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Hall DL, Wagner LI, Lebel S, Smith AB, Bergerot CD, Park ER. Guidelines needed for the management of fear of cancer recurrence in adult survivors of cancer in the United States: A consensus statement. Cancer 2024. [PMID: 38630904 DOI: 10.1002/cncr.35326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/04/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
Fear of cancer recurrence remains unaddressed in guidelines for managing anxiety and depression in adult cancer survivors in the United States. To ensure comprehensive psychosocial care, guidelines are needed for the clinical management of fear of cancer recurrence, including recommendations for screening, referral, and treatment pathways.
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Affiliation(s)
- Daniel L Hall
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lynne I Wagner
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | | | - Allan Ben Smith
- The Daffodil Center, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Cristiane D Bergerot
- Oncoclinicas & Co - Medica Scientia Innovation Research (MEDSIR), Sao Paulo, Brazil
| | - Elyse R Park
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Castro DV, Prajapati SR, Feng MI, Chan EH, Lee KO, Paul T, Sehgal I, Patel J, Li X, Zengin ZB, Ebrahimi H, Govindarajan A, Meza L, Mercier BD, Chawla NS, Dizman N, Philip EJ, Hsu J, Bergerot CD, Chehrazi-Raffle A, Rock A, Liu S, Tripathi A, Dorff TB, Pal SK. Assessment of eligibility criteria in renal cell carcinoma trials evaluating systemic therapy. BJU Int 2024; 133:297-304. [PMID: 37548533 DOI: 10.1111/bju.16148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
OBJECTIVES To characterise the restrictiveness of eligibility criteria in contemporary renal cell carcinoma (RCC) trials, using recommendations from the American Society of Clinical Oncology (ASCO)-Friends of Cancer Research (FCR) initiative. METHODS vPhase I-III trials assessing systemic therapies in patients with RCC starting between 30 June 2012 and 30 June 2022 were identified. Eligibility criteria regarding brain metastases, prior or concurrent malignancies, hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, and human immunodeficiency virus (HIV) infection were identified and stratified into three groups: exclusion, conditional inclusion, and not reported. Descriptive statistics were used to determine the frequency of eligibility criteria. Fisher's exact test or chi-square test were used to calculate their associations with certain trial characteristics. RESULTS A total of 423 RCC trials were initially identified of which 112 (26.5%) had sufficient accessible information. Exclusion of patients with HIV infection, HBV/HCV infection, brain metastases, and prior or concurrent malignancies were reported in 74.1%, 53.6%, 33.0%, and 8.0% of trials, respectively. In the context of HIV and HBV/HCV infection, patients were largely excluded from trials evaluating immunotherapy (94.4% and 77.8%, respectively). In addition, brain metastases were excluded in trials assessing targeted therapy (36.4%), combined therapy (33.3%), and immunotherapy (22.2%). Exclusion of patients with prior or concurrent malignancies was less frequently reported, accounting for 9.1%, 8.3%, and 5.6% targeted therapy, combined therapy and immunotherapy trials, respectively. CONCLUSION A substantial proportion of RCC trials utilise restrictive eligibility criteria, excluding patients with fairly prevalent comorbidities. Implementing the ASCO-FCR recommendations will ensure resulting data are more inclusive and aligned with patient populations in the real-world.
