1
|
Tagliamento M, Gennari A, Lambertini M, Salazar R, Harbeck N, Del Mastro L, Aguilar-Company J, Bower M, Sharkey R, Dalla Pria A, Plaja A, Jackson A, Handford J, Sita-Lumsden A, Martinez-Vila C, Matas M, Miguel Rodriguez A, Vincenzi B, Tonini G, Bertuzzi A, Brunet J, Pedrazzoli P, D'Avanzo F, Biello F, Sinclair A, Lee AJ, Rossi S, Rizzo G, Mirallas O, Pimentel I, Iglesias M, Sanchez de Torre A, Guida A, Berardi R, Zambelli A, Tondini C, Filetti M, Mazzoni F, Mukherjee U, Diamantis N, Parisi A, Aujayeb A, Prat A, Libertini M, Grisanti S, Rossi M, Zoratto F, Generali D, Saura C, Lyman GH, Kuderer NM, Pinato DJ, Cortellini A. Pandemic Phase-Adjusted Analysis of COVID-19 Outcomes Reveals Reduced Intrinsic Vulnerability and Substantial Vaccine Protection From Severe Acute Respiratory Syndrome Coronavirus 2 in Patients With Breast Cancer. J Clin Oncol 2023; 41:2800-2814. [PMID: 36720089 PMCID: PMC10414724 DOI: 10.1200/jco.22.01667] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/07/2022] [Accepted: 12/12/2022] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Although representing the majority of newly diagnosed cancers, patients with breast cancer appear less vulnerable to COVID-19 mortality compared with other malignancies. In the absence of patients on active cancer therapy included in vaccination trials, a contemporary real-world evaluation of outcomes during the various pandemic phases, as well as of the impact of vaccination, is needed to better inform clinical practice. METHODS We compared COVID-19 morbidity and mortality among patients with breast cancer across prevaccination (February 27, 2020-November 30, 2020), Alpha-Delta (December 1, 2020-December 14, 2021), and Omicron (December 15, 2021-January 31, 2022) phases using OnCovid registry participants (ClinicalTrials.gov identifier: NCT04393974). Twenty-eight-day case fatality rate (CFR28) and COVID-19 severity were compared in unvaccinated versus double-dosed/boosted patients (vaccinated) with inverse probability of treatment weighting models adjusted for country of origin, age, number of comorbidities, tumor stage, and receipt of systemic anticancer therapy within 1 month of COVID-19 diagnosis. RESULTS By the data lock of February 4, 2022, the registry counted 613 eligible patients with breast cancer: 60.1% (n = 312) hormone receptor-positive, 25.2% (n = 131) human epidermal growth factor receptor 2-positive, and 14.6% (n = 76) triple-negative. The majority (61%; n = 374) had localized/locally advanced disease. Median age was 62 years (interquartile range, 51-74 years). A total of 193 patients (31.5%) presented ≥ 2 comorbidities and 69% (n = 330) were never smokers. In total, 392 (63.9%), 164 (26.8%), and 57 (9.3%) were diagnosed during the prevaccination, Alpha-Delta, and Omicron phases, respectively. Analysis of CFR28 demonstrates comparable estimates of mortality across the three pandemic phases (13.9%, 12.2%, 5.3%, respectively; P = .182). Nevertheless, a significant improvement in outcome measures of COVID-19 severity across the three pandemic time periods was observed. Importantly, when reported separately, unvaccinated patients from the Alpha-Delta and Omicron phases achieved comparable outcomes to those from the prevaccination phase. Of 566 patients eligible for the vaccination analysis, 72 (12.7%) were fully vaccinated and 494 (87.3%) were unvaccinated. We confirmed with inverse probability of treatment weighting multivariable analysis and following a clustered robust correction for participating center that vaccinated patients achieved improved CFR28 (odds ratio [OR], 0.19; 95% CI, 0.09 to 0.40), hospitalization (OR, 0.28; 95% CI, 0.11 to 0.69), COVID-19 complications (OR, 0.16; 95% CI, 0.06 to 0.45), and reduced requirement of COVID-19-specific therapy (OR, 0.24; 95% CI, 0.09 to 0.63) and oxygen therapy (OR, 0.24; 95% CI, 0.09 to 0.67) compared with unvaccinated controls. CONCLUSION Our findings highlight a consistent reduction of COVID-19 severity in patients with breast cancer during the Omicron outbreak in Europe. We also demonstrate that even in this population, a complete severe acute respiratory syndrome coronavirus 2 vaccination course is a strong determinant of improved morbidity and mortality from COVID-19.
