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Chen X, Ou S, Luo J, He Z, Jiang Q. Advancing perspectives on the off-label use of anticancer drugs: an updated classification and exploration of categories. Front Pharmacol 2024; 15:1374549. [PMID: 38898925 PMCID: PMC11186405 DOI: 10.3389/fphar.2024.1374549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
To date, the definition that the off-label usage of drugs refers to the unapproved use of approved drugs, which covers unapproved indications, patient populations, doses, and/or routes of administration, has been in existence for many years. Currently, there is a limited frequency and prevalence of research on the off-label use of antineoplastic drugs, mainly due to incomplete definition and classification issues. It is time to embrace new categories for the off-label usage of anticancer drugs. This review provided an insight into an updated overview of the concept and categories of the off-label use of anticancer drugs, along with illustrating specific examples to establish the next studies about the extent of the off-label usage of anticancer drugs in the oncology setting. The scope of the off-label use of current anticancer drugs beyond the previous definitions not only includes off-label uses in terms of indications, patient populations, doses, and/or routes of administration but also off-label use in terms of medication course, combination, sequence of medication, clinical purpose, contraindications scenarios, etc. In addition, the definition of the off-label usage of anticancer drugs should be added to the condition at a given time, and it varies from approval authorities. We presented a new and relatively comprehensive classification, providing extensive analysis and illustrative examples of the off-label usage of antineoplastic drugs for the first time. Such a classification has the potential to promote practical adoption and enhance management strategies for the off-label use of antitumor drugs.
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Affiliation(s)
- Xiaoyi Chen
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Shunlong Ou
- Department of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jing Luo
- Department of Pharmacy, The Second People’s Hospital of Yibin, Yibin, Sichuan, China
| | - Zhisan He
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Qian Jiang
- Department of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, China
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Herrero Fernandez M, Molina Villaverde R, Arroyo Yustos M, Navarro Expósito F, Lopez Gonzalez JL, Luque Infantes MR, Alvarez-Mon Soto M. The Off-Label Use of Antineoplastics in Oncology Is Limited But Has Notable Scientific Support in a University Hospital Setting. Front Pharmacol 2019; 10:1210. [PMID: 31708769 PMCID: PMC6820060 DOI: 10.3389/fphar.2019.01210] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/20/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose: The off-label (OL) use of antineoplastic drugs for the treatment of various types of tumors in patients of different disease stages is becoming a common occurrence. The objective of this study was to analyze these patterns by quantification and characterization of the OL use of antineoplastic drugs and their level of scientific evidence in a medium/high-complexity Spanish general university hospital. Method: All oncology patients who underwent OL treatment with one or several antineoplastics during the 10 years from 2002 to 2012 were retrospectively selected. The use of these drugs was considered OL if they were used for indications, stages, lines of treatment, or chemotherapy schemes not reflected in the summary of product characteristics published by the European Medicines Agency at the time of prescription. To calculate the prevalence of patients who received one or more OL treatments during the study period, all patients whose primary or secondary diagnosis had been coded with the diagnoses included in the study were selected through the minimum basic data set (MBDS). This database was cross-referenced with that of the Farmatools® program (Dominion®), which collects information on all patients receiving chemotherapy to obtain the total number of patients who received chemotherapy in the hospital during this period. Results: In total, 684 patients and 866 OL treatments were included. The prevalence of patients undergoing OL treatment with antineoplastics was 6%. OL treatments were used mainly for breast, gynecological, lung, and gastric tumors. The most often-used antineoplastic was paclitaxel, followed by gemcitabine, carboplatin, vinorelbine, and capecitabine, which were used mainly in monotherapy and with palliative intent. A total of 56.1% of the OL schemes used had a level of evidence of 2A according to the National Comprehensive Cancer Network, and 55.3% had a level of evidence of 2B according to Micromedex®. Conclusion: The OL use of antineoplastics in oncology patients is limited; their use is mainly focused in a small group of tumors and at advanced stages of disease. OL use of antineoplastics occurs under palliative therapeutic strategies with a limited number of drugs, preferably off-patent drugs. In addition, these OL treatments have high levels of clinical evidence.
