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Oey O, Wijaya W, Redfern A. Eribulin in breast cancer: Current insights and therapeutic perspectives. World J Exp Med 2024; 14:92558. [PMID: 38948420 PMCID: PMC11212747 DOI: 10.5493/wjem.v14.i2.92558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/21/2024] [Accepted: 03/20/2024] [Indexed: 06/19/2024] Open
Abstract
Eribulin is a non-taxane synthetic analogue approved in many countries as third-line treatment for the treatment of patients with metastatic breast cancer. In addition to its mitotic property, eribulin has non-mitotic properties including but not limited to, its ability to induce phenotypic reversal of epithelial to mesenchymal transition, vascular remodelling, reduction in immunosuppressive tumour microenvironment. Since approval, there has been a surge in studies investigating the application of eribulin as an earlier-line treatment and also in combination with other agents such as immunotherapy and targeted therapy across all breast cancer sub-types, including hormone receptor positive, HER2 positive and triple negative breast cancer, many demonstrating promising activity. This review will focus on the application of eribulin in the treatment of metastatic breast cancer across all subtypes including its role as an earlier-line agent, its toxicity profile, and potential future directions.
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Affiliation(s)
- Oliver Oey
- Faculty of Medicine, University of Western Australia, Nedlands 6009, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands 6009, WA, Australia
| | - Wynne Wijaya
- Department of Oncology, University of Oxford, Oxford OX3 7DQ, United Kingdom
- Department of Internal Medicine, Universitas Gadjah Mada, Sleman 55281, Indonesia
| | - Andrew Redfern
- Department of Medical Oncology, Fiona Stanley Hospital, Murdoch 6150, WA, Australia
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Gagliato D, Reinert T, Rocha C, Tavares M, Pimentel S, Fuzita W, Araújo M, Matias D, Aleixo S, França B, Magaton É, Brito N, Cardoso AC, Castilho V. Real-World Study of Adjuvant Biosimilar Trastuzumab-dkst for HER2-Positive Breast Cancer Treatment in a Brazilian Population. Oncol Ther 2024:10.1007/s40487-024-00284-5. [PMID: 38836997 DOI: 10.1007/s40487-024-00284-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/21/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION Biological monoclonal antibodies play a pivotal role in cancer treatment, with biosimilars significantly enhancing their accessibility. In Brazil's ethnically diverse setting, real-world evidence is crucial for assessing the effectiveness and applicability of these therapies in routine clinical practice. METHODS We performed a multicentric, observational, prospective real-world study on biosimilar trastuzumab-dkst for adjuvant treatment of early HER2-positive breast cancer in Brazilian patients. Data were collected using a case-report form. RESULTS Of the 176 recruited, we present data from the first 59 patients (mean age 51.7 ± 12.9 years) who had completed treatment with trastuzumab-dkst. The mean time from diagnosis to the first adjuvant treatment with trastuzumab-dkst was 5.5 ± 2.7 months. Of the patients, 59% of patients achieved at least a 30-month follow-up. The 31.7-month invasive disease-free survival rate (IDFS) was 94.5% (95% CI 83.9-98.2%) and median IDFS was not achieved, since only three patients had invasive disease recurrence. The overall survival rate was 100% until the last assessment. The observed adverse events were similar to those presented by other studies using biosimilar or reference trastuzumab. Four serious adverse events (8.5%) were observed. A reduction in left ventricular ejection fraction of at least 10% was observed in 16.9% of participants. There was no treatment interruption, and three participants (5.1%) had their trastuzumab-dkst dose reduced. CONCLUSION Our study reinforces the existing pivotal data, underscoring the real-world efficacy and safety of biosimilar trastuzumab-dkst in the adjuvant treatment for early HER2-positive breast cancer. The preliminary long-term effectiveness and safety data we present further validate trastuzumab-dkst's role as a cost-saving alternative in oncological care. These findings have important implications for improving patient access to crucial treatments and for the more efficient use of healthcare resources. CLINICALTRIALS GOV REGISTRATION NCT03892655.
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Affiliation(s)
- Debora Gagliato
- Beneficência Portuguesa de São Paulo, Rua Maestro Cardim, 637-Bela Vista, São Paulo, SP, 01323-001, Brazil
| | - Tomás Reinert
- Centro de Pesquisa da Serra Gaúcha (CEPESG), Rua Vinte de Setembro, 2304, Bairro Centro, Caxias do Sul, RS, 95020-450, Brazil
| | - Cláudio Rocha
- Vencer e Oncoclínica Centro de Pesquisa, Rua Gardênia, 710-Jóquei, Teresina, PI, 64049-200, Brazil
| | - Monique Tavares
- A.C. Camargo Cancer Center, Rua Tamandaré, 753-Liberdade, São Paulo, SP, 01525-001, Brazil
| | - Sâmio Pimentel
- Ser Clínica Oncológica, Rua Passagem Euclídes da Cunha, 50-Batista Campos, Belém, PA, 66035-265, Brazil
| | - William Fuzita
- Instituto Sensumed de Ensino e Pesquisa (ISENP), Rua São Luíz, 510-Adrianópolis, Manaus, AM, 69029-520, Brazil
| | - Márcia Araújo
- Centro de Oncologia Leonardo da Vinci Ltda, Rua Rocha Lima, 1563-Aldeota, Fortaleza, CE, 60135-285, Brazil
| | - Danielli Matias
- Liga Norte Riograndense Contra O Câncer, Avenida Miguel Castro, 1355-Nossa Senhora de Nazaré, Natal, RN, 59062-000, Brazil
| | - Sabina Aleixo
- Hospital Evangélico de Cachoeiro de Itapemirim (CPCO/HECI), Rua Manoel Braga Machado, 2-Nossa Sra. da Penha, Cachoeiro de Itapemirim, ES, 29308-020, Brazil
| | - Bruno França
- Oncologia|Hematologia|Centro de Infusão, Av. das Américas, 2251-Barra da Tijuca, Rio de Janeiro, RJ, 22,631-001, Brazil
| | - Érida Magaton
- Libbs Farmacêutica, Av. Marquês de São Vicente, 2219-Jardim das Perdizes, São Paulo, SP, 05036-040, Brazil
| | - Natália Brito
- Libbs Farmacêutica, Av. Marquês de São Vicente, 2219-Jardim das Perdizes, São Paulo, SP, 05036-040, Brazil.
| | - Ana Carolina Cardoso
- Libbs Farmacêutica, Av. Marquês de São Vicente, 2219-Jardim das Perdizes, São Paulo, SP, 05036-040, Brazil
| | - Vivienne Castilho
- Libbs Farmacêutica, Av. Marquês de São Vicente, 2219-Jardim das Perdizes, São Paulo, SP, 05036-040, Brazil
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Park MH, Seo JH, Park JH, Seong MK, Park KU, Kim MK, Chang M, Koh SJ, Lee MH, Lim ST, Yoo YB, Oh SY, Kim SH, Ahn KY, Park TH, Ju H, Baek EH, Kim S, Kim N, Lee E, Kim TH. Efficacy and safety of biosimilar trastuzumab (CT-P6) in routine clinical practice in the Republic of Korea: a real-world post-marketing surveillance study. Expert Opin Biol Ther 2024; 24:305-312. [PMID: 38664937 DOI: 10.1080/14712598.2024.2334386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/20/2024] [Indexed: 04/30/2024]
Abstract
BACKGROUND The trastuzumab biosimilar CT-P6 is approved for human epidermal growth factor receptor 2 (HER2)-positive early breast cancer (EBC), metastatic breast cancer (MBC), and metastatic gastric cancer (MGC). The objective of this post-marketing surveillance (PMS) study was to evaluate the real-world safety and effectiveness of CT-P6 in patients with HER2-positive cancers. RESEARCH DESIGN AND METHODS This open-label, observational, prospective, PMS study collected data via investigator surveys from 35 centers in the Republic of Korea (5 October 2018-4 October 2022). Eligible patients with HER2-positive EBC, MBC, or MGC started CT-P6 treatment during routine clinical practice, followed by 1-year observation. Evaluations included adverse events (AEs), adverse drug reactions (ADRs), and effectiveness. RESULTS Safety was analyzed in 642 patients (494 EBC, 94 MBC, 54 MGC). Overall, 325 (50.6%) patients experienced 1316 AEs, and 550 ADRs occurred in 199 (31.0%) patients. Unexpected ADRs occurred in 62 (9.7%) patients. Unexpected ADRs and ADRs of special interest did not raise any new safety signals. Among trastuzumab-naïve patients, 34/106 (32.1%) with EBC achieved pathological complete response; 30/74 (40.5%) MBC and 24/49 (49.0%) MGC patients achieved complete or partial response. CONCLUSIONS In a real-world setting, CT-P6 demonstrated safety and efficacy findings consistent with previous CT-P6 studies.