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Affiliation(s)
- Daniela V Castro
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sweta R Prajapati
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Matthew I Feng
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Elyse H Chan
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Kyle O Lee
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Trishita Paul
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Ishaan Sehgal
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jalen Patel
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Xiaochen Li
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Zeynep B Zengin
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Hedyeh Ebrahimi
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Ameish Govindarajan
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Luis Meza
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Benjamin D Mercier
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Neal S Chawla
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Nazli Dizman
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
- Yale University School of Medicine, New Haven, CT, USA
| | - Errol J Philip
- University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - JoAnn Hsu
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Cristiane D Bergerot
- Centro de Câncer de Brasília (CETTRO), Instituto Unity de Ensino e Pesquisa, Brasília, Brazil
| | - Alex Chehrazi-Raffle
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Adam Rock
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sandy Liu
- Department of Medical Oncology, City of Hope Orange County Lennar Foundation Cancer Center, Irvine, CA, USA
| | - Abhishek Tripathi
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Tanya B Dorff
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sumanta K Pal
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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Ebrahimi H, Castro DV, Feng MI, Prajapati SR, Lee KO, Chan EH, Paul T, Sehgal I, Patel J, Li X, Zengin ZB, Meza L, Mercier BD, Hsu J, Govindarajan A, Chawla N, Dizman N, Bergerot CD, Rock A, Liu S, Tripathi A, Dorff T, Pal SK, Chehrazi-Raffle A. Examining Exclusion Criteria in Advanced Prostate Cancer Clinical Trials: An Assessment of recommendations From the American Society Of Clinical Oncology and Friends of Cancer Research. Clin Genitourin Cancer 2023; 21:e467-e473. [PMID: 37301665 DOI: 10.1016/j.clgc.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Eligibility criteria illustrate the characteristics of the study population and promote the safety of participants. However, overreliance on restrictive eligibility criteria may limit the generalizability of outcomes. As a result, the American Society of Clinical Oncology (ASCO) and Friends of Cancer Research (Friends) issued statements to curtail these challenges. In this study, we aimed to assess restrictiveness in eligibility criteria across advanced prostate cancer clinical trials. MATERIALS AND METHODS We identified all phase I, II, and III advanced prostate cancer clinical trials between June 30, 2012, and June 30, 2022, through Clinicaltrials.gov. We evaluated whether a clinical trial excluded, conditionally included, or did not report 4 common criteria: brain metastases, prior or concurrent malignancies, HIV infection, and hepatitis B virus (HBV)/hepatitis C virus (HCV) infection. Performance status (PS) criteria were recorded based on the Eastern Cooperative Oncology Group (ECOG) scale. RESULTS Out of 699 clinical trials within our search strategy, 265 (37.9%) trials possessed all the required data and were included in our analysis. The most common excluded condition of our interest was brain metastases (60.8%), followed by HIV positivity (46.4%), HBV/HCV positivity (46.0%), and concurrent malignancies (15.5%). Additionally, 50.9% of clinical trials only included patients with ECOG PS 0 to 1. HIV and HBV/HCV infection were exclusion criteria of 22 (80.8%) and 19 (73.1%) immunotherapy trials, respectively. CONCLUSION Patients with brain metastases, prior or concurrent malignancies, HIV infection, HBV/HCV infection, or low-functioning PS were overly restricted from participating in advanced prostate clinical trials. Advocating for broader criteria may ameliorate generalizability.
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Affiliation(s)
- Hedyeh Ebrahimi
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Daniela V Castro
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Matthew I Feng
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Sweta R Prajapati
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Kyle O Lee
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Elyse H Chan
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Trishita Paul
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Ishaan Sehgal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Jalen Patel
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Xiaochan Li
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Zeynep B Zengin
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Luis Meza
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Benjamin D Mercier
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - JoAnn Hsu
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Ameish Govindarajan
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Neal Chawla
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Nazli Dizman
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA; Department of Internal Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT
| | - Cristiane D Bergerot
- Centro de Câncer de Brasília (CETTRO), Instituto Unity de Ensino e Pesquisa, Brasília, Brazil
| | - Adam Rock
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Sandy Liu
- Department of Medical Oncology, City of Hope Orange County Medical Center, Irvine, CA
| | - Abhishek Tripathi
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Tanya Dorff
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Sumanta K Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Alexander Chehrazi-Raffle
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA.
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Castro DV, Zengin ZB, Malhotra J, Bergerot CD, Meza L, Dizman N, Govindarajan A, Hsu J, Chehrazi-Raffle A, Chawla N, Mercier BD, Chen SW, Feng M, Prajapati S, Lee KO, Philip EJ, Dorff TB, Lyou Y, Pal SK. Perceptions of COVID-19 Vaccination in Patients with Genitourinary Cancers: A Survey Study. Cancer Invest 2023; 41:70-76. [PMID: 36239609 DOI: 10.1080/07357907.2022.2136683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Since the approval of the COVID-19 vaccines, their safety and efficacy has been widely demonstrated in patients with cancer. However, there remain patients with reservations regarding vaccination. We aimed to assess genitourinary cancer patients' perceptions of the vaccines as well as barriers and influencers of decision-making through the completion of a questionnaire. While vaccine-associated concerns were observed, most patients with genitourinary cancers were willing to receive the vaccine. Moving forward, differing strategies could be considered to enhance patient education on the utility of vaccination in the setting of cancer and beyond.
