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Link H, Thompson SF, Tian M, Haas JS, Meise D, Maas C, Dimitrov S. A comparative assessment of neutropenia events, healthcare resource use, and costs among cancer patients treated with lipegfilgrastim compared with pegfilgrastim in Germany. Support Care Cancer 2022; 30:9317-9327. [PMID: 36076105 DOI: 10.1007/s00520-022-07353-3] [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: 03/17/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE We assessed the occurrence of neutropenia and febrile neutropenia (FN) and the associated healthcare resource in cancer patients receiving myelosuppressive chemotherapy in combination with pegfilgrastim versus lipegfilgrastim. METHODS This is a retrospective analysis using a German health insurance claims database. Adults receiving chemotherapy with a prescription code for pegfilgrastim (n = 734) or lipegfilgrastim (n = 346) were observed over a 1-year follow-up period. Patient subgroups were analyzed according to cancer type and FN risk. FN risk was based on the chemotherapy regimen and any additional neutropenia risk factors. Outcomes were adjusted via regression analysis. RESULTS Most patients were classified as high FN risk (70.0% pegfilgrastim; 65.6% lipegfilgrastim cohort). The mean age was 58.2 years in the pegfilgrastim cohort and 58.0 years in the lipegfilgrastim cohort, with more female patients than male patients (77.3% vs 79.8%, respectively), and the majority had breast cancer (64.9% and 68.8%, respectively). Overall, 10.0% and 10.4% of patients receiving pegfilgrastim or lipegfilgrastim experienced a neutropenia event (p = 0.82), with 4.4% and 3.5% of patients experiencing a FN event (p = 0.49). The mean neutropenia event-related healthcare costs were €604 and €441 for the pegfilgrastim and lipegfilgrastim cohorts; among patients with lymphoma, these costs were significantly greater (p = 0.03) with pegfilgrastim (€1,612) versus lipegfilgrastim (€382). The mean all-cause hospitalizations were significantly (p < 0.01) higher for lymphoma patients receiving pegfilgrastim (2.76) versus lipegfilgrastim (1.60). CONCLUSION Overall, patients treated with pegfilgrastim and lipegfilgrastim were comparable in terms of neutropenia occurrences in the 1-year follow-up. In patients with lymphoma, neutropenia event-related healthcare costs and all-cause hospitalizations were significantly higher with pegfilgrastim compared with lipegfilgrastim in this study; however, this should be interpreted with caution in light of the limited sample size and the absence of clinical information.
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Affiliation(s)
- Hartmut Link
- Private Practice Hematology and Oncology, Kaiserslautern, Germany.
| | | | - Marc Tian
- TEVA Pharmaceuticals Industries Ltd., West Chester, PA, USA
| | | | | | | | - Stamen Dimitrov
- TEVA Pharmaceuticals Europe, HQ Amsterdam, Amsterdam, Netherlands
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Zhao J, Qiao G, Liang Y, Li J, Hu W, Zuo X, Li J, Zhao C, Zhang X, Du S. Cost-Effectiveness Analysis of PEG-rhG-CSF as Primary Prophylaxis to Chemotherapy-Induced Neutropenia in Women With Breast Cancer in China: Results Based on Real-World Data. Front Pharmacol 2022; 12:754366. [PMID: 35185534 PMCID: PMC8850939 DOI: 10.3389/fphar.2021.754366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/30/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Pegylated recombinant human granulocyte colony-stimulating factors (PEG-rhG-CSFs) are more commonly and widely used than recombinant human granulocyte colony-stimulating factors (rhG-CSFs) in preventing chemotherapy-induced neutropenia in patients with stage II-IV breast cancer. To reduce the financial burden on these patients, the corresponding medical insurance directory needs to be revised. Objectives: To evaluate the cost-effectiveness of PEG-rhG-CSF versus rhG-CSF in patients with stage II-IV breast cancer in central China. Methods: Two Markov models, a chemotherapy model and a post-chemotherapy model, were developed to study the effects and costs, with a time horizon of 12 weeks and 35 years, respectively. Cost and probability input data were primarily obtained from a retrospective real-world study conducted in five tertiary hospitals. Propensity score matching was adopted to overcome retrospective bias. Other parameters were extracted from literature as well as advice from clinical experts. Univariate and probabilistic sensitivity analyses were conducted. Results: In the first chemotherapy model, PEG-rhG-CSF was