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Affiliation(s)
- Min Ho Park
- Chonnam National University Medical School and Hwasun Hospital, Hwasun, Republic of Korea
| | - Jae Hong Seo
- Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jung Ho Park
- Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Min-Ki Seong
- Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Keon Uk Park
- Keimyung University Dongsan Medical Hospital, Daegu, Republic of Korea
| | - Min Kyoon Kim
- Chung-Ang University Hospital, Seoul, Republic of Korea
| | | | - Su-Jin Koh
- Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Moon Hee Lee
- Inha University Hospital, Incheon, Republic of Korea
| | - Seung Taek Lim
- Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Young Bum Yoo
- Konkuk University Medical Center, Seoul, Republic of Korea
| | - So Yeon Oh
- Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | | | | | | | - Hana Ju
- Celltrion, Inc., Incheon, Republic of Korea
| | | | - Sinhye Kim
- Celltrion, Inc., Incheon, Republic of Korea
| | - Nahyun Kim
- Celltrion, Inc., Incheon, Republic of Korea
| | | | - Tae Hyun Kim
- Inje University, Busan Paik Hospital, Busan, Republic of Korea
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Bekele B, Masresha Z, Alemayehu M, Seyoum B, Wassie L, Abebe M. Intravenous Immunoglobulin G (IVIG) Need Assessment Survey Toward Local Manufacturing of IVIG Using a Mini-Pool Plasma Fractionation Technique. Health Serv Insights 2023; 16:11786329231157467. [PMID: 36860668 PMCID: PMC9969427 DOI: 10.1177/11786329231157467] [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: 07/12/2022] [Accepted: 01/27/2023] [Indexed: 02/27/2023] Open
Abstract
Immunoglobulin therapy has a crucial role in the treatment of primary and secondary immunodeficiencies as well as in a multitude of neurologic, hematologic, infectious, and autoimmune conditions. In the current study, a preliminary pilot scale needs assessment survey was conducted to examine the need for IVIG among patients in Addis Ababa, Ethiopia, and in so doing justify local manufacturing of IVIG products. The survey was performed by administering a structured questionnaire to private and government hospitals, a national blood bank, a regulatory body, and healthcare researchers working in academia and pharmaceutical companies. The questionnaire encompassed demographics and specific IVIG-related questions designed for each institution. Responses supplied in the study provide qualitative data. Our findings indicated that IVIG has been registered by the regulatory body for use in Ethiopia and there is a demand for the product in the country. The study also highlights that patients go as far as to clandestine markets to procure IVIG products at a cheaper price. To impede such illegal routes and make the product readily accessible, a small-scale and low-cost approach such as a mini-pool plasma fractionation technique could be implemented to locally purify and prepare IVIG using plasma collected through the national blood donation program.
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Affiliation(s)
- Bisrat Bekele
- Bisrat Bekele, Armauer Hansen Research
Institute, Biotechnology and Bioinformatics Directorate, Jimma Road, ALERT
Campus, P.O. Box 1005, Addis Ababa 1005, Ethiopia.
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Lengyel CG, Habeeb BS, Altuna SC, Trapani D, Khan SZ, Hussain S. The Global Landscape on the Access to Cancer Medicines for Breast Cancer: The ONCOLLEGE Experience. Cancer Treat Res 2023; 188:353-368. [PMID: 38175353 DOI: 10.1007/978-3-031-33602-7_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
There is a growing global debate over barriers affecting the timely access to innovative anticancer therapies. Access to medicines is often traced back to the issue of costs: however, more commonly, the distance between valuable innovative treatments and the actual treatment of patients is far beyond the mere problem of financial barriers. A comprehensive approach to understand, assess to medicines should be pursued, to dissect the determinants and formulate solutions for all patients. In this chapter, we discuss drivers of access to innovation for patients with breast cancer, based on a case study of access to HER2-diagnositcs and therapeutics yielding a global landscape analysis, based on the efforts and expertise of the global collaborative group "ONCOLLEGE".
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Affiliation(s)
| | - Baker Shalal Habeeb
- Department of Medical Oncology, Shaqlawa Teaching Hospital, Shaqlawa, Erbil, 44005, Iraq
| | | | - Dario Trapani
- Department of Oncology and Hematology, University of Milan, 20122, Milan, Italy
| | - Shah Zeb Khan
- Department of Clinical Oncology, Bannu Institute of Nuclear Medicine Oncology and Radiotherapy (BINOR), Bannu, Khyber Pakhtunkhwa, Pakistan
| | - Sadaqat Hussain
- Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, LE1 5WW, UK
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Morin S, Segafredo G, Piccolis M, Das A, Das M, Loffredi N, Larbi A, Mwamelo K, Villanueva E, Nobre S, Burrone E. Expanding access to biotherapeutics in low-income and middle-income countries through public health non-exclusive voluntary intellectual property licensing: considerations, requirements, and opportunities. Lancet Glob Health 2023; 11:e145-e154. [PMID: 36455593 DOI: 10.1016/s2214-109x(22)00460-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/07/2022] [Accepted: 10/19/2022] [Indexed: 11/30/2022]
Abstract
Biotherapeutics, such as recombinant proteins and monoclonal antibodies, have become mainstays of modern medicine as shown by their increasing number in the WHO Model List of Essential Medicines. However, despite frequently offering clinical advantages over standards of care, they remain largely out of reach for populations in low-income and middle-income countries (LMICs), partly because of high costs. Accordingly, the WHO Model List of Essential Medicines Expert Committee has requested that the Medicines Patent Pool explore intellectual property licensing to address this challenge. We therefore investigated how licensing could successfully improve affordability of and timely access to biotherapeutics in LMICs, by leveraging expert consultations, literature analysis, and internal technical knowledge. The key elements identified as relevant to support access to affordable biosimilars in LMICs through licensing include: prioritising potential biotherapeutic targets according to their potential for public health impact; supporting biosimilar product and clinical development (including through technology transfer to expedite regulatory approval); and facilitating biosimilars' entry and use in LMICs (by meeting procurement, supply chain, and health system requirements).