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Affiliation(s)
- Daniela V Castro
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Zeynep B Zengin
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Jasnoor Malhotra
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Cristiane D Bergerot
- Centro de Câncer de Brasília (CETTRO), Instituto Unity de Ensino e Pesquisa, Brasília, Brazil
| | - Luis Meza
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Nazli Dizman
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA.,Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ameish Govindarajan
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - JoAnn Hsu
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Alex Chehrazi-Raffle
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Neal Chawla
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Benjamin D Mercier
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Sean W Chen
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Matthew Feng
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Sweta Prajapati
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Kyle O Lee
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Errol J Philip
- University of California San Francisco (UCSF) School of Medicine, San Francisco, California, USA
| | - Tanya B Dorff
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Yung Lyou
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Sumanta K Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
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Costas-Muniz R, Torres-Blasco N, Gany F, Gonzalez CJ, Galindo-Vazquez O, Bergerot CD, Rocha-Cadman X, Lui F, Lichtenthal WG, Velazquez AI, Tergas AI, Castro-Figueroa EM. Cultural adaptation process of cancer-related interventions: A step-by-step guide. Psychooncology 2023; 32:179-186. [PMID: 36444126 PMCID: PMC9839501 DOI: 10.1002/pon.6071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To contribute to the reduction and elimination of cancer-related local and global health disparities, interventions must be culturally adapted to reach diverse cultural groups and demonstrate success in improving clinical and psychosocial outcomes. We provide step-by-step information on the conceptual and methodological challenges involved in culturally adapting interventions and provide guidelines, suggestions, tools, and concrete steps for implementing the process. METHODS This article provides information, guidelines, suggestions, tools, and concrete steps, based on three rigorous models of cultural adaptations, for implementing this process, followed with examples from the field, to illustrate the conceptual and methodological challenges involved in culturally adapting interventions. CONCLUSION Our systematic step-by-step approach recommends (1) the guidance of well-established research models; (2) use of multiple data sources and input from various stakeholders (i.e., from patients and providers); (3) qualitative and quantitative data usage and integration; (4) a steering committee with multiple perspectives, stakeholders assessments, and qualitative analyses; (5) consensus meetings; and (6) diverse representation on the steering committee and/or research team.
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Affiliation(s)
- Rosario Costas-Muniz
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA
| | - Normarie Torres-Blasco
- Department of Psychiatry and Human Behavior, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico, USA
| | - Francesca Gany
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA
| | - Carlos J Gonzalez
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Cristiane D Bergerot
- Centro de Cancer de Brasilia, Instituto Unity de Ensino e Pesquisa, Brasilia, Distrito Federal, Brazil
| | - Xiomara Rocha-Cadman
- Department of Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Florence Lui
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Wendy G Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA
| | - Ana I Velazquez
- Department of Medicine, Division of Hematology/Oncology, University of California, San Francisco, California, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Ana I Tergas
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Eida M Castro-Figueroa
- Department of Psychiatry and Human Behavior, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico, USA
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Castro DV, Dizman N, Zengin ZB, Malhotra J, Meza LA, Muddasani R, Govindarajan A, Chawla NS, Chehrazi-Raffle A, Hsu J, Bergerot PG, Bergerot CD, Dorff TB, Lyou Y, Pal SK. Abstract 6293: Genomic characteristics of nivolumab/ipilimumab with or without CBM-588 supplementation in patients with metastatic renal cell carcinoma. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-6293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In a previous randomized phase I trial, addition of CBM-588 to the nivolumab/ipilimumab (N/I) regimen showed improved objective response rate, clinical benefit rate, and progression free survival compared to N/I alone in patients (pts) with metastatic renal cell carcinoma (mRCC; Meza et al., ASCO 2021). Furthermore, genomic alterations such as PBRM1 have been associated with clinical benefit to anti-PD-1 monotherapy in patients with mRCC (Miao et al., Science 2018). The primary aim of this study was to investigate tumor genomic characteristics according to treatment arms.
