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Palassini E, Ferrari S, Verderio P, De Paoli A, Martin Broto J, Quagliuolo V, Comandone A, Sangalli C, Palmerini E, Lopez-Pousa A, De Sanctis R, Bottelli S, Libertini M, Picci P, Casali PG, Gronchi A. Feasibility of Preoperative Chemotherapy With or Without Radiation Therapy in Localized Soft Tissue Sarcomas of Limbs and Superficial Trunk in the Italian Sarcoma Group/Grupo Español de Investigación en Sarcomas Randomized Clinical Trial: Three Versus Five Cycles of Full-Dose Epirubicin Plus Ifosfamide. J Clin Oncol 2015; 33:3628-34. [PMID: 26351345 DOI: 10.1200/jco.2015.62.9394] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE We report on feasibility of preoperative chemotherapy with or without radiation therapy (RT) in the context of a phase III randomized clinical trial involving localized, high-risk, soft tissue sarcomas. PATIENTS AND METHODS Of 321 eligible patients, 161 were randomly assigned to three preoperative cycles of epirubicin 120 mg/m(2) plus ifosfamide 9 g/m(2), and 160 were randomly assigned to three preoperative plus two postoperative cycles. Among them, 303 patients were included in this analysis; 169 were male and 134 were female, with a median age of 48 years (range, 15 to 79 years). One hundred fifty-two patients received concurrent RT preoperatively at a total dose of 44 to 50 Gy. Preoperative chemotherapy-related hematologic toxicity and early postoperative complications were reported. The influence of RT, age, and sex on hematologic grade 3 or 4 toxicities and wound complications was analyzed. Chemotherapeutic dose intensity (DI) was analyzed. RESULTS Among the patients, 61.4%, 22.4%, and 23.8% experienced, grade 4 leucopenia, grade 3 or 4 anemia, and grade 3 or 4 thrombocytopenia, respectively. Respective rates were 66.4%, 24.3%, and 31.6% when RT was added preoperatively, and 56.3%, 20.5%, and 15.9% when preoperative chemotherapy was administered alone. Patient age affected grade 3 or 4 thrombocytopenia. Grade 4 leucopenia and grade 3 or 4 anemia presented 2.5 times more frequently in female patients than in male patients. Wound complications were observed in 13.5% of patients: 17% with preoperative RT and 10% without. Chemotherapeutic DI was greater than 90%, even in patients receiving preoperative RT and in patients age 65 years or older. CONCLUSION This preoperative chemotherapy is feasible and can also be proposed for selected elderly patients. Grade 3 or 4 hematologic toxicity was common, but DI was excellent. Concurrent preoperative RT is safe, although an increased rate of grade 4 thrombocytopenia and limited increase in wound complications may be observed.
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Affiliation(s)
- Elena Palassini
- Elena Palassini, Paolo Verderio, Claudia Sangalli, Stefano Bottelli, Michela Libertini, Paolo G. Casali, and Alessandro Gronchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori; Vittorio Quagliuolo and Rita De Sanctis, Istituto Clinico Humanitas, Milan; Stefano Ferrari, Emanuela Palmerini, and Piero Picci, Istituto Ortopedico Rizzoli, Bologna; Antonino De Paoli, Centro di Riferimento Oncologico, Aviano; Alessandro Comandone, Presidio Sanitario Gradenigo, Torino, Italy; Javier Martin Broto, Hospital Universitario Virgen del Rocío, Sevilla; and Antonio Lopez-Pousa, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Stefano Ferrari
- Elena Palassini, Paolo Verderio, Claudia Sangalli, Stefano Bottelli, Michela Libertini, Paolo G. Casali, and Alessandro Gronchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori; Vittorio Quagliuolo and Rita De Sanctis, Istituto Clinico Humanitas, Milan; Stefano Ferrari, Emanuela Palmerini, and Piero Picci, Istituto Ortopedico Rizzoli, Bologna; Antonino De Paoli, Centro di Riferimento Oncologico, Aviano; Alessandro Comandone, Presidio Sanitario Gradenigo, Torino, Italy; Javier Martin Broto, Hospital Universitario Virgen del Rocío, Sevilla; and Antonio Lopez-Pousa, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Paolo Verderio
- Elena Palassini, Paolo Verderio, Claudia Sangalli, Stefano Bottelli, Michela Libertini, Paolo G. Casali, and Alessandro Gronchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori; Vittorio Quagliuolo and Rita De Sanctis, Istituto Clinico Humanitas, Milan; Stefano Ferrari, Emanuela Palmerini, and Piero Picci, Istituto Ortopedico Rizzoli, Bologna; Antonino De Paoli, Centro di Riferimento Oncologico, Aviano; Alessandro Comandone, Presidio Sanitario Gradenigo, Torino, Italy; Javier Martin Broto, Hospital Universitario Virgen del Rocío, Sevilla; and Antonio Lopez-Pousa, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonino De Paoli