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Affiliation(s)
| | | | - Manuele Piccolis
- Business Development, Medicines Patent Pool, Geneva, Switzerland
| | - Aditi Das
- Business Development, Medicines Patent Pool, Mumbai, India
| | - Meghmala Das
- Business Development, Medicines Patent Pool, Mumbai, India
| | - Nicola Loffredi
- Business Development, Medicines Patent Pool, Geneva, Switzerland
| | - Amina Larbi
- Policy, Medicines Patent Pool, Geneva, Switzerland
| | - Kim Mwamelo
- Policy, Medicines Patent Pool, Geneva, Switzerland
| | | | - Sandra Nobre
- Business Development, Medicines Patent Pool, Geneva, Switzerland
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Werutsky G, Gössling G, Pellegrini RA, Ampuero GAS, Rebelatto T. Socioeconomic Impact of Cancer in Latin America and The Caribbean. Arch Med Res 2022; 53:818-825. [PMID: 36460548 DOI: 10.1016/j.arcmed.2022.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
The incidence of cancer in Latin America and the Caribbean (LAC) is increasing yearly and is expected to reach 2.4 million new cases by 2040, with a more pronounced effect in Central America and South America. In addition, cancer is already the most frequent cause of premature death for most countries in LAC, and the second cause of death independent of country socioeconomic status, clearly demonstrating that the cancer burden in LAC should be addressed now rather than considered as an issue to be dealt with in the future. LAC countries performed in a mid-range zone in terms of income and mortality-to-incidence ratio compared to other countries globally. The LAC continent has, in general, a median income per capita and a median availability of radiotherapy (RDT) machines per capita. Patients that have private health coverage are more likely to receive preventive care such as pap smears and mammography in many countries of the LAC. The human development index was negatively related to mortality from oral cancer in the LAC countries with medium and low Human Development Index (HDI). Cancer treatment adverse events can negatively affect survivors' workability compromising their return to work after diagnosis. In conclusion, the cancer burden can be a major public health issue with a considerable socioeconomic impact in LAC countries. It is demonstrated in several studies that unequal access to optimal care is frequent in LAC and that health insurance type may impact patients' diagnosis and outcome.
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Affiliation(s)
- Gustavo Werutsky
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil.
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Cuoghi IC, da Silva Soares MF, dos Santos GMC, dos-Reis FJC, Poli-Neto OB, de Andrade JM, Bosquesi PL, Orlandini LF, Tiezzi DG. 10-year opportunistic mammographic screening scenario in Brazil and its impact on breast cancer early detection: a nationwide population-based study. J Glob Health 2022; 12:04061. [PMID: 36227588 PMCID: PMC9564571 DOI: 10.7189/jogh.12.04061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Isabela Campeti Cuoghi
- CEPAM – Centro de Pesquisa Avançada em Medicina da UNILAGO, Faculdade de Medicina UNILAGO, União das Faculdades dos Grandes Lagos, São José do Rio Preto, São Paulo, Brazil
| | - Mariana Furlani da Silva Soares
- CEPAM – Centro de Pesquisa Avançada em Medicina da UNILAGO, Faculdade de Medicina UNILAGO, União das Faculdades dos Grandes Lagos, São José do Rio Preto, São Paulo, Brazil
| | | | | | - Omero Benedicto Poli-Neto
- Faculdade de Medicina de Ribeirão Preto FMRP – USP, Ribeirão Preto, São Paulo, Brazil
- Laboratory for Translational Data Science - University of São Paulo, São Paulo, Brazil
| | | | - Priscila Longhin Bosquesi
- CEPAM – Centro de Pesquisa Avançada em Medicina da UNILAGO, Faculdade de Medicina UNILAGO, União das Faculdades dos Grandes Lagos, São José do Rio Preto, São Paulo, Brazil
- Faculdade de Ciências Farmacêuticas UNESP, Araraquara, São Paulo, Brazil
| | | | - Daniel Guimarães Tiezzi
- CEPAM – Centro de Pesquisa Avançada em Medicina da UNILAGO, Faculdade de Medicina UNILAGO, União das Faculdades dos Grandes Lagos, São José do Rio Preto, São Paulo, Brazil
- Faculdade de Medicina de Ribeirão Preto FMRP – USP, Ribeirão Preto, São Paulo, Brazil
- Laboratory for Translational Data Science - University of São Paulo, São Paulo, Brazil
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Dos Santos RLB, Pepe VLE, Osorio-de-Castro CGS. Public procurement of antineoplastic agents used for treating breast cancer in Brazil between 2013 and 2019. BMC Cancer 2022; 22:769. [PMID: 35840933 PMCID: PMC9284867 DOI: 10.1186/s12885-022-09851-3] [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: 04/25/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background Breast cancer is the most common cancer among women in Brazil and the country’s public health care system is the main care provider. Timely treatment can increase the chance of cure, prevent metastasis and improve quality of life. Effective public procurement of antineoplastic agents can therefore improve access to drug therapy. This study investigates patterns in the procurement of selected antineoplastic agents used for treating breast cancer by public bodies and avoidable expenditure on these drugs between January 2013 and December 2019. Methods We selected antineoplastic agents used for adjuvant or preoperative chemotherapy listed in the 2018 Breast Cancer Diagnosis and Treatment Guidelines and included in category L of the WHO Anatomical Therapeutic Chemical classification system. We analyzed regular purchases of antineoplastic agents registered in the Integrated General Services Administration System (SIASG), considering purchased quantity, unit price, date of purchase and procuring entity. Prices were inflation-adjusted to July 2019 based on the National Consumer Price Index. Results A total of 10 antineoplastic agents were selected. Trastuzumab and tamoxifen accounted for the largest share of total spending and largest volume of purchases, respectively. The Ministry of Education was the largest purchaser in volume terms of all the drugs studied, except trastuzumab 440 mg, where the category “Other Institutions” accounted for most purchases, and vinorelbine 20 mg, where the Ministry of Health made most purchases. The category “Other Institutions” accounted for the largest share of total spending. Total avoidable expenditure was R$99,130,645. Prices paid for medicines and avoidable expenditure were highest in the Ministry of Defense. Conclusions The differences observed in the performance of different categories of buyers as to amounts purchased and prices practiced for antineoplastic agents could be reduced by employing strategies to expand the centralization of purchases, resulting in expanded access to breast cancer medicines in the public sector.
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Affiliation(s)
| | - Vera Lúcia Edais Pepe
- Department of Health Planning and Administration, Sergio Arouca National School of Public Health/Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Claudia Garcia Serpa Osorio-de-Castro
- Department of Pharmaceutical Policies and Pharmaceutical Services, Sergio Arouca National School of Public Health/Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Stark RT, Pye DR, Chen W, Newton OJ, Deadman BJ, Miller PW, Panayides JL, Riley DL, Hellgardt K, Hii KK(M. Assessing a sustainable manufacturing route to lapatinib. REACT CHEM ENG 2022. [DOI: 10.1039/d2re00267a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A synthetic route to an anti-cancer drug, lapatinib, was devised to support the development of a sustainable manufacturing process in South Africa.