Methods: We retrospectively identified pts with mRCC who received N/I alone or with CBM-588 supplementation along with whole exome and transcriptome sequencing (Ashion Analytics). Responses were measured according to RECIST v1.1. A two-tailed Fischer’s exact test was performed to compare genomic characteristics across arms.
Results: In this study, 29 mRCC pts were randomized to receive N/I +/- CBM-588 and 21 (72%) pts (71% in N/I with CBM-588 arm and 29% N/I arm) had available genomic data. Within this cohort, the median age was 66.8 (range 46-90) and 71% of pts were male. Eleven (52.4%) pts had clear-cell histology and 10 (47.6%) pts had sarcomatoid features; 15 pts received N/I with CBM-588 and 6 pts received N/I alone. The most commonly mutated genes in the overall cohort were VHL (61.9%), PBRM1 (42.9%), and SETD2 (33.3%). Alterations in VHL, PBRM1, and SETD2 were seen in 66.7% vs. 73.3% (p=0.115), 50.0% vs. 40.0% (p=0.523) and 33.3% vs. 33.3% (p=0.686), in N/I vs. N/I with CBM-588 arm, respectively.
Conclusions: There was no significant difference observed in clinically relevant genomic features across study arms. The clinical benefit from CBM-588 appears to be independent of tumor genomic characteristics. More extensive investigations are needed to characterize the determinants of benefit from CBM-588 supplementation.
Citation Format: Daniela V. Castro, Nazli Dizman, Zeynep B. Zengin, Jasnoor Malhotra, Luis A. Meza, Ramya Muddasani, Ameish Govindarajan, Neal S. Chawla, Alex Chehrazi-Raffle, JoAnn Hsu, Paulo G. Bergerot, Cristiane D. Bergerot, Tanya B. Dorff, Yung Lyou, Sumanta K. Pal. Genomic characteristics of nivolumab/ipilimumab with or without CBM-588 supplementation in patients with metastatic renal cell carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 6293.
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Affiliation(s)
| | - Nazli Dizman
- 1City of Hope Comprehensive Cancer Center, Duarte, CA
| | | | | | - Luis A. Meza
- 1City of Hope Comprehensive Cancer Center, Duarte, CA
| | | | | | | | | | - JoAnn Hsu
- 1City of Hope Comprehensive Cancer Center, Duarte, CA
| | | | | | | | - Yung Lyou
- 1City of Hope Comprehensive Cancer Center, Duarte, CA
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7
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Benton JZ, Bergerot CD, Woodruff P, Williams SB, Wallis CJD, Klaassen Z. Mental health screening and diagnosis in cancer patients: Impact on mortality and suggestion of racial bias. Cancer 2021; 128:234-236. [PMID: 34550606 DOI: 10.1002/cncr.33901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/14/2021] [Accepted: 08/18/2021] [Indexed: 11/08/2022]
Affiliation(s)
| | - Cristiane D Bergerot
- Centro de Cancer de Brasilia (CETTRO), Instituto Unity de Ensino e Pesquisa, Brasilia, DF, Brazil
| | - Phillip Woodruff
- St. George's University School of Medicine, St. George's, Grenada
| | - Stephen B Williams
- Division of Urology, The University of Texas Medical Brach at Galveston, Galveston, Texas
| | - Christopher J D Wallis
- Department of Urological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Zachary Klaassen
- Department of Surgery, Section of Urology, Medical College of Georgia-Augusta University, Augusta, Georgia.,Georgia Cancer Center, Augusta, Georgia
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8
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Jazzar U, Bergerot CD, Shan Y, Wallis CJD, Freedland SJ, Kamat AM, Tyler DS, Baillargeon J, Kuo YF, Klaassen Z, Williams SB. Use of psychotropic drugs among older patients with bladder cancer in the United States. Psychooncology 2021; 30:832-843. [PMID: 33507622 DOI: 10.1002/pon.5641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/09/2021] [Accepted: 01/24/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Older patients diagnosed with cancer are at increased risk of physical and emotional distress; however, prescription utilization patterns largely remain to be elucidated. Our objective was to comprehensively assess prescription patterns and predictors in older patients with bladder cancer. METHODS A total of 10,516 older patients diagnosed with clinical stage T1-T4a, N0, M0 bladder urothelial carcinoma from 1 January 2008 to 31 December 2012 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare were analyzed. We used multivariable analysis to determine predictors associated with psychotropic prescription rates (one or more). Medication possession ratio (MPR) was used as an index to measure adherence in intervals of 3 months, 6 months, 1 year, and 2 years. Evaluation