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Gascón P, Nagarkar R, Šmakal M, Syrigos KN, Barrios CH, Sánchez JC, Zhang L, Henry DH, Gordon D, Hirsh V, Kubota K, Orlov S, Thomas G, Steinmetz T, Kang JH, Tomita DK, Fleishman AN, Park JK, De Oliveira Brandao C. A Randomized, Double-Blind, Placebo-Controlled, Phase III Noninferiority Study of the Long-Term Safety and Efficacy of Darbepoetin Alfa for Chemotherapy-Induced Anemia in Patients With Advanced NSCLC. J Thorac Oncol 2019; 15:190-202. [PMID: 31629060 DOI: 10.1016/j.jtho.2019.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/30/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION This study evaluated noninferiority of darbepoetin alfa versus placebo for overall survival (OS) and progression-free survival (PFS) in anemic patients with NSCLC treated to a 12.0-g/dL hemoglobin (Hb) ceiling. METHODS Adults with stage IV NSCLC expected to receive two or more cycles of myelosuppressive chemotherapy and Hb less than or equal to 11.0 g/dL were randomized 2:1 to blinded 500 μg darbepoetin alfa or placebo every 3 weeks. The primary endpoint was OS; a stratified Cox proportional hazards model was used to evaluate noninferiority (upper confidence limit for hazard ratio [HR] < 1.15). Secondary endpoints were PFS and incidence of transfusions or Hb less than or equal to 8.0 g/dL from week 5 to end of the efficacy treatment period. RESULTS The primary analysis set included 2516 patients: 1680 were randomized to darbepoetin alfa; 836 to placebo. The study was stopped early per independent Data Monitoring Committee recommendation after the primary endpoint was met with no new safety concerns. Darbepoetin alfa was noninferior to placebo for OS (stratified HR = 0.92; 95% confidence interval [CI]: 0.83‒1.01) and PFS (stratified HR = 0.95; 95% CI: 0.87‒1.04). Darbepoetin alfa was superior to placebo for transfusion or Hb less than or equal to 8.0 g/dL from week 5 to end of the efficacy treatment period (stratified odds ratio = 0.70; 95% CI: 0.57‒0.86; p < 0.001). Objective tumor response was similar between the groups (darbepoetin alfa, 36.4%; placebo, 32.6%). Incidence of serious adverse events was 31.1% in both groups. No unexpected adverse events were observed. CONCLUSIONS Darbepoetin alfa dosed to a 12.0-g/dL Hb ceiling was noninferior to placebo for OS and PFS and significantly reduced odds of transfusion or Hb less than or equal to 8.0 g/dL in anemic patients with NSCLC receiving myelosuppressive chemotherapy.
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Affiliation(s)
- Pere Gascón
- Department of Hematology-Oncology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.
| | | | - Martin Šmakal
- Nemocnice Hořovice, NH Hospital a.s., Hořovice, Czech Republic
| | | | | | | | - Li Zhang
- Sun Yat-Sen University Cancer Center, East Guangzhou, China
| | - David H Henry
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Gordon
- Cancer Care Centers of South Texas and US Oncology Research Network, San Antonio, Texas
| | - Vera Hirsh
- MUHC Royal Victoria Hospital, Montreal, Quebec, Canada
| | | | - Sergey Orlov
- Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
| | - Gary Thomas
- South Carolina Cancer Specialists, Hilton Head Island, South Carolina
| | - Tilman Steinmetz
- Gemeinschaftspraxis für Hämatologie und Onkologie, Köln, Germany
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Martynov LD, Fleishman AN. Autonomous dysregulation of orthostatic disorders in young individuals engaged into manual work. Med Tr Prom Ekol 2016:28-31. [PMID: 30351701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The authors analyzed changes of statistic, spectral and non-linear parameters of cardiac rhythm variability in response to active orthostasis test in young individuals engaged into manual work, and the results are compared with hemodynamic parameters. Evidence is that the patients with neurogenous fainting present sympathetic vasomotory regulation disorders even in young age; before clinical manifestation as orthostatic hypotension. In comparison with common tilt-test, spectral analysis of cardiac rhythm variability in active orthostatic test can be more useful to reveal early disorders of autonomous regulation.
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Hellinger JA, Iwane MK, Smith JJ, Fleishman AN, Torres RA, Schrader S, Perez G, Cohen CJ, Skowron G, Giordano MF, Accetta G, Cooper EC, Frost KR. A randomized study of the safety and antiretroviral activity of hydroxyurea combined with didanosine in persons infected with human immunodeficiency virus type 1. American Foundation for AIDS Research Community-Based Clinical Trials Network. J Infect Dis 2000; 181:540-7. [PMID: 10669337 DOI: 10.1086/315231] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This randomized open-label trial of human immunodeficiency virus type 1-infected persons compared safety and efficacy for 38 patients receiving hydroxyurea/didanosine combination therapy with findings in 42 persons given didanosine monotherapy for 12 weeks, followed by 12 weeks of hydroxyurea/didanosine combination therapy for all patients. Week 12 on-treatment group comparisons showed a mean decrease in virus load between hydroxyurea/didanosine versus didanosine groups of -0.93 versus -0.74 log10 copies/mL (P=.20); a higher percentage of the hydroxyurea/didanosine group below the assay's detection limit (500 copies/mL), 29% versus 7% (P=.017); and median change in CD4 cells for the hydroxyurea/didanosine versus didanosine group of 0 versus 43 cells/mm3 (P=.045), although median change in CD4 percentage was similar (0.9% vs. 1.2%, P=.64). Week 24 virus load reductions and CD4 cell changes were similar in both groups. Intent-to-treat and on-treatment analyses showed similar results. The hydroxyurea/didanosine combination was well tolerated.
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Affiliation(s)
- J A Hellinger
- Community Research Initiative of New England, Brookline, Massachusetts, USA
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