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Affiliation(s)
| | - Raquel Molina Villaverde
- Diseases of the Immune System and Oncology Service, Príncipe de Asturias University Hospital, Madrid, Spain
- Department of Medicine and Medical Specialties, University of Alcalá de Henares, Madrid, Spain
- Instituto Ramon y Cajal de Investigaciones Sanitarias, IRYCIS, Madrid, Spain
| | - Monica Arroyo Yustos
- Diseases of the Immune System and Oncology Service, Príncipe de Asturias University Hospital, Madrid, Spain
- Department of Medicine and Medical Specialties, University of Alcalá de Henares, Madrid, Spain
- Instituto Ramon y Cajal de Investigaciones Sanitarias, IRYCIS, Madrid, Spain
| | - Fatima Navarro Expósito
- Diseases of the Immune System and Oncology Service, Príncipe de Asturias University Hospital, Madrid, Spain
- Department of Medicine and Medical Specialties, University of Alcalá de Henares, Madrid, Spain
- Instituto Ramon y Cajal de Investigaciones Sanitarias, IRYCIS, Madrid, Spain
| | - Jose Luis Lopez Gonzalez
- Diseases of the Immune System and Oncology Service, Príncipe de Asturias University Hospital, Madrid, Spain
- Department of Medicine and Medical Specialties, University of Alcalá de Henares, Madrid, Spain
- Instituto Ramon y Cajal de Investigaciones Sanitarias, IRYCIS, Madrid, Spain
| | | | - Melchor Alvarez-Mon Soto
- Diseases of the Immune System and Oncology Service, Príncipe de Asturias University Hospital, Madrid, Spain
- Department of Medicine and Medical Specialties, University of Alcalá de Henares, Madrid, Spain
- Instituto Ramon y Cajal de Investigaciones Sanitarias, IRYCIS, Madrid, Spain
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Guy JB, Vallard A, Espenel S, Langrand-Escure J, Trone JC, Méry B, Ben Mrad M, Diao P, Mattevi C, Chargari C, Magné N. Conflict of interests for radiation oncologists: Harnessing disclosures from policy to reality. Cancer Radiother 2016; 20:176-80. [PMID: 27020716 DOI: 10.1016/j.canrad.2015.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE An increasing attention is being paid to disclosures of conflicts of interests in the field of oncology. The purpose of this study was to examine how radiation oncologists report their conflicts of interests with pharmaceutical or technology industries. MATERIALS AND METHODS We collected the data of conflicts of interests disclosures in the abstract books from the annual 2012 and 2013 meetings of the American Society for Radiation Oncology (ASTRO) in Miami (FL, USA), and in Atlanta (GA, USA), respectively. Geographic origins of abstracts as well other factors were examined. RESULTS We identified a total of 4219 abstracts published in the past two years. The total number of involved authors was of 28,283. All of the published abstracts had conflicts of interests disclosures. Amongst them, 563 abstracts (13.4%) reported at least one potential conflict of interests, in which 1264 (4.5%) declared a potential conflict of interests in their disclosures. Geographic distribution of abstracts with financial relationship was as following: 67.9%, 15.5%, 7.7% and 7.7% for USA, Europe, Asia/Pacifica, and Canada, respectively. Abstracts with conflict of interest originated from North America in 75.6% of cases. USA distribution was 70.6% and 29.4% for Eastern and Western, respectively. CONCLUSIONS The proportion of physicians declaring financial conflicts of interests remains extremely low, whichever geographic area authors are from. In comparison to the rest of the world, the US proved itself better at declaring potential links. Changes in medical culture and education could represent a significant step to improve the process of revealing conflicts of interest in medical journal as well as in international meetings.
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Affiliation(s)
- J-B Guy
- Department of Radiation Oncology, centre Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - A Vallard
- Department of Radiation Oncology, centre Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - S Espenel
- Department of Radiation Oncology, centre Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - J Langrand-Escure
- Department of Radiation Oncology, centre Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - J-C Trone
- Department of Radiation Oncology, centre Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - B Méry
- Department of Medical Oncology, centre Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - M Ben Mrad
- Department of Radiation Oncology, centre Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - P Diao
- Department of Radiation Oncology, centre Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - C Mattevi
- Department of Radiation Oncology, centre Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - C Chargari
- Department of Radiation Oncology, hôpital d'instruction des armées du Val-de-Grâce, boulevard de Port-Royal, 75013 Paris, France
| | - N Magné
- Department of Radiation Oncology, centre Lucien-Neuwirth, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France.
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Buzyn A, Blay JY, Hoog-Labouret N, Jimenez M, Nowak F, Deley MCL, Pérol D, Cailliot C, Raynaud J, Vassal G. Equal access to innovative therapies and precision cancer care. Nat Rev Clin Oncol 2016; 13:385-93. [DOI: 10.1038/nrclinonc.2016.31] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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