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Serrano C, Rothschild S, Villacampa G, Heinrich MC, George S, Blay JY, Sicklick JK, Schwartz GK, Rastogi S, Jones RL, Rutkowski P, Somaiah N, Navarro V, Evans D, Trent JC. Rethinking placebos: embracing synthetic control arms in clinical trials for rare tumors. Nat Med 2023; 29:2689-2692. [PMID: 37828359 DOI: 10.1038/s41591-023-02578-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Affiliation(s)
- César Serrano
- Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain.
- Sarcoma Translational Research Program, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.
| | | | - Guillermo Villacampa
- Oncology Data Science, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
- The Institute of Cancer Research, London, UK
| | - Michael C Heinrich
- Portland VA Health Care System and Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Suzanne George
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
- Université Claude Bernard, Lyon, France
| | - Jason K Sicklick
- Department of Surgery, Division of Surgical Oncology, University of California San Diego, La Jolla, CA, USA
- Department of Pharmacology, University of California San Diego, San Diego, CA, USA
| | - Gary K Schwartz
- Case Comprehensive Cancer Center in Cleveland, Cleveland, OH, USA
| | - Sameer Rastogi
- Department of Medical Oncology, All India Institute of Medical Science (AIIMS), New Delhi, India
| | - Robin L Jones
- Division of Clinical Studies, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, UK
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Neeta Somaiah
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Víctor Navarro
- Oncology Data Science, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Jonathan C Trent
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
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Roberts TJ, Bailey AS, Tahir N, Jacobson JO. Care Fragmentation, Faulty Communication, and Documentation Lapses Derail a Treatment Plan. JCO Oncol Pract 2023; 19:37-44. [PMID: 36375113 DOI: 10.1200/op.22.00471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This is the second Cancer Morbidity, Mortality, and Improvement Rounds, a series of articles intended to explore the unique safety risks experienced by oncology patients through the lens of quality improvement, systems and human factors engineering, and cognitive psychology. This case describes the care of a patient who was diagnosed with locally advanced lung cancer during the COVID-19 pandemic; it highlights how gaps in communication and care coordination caused the patient to receive care that did not reflect the consensus of his multidisciplinary team. The discussion highlights the importance of multidisciplinary care, particularly for patients with stage III non-small-cell lung cancer, discusses factors that led to communication gaps, and examines how we should assign accountability across dispersed health care systems.Cancer Morbidity, Mortality, and Improvement Rounds is a series of articles intended to explore the unique safety risks experienced by oncology patients through the lens of quality improvement, systems and human factors engineering, and cognitive psychology. For purposes of clarity, each case focuses on a single theme, although, as is true for all medical incidents, there are almost always multiple, overlapping, contributing factors. The quality improvement paradigm used here, which focuses on root cause analyses and opportunities to improve care delivery systems, was previously outlined in this journal.
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Affiliation(s)
- Thomas J Roberts
- Dana-Farber Cancer Institute, Boston, MA.,Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | | | | | - Joseph O Jacobson
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Medical School, Boston, MA
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Davie A, Cuyun Carter G, Rider A, Bailey A, Lewis K, Price G, Ostojic H, Ringeisen F, Pivot X. Real-world clinical profile, treatment patterns and patient-reported outcomes in a subset of HR+/HER2- advanced breast cancer patients with poor prognostic factors: data from an international study. ESMO Open 2021; 6:100226. [PMID: 34371379 PMCID: PMC8358418 DOI: 10.1016/j.esmoop.2021.100226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 11/15/2022] Open
Abstract
Background Patients with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) advanced breast cancer (ABC) and disease-related poor prognostic factors are not well characterized. We aimed to describe patient demographics, disease characteristics, treatment patterns and patient-reported outcomes in a subset of HR+/HER2− ABC patients with these factors [at the time when cyclin-dependent kinase (CDK) 4 and 6 inhibitors were being introduced] and understand how these factors informed treatment decisions at the time of the survey. Methods Real-world data were derived from a large, multinational, point-in-time survey of oncologists and their consulting patients with HR+/HER2− ABC in the EU5 and USA over March-June 2017, at the start of the changing treatment landscape. Analysis focused on four poor prognostic factors: visceral metastases, liver metastases (subset of visceral metastases), progesterone receptor-negative status and high tumor grade. Results In total, 2259 patients with HR+/HER2− ABC had records eligible for this analysis. At least one poor prognostic factor was present in 63% of patients (most common visceral metastases; least common progesterone receptor-negative status), with varying degrees of overlap between factors. For physician-reported outcomes, pain increased, whereas performance status and activities of daily living declined with presence of poor prognostic factors, especially liver metastases. No clear trends were observed for patient-reported outcomes. Treatment with combined endocrine therapy plus CDK4 and 6 inhibitors was infrequent, as these agents were entering the market. Conclusions More than 60% of the HR+/HER2− ABC Adelphi Real World Disease Specific Programme™ sample had ≥1 disease-related poor prognostic factor, and patients appeared to be heterogeneous regarding occurrence and distribution of these factors. These patients typically have increased pain and reduced performance status, highlighting the importance of implementing effective therapy with CDK4 and 6 inhibitors. Future studies could inform how the treatment landscape has evolved over time with respect to patients with poor prognostic factors. Some 63% of HR+/HER2− ABC patients in this sample had ≥1 disease-related factors more likely to confer a poorer prognosis Patients with these factors typically had increased pain and reduced performance status Chemotherapy was prescribed more frequently in patients with poor prognostic factors Introduction of CDK4 and 6 inhibitors saw more patients with poor prognostic factors receive endocrine therapy-based regimens This study is a baseline to understand the impact of these new treatments on prognosis and aggressive disease
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Affiliation(s)
- A Davie
- Eli Lilly and Co. Ltd, Windlesham, UK
| | | | - A Rider
- Adelphi Real World, Bollington, Macclesfield, UK
| | - A Bailey
- Adelphi Real World, Bollington, Macclesfield, UK
| | - K Lewis
- Adelphi Real World, Bollington, Macclesfield, UK.