Collapse
Affiliation(s)
- Marco Tagliamento
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Ramon Salazar
- Department of Medical Oncology, ICO L'Hospitalet, Oncobell Program (IDIBELL), CIBERONC, Hospitalet de Llobregat, Barcelona, Spain
| | - Nadia Harbeck
- Department of Gynecology and Obstetrics, Breast Center and Gynecological Cancer Center and CCC Munich, University Hospital Munich, Munich, Germany
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Juan Aguilar-Company
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
- Infectious Diseases, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Rachel Sharkey
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Alessia Dalla Pria
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Andrea Plaja
- Medical Oncology Department, B-ARGO Group, IGTP, Catalan Institute of Oncology-Badalona, Badalona, Spain
| | | | - Jasmine Handford
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | | | | | | | - Bruno Vincenzi
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giuseppe Tonini
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Alexia Bertuzzi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Francesca D'Avanzo
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Federica Biello
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Alasdair Sinclair
- Cancer Division, University College London Hospitals, London, United Kingdom
| | - Alvin J.X. Lee
- Cancer Division, University College London Hospitals, London, United Kingdom
| | - Sabrina Rossi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gianpiero Rizzo
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Oriol Mirallas
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Isabel Pimentel
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | - Annalisa Guida
- Department of Oncology, Azienda Ospedaliera Santa Maria, Terni, Italy
| | - Rossana Berardi
- Medical Oncology, AOU Ospedali Riuniti, Polytechnic University of the Marche Region, Ancona, Italy
| | | | - Carlo Tondini
- Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Uma Mukherjee
- Medical Oncology, Barts Health NHS Trust, London, United Kingdom
| | | | - Alessandro Parisi
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare NHS Foundation Trust, North Shields, United Kingdom
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - Michela Libertini
- Medical Oncology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | | | - Maura Rossi
- Oncology Unit, Azienda Ospedaliera “SS Antonio e Biagio e Cesare Arrigo,” Alessandria, Italy
| | | | - Daniele Generali
- Multidisciplinary Breast Pathology and Translational Research Unit, ASST Cremona, Cremona, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Cristina Saura
- Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - Gary H. Lyman
- Public Health Sciences Division and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
- Divisions of Public Health Science and Clinical Research, Fred Hutchinson Cancer Center, Seattle, WA
| | | | - David J. Pinato
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Alessio Cortellini
- Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| |
Collapse
|
2
|
Mitigating acute chemotherapy-associated adverse events in patients with cancer. Nat Rev Clin Oncol 2022; 19:681-697. [PMID: 36221000 DOI: 10.1038/s41571-022-00685-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/08/2022]
Abstract
Despite the enthusiasm surrounding novel targeted agents and immunotherapies, chemotherapy remains the mainstay treatment for most human malignancies, either alone or in combination. Yet, the burden of chemotherapy-associated adverse events (CAAEs) remains high and, importantly, is associated with considerable morbidity, mortality and costs that affect patients across multiple dimensions, including physical, emotional and social functioning. CAAEs can directly affect patient outcomes and indirectly increase the risk of cancer recurrence by compromising treatment intensity and continuity. Systematic efforts to identify and critically summarize the evidence on management approaches for CAAEs remain limited. Herein, we review the most common acute CAAEs having a major effect on survival, quality of life, function and/or continuation of optimal therapy. We focus on selected acute toxicities that occur during treatment, summarizing their underlying pathophysiology, multifactorial aetiologies, evidenced-based treatments, prevention strategies and management recommendations. We also summarize the available evidence on risk factors, validated risk assessment tools and other efforts to optimize symptom control in patients most likely to benefit in order to personalize the prevention and treatment of acute CAAEs. Finally, we discuss innovative symptom monitoring and supportive care interventions that are under development to further improve the outcomes of patients with cancer.
