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Fekete B, Bársony L, Biró K, Gyergyay F, Géczi L, Patócs A, Budai B. A new method to quantify the effect of co-medication on the efficacy of abiraterone in metastatic castration-resistant prostate cancer patients. Front Pharmacol 2023; 14:1220457. [PMID: 37841911 PMCID: PMC10568029 DOI: 10.3389/fphar.2023.1220457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Background and Objective: Patients with metastatic castration-resistant prostate cancer (mCRPC) treated with abiraterone acetate (AA) have co-morbidities treated with different drugs. The aim was to quantify the potential effect of co-medications on AA treatment duration (TD) and overall survival (OS). Methods: A new parameter, called "individual drug score" (IDS) was calculated by summing the "drug score"-s (DS) of all co-medications for each patient. The DS was determined by quantifying the effect of a given co-drug on enzymes involved in steroidogenesis and metabolism of AA. The correlation between log (IDS) and TD was tested by non-linear curve fit. Kaplan-Meier method and multivariate Cox regression was used for analysis of TD and OS. Results: The IDS and TD of AA+prednisolone showed a dose-response correlation (n = 166). Patients with high IDS had significantly longer TD and OS (p <0.001). In multivariate analysis IDS proved to be an independent marker of TD and OS. The same analysis was performed in a separate group of 81 patients receiving AA+dexamethasone treatment. The previously observed relationships were observed again between IDS and TD or OS. After combining the AA+prednisolone and AA+dexamethasone groups, analysis of the IDS composition showed that patients in the high IDS group not only used more drugs (p <0.001), but their drugs also had a higher mean DS (p = 0.001). Conclusion: The more co-drugs with high DS, the longer the duration of AA treatment and OS, emphasizing the need for careful co-medication planning in patients with mCRPC treated with AA. It is recommended that, where possible, co-medication should be modified to minimize the number of drugs with negative DS and increase the number of drugs with high DS. Our new model can presumably be adapted to other drugs and other cancer types (or other diseases).
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Affiliation(s)
| | - Lili Bársony
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Krisztina Biró
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, Comprehensive Cancer Center, National Institute of Oncology, Budapest, Hungary
| | - Fruzsina Gyergyay
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, Comprehensive Cancer Center, National Institute of Oncology, Budapest, Hungary
| | - Lajos Géczi
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, Comprehensive Cancer Center, National Institute of Oncology, Budapest, Hungary
| | - Attila Patócs
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
- Department of Molecular Genetics, Comprehensive Cancer Center, National Institute of Oncology, Budapest, Hungary
- National Tumor Biology Laboratory, Comprehensive Cancer Center, National Institute of Oncology, Budapest, Hungary
| | - Barna Budai
- Department of Molecular Genetics, Comprehensive Cancer Center, National Institute of Oncology, Budapest, Hungary
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2
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Fallara G, Gedeborg R, Bill-Axelson A, Garmo H, Stattin P. A drug comorbidity index to predict mortality in men with castration resistant prostate cancer. PLoS One 2021; 16:e0255239. [PMID: 34320037 PMCID: PMC8318265 DOI: 10.1371/journal.pone.0255239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Charlson Comorbidity Index is a poor predictor of mortality in men with castration resistant prostate cancer (CRPC). To improve this prediction, we created a comorbidity index based on filled prescriptions intended to be used in registry-based studies. MATERIALS AND METHODS In a population-based cohort of men with CPRC a drug comorbidity index (DCI-CRPC) was calculated based on prescriptions filled during a 365-day period before the date of CRPC diagnosis to predict mortality. Five risk categories for men with CRPC were defined based on PSA kinetics. Mortality rates were described by Kaplan-Meier curves. The predictive ability of the DCI-CRPC was compared in univariable models to that of the original DCI, derived from men in the general population, and to that of the Charlson Comorbidity Index. RESULTS In 1,885 men with CRPC the median overall survival ranged from 3.0 years (95% confidence interval [CI] 2.8 to 3.4) in the first tertile of the DCI-CRPC, to 1.0 year (95% CI 0.9 to 1.1) in the third tertile of the DCI-CRPC. The index had higher discriminative ability (C-index 0.667) than the Charlson Comorbidity Index (C-index 0.508). The discriminative ability of the DCI-CRPC was highest in the subgroup with least aggressive cancer (C-index 0.651) and lowest in men with most aggressive cancer (C-index 0.618). The performance of the DCI-CRPC was comparable to that of the original DCI. CONCLUSION Our newly created comorbidity index using filled prescriptions predicted death in men with CRPC better than the Charlson Comorbidity Index.