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Affiliation(s)
- Roderick T. Stark
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, 82, Wood Lane, London W12 0BZ, UK
| | - Dominic R. Pye
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, 82, Wood Lane, London W12 0BZ, UK
| | - Wenyi Chen
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, 82, Wood Lane, London W12 0BZ, UK
| | - Oliver J. Newton
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, 82, Wood Lane, London W12 0BZ, UK
| | - Benjamin J. Deadman
- Centre for Rapid Online Analysis of Reactions (ROAR), Molecular Sciences Research Hub, 82, Wood Lane, London W12 0BZ, UK
| | - Philip W. Miller
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, 82, Wood Lane, London W12 0BZ, UK
| | - Jenny-Lee Panayides
- Pharmaceutical Technologies, Future Production: Chemicals, Council for Scientific & Industrial Research (CSIR), Meiring Naude Rd, Brummeria, Pretoria, 0184, South Africa
| | - Darren L. Riley
- Department of Chemistry, Faculty of Natural and Agricultural Sciences, University of Pretoria, Lynnwood Rd, Hatfield, Pretoria, 0002, South Africa
| | - Klaus Hellgardt
- Department of Chemical Engineering, Imperial College London, Exhibition Road, South Kensington, London SW7 2AZ, UK
| | - King Kuok (Mimi) Hii
- Department of Chemistry, Imperial College London, Molecular Sciences Research Hub, 82, Wood Lane, London W12 0BZ, UK
- Centre for Rapid Online Analysis of Reactions (ROAR), Molecular Sciences Research Hub, 82, Wood Lane, London W12 0BZ, UK
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MacDonald K, Alrawashdh N, McBride A, Abraham I. Conversion to biosimilar pegfilgrastim-cbqv enables budget-neutral access to FOLFIRINOX treatment for metastatic pancreatic cancer. Future Oncol 2021; 17:4561-4570. [PMID: 34382416 DOI: 10.2217/fon-2021-0718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To estimate the cost-savings from conversion to biosimilar pegfilgrastim-cbqv that can be reallocated to provide budget-neutral expanded access to FOLFIRINOX in patients with metastatic pancreatic cancer. Methods: Simulation modeling in a panel of 2500 FOLFIRINOX-treated patients, using varying treatment duration (1-12 cycles) and conversion rates (10-100%), to estimate cost-savings and additional FOLFIRINOX treatment that could be budget neutral. Results: In a 2500-patient panel at 100% conversion, savings of US$6,907.41 per converted patient over 12 cycles of prophylaxis translate to US$17.3 million and could provide 72,273 additional FOLFIRINOX doses or 6023 full 6-month regimens. Conclusion: Conversion to biosimilar CIN/FN prophylaxis can generate significant cost-savings and provide budget-neutral expanded access to FOLFIRINOX treatment for patients with metastatic pancreatic cancer.
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Affiliation(s)
| | - Neda Alrawashdh
- Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ 85721, USA
| | - Ali McBride
- Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ 85721, USA.,University of Arizona Cancer Center, Tucson, AZ 85724, USA.,Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA
| | - Ivo Abraham
- Matrix45, Tucson, AZ 85743, USA.,Center for Health Outcomes & PharmacoEconomic Research, University of Arizona, Tucson, AZ 85721, USA.,University of Arizona Cancer Center, Tucson, AZ 85724, USA.,Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA
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12
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Schettini F, Prat A. Dissecting the biological heterogeneity of HER2-positive breast cancer. Breast 2021; 59:339-350. [PMID: 34392185 PMCID: PMC8374722 DOI: 10.1016/j.breast.2021.07.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/19/2021] [Accepted: 07/29/2021] [Indexed: 12/24/2022] Open
Abstract
HER2-positive (HER2+) breast cancer (BC) is a heterogenous and multifaceted disease, with interesting therapeutic implications. First, all intrinsic molecular subtypes can be identified in HER2+ tumors, with the HER2-enriched being the most frequent. Such subtypes do not differ much from their counterparts in HER2-negative disease, apart for the high expression of genes in/near the HER2 amplicon on chromosome 17. Intrinsic subtyping, along with the quantification of ERBB2 mRNA levels, is associated with higher rates of pathologic complete response across neoadjuvant trials of dual HER2 blockade and might help select patients for de-escalation and escalation treatment strategies. Secondly, HER2+ tumors have a broad range of DNA alterations. ERBB2 mutations and alterations in the PI3K/Akt/mTOR pathway are among the most frequent and might predict benefit from potent pan-HER, PI3K and mTOR inhibitors. Moreover, HER2+ tumors are usually infiltrated by lymphocytes. These tumor infiltrating-lymphocytes (TILs) predict response to neoadjuvant anti-HER2-based treatment and exert a prognostic role. PD-L1, detected in ∼42 % of HER2+ BC, might also be useful to define patients responding to novel anti-PD1/PD-L1 immunotherapies. New multiparametric clinicopathologic and genomic tools accounting for this complexity, such as HER2DX, are under development to define more tailored treatment approaches. Finally, HER2-targeted antibody-drug conjugates (ADC) such as trastuzumab deruxtecan might be active in tumors with low expression of HER2. Overall, there is a need to molecularly characterize and develop novel targeted therapies for HER2+ disease. Almost 50 % of HER2+ breast cancer (BC) are molecularly HER2-Enriched (HER2-E). Most relevant mutations are found in ERBB2 (∼4 %) and PI3K/AKT/mTOR pathway (>30 %). Tumor infiltrating lymphocytes are frequent, predictive and prognostic in HER2+ BC. HER2 heterogeneity and HER2 low status are gaining therapeutic relevance. New treatments need to consider HER2+ molecular and microenvironmental complexity.
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Affiliation(s)
- Francesco Schettini
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Aleix Prat
- Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Department of Medical Oncology, Hospital Clinic de Barcelona, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain; Institute of Oncology (IOB)-Quirón, Barcelona, Spain.
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13
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Reinert T, Pellegrini R, Rol R, Werutsky G, Barrios CH. Estimation of the Number of Brazilian Women Living With Metastatic Breast Cancer. JCO Glob Oncol 2021; 6:307-312. [PMID: 32109156 PMCID: PMC7051793 DOI: 10.1200/jgo.19.00404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Breast cancer is the most common cancer and the leading cause of cancer-related death in women worldwide. The number of women living with metastatic breast cancer (MBC) in Brazil is unknown. The objective of this article was to use population-based data to estimate the prevalence of MBC in Brazil. METHODS Using 4 different sources and cancer registries (DataSUS, Registro Hospitalar de Câncer, the Brazilian National Health Agency, and the National Geography and Statistics Institute) with data from 2008 to 2018, we built a database that represents Brazilian MBC cases. The current number of women in the model living with MBC was considered the prevalence (recurrent or de novo), and new cases in the year 2018 represented the incidence. In each of these outcomes, we were able to separate our population on the basis of cancer subtype, age, and time from diagnosis. RESULTS We estimate that 44,642 women currently live with MBC in Brazil. This accounts for one in every 2,409 Brazilian women and approximately 41 women per 100,000. A total of 58% have hormone receptor–positive/human epidermal growth factor receptor 2–negative tumors, 25% are human epidermal growth factor receptor 2–positive, and 16% have triple-negative breast cancer. According to our methodology, the estimated median overall survival of Brazilian women after diagnosis of MBC is 26.2 months. CONCLUSION The significant number of patients living with MBC should inform and raise the interest of the many stakeholders involved. This collaborative effort is a clear requirement to improve the lives of these patients as well as to prepare for future challenges related to the trend of a progressive increase in MBC prevalence.