Collapse
|
3
|
Yoo J, Jung Y, Ahn JH, Choi YJ, Lee KH, Hur S. Incidence and clinical course of septic shock in neutropenic patients during chemotherapy for gynecological cancers. J Gynecol Oncol 2020; 31:e62. [PMID: 32808493 PMCID: PMC7440980 DOI: 10.3802/jgo.2020.31.e62] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/01/2020] [Accepted: 04/10/2020] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To identify the incidence and clinical course of septic shock combined with neutropenia during chemotherapy in gynecological cancer patients. METHODS We retrospectively reviewed the medical records of all gynecological cancer patients who received intravenous chemotherapy between March 2009 and March 2018. Patients diagnosed with neutropenic septic shock (NSS) during the course of chemotherapy were identified. We calculated the overall incidence and mortality rate of NSS, and analyzed risk factors and clinical course. RESULTS A total of 1,009 patients received 10,239 cycles of chemotherapy during the study period. Among these, 30 (3.0%) patients had 32 NSS events, of which 12 (1.2%) died. With respect to patient age during the first course of chemotherapy, the incidence of NSS after the age of 50 was significantly higher than that in patients under 50 (3.9% vs. 1.4%, p=0.034). As the number of chemotherapy courses increased, the incidence of NSS increased, and linear-by-linear association analysis showed a positive correlation (p=0.004). NSS events occurred on average 7.8 days after the last cycle of chemotherapy, and the median duration of vasopressor administration was 23.3 hours. The median age (64.0 vs. 56.5, p=0.017) and peak heart rate (149.5 min-1 vs. 123.5 min-1, p=0.015) were significantly higher in the group of patients who subsequently died of NSS than in those who survived. CONCLUSION The overall incidence of NSS in gynecological cancer patients receiving chemotherapy was 3.0%, which is higher than previously estimated. Peak heart rate during NSS events may be an indicator for predicting survival.
Collapse
Affiliation(s)
- Jigeun Yoo
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yuyeon Jung
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jung Hwan Ahn
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Youn Jin Choi
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Keun Ho Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sooyoung Hur
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
| |
Collapse
|
4
|
McFatrich M, Brondon J, Lucas NR, Hinds PS, Maurer SH, Mack JW, Freyer DR, Jacobs SS, Baker JN, Mowbray C, Wang M, Castellino SM, Barz Leahy A, Reeve BB. Mapping child and adolescent self-reported symptom data to clinician-reported adverse event grading to improve pediatric oncology care and research. Cancer 2019; 126:140-147. [PMID: 31553494 DOI: 10.1002/cncr.32525] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/07/2019] [Accepted: 08/26/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Clinicians are the standard source for adverse event (AE) reporting in oncology trials, despite the subjective nature of symptomatic AEs. The authors designed a pediatric patient-reported outcome (PRO) instrument for symptomatic AEs to support the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) (the Pediatric PRO-CTCAE). The current study developed a standardized algorithm that maps all possible Pediatric PRO-CTCAE response patterns to recommended CTCAE grades to improve the accuracy of AE reporting in pediatric oncology trials. METHODS Two rounds of surveys were administered to experienced cancer clinicians across 9 pediatric hospitals. In round 1, pediatric oncologists assigned CTCAE grades to all 101 possible Pediatric PRO-CTCAE response patterns. The authors evaluated clinician agreement of CTCAE grades across response patterns and categorized each response pattern as having high or low agreement. In round 2, a survey was sent to a larger clinician group to examine clinician agreement among a select set of Pediatric PRO-CTCAE response patterns, and the authors examined how clinical context influenced grade assignment. RESULTS A total of 10 pediatric oncologists participated in round 1. Of the 101 possible patterns, 89 (88%) had high agreement. The Light weighted kappa was averaged across the 10 oncologists (Light kappa = 0.73; 95% CI, 0.66-0.81). A total of 139 clinicians participated in round 2. High clinician agreement remained for the majority of generic response patterns and the clinical context did not typically change grades but rather improved agreement. CONCLUSIONS The current study provides a framework for integrating child self-reported symptom data directly into mandated AE reporting in oncology trials. Translating Pediatric PRO-CTCAE responses into clinically meaningful metrics will guide future cancer care and toxicity grading.
