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Polycystic Kidney Disease Drug Development: A Conference Report. Kidney Med 2022; 5:100596. [PMID: 36698747 PMCID: PMC9867973 DOI: 10.1016/j.xkme.2022.100596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is part of a spectrum of inherited diseases that also includes autosomal recessive polycystic kidney disease, autosomal dominant polycystic liver disease, and an expanding group of recessively inherited disorders collectively termed hepatorenal fibrocystic disorders. ADPKD is the most common monogenic disorder frequently leading to chronic kidney failure with an estimated prevalence of 12 million people worldwide. Currently, only one drug (tolvaptan) has been approved by regulatory agencies as disease-modifying therapy for ADPKD, but, given its mechanism of action and side effect profile, the need for an improved therapy for ADPKD remains a priority. Although significant regulatory progress has been made, with qualification of total kidney volume as a prognostic enrichment biomarker and its later designation as a reasonably likely surrogate endpoint for progression of ADPKD within clinical trials, further work is needed to accelerate drug development efforts for all forms of PKD. In May 2021, the PKD Outcomes Consortium at the Critical Path Institute and the PKD Foundation organized a PKD Regulatory Summit to spur conversations among patients, industry, academic, and regulatory stakeholders regarding future development of tools and drugs for ADPKD and autosomal recessive polycystic kidney disease. This Special Report reviews the key points discussed during the summit and provides future direction related to PKD drug development tools.
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Development of castration resistance in prostate cancer patients treated with luteinizing hormone-releasing hormone analogues (LHRHa): results of the ANARESISTANCE study. World J Urol 2022; 40:2459-2466. [PMID: 36057895 PMCID: PMC9512882 DOI: 10.1007/s00345-022-04108-x] [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: 04/22/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose Evaluate the percentage of patients with prostate cancer treated with luteinizing hormone-releasing hormone analogues (LHRHa) that develop castration resistance after a follow-up period of 3 years. The secondary objective is to evaluate the variables potentially related to the progression to castration resistant prostate cancer (CRPC). Methods A post-authorization, nation-wide, multicenter, prospective, observational, and longitudinal study that included 416 patients treated with LHRHa between 2012 and 2017 is presented. Patients were followed for 3 years or until development of CRPC, thus completing a per-protocol population of 350 patients. A Cox regression analysis was carried out to evaluate factors involved in progression to CRPC. Results After 3 years of treatment with LHRHa 18.2% of patients developed CRPC. In contrast, in the subgroup analysis, 39.6% of the metastatic patients developed CRPC, compared with 8.8% of the non-metastatic patients. The patients with the highest risk of developing CRPC were those with a nadir prostate-specific antigen (PSA) > 2 ng/ml (HR 21.6; 95% CI 11.7–39.8; p < 0.001) and those receiving concomitant medication, most commonly bicalutamide (HR 1.8; 95% CI 1–3.1, p = 0.0431). Conclusions The proportion of metastatic patients developing CRPC after 3 years of treatment with LHRHa is consistent with what has been previously described in the literature. In addition, this study provides new findings on CRPC in non-metastatic patients. Concomitant medication and nadir PSA are statistically significant predictive factors for the time to diagnosis of CRPC, the nadir PSA being the strongest predictor. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-022-04108-x.