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Affiliation(s)
- Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita‐Salute San Raffaele University, Milan, Italy
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Rolf Gedeborg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anna Bill-Axelson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Hans Garmo
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Regional Cancer Centre, Uppsala/Örebro, Uppsala University Hospital, Uppsala, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Lin YT, Huang YC, Liu CK, Lee TS, Chen M, Chien YN. Treatment-Emergent Co-Morbidities and Survival in Patients With Metastatic Castration-Resistant Prostate Cancer Receiving Abiraterone or Enzalutamide. Front Pharmacol 2021; 12:669236. [PMID: 34084142 PMCID: PMC8167063 DOI: 10.3389/fphar.2021.669236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Secondary hormone therapy, abiraterone and enzalutamide, has improved outcomes for metastatic castration-resistant prostate cancer (mCRPC) and prolonged patients' lives significantly. Various studies have compared the cancer-related outcomes, adverse effects, and drug-induced comorbidities in patients with mCRPC who are treated with abiraterone or enzalutamide. However, few studies have explored associations between survival and comorbidities or comprehensive analyzed newly developed comorbidities during and after secondary hormone therapy. We attempted to clarify whether the Charlson comorbidity index (CCI) overall or itemized is predictive for overall survival, and we compared newly developed comorbidities between abiraterone and enzalutamide groups. We extracted data about expenses and comorbidities for patients who have mCRPC, received abiraterone and enzalutamide and met pre-examination operation criteria between September 2016 and December 2017 from the Taiwan National Health Insurance database. A total of 1153 patients with mCRPC who received abiraterone (n = 782) or enzalutamide (n = 371) with or without previous chemotherapy were included. We used the propensity score to match confounding factors, including age, pre-existing comorbidities, and precipitating factors for comorbidity (e.g., hypertension, hyperlipidemia), to eliminate selection bias in the comparison of newly developed comorbidities. Cox regression analysis was used for overall survival. We found that enzalutamide is superior to abiraterone with regard to overall survival. Our study revealed that there is no statistically significant difference in development of new comorbidities between abiraterone and enzalutamide group. Moreover, the CCI score, rather than any single item of the CCI, was a statistically significant predictor for overall survival.