Collapse
Affiliation(s)
- Molly McFatrich
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Jennifer Brondon
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nicole R Lucas
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Pamela S Hinds
- Department of Nursing Science, Professional Practice, and Quality Outcomes, Children's National Health System, Washington, DC
| | - Scott H Maurer
- Division of Pediatric Hematology/Oncology and Blood and Marrow Transplantation, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jennifer W Mack
- Division of Population Sciences for Pediatric Hematology/Oncology, Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, Massachusetts
| | - David R Freyer
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California
| | - Shana S Jacobs
- Center for Cancer and Blood Disorders, Children's National Health System, Washington, DC
| | - Justin N Baker
- Division of Quality of Life and Palliative Care, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Catriona Mowbray
- Center for Cancer and Blood Disorders, Children's National Health System, Washington, DC
| | - Mian Wang
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sharon M Castellino
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Allison Barz Leahy
- Division of Oncology, Cellular Therapy and Transplant Section, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| |
Collapse
|
5
|
Tervonen HE, Chen TYT, Lin E, Boyle FM, Moylan EJ, Della-Fiorentina SA, Beith J, Johnston A, Currow DC. Risk of emergency hospitalisation and survival outcomes following adjuvant chemotherapy for early breast cancer in New South Wales, Australia. Eur J Cancer Care (Engl) 2019; 28:e13125. [PMID: 31222826 DOI: 10.1111/ecc.13125] [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: 01/24/2019] [Revised: 05/01/2019] [Accepted: 05/27/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine risk of emergency hospital admission and survival following adjuvant chemotherapy for early breast cancer. METHODS Linked data from New South Wales population-based and clinical cancer registries (2008-2012), hospital admissions, official death records and pharmaceutical benefit claims. Women aged ≥18 years receiving adjuvant chemotherapy for early-stage operable breast cancer in NSW public hospitals were included. Odds ratios (OR) for emergency hospitalisation within 6 months following chemotherapy initiation were estimated using logistic regression and survival using Kaplan-Meier and Cox proportional hazards methods. RESULTS A total of 3,950 women were included and 30.6% were hospitalised. The most common principal diagnosis at admission was neutropenia (30.8%). Women receiving docetaxel/carboplatin/trastuzumab (TCH) and docetaxel/cyclophosphamide (TC) were the most frequently hospitalised. After adjustment for demographic and clinical factors, the increased risk of hospitalisation for TCH and TC remained compared with doxorubicin/cyclophosphamide 3-weekly (OR 1.71, 95% confidence interval [CI] 1.24-2.37 and OR 1.47, 95% CI 1.17-1.85 respectively). Five-year overall survival was similar for women who were (92.2%, 95% CI 90.7-93.8) and were not hospitalised (93.1%, 95% CI 92.1-94.1). CONCLUSION Emergency hospitalisations following chemotherapy for early breast cancer were relatively common, especially following docetaxel-containing protocols. Further examination of reasons for admission is needed to inform actions to improve patient safety.