- Elena Palassini, Paolo Verderio, Claudia Sangalli, Stefano Bottelli, Michela Libertini, Paolo G. Casali, and Alessandro Gronchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori; Vittorio Quagliuolo and Rita De Sanctis, Istituto Clinico Humanitas, Milan; Stefano Ferrari, Emanuela Palmerini, and Piero Picci, Istituto Ortopedico Rizzoli, Bologna; Antonino De Paoli, Centro di Riferimento Oncologico, Aviano; Alessandro Comandone, Presidio Sanitario Gradenigo, Torino, Italy; Javier Martin Broto, Hospital Universitario Virgen del Rocío, Sevilla; and Antonio Lopez-Pousa, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Javier Martin Broto
- Elena Palassini, Paolo Verderio, Claudia Sangalli, Stefano Bottelli, Michela Libertini, Paolo G. Casali, and Alessandro Gronchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori; Vittorio Quagliuolo and Rita De Sanctis, Istituto Clinico Humanitas, Milan; Stefano Ferrari, Emanuela Palmerini, and Piero Picci, Istituto Ortopedico Rizzoli, Bologna; Antonino De Paoli, Centro di Riferimento Oncologico, Aviano; Alessandro Comandone, Presidio Sanitario Gradenigo, Torino, Italy; Javier Martin Broto, Hospital Universitario Virgen del Rocío, Sevilla; and Antonio Lopez-Pousa, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Vittorio Quagliuolo
- Elena Palassini, Paolo Verderio, Claudia Sangalli, Stefano Bottelli, Michela Libertini, Paolo G. Casali, and Alessandro Gronchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori; Vittorio Quagliuolo and Rita De Sanctis, Istituto Clinico Humanitas, Milan; Stefano Ferrari, Emanuela Palmerini, and Piero Picci, Istituto Ortopedico Rizzoli, Bologna; Antonino De Paoli, Centro di Riferimento Oncologico, Aviano; Alessandro Comandone, Presidio Sanitario Gradenigo, Torino, Italy; Javier Martin Broto, Hospital Universitario Virgen del Rocío, Sevilla; and Antonio Lopez-Pousa, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alessandro Comandone
- Elena Palassini, Paolo Verderio, Claudia Sangalli, Stefano Bottelli, Michela Libertini, Paolo G. Casali, and Alessandro Gronchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori; Vittorio Quagliuolo and Rita De Sanctis, Istituto Clinico Humanitas, Milan; Stefano Ferrari, Emanuela Palmerini, and Piero Picci, Istituto Ortopedico Rizzoli, Bologna; Antonino De Paoli, Centro di Riferimento Oncologico, Aviano; Alessandro Comandone, Presidio Sanitario Gradenigo, Torino, Italy; Javier Martin Broto, Hospital Universitario Virgen del Rocío, Sevilla; and Antonio Lopez-Pousa, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Claudia Sangalli
- Elena Palassini, Paolo Verderio, Claudia Sangalli, Stefano Bottelli, Michela Libertini, Paolo G. Casali, and Alessandro Gronchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori; Vittorio Quagliuolo and Rita De Sanctis, Istituto Clinico Humanitas, Milan; Stefano Ferrari, Emanuela Palmerini, and Piero Picci, Istituto Ortopedico Rizzoli, Bologna; Antonino De Paoli, Centro di Riferimento Oncologico, Aviano; Alessandro Comandone, Presidio Sanitario Gradenigo, Torino, Italy; Javier Martin Broto, Hospital Universitario Virgen del Rocío, Sevilla; and Antonio Lopez-Pousa, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Emanuela Palmerini
- Elena Palassini, Paolo Verderio, Claudia Sangalli, Stefano Bottelli, Michela Libertini, Paolo G. Casali, and Alessandro Gronchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori; Vittorio Quagliuolo and Rita De Sanctis, Istituto Clinico Humanitas, Milan; Stefano Ferrari, Emanuela Palmerini, and Piero Picci, Istituto Ortopedico Rizzoli, Bologna; Antonino De Paoli, Centro di Riferimento Oncologico, Aviano; Alessandro Comandone, Presidio Sanitario Gradenigo, Torino, Italy; Javier Martin Broto, Hospital Universitario Virgen del Rocío, Sevilla; and Antonio Lopez-Pousa, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio Lopez-Pousa
- Elena Palassini, Paolo Verderio, Claudia Sangalli, Stefano Bottelli, Michela Libertini, Paolo G. Casali, and Alessandro Gronchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori; Vittorio Quagliuolo and Rita De Sanctis, Istituto Clinico Humanitas, Milan; Stefano Ferrari, Emanuela Palmerini, and Piero Picci, Istituto Ortopedico Rizzoli, Bologna; Antonino De Paoli, Centro di Riferimento Oncologico, Aviano; Alessandro Comandone, Presidio Sanitario Gradenigo, Torino, Italy; Javier Martin Broto, Hospital Universitario Virgen del Rocío, Sevilla; and Antonio Lopez-Pousa, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Rita De Sanctis