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Affiliation(s)
- Yi-Ting Lin
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan.,AI Development Centers, Fu Jen Catholic University, New Taipei City, Taiwan.,Department of Urology, St. Joseph Hospital, Yunlin County, Taiwan
| | - Yen-Chun Huang
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan.,AI Development Centers, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chih-Kuan Liu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan.,Department of Urology, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Tian-Shyug Lee
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan.,AI Development Centers, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Mingchih Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, Taiwan.,AI Development Centers, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yu-Ning Chien
- AI Development Centers, Fu Jen Catholic University, New Taipei City, Taiwan.,College of Medicine Fu Jen Catholic University Master Program of Big Data Analysis in Biomedicine, New Taipei City, Taiwan
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4
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Huang TB, Zhou GC, Dong CP, Wang LP, Luan Y, Ye JT, Gu X, Yao XD, Zheng JH, Ding XF. Marital status independently predicts prostate cancer survival in men who underwent radical prostatectomy: An analysis of 95,846 individuals. Oncol Lett 2018; 15:4737-4744. [PMID: 29552113 PMCID: PMC5840566 DOI: 10.3892/ol.2018.7964] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/10/2017] [Indexed: 12/15/2022] Open
Abstract
Marital status is an independent prognostic factor for survival in several types of cancer, but has not been fully studied in prostate cancer (PCa). A total of 95,846 men diagnosed with PCa were treated with radical prostatectomy (RP) between 2004 and 2009 within 18 Surveillance, Epidemiology and End Results registries. Survival curves were generated using Kaplan-Meier estimates and differences in survival were assessed using the log-rank test. Cox regression models were used to assess the impact of marital status on survival outcomes. The results demonstrated that the 8-year cancer-cause specific survival (CSS) rate of married men was higher than unmarried individuals. Further analyses revealed that divorced/separated men had a higher proportion of high Gleason scores (GS) PCa at diagnosis [hazard ratio (HR), 1.12; P=0.007] and those patients had the worst survival outcomes independent of age, ethnicity, grade, stage and sequence number [HR, 1.61; 95% confidence interval (CI), 1.34-1.93]. Interestingly, it was observed that CSS among divorced/separated men decreased as the GS increased (GS≤6: HR, 2.5; GS=7: HR, 1.71; GS≥8: HR, 1.50; all P<0.05). Apart from that, no significant differences in CSS were observed in those who had never been married (HR, 1.20) or were widowed (HR, 1.13) relative to the married group. The results of the present study support the hypothesis that marital status is an independent prognostic factor among men with PCa who underwent RP. It was demonstrated that the mortality rates of divorced or separated men with PCa were significantly greater compared with the other groups. A further understanding of the potential associations among marital status, psychosocial factors and survival outcomes may help in developing novel, more effective methods of treating different groups of patients with PCa.
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Affiliation(s)
- Tian-Bao Huang
- Department of Urology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China.,Department of Urology, College of Clinical Medicine, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Guang-Chen Zhou
- Department of Urology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China.,Department of Urology, College of Clinical Medicine, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Chuan-Peng Dong
- Department of Biochemistry and Molecular Biology, Institute of Biomedical Science, Shanghai Medical College, Fudan University, Shanghai 200032, P.R. China
| | - Li-Ping Wang
- Department of Biobank, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China
| | - Yang Luan
- Department of Urology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China.,Department of Urology, College of Clinical Medicine, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Jing-Ting Ye
- Department of Cardiothoracic Surgery, College of Clinical Medicine, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Xiao Gu
- Department of Urology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China.,Department of Urology, College of Clinical Medicine, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Xu-Dong Yao
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, P.R. China
| | - Jun-Hua Zheng
- Department of Urology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, P.R. China
| | - Xue-Fei Ding