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Chen WJ, Kong DM, Li L. Prognostic value of ECOG performance status and Gleason score in the survival of castration-resistant prostate cancer: a systematic review. Asian J Androl 2021; 23:163-169. [PMID: 33159024 PMCID: PMC7991808 DOI: 10.4103/aja.aja_53_20] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/12/2020] [Indexed: 01/06/2023] Open
Abstract
Eastern Cooperative Oncology Group (ECOG) performance status and Gleason score are commonly investigated factors for overall survival (OS) in men with castration-resistant prostate cancer (CRPC). However, there is a lack of consistency regarding their prognostic or predictive value for OS. Therefore, we performed this meta-analysis to assess the associations of ECOG performance status and Gleason score with OS in CRPC patients and compare the two markers in patients under different treatment regimens or with different chemotherapy histories. A systematic literature review of monotherapy studies in CRPC patients was conducted in the PubMed database until May 2019. The data from 8247 patients in 34 studies, including clinical trials and real-world data, were included in our meta-analysis. Of these, twenty studies reported multivariate results and were included in our main analysis. CRPC patients with higher ECOG performance statuses (≥ 2) had a significantly increased mortality risk than those with lower ECOG performance statuses (<2), hazard ratio (HR): 2.10, 95% confidence interval (CI): 1.68-2.62, and P < 0.001. The synthesized HR of OS stratified by Gleason score was 1.01, with a 95% CI of 0.62-1.67 (Gleason score ≥ 8 vs <8). Subgroup analysis showed that there was no significant difference in pooled HRs for patients administered taxane chemotherapy (docetaxel and cabazitaxel) and androgen-targeting therapy (abiraterone acetate and enzalutamide) or for patients with different chemotherapy histories. ECOG performance status was identified as a significant prognostic factor in CRPC patients, while Gleason score showed a weak prognostic value for OS based on the available data in our meta-analysis.
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Affiliation(s)
- Wen-Jun Chen
- Center of Clinical Pharmacology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Da-Ming Kong
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System, Department of Pharmaceutics, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
| | - Liang Li
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System, Department of Pharmaceutics, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China
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Effective Data Sharing as a Conduit for Advancing Medical Product Development. Ther Innov Regul Sci 2021; 55:591-600. [PMID: 33398663 PMCID: PMC7780909 DOI: 10.1007/s43441-020-00255-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/17/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Patient-level data sharing has the potential to significantly impact the lives of patients by optimizing and improving the medical product development process. In the product development setting, successful data sharing is defined as data sharing that is actionable and facilitates decision making during the development and review of medical products. This often occurs through the creation of new product development tools or methodologies, such as novel clinical trial design and enrichment strategies, predictive pre-clinical and clinical models, clinical trial simulation tools, biomarkers, and clinical outcomes assessments, and more. METHODS To be successful, extensive partnerships must be established between all relevant stakeholders, including industry, academia, research institutes and societies, patient-advocacy groups, and governmental agencies, and a neutral third-party convening organization that can provide a pre-competitive space for data sharing to occur. CONCLUSIONS Data sharing focused on identified regulatory deliverables that improve the medical product development process encounters significant challenges that are not seen with data sharing aimed at advancing clinical decision making and requires the commitment of all stakeholders. Regulatory data sharing challenges and solutions, as well as multiple examples of previous successful data sharing initiatives are presented and discussed in the context of medical product development.
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Comparative assessment of docetaxel for safety and efficacy between hormone-sensitive and castration-resistant metastatic prostate cancer. Urol Oncol 2019; 37:999-1005. [PMID: 31377168 DOI: 10.1016/j.urolonc.2019.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/04/2019] [Accepted: 07/08/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To compare toxicity and response of docetaxel chemotherapy between metastatic hormone-sensitive prostate cancer (mHSPC) and castration-resistant metastatic prostate cancer (mCRPC) patients of the same therapeutic era for assessing of upfront docetaxel against the benchmark of docetaxel in the castrate resistant stage in the setting outside of clinical trials. METHODS A prospectively collected database of real-world prostate cancer patients receiving docetaxel was divided in mHSPC and mCRPC cases and retrospectively analyzed. Principal objectives were toxicity measured by the common criteria of adverse events terminology and response characterized by Prostate specific antigen decline and radiographic progression-free disease at restaging. The prognostic value of suspected variables for grade 3 to 5 toxicity and response was investigated by logistic regression analysis. RESULTS Of 72 patients 34 (47%) were treated for mHSPC and 38 (53%) for mCRPC. Patients with mCRPC were older and had worse performance status (P< 0.01). In mHSPC total number of grade 3 to 5 adverse events (24, median 0, interquartile range 0-1) was significantly less than in mCRPC (46, median 1, interquartile range 1-2) (P = 0.01). Multivariable analysis revealed age as independent predictive variable for grade 3 to 5 toxicity (P = 0.03) but not disease stage, Prostate specific antigen predocetaxel, volume of disease, and Eastern Cooperative Oncology Group performance status (P > 0.05). Objective response was significantly higher in mHSPC compared to mCRPC patients (P < 0.01). Multivariable analysis confirmed mHSPC stage as independent prognostic factor for radiographic progression free disease at restaging (P < 0.01). CONCLUSIONS The association of age with toxicity and of mHSPC stage with response resulted in significantly fewer grade 3 to 5 adverse events but higher response rates for upfront docetaxel in mHSPC compared with docetaxel in the later mCRPC stage.