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Affiliation(s)
- Tomás Reinert
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil.,Grupo Oncoclínicas, Porto Alegre, Brazil School of Medicine, Porto Alegre, Brazil
| | - Rodrigo Pellegrini
- Pontificia Universidade Catolica do Rio Grande do Sul, School of Medicine, Porto Alegre, Brazil
| | | | | | - Carlos Henrique Barrios
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil.,Grupo Oncoclínicas, Porto Alegre, Brazil School of Medicine, Porto Alegre, Brazil
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14
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Soares LR, Freitas-Junior R, Curado MP, Paulinelli RR, Martins E, Oliveira JC. Low Overall Survival in Women With De Novo Metastatic Breast Cancer: Does This Reflect Tumor Biology or a Lack of Access to Health Care? JCO Glob Oncol 2021; 6:679-687. [PMID: 32348160 PMCID: PMC7193803 DOI: 10.1200/jgo.19.00408] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE As a result of its epidemiologic and therapeutic aspects, metastatic breast cancer (MBC) is a highly relevant clinical condition. This study aimed to estimate overall survival (OS) in women with de novo MBC in a Brazilian population. PATIENTS AND METHODS Patients were identified in the Goiânia population-based cancer registry between 1995 and 2011. All women with metastatic disease at diagnosis were included in the study. OS was analyzed at 5 and 10 years of follow-up. We used the Kaplan-Meier estimator and Cox regression for statistical analysis. RESULTS Over the 16-year period covered by the study, 5,289 women were diagnosed with breast cancer in Goiânia. Of these, 277 women (5.2%) had MBC. OS rates at 5 and 10 years were 19.9% and 7.3%, respectively. The mean OS time of women treated in the public health system was 7.5 months shorter than in women who had private health care (19.7 v 27.2 months, respectively). In the univariable analysis, the following factors were statistically significant for OS: T3/4 staging, histologic grade 3, progesterone receptor status, tumor phenotype, breast surgery, CNS metastasis at initial presentation, and surgery for resection of metastasis. In multivariable analysis, initial CNS metastasis (hazard ratio, 3.09; 95% CI, 1.16 to 8.19) and breast surgery (hazard ratio, 0.45; 95% CI, 0.25 to 0.78) remained independent prognostic factors. CONCLUSION OS was lower than rates found in specialist centers in Brazil and in developed countries. Several intrinsic and extrinsic factors were significant in predicting OS. Despite the difference in the 5-year survival rate, the type of access to health care was not significant in the multivariable analysis of the entire period.
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Affiliation(s)
- Leonardo R Soares
- Breast Program, Teaching Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Ruffo Freitas-Junior
- Breast Program, Teaching Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil.,Hospital Araújo Jorge, Association for the Combat of Cancer in Goiás, Goiânia, Goiás, Brazil
| | - Maria P Curado
- A.C. Camargo Cancer Center, Fundação Antônio Prudente, São Paulo, São Paulo, Brazil
| | - Regis R Paulinelli
- Breast Program, Teaching Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil.,Hospital Araújo Jorge, Association for the Combat of Cancer in Goiás, Goiânia, Goiás, Brazil
| | - Edesio Martins
- Breast Program, Teaching Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - José C Oliveira
- Goiânia Population-Based Cancer Registry, Association for the Combat of Cancer in Goiás, Goiânia, Goiás, Brazil
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15
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Pellegrini R, Reinert T, Barrios CH. Cost-effectiveness of breast, lung, colon, prostate and cervical cancer outcomes in Brazil: a worldwide comparison. Ecancermedicalscience 2021; 15:1243. [PMID: 34267799 PMCID: PMC8241450 DOI: 10.3332/ecancer.2021.1243] [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: 01/18/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction Cancer is the second leading cause of death in the world, and it is expected to be the main cause by the year 2030. Current trends of higher incidence and the introduction of new treatments lead to the challenge of treating more people with increasing costs per capita. In Brazil, current and future challenges are even more significant because of the limited resources destined for healthcare. Methods We propose a methodology to compare cost-effectiveness performance with a regression of cancer lethality against the resources available for different nations, using the gross domestic product and the mortality-to-incidence ratio. Our objective is to evaluate and compare outcomes observed in Brazil. Results According to our methodology, Brazil is performing well in breast and prostate cancer (observed lethality 9% and 15% lower than expected, respectively). It performs close to expected in colon (0.8% higher) and cervix (2% higher). However, lung cancer had a higher lethality than expected (6.5% higher). We also found that breast, prostate and cervical cancers are the primary sites more related to income. Lung cancer had the weakest relationship with resources. Conclusion Brazil has different cost-effectiveness results in the management of cancer depending on the primary site. Also, national income has a significant and heterogeneous effect on the lethality of different tumour types. This economic analysis is important for low- to middle-income countries seeking to evaluate cancer outcomes in limited-resource settings.
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Affiliation(s)
- Rodrigo Pellegrini
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), School of Medicine, Av Ipiranga, 6681, Partenon, Porto Alegre, RS, 90619-900, Brazil
| | - Tomás Reinert
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, nº 6681, Prédio 99ª, Sala 806, CEP 90619-900, Porto Alegre, RS, Brazil.,Oncoclínicas, Av Praia de Belas, 1212, Sala 1606, Menino Deus, Porto Alegre, RS, 90110-000, Brazil
| | - Carlos Henrique Barrios
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, nº 6681, Prédio 99ª, Sala 806, CEP 90619-900, Porto Alegre, RS, Brazil.,Oncoclínicas, Av Praia de Belas, 1212, Sala 1606, Menino Deus, Porto Alegre, RS, 90110-000, Brazil
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16
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Valencia-Mesías G, Rioja-Viera P, Morante-Cruz Z, Toledo-Morote Y, Neciosup-Delgado S, Gómez-Moreno H. The current situation regarding the availability and accessibility of anticancer drugs for breast cancer in the Peruvian public health systems. Ecancermedicalscience 2021; 15:1224. [PMID: 34158828 PMCID: PMC8183645 DOI: 10.3332/ecancer.2021.1224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Indexed: 11/13/2022] Open
Abstract
The availability of effective, accessible, safe and high-quality anticancer drugs for the medical treatment of cancer is fundamental in ensuring optimal healthcare in the public health system in Peru. The main objective is to assess the current situation regarding anticancer drugs (termed ‘high-cost’) for breast cancer, as well as an analysis of the possible factors which negatively impact access to the Peruvian public health systems.There are similarities in the availability of anticancer drugs, since most treatments are covered by the Peruvian Ministry of Health. EsSalud offers an extra monoclonal antibody (pertuzumab) in the metastatic treatment stage. Meanwhile, the National Institute of Neoplastic Diseases (INEN), mainly for metastatic disease, has relied on more tested treatments over the last year. An agreement has been reached with the armed forces, which will enable patients to receive oncology care at the INEN and, thereby, benefit from the use of high-cost drugs.
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Affiliation(s)
| | - Patricia Rioja-Viera
- Medical Oncology Department, National Institute of Neoplastic Diseases, Lima 15036, Peru
| | - Zaida Morante-Cruz
- Medical Oncology Department, National Institute of Neoplastic Diseases, Lima 15036, Peru
| | - Yura Toledo-Morote
- Functional Insurance Unit, National Institute of Neoplastic Diseases, Lima 15036, Peru
| | | | - Henry Gómez-Moreno
- Medical Oncology Department, National Institute of Neoplastic Diseases, Lima 15036, Peru
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17
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Frequency and clinical characteristics of HER2 over-expressed breast cancer in Saudi Arabia: a retrospective study. BMC WOMENS HEALTH 2021; 21:10. [PMID: 33407382 PMCID: PMC7788710 DOI: 10.1186/s12905-020-01159-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/23/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION This study aimed to determine the frequency of human epidermal growth factor receptor 2 (HER2) over-expression in newly diagnosed breast cancer (BC) patients in Saudi Arabia and to assess the clinical characteristics and outcomes in patients with HER2-positive disease. METHODS In the first part of the study, we retrospectively reviewed the pathology records of all patients diagnosed with BC between 2007 and 2013 at 3 hospitals in the largest 3 cities in Saudi Arabia to determine the frequency of HER2 over-expression. In the second part, a representative sample from the patients identified with HER2 over-expressed BC was selected for further investigation. Data collected included demographic and clinical characteristics such as hormone-receptor status, treatment regimens, survival data, response to treatment, and selected adverse events. RESULTS 1867 BC records were included in the study. HER2 was overexpressed in 559 patients (29.9%); of those, 348 HER2-positive BC patients were included in subsequent analyses. In the sample of HER2-positive BC patients, median age at diagnosis was 46 years, 0.9% were male, 92.5% were Saudi, 42.4% were Hormone Receptor-negative, and 13.1% had stage IV tumors. Most patients (84.2%) underwent curative intent surgery and 71.8% received radiotherapy. Average tumor size was 3.5 ± 2.5 cm and infiltrating ductal carcinoma was the most common pathology (92.9%). As for pharmacological therapy, the most commonly used regimens were Chemotherapy + Trastuzumab combination (79.1%) in neoadjuvant setting, Hormonotherapy alone (56.2%) in adjuvant setting, and Chemotherapy + Targeted therapy combination (64.8%) as palliative treatment. At the last patient evaluation, 36.9% had complete response, while 33.2% had progressive disease. Median overall survival (OS) and progression-free survival (PFS) were not reached in patients on neoadjuvant/adjuvant pharmacotherapy. As for patients on palliative intent pharmacotherapy, median OS and PFS were 64.7 and 29.3 months respectively. CONCLUSION This study provided updated figures regarding HER2 overexpression in BC in Saudi Arabia: HER2 overexpression rate (29.9%) was within the range reported in previous studies. Patients' demographic and clinical characteristics were also similar to those reported earlier, with a median age at diagnosis of 46 years and one third of patients having locally advanced/metastatic disease at diagnosis.