associated with fewer episodes of febrile neutropenia (FN) (N = 19 per 1000 patients treated), infections (N = 24 per 1000 patients treated) and deaths (N = 2 per 1000 patients treated), but higher costs (¥36 more per patient treated). The post-chemotherapy model indicated that PEG-rhG-CSF led to higher gains in quality-adjusted life years (QALYs) (11.695 versus 11.516) in comparison to rhG-CSF. Sensitivity analysis showed that the cost of PEG-rhG-CSF had the greatest impact on the incremental costs, and incremental QALYs were very sensitive to the risk of RDI <85%. The probability of PEG-rhG-CSF being cost-effective compared to rhG-CSF was 66% at the willingness to pay (WTP) thresholds of ¥72,371 per QALY gained. Conclusion: According to this economic evaluation based on real-world data, PEG-rhG-CSF may be considered as a more cost-effective strategy relative to rhG-CSF for stage II-IV breast cancer patients in central China. However, to reflect a national perspective, further evidence is needed using data from larger-scale studies.
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Affiliation(s)
- Jie Zhao
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gaoxing Qiao
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Liang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jia Li
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Hu
- Department of Pharmacy, Xinyang Central Hospital, Xinyang, China
| | - Xu Zuo
- Department of Pharmacy, The Affiliated People’s Hospital of Xinxiang Medical University, Xinxiang, China
| | - Junfang Li
- Department of Pharmacy, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Chenglong Zhao
- Department of Pharmacy, Henan Provincial People’s Hospital, Zhengzhou, China
| | | | - Shuzhang Du
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Xiaojian Zhang, ; Shuzhang Du,
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Cadham CJ, Knoll M, Sánchez-Romero LM, Cummings KM, Douglas CE, Liber A, Mendez D, Meza R, Mistry R, Sertkaya A, Travis N, Levy DT. The Use of Expert Elicitation among Computational Modeling Studies in Health Research: A Systematic Review. Med Decis Making 2021; 42:684-703. [PMID: 34694168 DOI: 10.1177/0272989x211053794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Expert elicitation (EE) has been used across disciplines to estimate input parameters for computational modeling research when information is sparse or conflictual. OBJECTIVES We conducted a systematic review to compare EE methods used to generate model input parameters in health research. DATA SOURCES PubMed and Web of Science. STUDY ELIGIBILITY Modeling studies that reported the use of EE as the source for model input probabilities were included if they were published in English before June 2021 and reported health outcomes. DATA ABSTRACTION AND SYNTHESIS Studies were classified as "formal" EE methods if they explicitly reported details of their elicitation process. Those that stated use of expert opinion but provided limited information were classified as "indeterminate" methods. In both groups, we abstracted citation details, study design, modeling methodology, a description of elicited parameters, and elicitation methods. Comparisons were made between elicitation methods. STUDY APPRAISAL Studies that conducted a formal EE were appraised on the reporting quality of the EE. Quality appraisal was not conducted for studies of indeterminate methods. RESULTS The search identified 1520 articles, of which 152 were included. Of the included studies, 40 were classified as formal EE and 112 as indeterminate methods. Most studies were cost-effectiveness analyses (77.6%). Forty-seven indeterminate method studies provided no information on methods for generating estimates. Among formal EEs, the average reporting quality score was 9 out of 16. LIMITATIONS Elicitations on nonhealth topics and those reported in the gray literature were not included. CONCLUSIONS We found poor reporting of EE methods used in modeling studies, making it difficult to discern meaningful differences in approaches. Improved quality standards for EEs would improve the validity and replicability of computational models. HIGHLIGHTS We find extensive use of expert elicitation for the development of model input parameters, but most studies do not provide adequate details of their elicitation methods.Lack of reporting hinders greater discussion of the merits and challenges of using expert elicitation for model input parameter development.There is a need to establish expert elicitation best practices and reporting guidelines.