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Abdel-Rahman O. Impact of Diabetes on the Outcomes of Patients With Castration-resistant Prostate Cancer Treated With Docetaxel: A Pooled Analysis of Three Phase III Studies. Clin Genitourin Cancer 2019; 17:e104-e112. [DOI: 10.1016/j.clgc.2018.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/17/2018] [Accepted: 09/21/2018] [Indexed: 10/28/2022]
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Pinart M, Kunath F, Lieb V, Tsaur I, Wullich B, Schmidt S. Prognostic models for predicting overall survival in metastatic castration-resistant prostate cancer: a systematic review. World J Urol 2018; 38:613-635. [PMID: 30554274 DOI: 10.1007/s00345-018-2574-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/20/2018] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Prognostic models are developed to estimate the probability of the occurrence of future outcomes incorporating multiple variables. We aimed to identify and summarize existing multivariable prognostic models developed for predicting overall survival in patients with metastatic castration-resistant prostate cancer (mCRPC). METHODS The protocol was prospectively registered (CRD42017064448). We systematically searched Medline and reference lists up to May 2018 and included experimental and observational studies, which developed and/or internally validated prognostic models for mCRPC patients and were further externally validated or updated. The outcome of interest was overall survival. Two authors independently performed literature screening and quality assessment. RESULTS We included 12 studies that developed models including 8750 patients aged 42-95 years. Models included 4-11 predictor variables, mostly hemoglobin, baseline PSA, alkaline phosphatase, performance status, and lactate dehydrogenase. Very few incorporated Gleason score. Two models included predictors related to docetaxel and mitoxantrone treatments. Model performance after internal validation showed similar discrimination power ranging from 0.62 to 0.73. Overall survival models were mainly constructed as nomograms or risk groups/score. Two models obtained an overall judgment of low risk of bias. CONCLUSIONS Most models were not suitable for clinical use due to methodological shortcomings and lack of external validation. Further external validation and/or model updating is required to increase prognostic accuracy and clinical applicability prior to their incorporation in clinical practice as a useful tool in patient management.
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Affiliation(s)
- M Pinart
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany
| | - F Kunath
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany
| | - V Lieb
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - I Tsaur
- Department of Urology, University Medicine Mainz, Mainz, Germany
| | - B Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Stefanie Schmidt
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany.
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Martin LJ, Alibhai SMH, Komisarenko M, Timilshina N, Finelli A. Identification of subgroups of metastatic castrate-resistant prostate cancer (mCRPC) patients treated with abiraterone plus prednisone at low- vs. high-risk of radiographic progression: An analysis of COU-AA-302. Can Urol Assoc J 2018; 13:192-200. [PMID: 30407155 DOI: 10.5489/cuaj.5586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Radiographic imaging is used to monitor disease progression for men with metastatic castrate-resistant prostate cancer (mCRPC). The optimal frequency of imaging, a costly and limited resource, is not known. Our objective was to identify predictors of radiographic progression to inform the frequency of imaging for men with mCRPC. METHODS We accessed data for men with chemotherapy-naive mCRPC in the abiraterone acetate plus prednisone (AA-P) group of a randomized trial (COU-AA-302) (n=546). We used Cox proportional hazards modelling to identify predictors of time to progression. We divided patients into groups based on the most important predictors and estimated the probability of radiographic progression-free survival (RPFS) at six and 12 months. RESULTS Baseline disease and change in prostate-specific antigen (PSA) at eight weeks were the strongest determinants of RPFS. The probability of RPFS for men with bone-only disease and a ≥50% fall in PSA was 93% (95% confidence interval [CI] 87-96) at six months and 80% (95% CI 72-86) at 12 months. In contrast, the probability of RPFS for men with bone and soft tissue metastasis and <50% fall in PSA was 55% (95% CI 41-67) at six months and 34% (95% CI 22-47) at 12 months. These findings should be externally validated. CONCLUSIONS Patients with chemotherapy-naive mCRPC treated with first-line AA-P can be divided into groups with significantly different risks of radiographic progression based on a few clinically available variables, suggesting that imaging schedules could be individualized.