of psychotropic prescribing patterns and adherence across different drugs and demographic factors was done. RESULTS Of the 10,516 older patients, 5621 (53%) were prescribed psychotropic drugs following cancer diagnosis. Overall, 3972 (38%) patients had previous psychotropic prescriptions prior to cancer diagnosis, and these patients were much more likely to receive a post-cancer diagnosis prescription. Prescription rates for psychotropic medications were higher among patients with higher stage BC (p < 0.001). Gamma aminobutyric acid modulators/stimulators and serotonin reuptake inhibitors/stimulators were the highest prescribed psychotropic drugs in 21% of all patients. Adherence for all drugs was 32% at 3 months and continued to decrease over time. CONCLUSION Over half of the patients received psychotropic prescriptions within 2 years of their cancer diagnosis. Given the chronicity of psychiatric disorders with observed significantly low adherence to medications that warrants an emphasis on prolonged patient monitoring and further investigation.
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Affiliation(s)
- Usama Jazzar
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Cristiane D Bergerot
- Centro de Câncer de Brasília, Instituto Unity de Ensino e Pesquisa, Brasilia, Distrito Federal, Brazil
| | - Yong Shan
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | | | - Stephen J Freedland
- Department of Urology, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Douglas S Tyler
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Jacques Baillargeon
- Department of Preventive Medicine and Community Health, Sealy Center of Aging, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, Sealy Center of Aging, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Zachary Klaassen
- Department of Surgery, Section of Urology, Medical College of Georgia-Augusta University, Augusta, Georgia, USA
- Georgia Cancer Center, Augusta, Georgia, USA
| | - Stephen B Williams
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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Jazzar U, Shan Y, Bergerot CD, Wallis CJD, Freedland SJ, Kamat AM, Tyler DS, Baillargeon, Kuo YF, Klaassen Z, Williams SB. Use of Psychotropic Drugs Among Bladder Cancer Patients in the United States. Urol Oncol 2020. [DOI: 10.1016/j.urolonc.2020.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Bergerot CD, Razavi M, Philip EJ, Bergerot PG, Buso MM, Clark KL, Loscalzo M, Pal SK, Dale W. Association between hospital anxiety and depression scale and problem-related distress in patients with cancer in a Brazilian private institution. Psychooncology 2020; 30:296-302. [PMID: 33044794 DOI: 10.1002/pon.5571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/27/2020] [Revised: 08/23/2020] [Accepted: 10/07/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Emotional symptoms are frequently reported among patients with cancer. We evaluated the association between emotional symptoms and problem-related distress in a sample of patients with cancer about to initiate chemotherapy within a private hospital in Brazil. METHODS Patients were assessed before initiating chemotherapy, treatment mid-point, and on the last day of treatment for anxiety and depression (Hospital Anxiety and Depression Scale [HADS]) and for problem-related distress (Distress Thermometer Problem List). Problem-related distress variable was computed as the sum of practical, physical, spiritual and familial problems. Mixed-model analysis was applied to determine the association between HADS and problem-related distress, adjusting for age and gender. RESULTS A total of 655 consecutive patients were enrolled. There was a significant main effect of time (F = 8.99, p = 0.0001), showing that emotional symptoms improve over time. A significant main effect was observed for problem-related distress (F = 371.56, p < 0.0001) revealing that patients with elevated problem-related distress at baseline tend to have higher HADS across the three time points, compared to patients with lower problem-related distress. There was an interaction effect between problem-related distress and time (F = 85.22, p < 0.0001), suggesting that HADS scores decreased differently over time, depending on patients' initial level of problem-related distress. CONCLUSION Overall, emotional symptoms, while decreasing over time, remained associated with problem-related distress after chemotherapy in Brazil. The potential benefit of implementing a psychosocial intervention remains high throughout cancer treatment.