| | - G Price
- Eli Lilly and Co, Indianapolis, USA
| | | | | | - X Pivot
- Paul Strauss Cancer Center, Strasbourg, France
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Lim C, Goumard C, Casellas-Robert M, Lopez-Ben S, Lladó L, Busquets J, Salloum C, Albiol-Quer MT, Castro-Gutiérrez E, Rosmorduc O, Feray C, Ramos E, Figueras J, Scatton O, Azoulay D. Impact on Oncological Outcomes and Intent-to-Treat Survival of Resection Margin for Transplantable Hepatocellular Carcinoma in All-Comers and in Patients with Cirrhosis: A Multicenter Study. World J Surg 2021; 44:1966-1974. [PMID: 32095855 DOI: 10.1007/s00268-020-05424-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The outcomes of liver resection (LR) with a narrow margin in patients with transplantable hepatocellular carcinoma (HCC) have not been studied. The aim was to assess whether narrow margin following up-front LR impacts the incidence, timing, pattern, and transplantability of tumor recurrence in patients with initially transplantable HCC. METHODS All initially transplantable HCC patients undergoing hepatectomy with either narrow (<10 mm) or wide (≥10 mm) margins from 2007 to 2016 at four Western university centers were compared in terms of recurrence, transplantability of recurrence, recurrence-free survival (RFS), and intention-to-treat overall survival (ITT-OS). Independent predictors of non-transplantability of recurrence were assessed. RESULTS This study included 187 patients (narrow group, n = 107 vs. wide group, n = 80). Recurrence was significantly more frequent in the narrow margin group (44% vs. 26%; p = 0.01) with a shorter RFS (p = 0.03). The transplantability of recurrence and ITT-OS were, however, not different between the two groups. The presence of satellite nodules on the resected specimens emerged as the sole independent predictor of non-transplantability of tumor recurrence. The stratification of the analysis according to the presence of cirrhosis achieved essentially the same results as in the whole study population. CONCLUSIONS Narrow margin was associated with a higher tumor recurrence rate and a shorter RFS for patients with initially transplantable HCC. However, transplantability of recurrence and long-term ITT-OS were not impaired.
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Affiliation(s)
- Chetana Lim
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpétrière Hospital, Paris, France
| | - Claire Goumard
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpétrière Hospital, Paris, France
| | - Margarida Casellas-Robert
- Department of Hepato-Biliary and Pancreatic Surgery, Hospital Universitari Dr. Josep Trueta, Girona, Catalonia, Spain
| | - Santiago Lopez-Ben
- Department of Hepato-Biliary and Pancreatic Surgery, Hospital Universitari Dr. Josep Trueta, Girona, Catalonia, Spain
| | - Laura Lladó
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, CIBERehd., Barcelona, Catalonia, Spain
| | - Juli Busquets
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, CIBERehd., Barcelona, Catalonia, Spain
| | - Chady Salloum
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France
| | - Maria Teresa Albiol-Quer
- Department of Hepato-Biliary and Pancreatic Surgery, Hospital Universitari Dr. Josep Trueta, Girona, Catalonia, Spain
| | - Ernest Castro-Gutiérrez
- Department of Hepato-Biliary and Pancreatic Surgery, Hospital Universitari Dr. Josep Trueta, Girona, Catalonia, Spain
| | - Olivier Rosmorduc
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpétrière Hospital, Paris, France
| | - Cyrille Feray
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France
| | - Emilio Ramos
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, CIBERehd., Barcelona, Catalonia, Spain
| | - Joan Figueras
- Department of Hepato-Biliary and Pancreatic Surgery, Hospital Universitari Dr. Josep Trueta, Girona, Catalonia, Spain
| | - Olivier Scatton
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpétrière Hospital, Paris, France
| | - Daniel Azoulay
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France. .,Department of Hepatobiliary and Pancreatic Surgery and Transplantation, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Avenue Paul Vaillant Couturier, 94000, Villejuif, France.
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6
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Myint ZW, Shrestha R, Siddiqui S, Slone S, Huang B, Ramlal R, Monohan GP, Hildebrandt GC, Saeed H. Ten-year survival outcomes for patients with early stage classical Hodgkin lymphoma: An analysis from Kentucky Cancer Registry. Hematol Oncol Stem Cell Ther 2019; 13:17-22. [PMID: 31629724 DOI: 10.1016/j.hemonc.2019.08.009] [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] [Received: 04/19/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE/BACKGROUND Early stage classical Hodgkin lymphoma (cHL) has an excellent outcome. Recent studies focus on decreasing toxicity related to the addition of radiation along with chemotherapy. Real-life reporting of the addition of radiation to chemotherapy is lacking. This study investigates the outcomes obtained from a statewide cancer registry for early stage cHL patients treated with chemotherapy alone (CT) versus patients treated with the combined modality of chemotherapy and radiation (CMT). METHODS A retrospective study of cHL patients diagnosed and treated was identified using a statewide cancer registry from 2005 to 2014. Patients with early stage disease (I, II) were then grouped on the basis of the presence of B symptoms into favorable and unfavorable groups. Baseline characteristics (age, gender, extranodal involvement, and histology) as well as overall survival were compared for both groups depending on whether they received CT or CMT as first line therapy for their cHL. RESULTS A total of 961 patients were identified; of those, 127 were excluded as they received only radiation or another form of treatment. Of the remaining patients, 293 were categorized as early stage favorable cHL (Group 1) and 130 adults were in the unfavorable cHL (Group 2). There were 335 patients with advanced stage cHL (Group 3) and 76 patients in an unknown stage. The 10-year overall survival for Group 1 was 81.3% versus 76.3% for Group 2 and 52.7% for Group 3. For Group 1, 10-year overall survival was 86.7% with CMT versus 75.1% for those receiving CT only (p = .004). For Group 2, there was no difference in 10-year overall survival between the CMT group (80.0%) and CT (72.5%) (p = .73). CONCLUSION While radiation therapy might increase long-term toxicity in cHL, in our large data cohort, radiotherapy consolidation as part of the initial therapy for early stage disease provides superior survival at 10 years, especially in favorable risk cHL.