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Affiliation(s)
- Lisa J Martin
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Shabbir M H Alibhai
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Maria Komisarenko
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Antonio Finelli
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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N��ez-Iglesias M, Novio S, Garc�a-Santiago C, Cartea M, Soengas P, Velasco P, Freire-Garabal M. Effects of 3-butenyl isothiocyanate on phenotypically different prostate cancer cells. Int J Oncol 2018; 53:2213-2223. [DOI: 10.3892/ijo.2018.4545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/27/2018] [Indexed: 11/05/2022] Open
Affiliation(s)
- M.j. N��ez-Iglesias
- Screening of New Libraries Laboratory, School of Medicine and Dentistry, University of Santiago de Compostela, 15782 A Coru�a, Spain
| | - S. Novio
- Screening of New Libraries Laboratory, School of Medicine and Dentistry, University of Santiago de Compostela, 15782 A Coru�a, Spain
| | - C. Garc�a-Santiago
- Screening of New Libraries Laboratory, School of Medicine and Dentistry, University of Santiago de Compostela, 15782 A Coru�a, Spain
| | - M.e. Cartea
- Group of Genetics, Breeding and Biochemistry of Brassicas, Biological Mission of Galicia, CSIC, 36143 Pontevedra, Spain
| | - P. Soengas
- Group of Genetics, Breeding and Biochemistry of Brassicas, Biological Mission of Galicia, CSIC, 36143 Pontevedra, Spain
| | - P. Velasco
- Group of Genetics, Breeding and Biochemistry of Brassicas, Biological Mission of Galicia, CSIC, 36143 Pontevedra, Spain
| | - M. Freire-Garabal
- Screening of New Libraries Laboratory, School of Medicine and Dentistry, University of Santiago de Compostela, 15782 A Coru�a, Spain
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Huser V, Shmueli-Blumberg D. Data sharing platforms for de-identified data from human clinical trials. Clin Trials 2018; 15:413-423. [PMID: 29676586 DOI: 10.1177/1740774518769655] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Data sharing of de-identified individual participant data is being adopted by an increasing number of sponsors of human clinical trials. In addition to standardizing data syntax for shared trial data, semantic integration of various data elements is the focus of several initiatives that define research common data elements. This perspective article, in the first part, compares several data sharing platforms for de-identified clinical research data in terms of their size, policies and supported features. In the second part, we use a case study approach to describe in greater detail one data sharing platform (Data Share from National Institute of Drug Abuse). We present data on the past use of the platform, data formats offered, data de-identification approaches and its use of research common data elements. We conclude with a summary of current and expected future trends that facilitate secondary research use of data from completed human clinical trials.
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Affiliation(s)
- Vojtech Huser
- 1 National Library of Medicine, National Institutes of Health, Bethesda, MD, USA
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11
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Bertagnolli MM, Sartor O, Chabner BA, Rothenberg ML, Khozin S, Hugh-Jones C, Reese DM, Murphy MJ. Advantages of a Truly Open-Access Data-Sharing Model. N Engl J Med 2017; 376:1178-1181. [PMID: 28328337 DOI: 10.1056/nejmsb1702054] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Monica M Bertagnolli
- From the Dana-Farber Cancer Institute, Brigham and Women's Hospital (M.M.B.), and Massachusetts General Hospital Cancer Center (B.A.C.), Boston; Tulane Medical School, New Orleans (O.S.); Pfizer (M.L.R.) and Carmine Research (C.H.-J.), New York; Food and Drug Administration, Silver Spring, MD (S.K.); Amgen, Thousand Oaks, CA (D.M.R.); and Project Data Sphere, Cary, NC (M.J.M.)