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Affiliation(s)
- Cristiane D Bergerot
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA.,Instituto Unity de Ensino e Pesquisa, Centro de Câncer de Brasília (CETTRO), Brasília, DF, Brazil
| | - Marianne Razavi
- Department of Supportive Care Medicine, City of Hope-National Medical Center, Duarte, California, USA
| | - Errol J Philip
- Medical School, University of California San Francisco, San Francisco, California, USA
| | - Paulo G Bergerot
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA.,Instituto Unity de Ensino e Pesquisa, Centro de Câncer de Brasília (CETTRO), Brasília, DF, Brazil
| | - Marco M Buso
- Department of Oncology, Centro de Câncer de Brasília (CETTRO), Brasília, DF, Brazil
| | - Karen L Clark
- Department of Supportive Care Medicine, City of Hope-National Medical Center, Duarte, California, USA
| | - Matthew Loscalzo
- Department of Supportive Care Medicine, City of Hope-National Medical Center, Duarte, California, USA
| | - Sumanta K Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - William Dale
- Department of Supportive Care Medicine, City of Hope-National Medical Center, Duarte, California, USA
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11
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Staehler MD, Battle DJ, Bergerot CD, Pal SK, Penson DF. COVID-19 and financial toxicity in patients with renal cell carcinoma. World J Urol 2020; 39:2559-2565. [PMID: 33090258 PMCID: PMC7578440 DOI: 10.1007/s00345-020-03476-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/01/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose To ascertain renal cell carcinoma (RCC) financial toxicity on COVID-19 during the COVID-19 crisis as patients are struggling with therapeutic and financial implications. Methods An online survey was conducted from March 22 to March 25, 2020. It included baseline demographic, clinicopathologic, treatment-related information, anxiety levels related to COVID-19, questions related to financial concerns about COVID-19 as well as the validated 11-item COST measure. Results Five-hundred-and-thirty-nine patients (39%:58% male:female) from 14 countries responded. 23% of the patients did not feel in control of their financial situation but 8% reported being very satisfied with their finances. The median COST score was 21.5 (range 1–44). Metastatic patients who have not started systemic therapy had a COST score (19.8 range 2–41) versus patients on oral systemic therapy had a COST score (23.9 range 4–44). Patients in follow-up after surgery had a median COST score at 20.8 (range 1–40). A low COST scores correlated (p < 0.001) were female gender (r = 0.108), younger age (r = 0.210), urban living situation (r = 0.68), a lower educational level (r = 0.155), lower income (r = 0.165), higher anxiety about acquiring COVID-19 (r = 0.198), having metastatic disease (r = 0.073) and a higher distress score about cancer progression (r = 0.224). Conclusion Our data highlight severe financial impact of COVID-19. Acknowledging financial hardship and thorough counseling of cancer patients should be part of the conversation during the pandemic. Treatment and surveillance of RCC patients might have to be adjusted to contemplate financial and medical needs. Electronic supplementary material The online version of this article (10.1007/s00345-020-03476-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael D Staehler
- Department of Urology, Ludwig-Maximilians University, University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Dena J Battle
- Kidney Cancer Research Alliance (KCCure), Alexandria, VA, USA
| | - Cristiane D Bergerot
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sumanta Kumar Pal
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
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12
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Jazzar U, Shan Y, Klaassen Z, Freedland SJ, Kamat AM, Raji MA, Masel T, Tyler DS, Baillargeon J, Kuo YF, Mehta HB, Bergerot CD, Williams SB. Impact of Alzheimer's disease and related dementia diagnosis following treatment for bladder cancer. J Geriatr Oncol 2020; 11:1118-1124. [PMID: 32354675 DOI: 10.1016/j.jgo.2020.