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Affiliation(s)
- Zin W Myint
- Department of Internal Medicine, Division of Medical Oncology, University of Kentucky, USA
| | - Runa Shrestha
- Department of Internal Medicine, Division of Hematology/BMT, USA
| | | | - Stacey Slone
- Biostatistics and Bioinformatics Shared Resources Facility, USA
| | - Bin Huang
- Department of Internal Medicine, Division of Hematology/BMT, USA; Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Reshma Ramlal
- Department of Internal Medicine, Division of Hematology/BMT, USA
| | | | | | - Hayder Saeed
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
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Abstract
The use of data from the real world to address clinical and policy-relevant questions that cannot be answered using data from clinical trials is garnering increased interest. Indeed, data from cancer registries and linked treatment records can provide unique insights into patients, treatments and outcomes in routine oncology practice. In this Review, we explore the quality of real-world data (RWD), provide a framework for the use of RWD and draw attention to the methodological pitfalls inherent to using RWD in studies of comparative effectiveness. Randomized controlled trials and RWD remain complementary forms of medical evidence; studies using RWD should not be used as substitutes for clinical trials. The comparison of outcomes between nonrandomized groups of patients who have received different treatments in routine practice remains problematic. Accordingly, comparative effectiveness studies need to be designed and interpreted very carefully. With due diligence, RWD can be used to identify and close gaps in health care, offering the potential for short-term improvement in health-care systems by enabling them to achieve the achievable.
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Karim S, Booth CM. Effectiveness in the Absence of Efficacy: Cautionary Tales From Real-World Evidence. J Clin Oncol 2019; 37:1047-1050. [DOI: 10.1200/jco.18.02105] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Booth CM, Karim S, Peng Y, Siemens DR, Brennan K, Mackillop WJ. Radical Treatment of the Primary Tumor in Metastatic Bladder Cancer: Potentially Dangerous Findings From Observational Data. J Clin Oncol 2018; 36:533-535. [DOI: 10.1200/jco.2017.76.1759] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Christopher M. Booth
- Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston, ON, Canada; Safiya Karim, Queen’s University Cancer Research Institute, Kingston, ON, Canada; Yingwei Peng, Queen’s University Cancer Research Institute, Kingston, ON, Canada; D. Robert Siemens, Queen’s University Cancer Research Institute, Kingston, ON, Canada; Kelly Brennan, Queen’s University Cancer Research Institute, Kingston, ON, Canada; and William J. Mackillop, Queen’s University Cancer Research Institute, Kingston, ON,
| | - Safiya Karim
- Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston, ON, Canada; Safiya Karim, Queen’s University Cancer Research Institute, Kingston, ON, Canada; Yingwei Peng, Queen’s University Cancer Research Institute, Kingston, ON, Canada; D. Robert Siemens, Queen’s University Cancer Research Institute, Kingston, ON, Canada; Kelly Brennan, Queen’s University Cancer Research Institute, Kingston, ON, Canada; and William J. Mackillop, Queen’s University Cancer Research Institute, Kingston, ON,
| | - Yingwei Peng
- Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston, ON, Canada; Safiya Karim, Queen’s University Cancer Research Institute, Kingston, ON, Canada; Yingwei Peng, Queen’s University Cancer Research Institute, Kingston, ON, Canada; D. Robert Siemens, Queen’s University Cancer Research Institute, Kingston, ON, Canada; Kelly Brennan, Queen’s University Cancer Research Institute, Kingston, ON, Canada; and William J. Mackillop, Queen’s University Cancer Research Institute, Kingston, ON,
| | - D. Robert Siemens
- Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston, ON, Canada; Safiya Karim, Queen’s University Cancer Research Institute, Kingston, ON, Canada; Yingwei Peng, Queen’s University Cancer Research Institute, Kingston, ON, Canada; D. Robert Siemens, Queen’s University Cancer Research Institute, Kingston, ON, Canada; Kelly Brennan, Queen’s University Cancer Research Institute, Kingston, ON, Canada; and William J. Mackillop, Queen’s University Cancer Research Institute, Kingston, ON,
| | - Kelly Brennan
- Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston, ON, Canada; Safiya Karim, Queen’s University Cancer Research Institute, Kingston, ON, Canada; Yingwei Peng, Queen’s University Cancer Research Institute, Kingston, ON, Canada; D. Robert Siemens, Queen’s University Cancer Research Institute, Kingston, ON, Canada; Kelly Brennan, Queen’s University Cancer Research Institute, Kingston, ON, Canada; and William J. Mackillop, Queen’s University Cancer Research Institute, Kingston, ON,
| | - William J. Mackillop
- Christopher M. Booth, Queen’s University Cancer Research Institute, Kingston, ON, Canada; Safiya Karim, Queen’s University Cancer Research Institute, Kingston, ON, Canada; Yingwei Peng, Queen’s University Cancer Research Institute, Kingston, ON, Canada; D. Robert Siemens, Queen’s University Cancer Research Institute, Kingston, ON, Canada; Kelly Brennan, Queen’s University Cancer Research Institute, Kingston, ON, Canada; and William J. Mackillop, Queen’s University Cancer Research Institute, Kingston, ON,
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Biau J, Chautard E, De Schlichting E, Dupic G, Pereira B, Fogli A, Müller-Barthélémy M, Dalloz P, Khalil T, Dillies AF, Durando X, Godfraind C, Verrelle P. Radiotherapy plus temozolomide in elderly patients with glioblastoma: a "real-life" report. Radiat Oncol 2017; 12:197. [PMID: 29212499 PMCID: PMC5719937 DOI: 10.1186/s13014-017-0929-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/21/2017] [Indexed: 11/22/2022] Open
Abstract