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Affiliation(s)
- Christopher J Cadham
- Department of Health Management and Policy, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Marie Knoll
- Georgetown University, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | | | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Clifford E Douglas
- Department of Health Management and Policy, University of Michigan, School of Public Health, Ann Arbor, MI, USA.,University of Michigan, Tobacco Research Network, Ann Arbor, MI, USA
| | - Alex Liber
- Georgetown University, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - David Mendez
- Department of Health Management and Policy, University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Ritesh Mistry
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Nargiz Travis
- Department of Health Management and Policy, University of Michigan, School of Public Health, Ann Arbor, MI, USA.,Georgetown University, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - David T Levy
- Georgetown University, Lombardi Comprehensive Cancer Center, Washington, DC, USA
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Link H, Illerhaus G, Martens UM, Salar A, Depenbusch R, Köhler A, Engelhardt M, Mahlmann S, Zaiss M, Lammerich A, Bias P, Buchner A. Efficacy and safety of lipegfilgrastim versus pegfilgrastim in elderly patients with aggressive B cell non-Hodgkin lymphoma (B-NHL): results of the randomized, open-label, non-inferiority AVOID neutropenia study. Support Care Cancer 2020; 29:2519-2527. [PMID: 32944800 PMCID: PMC7981320 DOI: 10.1007/s00520-020-05711-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/20/2020] [Indexed: 12/22/2022]
Abstract
Background Lipegfilgrastim has been shown to be non-inferior to pegfilgrastim for reduction of the duration of severe neutropenia (DSN) in breast cancer patients. This open-label, non-inferiority study assessed the efficacy and safety of lipegfilgrastim versus pegfilgrastim in elderly patients with aggressive B cell non-Hodgkin lymphoma (NHL) at high risk for chemotherapy-induced neutropenia. Patient and methods One hundred and one patients (median age, 75 years) were randomized to lipegfilgrastim or pegfilgrastim (6 mg/cycle) during six cycles of R-CHOP21. Results Lipegfilgrastim was non-inferior to pegfilgrastim for the primary efficacy endpoint, reduction of DSN in cycle 1. In the per-protocol population, mean (standard deviation) DSN was 0.8 (0.92) and 0.9 (1.11) days in the two groups, respectively; the adjusted mean difference between groups was − 0.3 days (95% confidence interval, − 0.70 to 0.19). Non-inferiority was also demonstrated in the intent-to-treat population. The incidence of severe neutropenia in cycle 1 was 51% (21/41) in the lipegfilgrastim group and 52% (23/44) in the pegfilgrastim group. Very severe neutropenia (ANC < 0.1 × 109/L) in cycle 1 was reported by 5 (12%) patients in the lipegfilgrastim group and 8 (18%) patients in the pegfilgrastim group. However, over all cycles, febrile neutropenia (strict definition) was reported by only 1 (2%) patient in each treatment group (during cycle 1 in the lipegfilgrastim group and cycle 6 in the pegfilgrastim group). The mean time to absolute neutrophil count recovery (defined as ≥ 2.0 × 109/L) was 8.3 and 9.4 days in the two groups, respectively. Serious adverse events occurred in 46% of patients in each group; none were considered treatment-related. Eight patients died during the study (2 in the lipegfilgrastim group, 5 in the pegfilgrastim group, and 1 who died before starting study treatment). No deaths occurred during the treatment period, and all were considered to be related to the underlying disease. Conclusions This study shows lipegfilgrastim to be non-inferior to pegfilgrastim for the reduction of DSN in elderly patients with aggressive B cell NHL receiving myelosuppressive chemotherapy, with a comparable safety profile. Trial registration number ClinicalTrials.gov identifier NCT02044276; EudraCT number 2013-001284-23 Electronic supplementary material The online version of this article (10.1007/s00520-020-05711-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hartmut Link
- Private Practice Hematology Medical Oncology, Finkenhain 8, 67661, Kaiserslautern, Germany.