Collapse
Affiliation(s)
| | - Tina Y T Chen
- Cancer Institute NSW, Alexandria, New South Wales, Australia
| | - Enmoore Lin
- Cancer Institute NSW, Alexandria, New South Wales, Australia
| | - Frances M Boyle
- University of Sydney and Mater Hospital, Sydney, New South Wales, Australia
| | | | | | - Jane Beith
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Amy Johnston
- Cancer Institute NSW, Alexandria, New South Wales, Australia
| | - David C Currow
- Cancer Institute NSW, Alexandria, New South Wales, Australia
| |
Collapse
|
6
|
Mateos M, Trahair T, Mayoh C, Barbaro P, Sutton R, Revesz T, Barbaric D, Giles J, Alvaro F, Mechinaud F, Catchpoole D, Kotecha R, Dalla-Pozza L, Quinn M, MacGregor S, Chenevix-Trench G, Marshall G. Risk factors for symptomatic venous thromboembolism during therapy for childhood acute lymphoblastic leukemia. Thromb Res 2019; 178:132-138. [DOI: 10.1016/j.thromres.2019.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/10/2019] [Accepted: 04/10/2019] [Indexed: 01/19/2023]
|
7
|
van Eenbergen MC, van den Hurk C, Mols F, van de Poll-Franse LV. Usability of an online application for reporting the burden of side effects in cancer patients. Support Care Cancer 2019; 27:3411-3419. [DOI: 10.1007/s00520-019-4639-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/07/2019] [Indexed: 12/16/2022]
|
8
|
Kuderer NM, Lyman GH. Evolving Landscape of US Food and Drug Administration Drug Approval in the Era of Precision Oncology: Finding the Right Balance Between Access and Safety. J Clin Oncol 2018; 36:1773-1776. [PMID: 29742010 DOI: 10.1200/jco.2018.78.5592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Nicole M Kuderer
- Nicole M. Kuderer, Advanced Cancer Research Group, Seattle, WA; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Gary H Lyman
- Nicole M. Kuderer, Advanced Cancer Research Group, Seattle, WA; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| |
Collapse
|
9
|
Pettit SD, Kirch R. Do current approaches to assessing therapy related adverse events align with the needs of long-term cancer patients and survivors? CARDIO-ONCOLOGY (LONDON, ENGLAND) 2018; 4:5. [PMID: 32154005 PMCID: PMC7048033 DOI: 10.1186/s40959-018-0031-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/30/2018] [Indexed: 01/29/2023]
Abstract
The increasing efficacy of cancer therapeutics means that the timespan of cancer therapy administration is undergoing a transition to increasingly long-term settings. Unfortunately, chronic therapy-related adverse health events are an unintended, but not infrequent, outcome of these life-saving therapies. Historically, the cardio-oncology field has evolved as retrospective effort to understand the scope, mechanisms, and impact of treatment-related toxicities that were already impacting patients. This review explores whether current systemic approaches to detecting, reporting, tracking, and communicating AEs are better positioned to provide more proactive or concurrent information to mitigate the impact of AE's on patient health and quality of life. Because the existing tools and frameworks for capturing these effects are not specific to cardiology, this study looks broadly at the landscape of approaches and assumptions. This review finds evidence of increasing focus on the provision of actionable information to support long-term health and quality of life for survivors and those on chronic therapy. However, the current means to assess and support the impact of this burden on patients and the healthcare system are often of limited relevance for an increasingly long-lived survivor and patient population.
Collapse
Affiliation(s)
- Syril D. Pettit
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
- Health and Environmental Sciences Institute, Washington DC, USA
| | - Rebecca Kirch
- National Patient Advocate Foundation, Washington DC, USA
| |
Collapse
|
10
|
Zhang S, Chen Q, Wang Q. The use of and adherence to CTCAE v3.0 in cancer clinical trial publications. Oncotarget 2018; 7:65577-65588. [PMID: 27564109 PMCID: PMC5323176 DOI: 10.18632/oncotarget.11576] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 08/12/2016] [Indexed: 12/21/2022] Open
Abstract
Background The Common Terminology Criteria for Adverse Events, Version 3.0 (CTCAE v3.0) was released in 2003, and has been widely used as the predominant set of toxicity criteria for cancer clinical trials and scientific meetings. However, the degree to which the elements of CTCAE v3.0 are followed in oncology publications has not been comprehensively evaluated. Methods We reviewed phase III randomized clinical trials evaluating systemic cancer therapies, published between Jan 1, 2012 and December 31, 2013, to identify eligible studies that explicitly mentioned using CTCAE v3.0 as the toxicity criteria. A 10-point score based on adherence to CTCAE v3.0 was used to assess the studies. Multivariate linear regression was used to identify features associated with improved adherence. Results In total, 104 publications reporting data on 86,957 patients were included in this analysis. The mean total score for adherence to all four elements of CTCAE v3.0 was 4.03 on a 10-point scale (range, 1 to 9), with 16 publications (15%) having total scores ≤2. Highly heterogeneous and unstandardized adverse event terms were frequently used. In addition, Supra-ordinate terms, terms using ‘Other, specify’, and Grades were often used incorrectly. The multivariate regression model revealed that the absence of a placebo (P=0.003) and a higher total number of AE terms in the table (P<0.001) were independent predictors of a lower total score. Conclusion Given the importance of understanding the toxicity of new treatments, better adherence to CTCAE v3.0 should be encouraged to ensure the consistency and comparability of toxicity data across different studies.