Background The optimization of the management for elderly glioblastoma patients is crucial given the demographics of aging in many countries. We report the outcomes for a “real-life” patient cohort (i.e. unselected) comprising consecutive glioblastoma patients aged 70 years or more, treated with different radiotherapy +/− temozolomide regimens. Methods From 2003 to 2016, 104 patients ≥ 70 years of age, consecutively treated by radiotherapy for glioblastoma, were included in this study. All patients were diagnosed with IDH-wild type glioblastoma according to pathological criteria. Results Our patient cohort comprised 51 female patients (49%) and 53 male. The median cohort age was 75 years (70–88), and the median Karnofsky performance status (KPS) was 70 (30–100). Five (5%) patients underwent macroscopic complete resection, 9 (9%) had partial resection, and 90 (86%), a stereotactic biopsy. The MGMT promoter was methylated in 33/73 cases (45%). Fifty-two (50%), 38 (36%), and 14 (14%) patients were categorized with RPA scores of III, IV, and I-II. Thirty-three (32%) patients received normofractionated radiotherapy (60 Gy, 30 sessions) with temozolomide (Stupp), 37 (35%) received hypofractionated radiotherapy (median dose 40 Gy, 15 sessions) with temozolomide (HFRT + TMZ), and 34 (33%) HFRT alone. Patients receiving only HFRT were significantly older, with lower KPSs. The median overall survival (OS; all patients) was 5.2 months. OS rates at 12, 18, and 24 months, were 19%, 12%, and 5%, respectively, with no statistical differences between patients receiving Stupp or HFRT + TMZ (P = 0.22). In contrast, patients receiving HFRT alone manifested a significantly shorter survival time (3.9 months vs. 5.9 months, P = 0.018). In multivariate analyses, the prognostic factors for OS were: i) the type of surgery (HR: 0.47 [0.26–0.86], P = 0.014), ii) RPA class (HR: 2.15 [1.17–3.95], P = 0.014), and iii) temozolomide use irrespective of radiotherapy schedule (HR: 0.54 [0.33–0.88], P < 0.02). MGMT promoter methylation was neither a prognostic nor a predictive factor. Conclusions These outcomes agree with the literature in terms of optimal surgery and the use of HFRT as a standard treatment for elderly GBM patients. Our study emphasizes the potential benefit of using temozolomide with radiotherapy in a real-life cohort of elderly GBM patients, irrespective of their MGMT status.
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Affiliation(s)
- J Biau
- Radiotherapy Department, Université Clermont Auvergne, Centre Jean Perrin, 63011, Clermont-Ferrand, France. .,Université Clermont Auvergne, INSERM, U1240 IMoST, F-63000, Clermont Ferrand, France.
| | - E Chautard
- Radiotherapy Department, Université Clermont Auvergne, Centre Jean Perrin, 63011, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM, U1240 IMoST, F-63000, Clermont Ferrand, France
| | - E De Schlichting
- Neurosurgery Department, Clermont-Ferrand Hospital, 63003, Clermont-Ferrand, France
| | - G Dupic
- Radiotherapy Department, Université Clermont Auvergne, Centre Jean Perrin, 63011, Clermont-Ferrand, France
| | - B Pereira
- Biostatistics Department, DRCI, Clermont-Ferrand Hospital, 63003, Clermont-Ferrand, France
| | - A Fogli
- Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD Laboratory, 63000, Clermont-Ferrand, France
| | - M Müller-Barthélémy
- Université Clermont Auvergne, INSERM, U1240 IMoST, F-63000, Clermont Ferrand, France
| | - P Dalloz
- Oncology Department, Université Clermont Auvergne, Centre Jean Perrin, 63011, Clermont-Ferrand, France
| | - T Khalil
- Neurosurgery Department, Clermont-Ferrand Hospital, 63003, Clermont-Ferrand, France
| | - A F Dillies
- Oncology Department, Université Clermont Auvergne, Centre Jean Perrin, 63011, Clermont-Ferrand, France
| | - X Durando
- Université Clermont Auvergne, INSERM, U1240 IMoST, F-63000, Clermont Ferrand, France.,Oncology Department, Université Clermont Auvergne, Centre Jean Perrin, 63011, Clermont-Ferrand, France
| | - C Godfraind
- Université Clermont Auvergne, INSERM, U1240 IMoST, F-63000, Clermont Ferrand, France.,Anatomopathology Department, Clermont-Ferrand Hospital, 63003, Clermont-Ferrand, France
| | - P Verrelle
- Radiotherapy Department, Université Clermont Auvergne, Centre Jean Perrin, 63011, Clermont-Ferrand, France.,Radiation Oncology Department, Institut Curie, 75248, Paris, France
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Lim C, Shinkawa H, Hasegawa K, Bhangui P, Salloum C, Gomez Gavara C, Lahat E, Omichi K, Arita J, Sakamoto Y, Compagnon P, Feray C, Kokudo N, Azoulay D. Salvage liver transplantation or repeat hepatectomy for recurrent hepatocellular carcinoma: An intent-to-treat analysis. Liver Transpl 2017; 23:1553-1563. [PMID: 28945955 DOI: 10.1002/lt.24952] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/09/2017] [Accepted: 09/17/2017] [Indexed: 02/07/2023]
Abstract
The salvage liver transplantation (LT) strategy was conceived for initially resectable and transplantable hepatocellular carcinoma (HCC) to obviate upfront transplantation, with salvage LT in the case of recurrence. The longterm outcomes of a second resection for recurrent HCC have improved. The aim of this study was to perform an intention-to-treat analysis of overall survival (OS) comparing these 2 strategies for initially resectable and transplantable recurrent HCC. From 1994 to 2011, 391 patients with HCC who underwent salvage LT (n = 77) or a second resection (n = 314) were analyzed. Of 77 patients in the salvage LT group, 21 presented with resectable and transplantable recurrent HCC and 18 underwent transplantation. Of 314 patients in the second resection group, 81 presented with resectable and transplantable recurrent HCC and 81 underwent a second resection. The 5-year intention-to-treat OS rates, calculated from the time of primary hepatectomy, were comparable between the 2 strategies (72% for salvage transplantation versus 77% for second resection; P = 0.57). In patients who completed the salvage LT or second resection procedure, the 5-year OS rates, calculated from the time of the second surgery, were comparable between the 2 strategies (71% versus 71%; P = 0.99). The 5-year disease-free survival (DFS) rates were 72% following transplantation and 18% following the second resection (P < 0.001). Similar results were observed after propensity score matching. In conclusion, although the 5-year OS rates were similar in the salvage LT and second resection groups, the salvage LT strategy still achieves better DFS. Second resection for recurrent HCC might be considered to be the best alternative option to LT in the current organ shortage. Liver Transplantation 23 1553-1563 2017 AASLD.