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18
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McBride A, MacDonald K, Fuentes-Alburo A, Abraham I. Cost-efficiency and expanded access modeling of conversion to biosimilar trastuzumab-dkst with or without pertuzumab in metastatic breast cancer. J Med Econ 2021; 24:743-756. [PMID: 34003067 DOI: 10.1080/13696998.2021.1928515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS To investigate the cost-efficiency and budget-neutral expanded access of biosimilar intravenous trastuzumab-dkst versus reference intravenous (trastuzumab-IV) and subcutaneous trastuzumab (trastuzumab-SC) (with/without pertuzumab) in metastatic breast cancer (MBC). METHODS Economic simulation modeling in a panel of 1,000 MBC patients to estimate: 1) cost-savings by conversion from trastuzumab-IV or trastuzumab-SC to trastuzumab-dkst at 10-100% conversion rates in 3 weight groups: first quartile (Q1:62.2 kg), median (73.1 kg), third quartile (Q3:88.6 kg), and 2) budget-neutral expanded access to trastuzumab-dkst from cost-savings. RESULTS In monotherapy, conversion (%) from trastuzumab-IV generates one-year cost-savings from $2,272,189 (Q1;10%) to $31,506,804 (Q3;100%) and from trastuzumab-SC monotherapy savings range from $2,071,277 (Q3;10%) to $35,775,475 (Q1;100%). In combination with pertuzumab, trastuzumab-dkst is cost-efficient in all patient weights with one-year savings over trastuzumab-IV up to $32,662,714 (Q3;100%) and over trastuzumab-SC up to $35,322,461 (Q1;100%). Savings from conversion from trastuzumab-IV monotherapy could provide between 3,087 (Q1;10%) and 30,911 (Q3;100%) additional trastuzumab-dkst doses-enough to treat 58 to 583 patients for one year. Conversion from trastuzumab-SC monotherapy could provide between 1,559 (Q3;10%) and 48,598 (Q1;100%) additional trastuzumab-dkst doses or 38 to 918 additional one-year treatments with trastuzumab-dkst. In combination with pertuzumab, conversion from trastuzumab-IV could provide from 311 (Q1;10%) to 3,939 (Q3;100%) maintenance doses (pertuzumab + trastuzumab-dkst) or 17 to 210 additional one-year regimens (all agents). Savings from conversion from trastuzumab-SC could expand access to 226 (Q3;10%) to 4,782 (Q1;100%) additional maintenance doses or 12 to 254 one-year regimens. CONCLUSIONS This first cost-efficiency and expanded access study of biosimilar therapeutic cancer agents shows that trastuzumab-dkst is cost-efficient over trastuzumab-IV and trastuzumab-SC across all patient weights in both monotherapy and combination with pertuzumab and paclitaxel. These cost savings could provide more patients with trastuzumab-dkst treatment on a budget-neutral basis.
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Affiliation(s)
- Ali McBride
- The University of Arizona Cancer Center, Tucson, AZ, USA
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA
- Banner University Medical Center, Tucson, AZ, USA
| | | | | | - Ivo Abraham
- The University of Arizona Cancer Center, Tucson, AZ, USA
- Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ, USA
- Matrix45, Tucson, AZ, USA
- Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, AZ, USA
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19
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Reinert T, Pellegrini R, Barrios CH. Lack of access to CDK4/6 inhibitors for premenopausal patients with metastatic breast cancer in Brazil: estimation of the number of premature deaths. Ecancermedicalscience 2020; 14:1081. [PMID: 32863875 PMCID: PMC7434502 DOI: 10.3332/ecancer.2020.1081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose A CDK4/6 inhibitor (CDK4/6i) combined with endocrine therapy is the standard of care for patients with hormone receptor-positive (HR+) and HER2-negative (HER2-) metastatic breast cancer (MBC). However, the incorporation of these agents into clinical practice remains challenging. This study aims to estimate the impact of the lack of access to ribociclib on mortality of premenopausal patients with MBC in Brazil. Methods Based on published epidemiological studies and national cancer registries, we estimated the number of premenopausal patients with potential indication of ribociclib as first-line treatment for MBC. Efficacy estimates were based on results from the Monaleesa-7 trial. Our analysis is made under the unrealistic assumption that all premenopausal MBC patients would be candidates for the treatment. To estimate the number of yearly premature deaths that could be prevented, we considered the largest absolute effect on mortality when sequentially applying the observed hazard ratio. Results We estimated an annual incidence of 4,294 premenopausal HR+, HER2- MBC patients in Brazil. Considering these patients, at 12, 24 and 60 months, the number of surviving subjects would be 3,504, 2,859 and 1,553 for endocrine therapy (ET) alone; and 3,717, 3,217 and 2,086 for ET plus ribociclib. The largest difference between both groups was observed at the end of the sixth year when the use of ribociclib would prevent 538 premature deaths (survival of 1,805 versus 1,267 patients by the 72nd month). Conclusion We estimate that lack of access to CDK4/6i for patients with HR+, HER2-, MBC will cause the premature death of a significant number of premenopausal women with MBC. The unavailability of effective therapies has measurable consequences. Progress in this area demands a concerted effort to prevent further loss of lives.
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Affiliation(s)
- Tomás Reinert
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, 90619-900, Brazil.,Oncoclinicas, Porto Alegre, 90570-020, Brazil
| | - Rodrigo Pellegrini
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) School of Medicine, Porto Alegre, 90619-900, Brazil
| | - Carlos Henrique Barrios
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, 90619-900, Brazil.,Oncoclinicas, Porto Alegre, 90570-020, Brazil
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20
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Romeu B, Perez Cristiá R. The CECMED Office of Innovation: A Core Initiative to Bolster Novel Pharmaceutical Products-The Cuban Approach. Ther Innov Regul Sci 2020; 55:163-169. [PMID: 32720296 DOI: 10.1007/s43441-020-00202-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/14/2020] [Indexed: 11/29/2022]
Abstract
Regulatory agencies across the Latin American region have strengthened their activities through the development of new regulatory science-based tools, standards and other approaches to evaluate and assess the safety, efficacy, quality and performance of therapeutics and devices. These processes have been implemented to promote the development and authorization of innovative new drugs and technologies, which pose a challenge to even well-established regulatory frameworks. Furthermore, in today's environment, the regulatory framework to protect public health can create barriers to marketing entry of novel drugs and medical devices. This article describes the pioneering approach that the Cuban regulatory agency (CECMED) has developed with the aim of building a comprehensive regulatory framework geared to accelerated innovation and enable successful transition of novel products from research and development to clinical practice. The Office of Innovation recently established at CECMED is the first flagship initiative of this type in Latin America and the Caribbean region. Its goal is to serve a leading role as a driving force for national and regional biopharmaceutical innovation. Herein, we discuss the conceptualization and management of the Office from the Latin American regional and national Cuban contexts.