- Department of Urology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China.,Department of Urology, College of Clinical Medicine, Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
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Hamid AA, Willson K, Vincent AD, Tamjid B, Lee M, Bergin A, Gan C, Campbell A, Stewart J, Pezaro C, Tran B, Weickhardt AJ. Risk of febrile neutropenia and early treatment cessation in men receiving standard and dose-reduced 3-weekly docetaxel for metastatic castration-resistant prostate cancer. Asia Pac J Clin Oncol 2018; 14:e399-e404. [DOI: 10.1111/ajco.12840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/18/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Anis A. Hamid
- Olivia Newton-John Cancer Wellness and Research Center; Austin Hospital; Heidelberg Victoria Australia
| | - Kaspar Willson
- Olivia Newton-John Cancer Wellness and Research Center; Austin Hospital; Heidelberg Victoria Australia
| | - Andrew D. Vincent
- Freemasons Foundation Center for Men's Health; Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Babak Tamjid
- Olivia Newton-John Cancer Wellness and Research Center; Austin Hospital; Heidelberg Victoria Australia
| | - Margaret Lee
- Eastern Health and Monash University Eastern Health Clinical School; Box Hill Victoria Australia
| | - Alice Bergin
- Epworth Freemasons; East Melbourne Victoria Australia
| | - Chun Gan
- Royal Melbourne Hospital; Parkville Victoria Australia
| | - Ainsley Campbell
- Olivia Newton-John Cancer Wellness and Research Center; Austin Hospital; Heidelberg Victoria Australia
| | - Josephine Stewart
- Olivia Newton-John Cancer Wellness and Research Center; Austin Hospital; Heidelberg Victoria Australia
| | - Carmel Pezaro
- Eastern Health and Monash University Eastern Health Clinical School; Box Hill Victoria Australia
| | - Ben Tran
- Epworth Freemasons; East Melbourne Victoria Australia
- Royal Melbourne Hospital; Parkville Victoria Australia
- Peter MacCallum Cancer Center; Victorian Comprehensive Cancer Center; Parkville Victoria Australia
| | - Andrew J. Weickhardt
- Olivia Newton-John Cancer Wellness and Research Center; Austin Hospital; Heidelberg Victoria Australia
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Saygin C, Jia X, Hill B, Dean R, Pohlman B, Smith MR, Jagadeesh D. Impact of comorbidities on outcomes of elderly patients with diffuse large B-cell lymphoma. Am J Hematol 2017; 92:989-996. [PMID: 28612386 DOI: 10.1002/ajh.24819] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/22/2017] [Accepted: 06/07/2017] [Indexed: 12/19/2022]
Abstract
International prognostic index (IPI) has remained the primary prognostic tool in diffuse large B cell lymphoma (DLBCL) for more than 20 years. Even though the disease is more common in older population, the impact of comorbidities, dose reductions, and treatment-related adverse events (TAEs) on the outcome in elderly DLBCL patients has not been well established. We studied 413 consecutive patients aged ≥ 60 years who were treated at the Cleveland Clinic. The median age at diagnosis was 69 years, 58% of patients had high IPI score, and 85% had low Charlson comorbidity index (CCI). Forty percent of patients required dose reductions during treatment, 78% achieved CR, and 70% experienced at least one grade II-IV TAE. High IPI score, high CCI, reduced dose chemotherapy, TAE, and hospitalization were significant predictors of death and relapse. In multivariable analysis, high IPI and CCI were independent predictors of overall and progression free survival. A simple model combining IPI and CCI could reliably distinguish three prognostically separate risk groups. Our results suggest that incorporation of CCI in current prognostic models can improve prognostication of older DLBCL patients and CCI might be a valuable tool in evaluating the eligibility of older patients for clinical trial enrollment.
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Affiliation(s)
- Caner Saygin
- Department of Hematology and Medical Oncology; Taussig Cancer Institute, Cleveland Clinic; 9500 Euclid Ave, Cleveland, Ohio 44195
| | - Xuefei Jia
- Quantitative Health Sciences, Cleveland Clinic; Cleveland Ohio 44195 USA
| | - Brian Hill
- Department of Hematology and Medical Oncology; Taussig Cancer Institute, Cleveland Clinic; 9500 Euclid Ave, Cleveland, Ohio 44195
| | - Robert Dean
- Department of Hematology and Medical Oncology; Taussig Cancer Institute, Cleveland Clinic; 9500 Euclid Ave, Cleveland, Ohio 44195
| | - Brad Pohlman
- Department of Hematology and Medical Oncology; Taussig Cancer Institute, Cleveland Clinic; 9500 Euclid Ave, Cleveland, Ohio 44195
| | - Mitchell R. Smith
- Department of Hematology and Medical Oncology; Taussig Cancer Institute, Cleveland Clinic; 9500 Euclid Ave, Cleveland, Ohio 44195
| | - Deepa Jagadeesh
- Department of Hematology and Medical Oncology; Taussig Cancer Institute, Cleveland Clinic; 9500 Euclid Ave, Cleveland, Ohio 44195
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