- Elena Palassini, Paolo Verderio, Claudia Sangalli, Stefano Bottelli, Michela Libertini, Paolo G. Casali, and Alessandro Gronchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori; Vittorio Quagliuolo and Rita De Sanctis, Istituto Clinico Humanitas, Milan; Stefano Ferrari, Emanuela Palmerini, and Piero Picci, Istituto Ortopedico Rizzoli, Bologna; Antonino De Paoli, Centro di Riferimento Oncologico, Aviano; Alessandro Comandone, Presidio Sanitario Gradenigo, Torino, Italy; Javier Martin Broto, Hospital Universitario Virgen del Rocío, Sevilla; and Antonio Lopez-Pousa, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Stefano Bottelli
- Elena Palassini, Paolo Verderio, Claudia Sangalli, Stefano Bottelli, Michela Libertini, Paolo G. Casali, and Alessandro Gronchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori; Vittorio Quagliuolo and Rita De Sanctis, Istituto Clinico Humanitas, Milan; Stefano Ferrari, Emanuela Palmerini, and Piero Picci, Istituto Ortopedico Rizzoli, Bologna; Antonino De Paoli, Centro di Riferimento Oncologico, Aviano; Alessandro Comandone, Presidio Sanitario Gradenigo, Torino, Italy; Javier Martin Broto, Hospital Universitario Virgen del Rocío, Sevilla; and Antonio Lopez-Pousa, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Michela Libertini
- Elena Palassini, Paolo Verderio, Claudia Sangalli, Stefano Bottelli, Michela Libertini, Paolo G. Casali, and Alessandro Gronchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori; Vittorio Quagliuolo and Rita De Sanctis, Istituto Clinico Humanitas, Milan; Stefano Ferrari, Emanuela Palmerini, and Piero Picci, Istituto Ortopedico Rizzoli, Bologna; Antonino De Paoli, Centro di Riferimento Oncologico, Aviano; Alessandro Comandone, Presidio Sanitario Gradenigo, Torino, Italy; Javier Martin Broto, Hospital Universitario Virgen del Rocío, Sevilla; and Antonio Lopez-Pousa, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Piero Picci
- Elena Palassini, Paolo Verderio, Claudia Sangalli, Stefano Bottelli, Michela Libertini, Paolo G. Casali, and Alessandro Gronchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori; Vittorio Quagliuolo and Rita De Sanctis, Istituto Clinico Humanitas, Milan; Stefano Ferrari, Emanuela Palmerini, and Piero Picci, Istituto Ortopedico Rizzoli, Bologna; Antonino De Paoli, Centro di Riferimento Oncologico, Aviano; Alessandro Comandone, Presidio Sanitario Gradenigo, Torino, Italy; Javier Martin Broto, Hospital Universitario Virgen del Rocío, Sevilla; and Antonio Lopez-Pousa, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Paolo G Casali
- Elena Palassini, Paolo Verderio, Claudia Sangalli, Stefano Bottelli, Michela Libertini, Paolo G. Casali, and Alessandro Gronchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori; Vittorio Quagliuolo and Rita De Sanctis, Istituto Clinico Humanitas, Milan; Stefano Ferrari, Emanuela Palmerini, and Piero Picci, Istituto Ortopedico Rizzoli, Bologna; Antonino De Paoli, Centro di Riferimento Oncologico, Aviano; Alessandro Comandone, Presidio Sanitario Gradenigo, Torino, Italy; Javier Martin Broto, Hospital Universitario Virgen del Rocío, Sevilla; and Antonio Lopez-Pousa, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alessandro Gronchi
- Elena Palassini, Paolo Verderio, Claudia Sangalli, Stefano Bottelli, Michela Libertini, Paolo G. Casali, and Alessandro Gronchi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori; Vittorio Quagliuolo and Rita De Sanctis, Istituto Clinico Humanitas, Milan; Stefano Ferrari, Emanuela Palmerini, and Piero Picci, Istituto Ortopedico Rizzoli, Bologna; Antonino De Paoli, Centro di Riferimento Oncologico, Aviano; Alessandro Comandone, Presidio Sanitario Gradenigo, Torino, Italy; Javier Martin Broto, Hospital Universitario Virgen del Rocío, Sevilla; and Antonio Lopez-Pousa, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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Unger JM, Hershman DL, Martin D, Etzioni RB, Barlow WE, LeBlanc M, Ramsey SR. The diffusion of docetaxel in patients with metastatic prostate cancer. J Natl Cancer Inst 2014; 107:dju412. [PMID: 25540245 DOI: 10.1093/jnci/dju412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Diffusion of new cancer treatments can be both inefficient and incomplete. The uptake of new treatments over time (diffusion) has not been well studied. We