| | - Oliver Sartor
- From the Dana-Farber Cancer Institute, Brigham and Women's Hospital (M.M.B.), and Massachusetts General Hospital Cancer Center (B.A.C.), Boston; Tulane Medical School, New Orleans (O.S.); Pfizer (M.L.R.) and Carmine Research (C.H.-J.), New York; Food and Drug Administration, Silver Spring, MD (S.K.); Amgen, Thousand Oaks, CA (D.M.R.); and Project Data Sphere, Cary, NC (M.J.M.)
| | - Bruce A Chabner
- From the Dana-Farber Cancer Institute, Brigham and Women's Hospital (M.M.B.), and Massachusetts General Hospital Cancer Center (B.A.C.), Boston; Tulane Medical School, New Orleans (O.S.); Pfizer (M.L.R.) and Carmine Research (C.H.-J.), New York; Food and Drug Administration, Silver Spring, MD (S.K.); Amgen, Thousand Oaks, CA (D.M.R.); and Project Data Sphere, Cary, NC (M.J.M.)
| | - Mace L Rothenberg
- From the Dana-Farber Cancer Institute, Brigham and Women's Hospital (M.M.B.), and Massachusetts General Hospital Cancer Center (B.A.C.), Boston; Tulane Medical School, New Orleans (O.S.); Pfizer (M.L.R.) and Carmine Research (C.H.-J.), New York; Food and Drug Administration, Silver Spring, MD (S.K.); Amgen, Thousand Oaks, CA (D.M.R.); and Project Data Sphere, Cary, NC (M.J.M.)
| | - Sean Khozin
- From the Dana-Farber Cancer Institute, Brigham and Women's Hospital (M.M.B.), and Massachusetts General Hospital Cancer Center (B.A.C.), Boston; Tulane Medical School, New Orleans (O.S.); Pfizer (M.L.R.) and Carmine Research (C.H.-J.), New York; Food and Drug Administration, Silver Spring, MD (S.K.); Amgen, Thousand Oaks, CA (D.M.R.); and Project Data Sphere, Cary, NC (M.J.M.)
| | - Charles Hugh-Jones
- From the Dana-Farber Cancer Institute, Brigham and Women's Hospital (M.M.B.), and Massachusetts General Hospital Cancer Center (B.A.C.), Boston; Tulane Medical School, New Orleans (O.S.); Pfizer (M.L.R.) and Carmine Research (C.H.-J.), New York; Food and Drug Administration, Silver Spring, MD (S.K.); Amgen, Thousand Oaks, CA (D.M.R.); and Project Data Sphere, Cary, NC (M.J.M.)
| | - David M Reese
- From the Dana-Farber Cancer Institute, Brigham and Women's Hospital (M.M.B.), and Massachusetts General Hospital Cancer Center (B.A.C.), Boston; Tulane Medical School, New Orleans (O.S.); Pfizer (M.L.R.) and Carmine Research (C.H.-J.), New York; Food and Drug Administration, Silver Spring, MD (S.K.); Amgen, Thousand Oaks, CA (D.M.R.); and Project Data Sphere, Cary, NC (M.J.M.)
| | - Martin J Murphy
- From the Dana-Farber Cancer Institute, Brigham and Women's Hospital (M.M.B.), and Massachusetts General Hospital Cancer Center (B.A.C.), Boston; Tulane Medical School, New Orleans (O.S.); Pfizer (M.L.R.) and Carmine Research (C.H.-J.), New York; Food and Drug Administration, Silver Spring, MD (S.K.); Amgen, Thousand Oaks, CA (D.M.R.); and Project Data Sphere, Cary, NC (M.J.M.)
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