| | - G Illerhaus
- Hematology, Oncology and Palliative Medicine Clinic, Klinikum Stuttgart, Stuttgart, Germany
| | - U M Martens
- Hematology, Oncology and Palliative Medicine Clinic, SLK-Clinics, Heilbronn, Germany
| | - A Salar
- Hospital del Mar Paseo Marítimo, Hematology, Barcelona, Spain
| | - R Depenbusch
- Oncology Practice, Gütersloh, Gütersloh, Germany
| | - A Köhler
- Hematology and Oncology Collective Practice, Asklepios Clinic Specialist Medical Centre Langen, Langen, Germany
| | - M Engelhardt
- Internal Medicine Clinic I, Hematology, Oncology and Stem Cell Transplantation, University Clinic, Faculty of Freiburg, Freiburg, Germany
| | - S Mahlmann
- Hematology/Oncology and Nephrology Clinic, Friedrich-Ebert-Hospital Neumünster, Neumünster, Germany
| | - M Zaiss
- Interdiscliplinary Practice for Oncology and Hematology, Freiburg, Germany
| | - A Lammerich
- Teva Pharmaceuticals Industries, Ulm, Germany
| | - P Bias
- Teva Pharmaceuticals Industries, Ulm, Germany
| | - A Buchner
- Teva Pharmaceuticals Industries, Ulm, Germany
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6
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Xie J, Cao J, Wang JF, Zhang BH, Zeng XH, Zheng H, Zhang Y, Cai L, Wu YD, Yao Q, Zhao XC, Mao WD, Jiang AM, Chen SS, Yang SE, Wang SS, Wang JH, Pan YY, Ren BY, Chen YJ, Ouyang LZ, Lei KJ, Gao JH, Huang WH, Huang Z, Shou T, He YL, Cheng J, Sun Y, Li WM, Cui SD, Wang X, Rao ZG, Ma H, Liu W, Wu XY, Shen WX, Cao FL, Xiao ZM, Wu B, Tian SY, Meng D, Shen P, Wang BY, Wang Z, Zhang J, Wang L, Hu XC. Advantages with prophylactic PEG-rhG-CSF versus rhG-CSF in breast cancer patients receiving multiple cycles of myelosuppressive chemotherapy: an open-label, randomized, multicenter phase III study. Breast Cancer Res Treat 2018; 168:389-399. [PMID: 29230663 DOI: 10.1007/s10549-017-4609-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 12/06/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND PEG-rhG-CSF reduces neutropenia and improves chemotherapy safety. In China's registration trial (CFDA: 2006L01305), we assessed its efficacy and safety against rhG-CSF, and prospectively explored its value over multiple cycles of chemotherapy. METHODS In this open-label, randomized, multicenter phase 3 study, breast cancer patients (n = 569) were randomized to receive PEG-rhG-CSF 100 µg/kg, PEG-rhG-CSF 6 mg, or rhG-CSF 5 µg/kg/d after chemotherapy. The primary endpoints were the incidence and duration of grade 3/4 neutropenia during cycle 1. Secondary endpoints included the incidence and duration of grade 3/4 neutropenia during cycles 2-4, the incidence of febrile neutropenia, and the safety. RESULTS A once-per-cycle PEG-rhG-CSF at either 100 µg/kg or 6 mg was not different from daily injections of rhG-CSF for either incidence or duration of grade 3/4 neutropenia. Interestingly, a substantial difference was noted during cycle 2, and the difference became bigger over cycles 3-4, reaching a statistical significance at cycle 4 in either incidence (P = 0.0309) or duration (P = 0.0289) favoring PEG-rhG-CSF. A significant trend toward a lower incidence of all-grade adverse events was noted at 129 (68.98%), 142 (75.53%), and 160 (82.47%) in the PEG-rhG-CSF 100 µg/kg and 6 mg and rhG-CSF groups, respectively (P = 0.0085). The corresponding incidence of grade 3/4 drug-related adverse events was 2/187 (1.07%), 1/188 (0.53%), and 8/194 (4.12%), respectively (P = 0.0477). Additionally, PFS in metastatic patients preferred PEG-rhG-CSF to rhG-CSF despite no significance observed by Kaplan-Meier analysis (n = 49, P = 0.153). CONCLUSIONS PEG-rhG-CSF is a more convenient and safe formulation and a more effective prophylactic measure in breast cancer patients receiving multiple cycles of chemotherapy.