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Affiliation(s)
- Belkis Romeu
- Center for State Control of Drugs, Equipment and Medical Devices (CECMED), Innovation Office, Calle 5ta A #6020 e/60 y 62. Miramar, Playa. Código Postal 11300, Havana, Cuba.
| | - Rafael Perez Cristiá
- Center for State Control of Drugs, Equipment and Medical Devices (CECMED), Innovation Office, Calle 5ta A #6020 e/60 y 62. Miramar, Playa. Código Postal 11300, Havana, Cuba.
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21
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Gomez HL, Castañeda C, Valencia F, Muñoz-Bermeo R, Torrico MDC, Neciosup S. ABC4 Consensus: First Latin American Meeting-Assessment, Comments, and Application of Its Recommendations. JCO Glob Oncol 2020; 6:819-827. [PMID: 32539467 PMCID: PMC7328106 DOI: 10.1200/go.20.00081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Breast cancer accounts for a high burden among all the neoplasms in Latin America, with more-advanced stages at presentation, which could result in high mortality rates. The 4th International Consensus Conference for Advanced Breast Cancer (ABC4) is focused on standardizing therapy for advanced breast cancer (ABC) and has held 5 meetings so far. ABC4 took place in Lisbon, Portugal, from November 2 to 4, 2017; however, the first Latin American ABC conference was held in Lima, Peru, from 18 to 19 May, 2018, chaired by Fatima Cardoso, MD, PhD. During these 2 days, the ABC4 consensus recommendations for advanced and locally advanced breast cancer were presented. Local treatment and systemic therapy were discussed with local experts, mainly focusing on anti-human epidermal growth factor receptor 2 therapy and newly approved drugs for hormone receptor-positive breast cancer, such as as CDK4/6, mammalian target of rapamycin, and poly (ADP-ribose) polymerase inhibitors for triple-negative breast cancer. The discussion focused additionally on access to drugs and ABC4 consensus recommendations as regards Latin American patients.
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Affiliation(s)
- Henry L Gomez
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
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22
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Soares LR, Rosa VDL, Freitas-Junior R. Anti-HER2 therapy for metastatic breast cancer in low- and middle-income countries: bridging the gap between clinical trials and real life. Breast Cancer Res Treat 2020; 181:693-694. [PMID: 32350678 DOI: 10.1007/s10549-020-05659-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Leonardo Ribeiro Soares
- Program of Mastology, Federal University of Goiás (UFG), 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, CEP: 74.605-020, Brazil
| | - Victor Domingos Lisita Rosa
- Program of Mastology, Federal University of Goiás (UFG), 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, CEP: 74.605-020, Brazil
| | - Ruffo Freitas-Junior
- Program of Mastology, Federal University of Goiás (UFG), 1ª Avenida, s/n, Setor Universitário, Goiânia, Goiás, CEP: 74.605-020, Brazil.
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23
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Urbina-Jara LK, Rojas-Martinez A, Martinez-Ledesma E, Aguilar D, Villarreal-Garza C, Ortiz-Lopez R. Landscape of Germline Mutations in DNA Repair Genes for Breast Cancer in Latin America: Opportunities for PARP-Like Inhibitors and Immunotherapy. Genes (Basel) 2019; 10:E786. [PMID: 31658756 PMCID: PMC6827033 DOI: 10.3390/genes10100786] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 09/28/2019] [Accepted: 10/04/2019] [Indexed: 12/24/2022] Open
Abstract
Germline mutations in BRCA1 and BRCA2 (BRCA1/2) genes are present in about 50% of cases of hereditary breast cancer. Proteins encoded by these genes are key players in DNA repair by homologous recombination (HR). Advances in next generation sequencing and gene panels for breast cancer testing have generated a large amount of data on gene variants implicated in hereditary breast cancer, particularly in genes such as PALB2, ATM, CHEK2, RAD51, MSH2, and BARD1. These genes are involved in DNA repair. Most of these variants have been reported for Caucasian, Jewish, and Asian population, with few reports for other communities, like those in Latin American (LA) countries. We reviewed 81 studies from 11 LA countries published between 2000 and 2019 but most of these studies focused on BRCA1/2 genes. In addition to these genes, breast cancer-related variants have been reported for PALB2, ATM, CHEK2, BARD1, MLH1, BRIP1, MSH2, NBN, MSH6, and PMS2 genes. Some of these variants are unique to LA populations. This analysis may contribute to enhance breast cancer variant characterization, and thus to find therapies and implement precision medicine for LA communities.
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Affiliation(s)
- Laura Keren Urbina-Jara
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey 64710, Mexico.
| | - Augusto Rojas-Martinez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey 64710, Mexico.
| | | | - Dione Aguilar
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey 64710, Mexico.
- Tecnologico de Monterrey, Centro de Cancer de Mama, Hospital Zambrano Hellion, San Pedro Garza Garcia 66278, Mexico.
| | - Cynthia Villarreal-Garza
- Tecnologico de Monterrey, Centro de Cancer de Mama, Hospital Zambrano Hellion, San Pedro Garza Garcia 66278, Mexico.
- Instituto Nacional de Cancerologia, Departamento de Investigacion, Av. San Fernando #22, Tlalpan, Ciudad de Mexico 14080, Mexico.
| | - Rocio Ortiz-Lopez
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey 64710, Mexico.
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Li CJ, Chu PY, Yiang GT, Wu MY. The Molecular Mechanism of Epithelial-Mesenchymal Transition for Breast Carcinogenesis. Biomolecules 2019; 9:biom9090476. [PMID: 31514467 PMCID: PMC6770718 DOI: 10.3390/biom9090476] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 12/23/2022] Open
Abstract
The transforming growth factor-β (TGF-β) signaling pathway plays multiple regulatory roles in the tumorigenesis and development of cancer. TGF-β can inhibit the growth and proliferation of epithelial cells and induce apoptosis, thereby playing a role in inhibiting breast cancer. Therefore, the loss of response in epithelial cells that leads to the inhibition of cell proliferation due to TGF-β is a landmark event in tumorigenesis. As tumors progress, TGF-β can promote tumor cell invasion, metastasis, and drug resistance. At present, the above-mentioned role of TGF-β is related to the interaction of multiple signaling pathways in the cell, which can attenuate or abolish the inhibition of proliferation and apoptosis-promoting effects of TGF-β and enhance its promotion of tumor progression. This article focuses on the molecular mechanisms through which TGF-β interacts with multiple intracellular signaling pathways in tumor progression and the effects of these interactions on tumorigenesis.
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Affiliation(s)
- Chia-Jung Li
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
| | - Pei-Yi Chu
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei 242, Taiwan
- Department of Pathology, Show Chwan Memorial Hospital, Changhua 500, Taiwan
- Department of Health Food, Chung Chou University of Science and Technology, Changhua 510, Taiwan
| | - Giou-Teng Yiang
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Meng-Yu Wu
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan.