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Affiliation(s)
- Chetana Lim
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation and, Henri Mondor Hospital, AP-HP, Paris-Est University, Créteil, France
| | - Hiroji Shinkawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Prashant Bhangui
- Medanta Institute of Liver Transplantation and Regenerative Medicine, New Delhi, India
| | - Chady Salloum
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation and, Henri Mondor Hospital, AP-HP, Paris-Est University, Créteil, France
| | - Concepcion Gomez Gavara
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation and, Henri Mondor Hospital, AP-HP, Paris-Est University, Créteil, France
| | - Eylon Lahat
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation and, Henri Mondor Hospital, AP-HP, Paris-Est University, Créteil, France
| | - Kiyohiko Omichi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Junichi Arita
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoshihiro Sakamoto
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Philippe Compagnon
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation and, Henri Mondor Hospital, AP-HP, Paris-Est University, Créteil, France
| | - Cyrille Feray
- Department of Hepatology, Henri Mondor Hospital, AP-HP, Paris-Est University, Créteil, France
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Daniel Azoulay
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation and, Henri Mondor Hospital, AP-HP, Paris-Est University, Créteil, France
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Hall SF, Irish J, Groome P, Griffiths R, Hurlbut D. Do Lower-Risk Thyroid Cancer Patients Who Live in Regions with More Aggressive Treatments Have Better Outcomes? Thyroid 2017; 27:1246-1257. [PMID: 28851261 DOI: 10.1089/thy.2017.0103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The management of differentiated thyroid cancer has traditionally consisted of total thyroidectomy with or without adjuvant radioactive iodine. However, in the last two decades, this approach has been challenged, with the consideration of more conservative approaches such as less radical surgery and deferring adjuvant treatment, especially in lower-risk patients. The objective of this study was to consider the effectiveness of current treatment options by comparing the survival outcomes from different geographic regions with different treatment philosophies. This study design was based on the concept of natural experiments in patient care that occur when physicians in different regions treat the spectrum of typical patients with varying treatments. METHOD This population-based retrospective cohort study investigated 2444 patients with differentiated thyroid cancer ≤4 cm between 1990 and 2001 from Ontario, Canada. Extent of disease and extent of surgery were abstracted from pathology reports and were linked to downstream administrative medical information on treatments and outcomes. Patient demographics, tumor characteristics, treatments, and outcomes were compared between those geographic regions with more aggressive treatments and those regions with less aggressive treatments. RESULTS Treatment varied across the province. When comparing outcomes in regions where patients had more extensive treatment to those in regions where patients had less extensive therapy, similar rates were found for 15-year survival, recurrence, and survival after recurrence. CONCLUSION There were significant variations in treatment but no differences in outcomes for regions with more versus less aggressive approaches. These findings support the trend toward more conservative management approaches in the treatment of thyroid cancer.
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Affiliation(s)
- Stephen F Hall
- 1 Department of Otolaryngology/Head and Neck Surgery, Cancer Care and Epidemiology, Queen's University , Kingston, Canada
| | - Jonathan Irish
- 2 Department of Otolaryngology/Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Center, University of Toronto , Toronto, Canada
| | - Patti Groome
- 3 Cancer Care and Epidemiology, Department of Public Health Sciences, Queen's University , Kingston, Canada
| | - Rebecca Griffiths
- 4 Cancer Care and Epidemiology, Queen's University , Kingston, Canada
| | - David Hurlbut
- 5 Department of Pathology and Laboratory Sciences, Queen's University , Kingston, Canada
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Pivot X, Fumoleau P, Pierga JY, Delaloge S, Bonnefoi H, Bachelot T, Jouannaud C, Bourgeois H, Rios M, Soulié P, Jacquin JP, Lavau-Denes S, Kerbrat P, Cox D, Faure-Mercier C, Pauporte I, Gligorov J, Curtit E, Henriques J, Paget-Bailly S, Romieu G. Superimposable outcomes for sequential and concomitant administration of adjuvant trastuzumab in HER2-positive breast cancer: Results from the SIGNAL/PHARE prospective cohort. Eur J Cancer 2017. [PMID: 28624696 DOI: 10.1016/j.ejca.2017.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AIM Adjuvant clinical trials in early human epidermal growth factor receptor 2 (HER2)-positive breast cancer have assessed either sequential or concomitant incorporation of trastuzumab with chemotherapy; only the North Central Cancer Treatment Group (NCCTG)-N9831 trial prospectively compared both modalities. In routine trastuzumab has been incorporated into a concurrent regimen with taxane chemotherapy instead of sequential modality on the basis of a positive risk-benefit ratio. This present study assessed sequential versus concomitant administration of adjuvant trastuzumab. METHODS A population combining patients from Protocol for Herceptin® as Adjuvant therapy with Reduced Exposure (PHARE) a randomised phase III clinical trial (NCT00381901) and SIGNAL (RECF1098) a prospective study specifically designed for Genome-wide Association Studies (GWAS) analyses was studied. In this cohort with 58 months of median follow-up, the comparison in the HER2-positive group of adjuvant trastuzumab and chemotherapy modalities was based on a propensity score methodology. Treatment modalities were based on physician's choice and comparisons adjustment were made by a propensity score methodology. Overall Survival (OS) and Disease-Free Survival (DFS) were estimated using the Kaplan-Meier method, and comparisons between groups were based on the log rank test. RESULTS The SIGNAL/PHARE cohort included 11,728 breast cancer cases treated in adjuvant setting; some 5502 of them with HER2-positive tumour: 34.5% (1897/5502) were treated by sequential and 65.5% (3605/5502) by concomitant modality of administration for taxane-chemotherapy and trastuzumab. The adjusted comparison found similar OS (HR = 1.01; 95% CI: 0.86-1.19) and similar DFS (HR = 1.08; 95% CI: 0.96-1.21). CONCLUSION These results suggest that the sequential administration of trastuzumab given after the completion of adjuvant chemotherapy might be as valid as the concomitant administration of trastuzumab and taxane chemotherapy in the adjuvant setting.