Collapse
Affiliation(s)
- Sheng Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Qiang Chen
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qing Wang
- Department of Clinical Laboratory, Affiliated Hospital of Qingdao University, China
| |
Collapse
|
11
|
Impact of chemotherapy-induced neutropenia (CIN) and febrile neutropenia (FN) on cancer treatment outcomes: An overview about well-established and recently emerging clinical data. Crit Rev Oncol Hematol 2017; 120:163-179. [DOI: 10.1016/j.critrevonc.2017.11.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/20/2017] [Accepted: 11/06/2017] [Indexed: 12/13/2022] Open
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Impact of treatment regimen on acute care use during and after adjuvant chemotherapy for early-stage breast cancer. Breast Cancer Res Treat 2017; 164:515-525. [DOI: 10.1007/s10549-017-4280-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
|
14
|
Knerr S, Hu EY, Zeliadt SB. Incidence of Neutropenia in Veterans Receiving Lung Cancer Chemotherapy: A Comparison of Administrative Coding and Electronic Laboratory Data. EGEMS 2017; 5:1269. [PMID: 28459084 PMCID: PMC5389434 DOI: 10.13063/2327-9214.1269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction: The frequency of neutropenia associated with lung cancer chemotherapy outside of randomized trials is largely unknown because administrative coding underestimates its prevalence. This study compared International Classification of Diseases (ICD) diagnosis codes and electronic laboratory results, alone and in combination, for identifying neutropenia events. Methods: Retrospective cohort study of 718 veterans receiving their first course of chemotherapy for non-small cell lung cancer. Incidence of neutropenia was assessed using electronic laboratory results and ICD-9 codes captured in the Department of Veterans Affairs (VA) electronic medical records (EMR). Results: A total of 118 of 718 patients (16.4 percent) were identified with an absolute neutrophil count (ANC) less than 1,000 cells/mm3, while only 49 of 718 patients (6.8 percent) had ICD-9 codes for neutropenia. Using the combination of laboratory results and diagnosis codes, 136 of 718 patients (18.9 percent) experienced a neutropenic event. Compared to laboratory results as a gold standard, diagnosis codes were specific (not present for individuals without a laboratory-documented low ANC), but not sensitive (missing for many individuals with a low ANC documented in their laboratory test results). Conclusion: Relying on ICD codes to identify neutropenia in administrative data likely results in under-reporting. The emerging availability of electronic laboratory results provides an opportunity to more accurately quantify patterns of neutropenia, identify individual risk factors, and assess clinical management practices—including use of colony-stimulating factor prophylaxis—in large community cohorts.
Collapse
Affiliation(s)
- Sarah Knerr
- University of Washington, Department of Health Services
| | - Elaine Y Hu
- VA Puget Sound Health Care System Health Services Research and Development Service
| | - Steven B Zeliadt
- University of Washington, Department of Health Services.,VA Puget Sound Health Care System Health Services Research and Development Service
| |
Collapse
|
15
|
Lyman GH. Issues on the Use of White Blood Cell Growth Factors in Oncology Practice. Am Soc Clin Oncol Educ Book 2017; 35:e528-32. [PMID: 27249763 DOI: 10.1200/edbk_156064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Appropriate use of myeloid growth factors may reduce the risk of neutropenic complications including febrile neutropenia (FN) in patients receiving cancer chemotherapy. The recently updated American Society of Clinical Oncology (ASCO) Guidelines on the Use of the White Blood Cell Growth Factors recommends routine prophylaxis with these agents starting in the first cycle when the risk of FN is 20% or greater. However, the risks for neutropenic complications and the risk of serious adverse consequences from FN vary considerably with different chemotherapy regimens as well as other disease-, treatment-, and patient-specific risk factors. Considerably more information is now available on the major risk factors for FN. Multivariable risk models combining factors look promising but require further validation. Most clinical studies of myeloid growth factor prophylaxis assessed relative risk (RR) of FN but were not powered to evaluate the effect of prophylaxis on disease-free or overall survival. Accumulating evidence suggests, however, that the appropriate use of these agents in selected patients may improve both short-term and long-term survival by reducing the immediate risk of mortality accompanying patients with high-risk disease developing FN as well as improving disease-free and overall survival by enabling the delivery of full dose intensity chemotherapy and reducing the risk of disease recurrence in patients treated with curative intent. Further studies to evaluate risk factors and models for FN are needed to guide clinical and shared decision making for the optimal personalized use of these agents and offer patients at increased risk the best chance of long-term disease control.