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
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25
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Choi HCW, Lam KO, Pang HHM, Tsang SKC, Ngan RKC, Lee AWM. Global comparison of cancer outcomes: standardization and correlation with healthcare expenditures. BMC Public Health 2019; 19:1065. [PMID: 31391013 PMCID: PMC6686500 DOI: 10.1186/s12889-019-7384-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/26/2019] [Indexed: 12/13/2022] Open
Abstract
Background Cancer outcomes vary widely among different countries. However, comparisons of cost-effectiveness and cost-efficiency of different systems are complex because the incidences of different cancers vary across countries and their chances of cure also differ substantially. We aim to propose a new standardized method for global comparison and to explore its relationship with economic indicators. Methods Cancer statistics from all 184 countries and 27 cancers listed in GLOBOCAN 2012 were analyzed. The complement of age-standardized mortality/incidence ratio [1 – (ASM/ASI)] was taken as the proxy relative survival (RS). Accounting for various country-specific cancer patterns, the cancer site-standardized proxy RS (proxy SS-RS) of individual countries were calculated by weighting the proportion of specific cancer sites as compared with the global pattern of incidence. Economic indicators of different countries listed by the World Bank were correlated with corresponding proxy SS-RS. Results Substantial variation in site-specific survival and new case distribution supported the use of proxy SS-RS, which ranged from 0.124 to 0.622 (median 0.359). The median total health expenditure per capita (HEpc) increased from US$44 for countries with proxy SS-RS < 0.25, to US$4643 for countries with proxy SS-RS ≥0.55. Results from logarithmic regression model showed exponential increase in total HEpc for better outcome. The expenditure varied widely among different strata, with the widest difference observed among countries with SS-RS ≥0.55 (total HEpc US$1412–$9361). Conclusions Similar to age-standardization, cancer site-standardization adjusted for variation in pattern of cancer incidence provides the best available and feasible strategies for comparing cancer survivals across countries globally. Furthermore, cancer outcome correlated significantly with economic indicators and the amount of HEpc escalated exponentially. Our findings call for more in-depth studies applying cancer-site standardization to provide essential data for sharing of experience and urgent actions by policy makers to develop comprehensive and financially sustainable cancer plan for greater equity. Electronic supplementary material The online version of this article (10.1186/s12889-019-7384-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Horace C W Choi
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ka-On Lam
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. .,Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
| | - Herbert H M Pang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Steven K C Tsang
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Roger K C Ngan
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Anne W M Lee
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Rodrigues DCN, Freitas-Junior R, Rahal RMS, da Silveira Corrêa R, Gouveia PA, Peixoto JE, Martins E, Soares LR. Temporal changes in breast cancer screening coverage provided under the Brazilian National Health Service between 2008 and 2017. BMC Public Health 2019; 19:959. [PMID: 31319826 PMCID: PMC6637648 DOI: 10.1186/s12889-019-7278-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 07/03/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In Brazil, 70% of the population depends on the public healthcare system. Since early detection is considered crucial, this study aimed to evaluate temporal changes in breast cancer screening coverage provided under the Brazilian National Health Service (SUS) according to the different regions of the country between 2008 and 2017. METHODS This ecological study analyzed data on breast cancer screening within the SUS for women aged 50-69 years. Coverage was calculated from the ratio between the number of screening tests conducted and the expected number for the target population. Joinpoint regression analysis was used to calculate annual percent changes (APC) in coverage. RESULTS Around 19 million mammograms were performed in 50-69-year old women within the SUS between 2008 and 2016. The estimated APC indicates that breast cancer screening coverage increased by 14.5% annually in Brazil between 2008 and 2012 (p < 0.01), with figures stabilizing between 2012 and 2017 as shown by an APC of - 0.4% (p = 0.3). In the five geographic regions of the country, the APC initially increased, then stabilized in the north, northeast and southeast and decreased in the south and Midwest. Of the 26 states, coverage increased in seven and remained stable in six. In the other 13, there was an initial increase followed by stabilization in 11, and a reduction in coverage in two. In the Federal District, coverage remained stable throughout the study period. CONCLUSION Evaluation of the temporal changes in breast cancer screening coverage provided under the Brazilian National Health Service revealed an initial increase, confirming that public policies were effective, although insufficient to ensure organized screening. There appears to be a lack of uniformity between the different regions and states and this situation is highlighted in the final 5-year period, with the APC reflecting stabilization of breast cancer screening coverage.
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Affiliation(s)
- Danielle Cristina Netto Rodrigues
- Brazilian Breast Cancer Research Network, Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goiás, Primeira Avenida, s/n, Bloco II, Setor Universitário, Goiânia, Goiás, 74605-020, Brazil.
| | - Ruffo Freitas-Junior
- Brazilian Breast Cancer Research Network, Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goiás, Primeira Avenida, s/n, Bloco II, Setor Universitário, Goiânia, Goiás, 74605-020, Brazil
| | - Rosemar Macedo Sousa Rahal
- Brazilian Breast Cancer Research Network, Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goiás, Primeira Avenida, s/n, Bloco II, Setor Universitário, Goiânia, Goiás, 74605-020, Brazil
| | - Rosangela da Silveira Corrêa
- Brazilian Breast Cancer Research Network, Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goiás, Primeira Avenida, s/n, Bloco II, Setor Universitário, Goiânia, Goiás, 74605-020, Brazil
| | - Pollyana Alves Gouveia
- Brazilian Breast Cancer Research Network, Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goiás, Primeira Avenida, s/n, Bloco II, Setor Universitário, Goiânia, Goiás, 74605-020, Brazil
| | - João Emílio Peixoto
- Brazilian Breast Cancer Research Network, Division of Quality Control in Ionizing Radiation, National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| | - Edésio Martins
- Brazilian Breast Cancer Research Network, Faculdade Unida de Campinas, Goiânia, Goiás, Brazil
| | - Leonardo Ribeiro Soares
- Brazilian Breast Cancer Research Network, Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goiás, Primeira Avenida, s/n, Bloco II, Setor Universitário, Goiânia, Goiás, 74605-020, Brazil
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Calderón-Aparicio A, Orue A. Precision oncology in Latin America: current situation, challenges and perspectives. Ecancermedicalscience 2019; 13:920. [PMID: 31281417 PMCID: PMC6546257 DOI: 10.3332/ecancer.2019.920] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anti-cancer cytotoxic treatments like platinum-derived compounds often show low therapeutic efficacy, high-risk side effects and resistance. Hence, targeted treatments designed to attack only tumour cells avoiding these harmful side effects are highly needed in clinical practice. Due to this, precision oncology has arisen as an approach to specifically target alterations present only in cancer cells, minimising side effects for patients. It involves the use of molecular biomarkers present in each kind of tumour for diagnosis, prognosis and treatment. Since these biomarkers are specific for each cancer type, physicians use them to stratify, diagnose or take the best therapeutic options for each patient depending on the features of the specific tumour. AIM This review aims to describe the current situation, limitations, advantages and perspectives about precision oncology in Latin America. MAIN BODY For many years, many biomarkers have been used in a clinical setting in developed countries. However, in Latin American countries, their broad application has not been affordable partially due to financial and technical limitations associated with precarious health systems and poor access of low-income populations to quality health care. Furthermore, the genetic mixture in Latin American populations could generate differences in treatment responses from one population to another (pharmacoethnicity) and this should be evaluated before establishing precision therapy in particular populations. Some research groups in the region have done a lot of work in this field and these data should be taken as a starting point to establish networks oriented to finding clinically useful cancer biomarkers in Latin American populations. CONCLUSION Latin America must create policies allowing excluded populations to gain access to health systems and next generation anti-cancer drugs, i.e. high-cost targeted therapies to improve survival. Also, cancer clinical research must be oriented to establish cancer biomarkers adapted to specific populations with different ethnicity, allowing the improvement of patient outcomes.
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Affiliation(s)
- Ali Calderón-Aparicio
- Tumor Cell Biology Laboratory, Instituto Venezolano de Investigaciones Científicas IVIC, Centro de Microbiología, Caracas 1020A, Venezuela
| | - Andrea Orue
- Tumor Cell Biology Laboratory, Instituto Venezolano de Investigaciones Científicas IVIC, Centro de Microbiología, Caracas 1020A, Venezuela
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