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Affiliation(s)
- Xavier Pivot
- Hôpital Jean-Minjoz, Centre Hospitalier Universitaire INSERM 1098, Boulevard Fleming, 25030 Besançon, France.
| | - Pierre Fumoleau
- Georges-François Leclerc, 1 Rue du Professeur Marion, 21000 Dijon, France
| | - Jean-Yves Pierga
- Institut Curie, Department of Medical Oncology, 26 rue d'Ulm, 75248 Paris Cedex 05, France
| | - Suzette Delaloge
- Institut Gustave Roussy, Comité de Pathologie mammaire, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France
| | - Hervé Bonnefoi
- Institut Bergonié, Département d'Oncologie Médicale, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Thomas Bachelot
- Centre Léon Bérard, Département de Cancérologie Médicale, 28 rue Laënnec, Lyon Cedex 08, France
| | - Christelle Jouannaud
- Institut Jean Godinot, Service Oncologie Médicale, 1 rue du Général Koenig, 51056 Reims Cedex, France
| | - Hugues Bourgeois
- Clinique Victor Hugo-Centre Jean Bernard, 18 rue Victor Hugo, 72015 Le Mans Cedex 2, France
| | - Maria Rios
- Institut de Cancérologie de Lorraine - Alexis Vautrin, département d'Oncologie Médicale, 6, avenue de Bourgogne, 54511 Vandoeuvre Les Nancy Cedex, France
| | - Patrick Soulié
- Institut de Cancérologie de l'Ouest, Service Oncologie Médicale, 2 rue Moll, 49993 Angers Cedex 09, France
| | - Jean-Philippe Jacquin
- Institut de Cancérologie Lucien Neuwirth, Service Oncologie Médicale, 108 bis avenue Albert Raimond, 42270 Saint Priest en Jarez, France
| | - Sandrine Lavau-Denes
- Centre Hospitalier de Limoges, Service d'Oncologie Médicale, 2 avenue Martin Luther King, 87042 Limoges Cedex, France
| | - Pierre Kerbrat
- Centre Eugène Marquis, Service Oncologie médicale, Rue de la Bataille Flandres-Dunkerque, CS 44229, 35042 Rennes Cedex, France
| | - David Cox
- Centre de Recherche en Cancérologie de Lyon, INSERM U1052 - Centre Léon Bérard, 28 rue Laennec, 69373 Lyon, France
| | - Céline Faure-Mercier
- Institut National du Cancer, Direction de la Recherche, 52 avenue Morizet, 92513 Boulogne-Billancourt, France
| | - Iris Pauporte
- Institut National du Cancer, Direction de la Recherche, 52 avenue Morizet, 92513 Boulogne-Billancourt, France
| | - Joseph Gligorov
- Hôpital Tenon, Service Oncologie médicale, 4 rue de la Chine, 75970 Paris Cedex 20, France
| | - Elsa Curtit
- Hôpital Jean-Minjoz, Centre Hospitalier Universitaire INSERM 1098, Boulevard Fleming, 25030 Besançon, France
| | - Julie Henriques
- Centre Hospitalier Universitaire, Unité de Méthodologie et de Qualité de Vie en Cancérologie, 2 place St Jacques, 25000 Besançon, France
| | - Sophie Paget-Bailly
- Centre Hospitalier Universitaire, Unité de Méthodologie et de Qualité de Vie en Cancérologie, 2 place St Jacques, 25000 Besançon, France
| | - Gilles Romieu
- Oncologie Sénologie, ICM Institut Régional du Cancer, 34298 Montpellier Cedex, France
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Hester LL, Poole C, Suarez EA, Der JS, Anderson OG, Almon KG, Shirke AV, Brookhart MA. Publication of comparative effectiveness research has not increased in high-impact medical journals, 2004-2013. J Clin Epidemiol 2017; 84:185-187. [PMID: 28188899 PMCID: PMC5441956 DOI: 10.1016/j.jclinepi.2017.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 12/17/2016] [Accepted: 01/19/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore the impact of increasing interest and investment in patient-centered research, this study sought to describe patterns of comparative effectiveness research (CER) and patient-reported outcomes (PROs) in pharmacologic intervention studies published in widely read medical journals from 2004-2013. DESIGN AND SETTING We identified 2335 articles published in five widely read medical journals from 2004-2013 with ≥1 intervention meeting the US Food and Drug Administration's definitions for a drug, biologic, or vaccine. Six trained reviewers extracted characteristics from a 20% random sample of articles (468 studies). We calculated the proportion of studies with CER and PROs. Trends were summarized using locally-weighted means and 95% confidence intervals. RESULTS Of the 468 sampled studies, 30% used CER designs and 33% assessed PROs. The proportion of studies using CER designs did not meaningfully increase over the study period. However, we observed an increase in the use of PROs. CONCLUSIONS Among pharmacological intervention studies published in widely read medical journals from 2004-2013, we identified no increase in CER. Randomized, placebo-controlled trials continue to be the dominant study design for assessing pharmacologic interventions. Increasing trends in PRO use may indicate greater acceptance of these outcomes as evidence for clinical benefit.