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Affiliation(s)
- Jie Xie
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong'an Road, Shanghai, 200032, China
| | - Jun Cao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong'an Road, Shanghai, 200032, China
| | | | - Bai-Hong Zhang
- Lanzhou Military General Hospital of People's Liberation Army, Gansu Lanzhou, 730050, China
| | | | - Hong Zheng
- Chongqing Cancer Hospital, Chongqing, 400030, China
| | - Yang Zhang
- Liaocheng People's Hospital, Liaocheng, 252000, China
| | - Li Cai
- The Affiliated Tumor Hospital of Harbin Medical University, Harbin, 150081, China
| | - Yu-Dong Wu
- Jiangxi Cancer Hospital, Nanchang, 330029, China
| | - Qiang Yao
- Tianjin People's Hospital, Tianjin, 300121, China
| | - Xiao-Chun Zhao
- The First Affiliated Hospital Of University Of South China, Hengyang, 421001, China
| | - Wei-Dong Mao
- The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, 214400, China
| | - Ai-Mei Jiang
- First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - Shao-Shui Chen
- Binzhou Medical School Affiliated Hospital, Binzhou, 256603, China
| | - Shun-E Yang
- Tumour Hospital Affiliated To Xinjiang Medical University, Urumqi, 830000, China
| | - Shu-Sen Wang
- Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | | | - Yue-Yin Pan
- The First Affiliated Hospital Of Anhui Medical University, Hefei, 230022, China
| | - Bi-Yong Ren
- Chongqing Three Gorges Central Hospital, Chongqing, 404000, China
| | - Yan-Ju Chen
- Hainan General Hospital, Haikou, 570311, China
| | | | - Kai-Jian Lei
- The Second People's Hospital of Yibin, Yibin, 644000, China
| | - Jing-Hua Gao
- Cangzhou Central Hospital, Cangzhou, 061001, China
| | - Wen-He Huang
- Cancer Hospital of Shantou University Medical College, Shantou, 515000, China
| | - Zhan Huang
- Yue Bei People's Hospital, Shaoguan, 512025, China
| | - Tao Shou
- The First People's Hospital of Yunnan Province, Kunming, 650032, China
| | - Yan-Ling He
- Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Jing Cheng
- Huazhong University of Science and Technology Wuhan Union Hospital, Wuhan, 430022, China
| | - Yang Sun
- People's Hospital of Sanya, Sanya, 572000, China
| | - Wei-Ming Li
- The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China
| | - Shu-de Cui
- Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Xin Wang
- Zhongshan Hospital Affiliated To Xiamen University, Xiamen, 361004, China
| | - Zhi-Guo Rao
- Wuhan General Hospital of Guangzhou Military, Wuhan, 430070, China
| | - Hu Ma
- Affiliated Hospital of Zunyi Medical College, Zunyi, 563000, China
| | - Wei Liu
- Affiliated Hospital of Beihua University, Jilin, 132011, China
| | - Xue-Yong Wu
- Jing'an District Centre Hospital of Shanghai, Shanghai, 200040, China
| | - Wei-Xi Shen
- Shenzhen People's Hospital, Shenzhen, 518020, China
| | - Fei-Lin Cao
- Taizhou Hospital of Zhejiang Province, Taizhou, 317000, China
| | - Ze-Min Xiao
- The First People's Hospital of Changde City, Changde, 415003, China
| | - Biao Wu
- The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Shu-Yan Tian
- The Centre Hospital of Siping City, Siping, 136000, China
| | - Dong Meng
- Wu Xi No.4 People's Hospital, Wuxi, 214000, China
| | - Peng Shen
- The First Affiliated Hospital Of Zhejiang University, Hangzhou, 310003, China
| | - Bi-Yun Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong'an Road, Shanghai, 200032, China
| | - Zhonghua Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong'an Road, Shanghai, 200032, China
| | - Jian Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong'an Road, Shanghai, 200032, China
| | - Leiping Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong'an Road, Shanghai, 200032, China
| | - Xi-Chun Hu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, 130 Dong'an Road, Shanghai, 200032, China.
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