Collapse
Affiliation(s)
- Gary H Lyman
- From the Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, and the University of Washington, Seattle, WA
| |
Collapse
|
16
|
Zhang S, Liang F, Tannock I. Use and misuse of common terminology criteria for adverse events in cancer clinical trials. BMC Cancer 2016; 16:392. [PMID: 27377548 PMCID: PMC4932726 DOI: 10.1186/s12885-016-2408-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 06/28/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Common Terminology Criteria for Adverse Events, Version 3.0 (CTCAE v3.0) were released in 2003 and have been used widely to report toxicity in publications or presentations describing cancer clinical trials. Here we evaluate whether guidelines for reporting toxicity are followed in publications reporting randomized clinical trials (RCTs) for cancer. METHODS Phase III RCTs evaluating systemic cancer therapy published between 2011 and 2013, were reviewed to identify eligible studies, which stated explicitly that CTCAE v3.0 was used to report toxicity. Each AE term and its grade were located in CTCAE v3.0 to determine if they fell within the guidelines provided in the explanatory file. RESULTS A total of 166 publications were included in this analysis. Criteria from CTCAE v3.0 were frequently used incorrectly. For example, CATEGORY names such as Metabolic were misreported as AEs in 19 trials, and inappropriate grades for AEs assigned frequently. For example, febrile neutropenia was graded 1 or 2 in 35 of 91 studies (38 %), but the minimum grade for this toxicity is 3. Alopecia was graded 3 or more in 19 of 77 studies (25 %), but the maximum is only grade 2. CONCLUSION The present study provides evidence of poor reporting of toxicity in clinical trials. The study provides a lower estimate for the misuse of AE terms and grades, and implies that other AE terms and grades that conform to CTCAE v3.0 guidelines may have been assigned incorrectly. Inaccurate reporting of toxicity in clinical trials can lead clinicians to make inappropriate treatment decisions.
Collapse
Affiliation(s)
- Sheng Zhang
- Shanghai Cancer Center and Shanghai Medical College, Fudan University, Shanghai, China. .,Medical Oncology, Shanghai Cancer Center, Fudan University, 270 Dongan Road, 200032, Shanghai, China.
| | - Fei Liang
- Shanghai Cancer Center and Shanghai Medical College, Fudan University, Shanghai, China
| | - Ian Tannock
- Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| |
Collapse
|
17
|
Lyman GH, Poniewierski MS, Culakova E. Risk of chemotherapy-induced neutropenic complications when treating patients with non-Hodgkin lymphoma. Expert Opin Drug Saf 2016; 15:483-92. [DOI: 10.1517/14740338.2016.1146675] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Gary H. Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Marek S. Poniewierski
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Eva Culakova
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| |
Collapse
|
18
|
Faithfull S, Lemanska A, Chen T. Patient-reported Outcome Measures in Radiotherapy: Clinical Advances and Research Opportunities in Measurement for Survivorship. Clin Oncol (R Coll Radiol) 2015; 27:679-85. [DOI: 10.1016/j.clon.2015.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 07/20/2015] [Indexed: 12/23/2022]
|
19
|
Incidence, risk factors, and reasons for hospitalization among glioblastoma patients receiving chemoradiation. J Neurooncol 2015; 124:137-46. [PMID: 26033544 DOI: 10.1007/s11060-015-1820-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 05/22/2015] [Indexed: 12/21/2022]
Abstract