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Affiliation(s)
- Laura L Hester
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599, USA.
| | - Charles Poole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599, USA
| | - Elizabeth A Suarez
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599, USA
| | - Jane S Der
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599, USA
| | - Olivia G Anderson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599, USA
| | - Kathryn G Almon
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599, USA
| | - Avanti V Shirke
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599, USA
| | - M Alan Brookhart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599, USA
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Impact of concurrent chemotherapy with radiation therapy for elderly patients with newly diagnosed glioblastoma: a review of the National Cancer Data Base. J Neurooncol 2016; 131:593-601. [PMID: 27844308 DOI: 10.1007/s11060-016-2331-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 11/09/2016] [Indexed: 10/20/2022]
Abstract
To investigate the utilization and overall survival (OS) impact of concurrent chemotherapy in combination with radiation therapy (RT) for elderly glioblastoma (GBM) patients. Elderly patients (age >70) with supratentorial and nonmetastatic GBM who received RT of 20-75 Gy with concurrent single-agent chemotherapy (ChemoRT) or without (RT alone) during 2004-2012 were identified from the National Cancer Data Base (NCDB). The Cochran-Armitage test was used for trend analysis. Hazard ratios (HR) and 95% confidence intervals (CIs) were determined using Cox proportional hazards. Propensity score analysis was performed to reduce selection bias in treatment allocation. A total of 5252 patients were identified (RT alone: n = 1389; ChemoRT: n = 3863). There was increasing utilization of chemotherapy during this period (45-80%, P < .001). A similar trend was also observed for the subset of age >80 (25-68%, P < .001). ChemoRT was associated with significantly better OS than RT alone (HR 0.79, 95% CI 0.70-0.89, P < .001) on multivariate analysis, and similar OS benefit was demonstrated with 1202 pairs of propensity-matched patients (HR 0.79, 95% CI 0.73-0.86, P < .001). For the matched pair, the median OS was 5.8 months with ChemoRT and 5.0 months with RT alone; the 2-year OS rate was 9% with ChemoRT and 4% with RT alone (P < .001). Concurrent chemotherapy has been administered with RT for the majority of elderly GBM patients. Addition of chemotherapy to RT for elderly GBM patients is associated with significantly improve OS in routine clinical practice.
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Verlut C, Mouillet G, Magnin E, Buffet-Miny J, Viennet G, Cattin F, Billon-Grand NC, Bonnet E, Servagi-Vernat S, Godard J, Billon-Grand R, Petit A, Moulin T, Cals L, Pivot X, Curtit E. Age, Neurological Status MRC Scale, and Postoperative Morbidity are Prognostic Factors in Patients with Glioblastoma Treated by Chemoradiotherapy. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2016; 10:77-82. [PMID: 27559302 PMCID: PMC4990148 DOI: 10.4137/cmo.s38474] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/29/2016] [Accepted: 03/31/2016] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Temozolomide and concomitant radiotherapy followed by temozolomide has been used as a standard therapy for the treatment of newly diagnosed glioblastoma multiform since 2005. A search for prognostic factors was conducted in patients with glioblastoma routinely treated by this strategy in our institution. METHODS This retrospective study included all patients with histologically proven glioblastoma diagnosed between June 1, 2005, and January 1, 2012, in the Franche-Comté region and treated by radiotherapy (daily fractions of 2 Gy for a total of 60 Gy) combined with temozolomide at a dose of 75 mg/m2 per day, followed by six cycles of maintenance temozolomide (150–200 mg/m2, five consecutive days per month). The primary aim was to identify prognostic factors associated with overall survival (OS) in this cohort of patients. RESULTS One hundred three patients were included in this study. The median age was 64 years. The median OS was 13.7 months (95% confidence interval, 12.5–15.9 months). In multivariate analysis, age over 65 years (hazard ratio [HR] = 1.88; P = 0.01), Medical Research Council (MRC) scale 3–4 (HR = 1.62; P = 0.038), and occurrence of postoperative complications (HR = 2.15; P = 0.028) were associated with unfavorable OS. CONCLUSIONS This study identified three prognostic factors in patients with glioblastoma eligible to the standard chemotherapy and radiotherapy treatment. Age over 65 years, MRC scale 3–4, and occurrence of postoperative complications were associated with unfavorable OS. A simple clinical evaluation including these three factors enables to estimate the patient prognosis. MRC neurological scale could be a useful, quick, and simple measure to assess neurological status in glioblastoma patients.
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Affiliation(s)
- Clotilde Verlut
- Department of Neurology, University Hospital Jean Minjoz, Besançon cedex, France
| | - Guillaume Mouillet
- Department of Medical Oncology, University Hospital Jean Minjoz, Besançon cedex, France
| | - Eloi Magnin
- Department of Neurology, University Hospital Jean Minjoz, Besançon cedex, France
| | - Joëlle Buffet-Miny
- Department of Radiation Oncology, University Hospital Jean Minjoz, Besançon cedex, France
| | - Gabriel Viennet
- Department of Pathology, University Hospital Jean Minjoz, Besançon cedex, France
| | - Françoise Cattin
- Department of Radiology, University Hospital Jean Minjoz, Besançon cedex, France
| | | | - Emilie Bonnet
- Department of Radiation Oncology, University Hospital Jean Minjoz, Besançon cedex, France
| | | | - Joël Godard
- Department of Neurosurgery, University Hospital Jean Minjoz, Besançon cedex, France
| | - Romain Billon-Grand
- Department of Neurosurgery, University Hospital Jean Minjoz, Besançon cedex, France
| | - Antoine Petit
- Department of Neurosurgery, University Hospital Jean Minjoz, Besançon cedex, France
| | - Thierry Moulin
- Department of Neurology, University Hospital Jean Minjoz, Besançon cedex, France.; University of Franche-Comté, UMR1098, SFR IBCT, Besançon, France
| | - Laurent Cals
- Department of Medical Oncology, University Hospital Jean Minjoz, Besançon cedex, France
| | - Xavier Pivot
- Department of Medical Oncology, University Hospital Jean Minjoz, Besançon cedex, France.; University of Franche-Comté, UMR1098, SFR IBCT, Besançon, France.; INSERM UMR1098, Besançon, France
| | - Elsa Curtit
- Department of Medical Oncology, University Hospital Jean Minjoz, Besançon cedex, France.; University of Franche-Comté, UMR1098, SFR IBCT, Besançon, France.; INSERM UMR1098, Besançon, France
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Olszewski AJ, Falah J, Castillo JJ. Survival Claims From Observational Data on Cancer Therapy. J Clin Oncol 2016; 34:1425-7. [PMID: 26884574 DOI: 10.1200/jco.2015.64.7644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Adam J Olszewski
- Alpert Medical School of Brown University, Providence; and Memorial Hospital of Rhode Island, Pawtucket, RI
| | - Jaleh Falah
- Alpert Medical School of Brown University, Providence; and Memorial Hospital of Rhode Island, Pawtucket, RI
| | - Jorge J Castillo
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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McNiff KK, Jacobson JO. Aiming for ideal care: a proposed framework for cancer quality improvement. J Oncol Pract 2015; 10:339-44. [PMID: 25398953 DOI: 10.1200/jop.2014.001305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The authors review the advances made in oncology over the past 50 years and describe methods for closing the gap in care quality.