analyzed the diffusion of docetaxel in metastatic prostate cancer. METHODS We identified metastatic prostate cancer patients diagnosed from 1995 to 2007 using the Surveillance, Epidemiology, and End Results Program (SEER)-Medicare database. Medicare claims through 2008 were analyzed. We assessed cumulative incidence of docetaxel by socioeconomic, demographic, and comorbidity variables, and compared diffusion patterns to landmark events including release of phase III results and FDA approval dates. We compared docetaxel diffusion patterns in prostate cancer to those in metastatic breast, lung, ovarian, and gastric cancers. To model docetaxel use over time, we used the classic "mixed influence" deterministic diffusion model. All statistical tests were two-sided. RESULTS We identified 6561 metastatic prostate cancer patients; 1350 subsequently received chemotherapy. Among patients who received chemotherapy, docetaxel use was 95% by 2008. Docetaxel uptake was statistically significantly slower (P < .01) for patients older than 65 years, blacks, patients in lower income areas, and those who experienced poverty. Eighty percent of docetaxel diffusion occurred prior to the May, 2004 release of phase III results showing superiority of docetaxel over standard-of-care. The maximum increase in the rate of use of docetaxel occurred nearly simultaneously for prostate cancer as for all other cancers combined (in 2000). CONCLUSION Efforts to increase the diffusion of treatments with proven survival benefits among disadvantaged populations could lead to cancer population survival gains. Docetaxel diffusion mostly preceded phase III evidence for its efficacy in castration-resistant prostate cancer, and appeared to be a cancer-wide-rather than a disease-specific-phenomenon. Diffusion prior to definitive evidence indicates the prevalence of off-label chemotherapy use.
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Affiliation(s)
- Joseph M Unger
- Affiliations of authors: SWOG Statistical Center, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (JMU, WEB, ML); University of Washington, Department of Health Services Research, Seattle, WA (DM); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SRR, RBE); Division of Hematology/Oncology, Columbia University, New York, NY (DLH).
| | - Dawn L Hershman
- Affiliations of authors: SWOG Statistical Center, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (JMU, WEB, ML); University of Washington, Department of Health Services Research, Seattle, WA (DM); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SRR, RBE); Division of Hematology/Oncology, Columbia University, New York, NY (DLH)
| | - Diane Martin
- Affiliations of authors: SWOG Statistical Center, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (JMU, WEB, ML); University of Washington, Department of Health Services Research, Seattle, WA (DM); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SRR, RBE); Division of Hematology/Oncology, Columbia University, New York, NY (DLH)
| | - Ruth B Etzioni
- Affiliations of authors: SWOG Statistical Center, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (JMU, WEB, ML); University of Washington, Department of Health Services Research, Seattle, WA (DM); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SRR, RBE); Division of Hematology/Oncology, Columbia University, New York, NY (DLH)
| | - William E Barlow
- Affiliations of authors: SWOG Statistical Center, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (JMU, WEB, ML); University of Washington, Department of Health Services Research, Seattle, WA (DM); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SRR, RBE); Division of Hematology/Oncology, Columbia University, New York, NY (DLH)
| | - Michael LeBlanc
- Affiliations of authors: SWOG Statistical Center, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (JMU, WEB, ML); University of Washington, Department of Health Services Research, Seattle, WA (DM); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SRR, RBE); Division of Hematology/Oncology, Columbia University, New York, NY (DLH)
| | - Scott R Ramsey
- Affiliations of authors: SWOG Statistical Center, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (JMU, WEB, ML); University of Washington, Department of Health Services Research, Seattle, WA (DM); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (SRR, RBE); Division of Hematology/Oncology, Columbia University, New York, NY (DLH)
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