnts traités par une chimiothérapie anticancéreuse cytotoXique en praTique courante) and VENICE (VErträglichkeit von NIvestim unter zytotoxischer Chemotherapie in der Behandlung malinger Erkrankungen) trials are multicentre, prospective, longitudinal, observational studies evaluating the safety profile of Nivestim™ in 'real-world’ clinical practice. Inclusion criteria include patients undergoing cytotoxic chemotherapy for malignancy and receiving Nivestim as primary or secondary prophylaxis (NEXT and VENICE), or as treatment for ongoing FN (NEXT only). In accordance with European Union pharmacovigilance guidelines, the primary objective is to evaluate the safety of Nivestim™ by gathering data on adverse events in all system organ classes. Secondary objectives include obtaining information on patient characteristics, efficacy of Nivestim™ therapy (including chemotherapy dose intensity), patterns of use of Nivestim™, and physician knowledge regarding filgrastim prescription and the reasons for choosing Nivestim™. Data will be gathered at three visits: 1. At the initial inclusion visit, 2. At a 1-month follow-up visit, and 3. At the end of chemotherapy. Recruitment for VENICE commenced in July 2011 and in November 2011 for NEXT. VENICE completed recruitment in July 2013 with 407 patients, and NEXT in September 2013 with 2123 patients. Last patient, last visit for each study will be December 2013 and March 2014 respectively. Discussion The NEXT and VENICE studies will provide long-term safety, efficacy and practice pattern data in patients receiving Nivestim™ to support myelosuppressive chemotherapy in real world clinical practice. These data will improve our understanding of the performance of Nivestim™ in patients encountered in the general patient population. Trial registration NEXT NCT01574235, VENICE NCT01627990
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Affiliation(s)
- Didier Kamioner
- AFSOS and Hôpital Privé de l'Ouest Parisien, 78190 Trappes, France.
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Hershman DL, Wright JD, Lim E, Buono DL, Tsai WY, Neugut AI. Contraindicated use of bevacizumab and toxicity in elderly patients with cancer. J Clin Oncol 2013; 31:3592-9. [PMID: 24002522 DOI: 10.1200/jco.2012.48.4857] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Drugs are approved on the basis of randomized trials conducted in selected populations. However, once approved, these treatments are usually expanded to patients ineligible for the trial. PATIENTS AND METHODS We used the SEER-Medicare database to identify subjects older than 65 years with metastatic breast, lung, and colon cancer, diagnosed between 2004 and 2007 and undergoing follow-up to 2009, who received bevacizumab. We defined a contraindication as having at least two billing claims before bevacizumab for thrombosis, cardiac disease, stroke, hemorrhage, hemoptysis, or GI perforation. We defined toxicity as first development of one of these conditions after therapy. RESULTS Among 16,085 metastatic patients identified, 3,039 (18.9%) received bevacizumab. Receipt of bevacizumab was associated with white race, later year of diagnosis, tumor type, and decreased comorbid conditions. Of patients who received bevacizumab, 1,082 (35.5%) had a contraindication. In multivariate analysis, receipt of bevacizumab with a contraindication was associated with black race (odds ratio [OR] = 2.6; 95% CI, 1.4 to 4.9), increased age, comorbidity, later year of diagnosis, and lower socioeconomic status. Patients with lung (OR = 1.7; 95% CI, 1.1 to 2.4) and colon cancer (OR = 1.4; 95% CI, 1.1 to 1.9) were more likely to have a contraindication. In the group with no contraindication, 30% had a complication after bevacizumab; black patients were more likely to have a complication than were white patients (OR = 1.9; 95% CI, 1.21 to 2.93). CONCLUSION Our study demonstrates widespread use of bevacizumab among patients who had contraindications. Black patients were less likely to receive the drug, but those who did were more likely to have a contraindication. Efforts to understand toxicity and efficacy in populations excluded from clinical trials are needed.
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Affiliation(s)
- Dawn L Hershman
- Dawn L. Hershman, Jason D. Wright, Emerson Lim, Donna L. Buono, Wei Yann Tsai, and Alfred I. Neugut, Columbia University; and Dawn L. Hershman, Jason D. Wright, Emerson Lim, and Alfred I. Neugut, New York Presbyterian Hospital, New York, NY
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Jacobs VR, Augustin D, Wischnik A, Kiechle M, Höss C, Steinkohl O, Rack B, Kapitza T, Krase P. Prospective multi-center study for quantification of chemotherapies and CTX-related direct medication costs avoided by use of biomarkers uPA and PAI-1 in primary breast cancer. Breast 2013; 22:436-43. [DOI: 10.1016/j.breast.2013.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 03/24/2013] [Accepted: 04/03/2013] [Indexed: 11/24/2022] Open
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Health economic impact of risk group selection according to ASCO-recommended biomarkers uPA/PAI-1 in node-negative primary breast cancer. Breast Cancer Res Treat 2013; 138:839-50. [DOI: 10.1007/s10549-013-2496-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 03/20/2013] [Indexed: 10/27/2022]
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Hudis CA, Citron ML, Muss H, Norton L, Winer EP. Can We Really Use Retrospective Subset Analyses and Surveillance, Epidemiology, and End Results Data to Drive Clinical Practice? J Clin Oncol 2012; 30:3148-9; author reply 3149-50. [DOI: 10.1200/jco.2012.43.4746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Hy Muss
- University of North Carolina, Chapel Hill, NC
| | - Larry Norton
- Memorial Sloan-Kettering Cancer Center, New York City, NY
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Hershman DL, Wright JD, Neugut AI. Reply to C.A. Hudis et al. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.43.8192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Dawn L. Hershman
- Columbia University College of Physicians and Surgeons, Columbia University Medical Center, New York City, NY
| | | | - Alfred I. Neugut
- Columbia University Medical Center; Herbert Irving Comprehensive Cancer Center, New York City, NY
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Smith TJ, Hillner BE. A way forward on the medically appropriate use of white cell growth factors. J Clin Oncol 2012; 30:1584-7. [PMID: 22370327 PMCID: PMC3383110 DOI: 10.1200/jco.2011.39.9980] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Thomas J Smith
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD 21287-0005, USA.
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Hillner BE, Smith TJ. Wiser Use of Dose-Dense Adjuvant Therapy in Breast Cancer. J Clin Oncol 2012; 30:772-4. [DOI: 10.1200/jco.2011.40.2537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bruce E. Hillner
- The Massey Cancer Center of Virginia Commonwealth University, Richmond, VA
| | - Thomas J. Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
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