Despite a high symptom burden, little is known about the incidence or predictors of hospitalization among glioblastoma patients, including risks during chemoradiation (CRT). We studied 196 consecutive newly diagnosed glioblastoma patients treated at our institution from 2006-2010. Toxicity data were reviewed during and after the CRT phase, defined as the period between diagnosis and 6 weeks after radiotherapy completion. Logistic regression and proportional hazards modeling identified predictors of hospitalization and overall survival (OS). Median age was 59 years (range, 23-90) and 83 % had Karnofsky performance status (KPS) score ≥ 70. Twenty-six percent of patients underwent gross total resection, 77 % received ≥ 59.4 Gy of radiotherapy, and 89 % received concurrent temozolomide. Median OS was 15.6 months (IQR, 8.5-26.8 months). Forty-three percent of patients were hospitalized during the CRT phase; OS was 10.7 vs. 17.8 months for patients who were vs. were not hospitalized, respectively (P < .001). Nearly half of the hospitalizations were due to generalized weakness (17 % of hospitalizations), seizures (16 %), or venous thromboembolism (13 %). On multivariate analysis, age (odds ratio [OR], 1.03; 95 % CI, 1.002-1.060; P = .034) and KPS (OR, 0.95; 95 % CI, 0.93-0.97; P < .001) were associated with risk of hospitalization. Hospitalization during the CRT phase was associated with decreased OS (adjusted hazard ratio, 1.47; 95 % CI, 1.01-2.13; P = .043), after adjustment for known prognostic factors. Hospitalization during the CRT phase is common among glioblastoma patients in the temozolomide era and is associated with shorter overall survival.
Collapse
|
20
|
van den Hurk CJG, Winstanley J, Young A, Boyle F. Measurement of chemotherapy-induced alopecia-time to change. Support Care Cancer 2015; 23:1197-9. [PMID: 25663579 DOI: 10.1007/s00520-015-2647-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 01/29/2015] [Indexed: 10/24/2022]
Abstract
Data on chemotherapy-induced alopecia (CIA) as a side effect of cancer treatment are scarce. CIA is given minimal attention in clinical trials and in the literature. However, when asking the patients with cancer for their opinion, CIA appears to have a major impact, particularly on body image and quality of life. Currently, there is no commonly used measure to evaluate CIA; It is time to improve the management and measurement of CIA.
Collapse
Affiliation(s)
- C J G van den Hurk
- Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands,
| | | | | | | |
Collapse
|
21
|
Weycker D, Li X, Edelsberg J, Barron R, Kartashov A, Xu H, Lyman GH. Risk and Consequences of Chemotherapy-Induced Febrile Neutropenia in Patients With Metastatic Solid Tumors. J Oncol Pract 2015; 11:47-54. [DOI: 10.1200/jop.2014.001492] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Among patients receiving myelosuppressive chemotherapy for metastatic cancer in US clinical practice, febrile neutropenia is a frequent complication associated with morbidity, mortality, and economic costs.
Collapse
Affiliation(s)
- Derek Weycker
- Policy Analysis (PAI), Brookline, MA; Amgen, Thousand Oaks, CA; and Hutchinson Cancer Research Center, Seattle, WA
| | - Xiaoyan Li
- Policy Analysis (PAI), Brookline, MA; Amgen, Thousand Oaks, CA; and Hutchinson Cancer Research Center, Seattle, WA
| | - John Edelsberg
- Policy Analysis (PAI), Brookline, MA; Amgen, Thousand Oaks, CA; and Hutchinson Cancer Research Center, Seattle, WA
| | - Rich Barron
- Policy Analysis (PAI), Brookline, MA; Amgen, Thousand Oaks, CA; and Hutchinson Cancer Research Center, Seattle, WA
| | - Alex Kartashov
- Policy Analysis (PAI), Brookline, MA; Amgen, Thousand Oaks, CA; and Hutchinson Cancer Research Center, Seattle, WA
| | - Hairong Xu
- Policy Analysis (PAI), Brookline, MA; Amgen, Thousand Oaks, CA; and Hutchinson Cancer Research Center, Seattle, WA
| | - Gary H. Lyman
- Policy Analysis (PAI), Brookline, MA; Amgen, Thousand Oaks, CA; and Hutchinson Cancer Research Center, Seattle, WA
| |
Collapse
|