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20
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Paillard MJ, Curtit E, Dobi E, Mansi L, Bazan F, Villanueva C, Chaigneau L, Montcuquet P, Meneveau N, Thiery-Vuillemin A, Nerich V, Pivot X. Efficacité, tolérance et coût de l’éribuline chez des patientes présentant un cancer du sein métastatique. Bull Cancer 2015; 102:737-48. [DOI: 10.1016/j.bulcan.2015.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 03/25/2015] [Indexed: 01/28/2023]
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Hall SF, Irish JC, Gregg RW, Groome PA, Rohland S. Adherence to and uptake of clinical practice guidelines: lessons learned from a clinical practice guideline on chemotherapy concomitant with radiotherapy in head-and-neck cancer. ACTA ACUST UNITED AC 2015; 22:e61-8. [PMID: 25908922 DOI: 10.3747/co.22.2235] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Clinical practice guidelines (cpgs) are systematically developed statements designed to assist practitioners and patients in making decisions about appropriate heath care interventions. Clinical practice guidelines are expensive and time-consuming to create. A cpg on concurrent chemotherapy with radiation therapy (ccrt) was developed in Ontario at a time when treatment approaches for head-and-neck cancer were changing significantly. METHODS An assessment of treatments and outcomes based on electronic and chart data obtained from a population-based study of 571 patients with oropharynx cancer treated in Ontario (2003-2004) was combined with a review of relevant knowledge transfer (publications and presentations at major meetings) to understand variation in adherence to a cpg. RESULTS In 9 Ontario cancer treatment centres, ccrt was used for 55% of all patients with oropharyngeal cancer; however, at the centres individually, that proportion ranged from 82% to 39%. Furthermore, there was no agreement on the chemotherapy regimen: 2-4 years later (a period during which newer regimens were emerging), only 4 of 9 centres were following the guideline for most patients. When outcomes of treated patients were compared for centres with "higher" and "lower" use of ccrt, no difference in survival was observed (p = 0.64). CONCLUSIONS At a time of treatment evolution, the new guideline was controversial, and there are many reasons for the mixed adherence. An estimation of adherence should be included during both development and review of guidelines.
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Affiliation(s)
- S F Hall
- Department of Otolaryngology, Queen's University, Kingston, ON. ; Division of Cancer Care and Epidemiology, Queen's University, Kingston, ON
| | - J C Irish
- Department of Otolaryngology, Queen's University, Kingston, ON. ; Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - R W Gregg
- Department of Oncology, Queen's University, Kingston, ON
| | - P A Groome
- Division of Cancer Care and Epidemiology, Queen's University, Kingston, ON
| | - S Rohland
- Division of Cancer Care and Epidemiology, Queen's University, Kingston, ON
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Hall SF, O'Sullivan B, Irish JC, Meyer RM, Gregg R, Groome P. Impact of the addition of chemotherapy to radiotherapy for oropharyngeal cancer in 2003-2004: Population-based study from the Province of Ontario, Canada. Head Neck 2014; 37:1461-9. [PMID: 24844415 DOI: 10.1002/hed.23777] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Concurrent chemoradiotherapy (CRT) became the standard of care for locoregionally advanced head and neck cancers based on clinical trials but its effectiveness at the community level is not reported. METHODS We conducted a population-based comparative effectiveness study of all 571 patients with oropharyngeal cancer in Ontario Canada (2003-2004) that describes the patients and the treatments and compares concurrent CRT to radiotherapy (RT) alone. RESULTS When comparing the outcomes (CRT vs RT) for all patients or patients eligible for either treatment, for patients of centers with the "higher use" of CRT to patients of the 'lower use' centers and comparing all centers, we found no overall or disease-specific advantage to CRT over RT alone. There was also no difference in recurrence-free survival, pattern of recurrences, or distant control. CONCLUSION In Ontario (2003-2004), in daily clinical practice, the addition of concurrent CRT to RT had little impact on survival in patients with oropharyngeal carcinoma.
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Affiliation(s)
- Stephen F Hall
- Department of Otolaryngology and Division of Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology, University of Toronto, Toronto, Ontario, Canada
| | - Ralph M Meyer
- Juravinski Hospital and Cancer Center, Hamilton, Ontario, Canada
| | - Richard Gregg
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Patti Groome
- Department of Public Health Sciences and Division of Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada
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Booth CM, Tannock IF. Randomised controlled trials and population-based observational research: partners in the evolution of medical evidence. Br J Cancer 2014; 110:551-5. [PMID: 24495873 PMCID: PMC3915111 DOI: 10.1038/bjc.2013.725] [Citation(s) in RCA: 325] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- C M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, 10 Stuart Street, Kingston, ON K7L 5PG, Canada
| | - I F Tannock
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Booth CM, Tannock IF. Evaluation of Treatment Benefit: Randomized Controlled Trials and Population-Based Observational Research. J Clin Oncol 2013; 31:3298-9. [DOI: 10.1200/jco.2013.51.5023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Ian F. Tannock
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
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Goodwin PJ, Ballman KV, Small EJ, Levine M, Cannistra SA. Reply to C.M. Booth et al. J Clin Oncol 2013; 31:3300. [DOI: 10.1200/jco.2013.51.8241] [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)
- Pamela J. Goodwin
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital; University of Toronto, Toronto, Ontario, Canada
| | | | - Eric J. Small
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Mark Levine
- McMaster University, Hamilton, Ontario, Canada
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