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/30/2020] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Our objective was to assess the incidence of Alzheimer's Disease and related dementia diagnosis following treatment for muscle-invasive bladder cancer and impact on survival outcomes. MATERIALS AND METHODS A total of 4814 patients diagnosed with clinical stage T2-T4a, N0, M0 bladder cancer between January 1, 2002 to December 31, 2011 using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database were identified. Alzheimer's disease and related dementia diagnosis was identified using International Statistical Classification of Disease-Ninth Edition outpatient and inpatient codes. Incidence of dementia following treatment were calculated and reported as dementia cases per 10,000 person-years. Cox proportional hazards models were used to assess the impact of dementia on survival outcomes. RESULTS Of the 4814 patients, 2403 (49.9%) underwent radical cystectomy (RC) and 2411 (50.1%) underwent radiotherapy (RTX) and/or chemotherapy (CTX). Overall, 837 (17.4%) patients developed Alzheimer's disease and related dementia following bladder cancer treatment. There was no significant difference in the incidence of Alzheimer's disease and related dementia following either treatment. Patients diagnosed with Alzheimer's disease and related dementia had worse overall (Hazard Ratio (HR), 2.64; 95% Confidence Interval (CI), 2.41-2.89) and cancer-specific (HR, 2.45; 95% CI, 2.18-2.76) survival than those without a dementia diagnosis following treatment. CONCLUSION While we observed no difference in new-onset Alzheimer's disease and related dementia diagnosis following RC or RTX and/or CTX, patients with a Alzheimer's and related dementia diagnosis was associated with worse overall and cancer-specific survival. These findings have important implications for screening and the development of targeted interventions for improving outcomes in older adults following complex cancer treatments, as observed in this bladder cancer population.
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Affiliation(s)
- Usama Jazzar
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States of America
| | - Yong Shan
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States of America
| | - Zachary Klaassen
- Department of Surgery, Section of Urology, Medical College of Georgia, Georgia Regents University, Augusta, GA, United States of America
| | - Stephen J Freedland
- Department of Urology, Cedars Sinai Medical Center, Los Angeles, CA, United States of America
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Mukaila A Raji
- Department of Preventive Medicine and Community Health, Sealy Center of Aging, The University of Texas Medical Branch, Galveston, TX, United States of America
| | - Todd Masel
- Department of Neurology, The University of Texas Medical Branch, Galveston, TX, United States of America
| | - Douglas S Tyler
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX, United States of America
| | - Jacques Baillargeon
- Department of Preventive Medicine and Community Health, Sealy Center of Aging, The University of Texas Medical Branch, Galveston, TX, United States of America
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, Sealy Center of Aging, The University of Texas Medical Branch, Galveston, TX, United States of America
| | - Hemalkumar B Mehta
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX, United States of America
| | - Cristiane D Bergerot
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, United States of America
| | - Stephen B Williams
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States of America.
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13
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Dizman N, Bergerot PG, Bergerot CD, Hsu J, Pal SK. Targeted Therapies Following First-Line Immune Checkpoint Inhibitor Combination in Metastatic Renal Cell Carcinoma: A Single Center Experience. KCA 2019. [DOI: 10.3233/kca-190056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Nazli Dizman
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Paulo G. Bergerot
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Cristiane D. Bergerot
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - JoAnn Hsu
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Sumanta K. Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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Dizman N, Adashek JJ, Hsu J, Bergerot PG, Bergerot CD, Pal SK. Adjuvant treatment in renal cell carcinoma. Clin Adv Hematol Oncol 2018; 16:555-563. [PMID: 30148828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In parallel with advances in the treatment of metastatic renal cell carcinoma (RCC), multiple adjuvant treatments have been tested for RCC. Adjuvant approaches now extend beyond conventional immunotherapies, such as interferon alfa and interleukins, to targeted therapies and immune checkpoint inhibitors. Most treatment approaches before the targeted treatment era did not improve patient outcomes, or study results were mixed. For example, a recent study found that disease-free survival was longer with sunitinib than with placebo in high-risk clear cell RCC, which led to the regulatory approval of sunitinib. However, another large study of adjuvant sunitinib in a slightly different patient population did not confirm these results. Ongoing studies of targeted treatments and immune checkpoint inhibitors may clarify the effectiveness of these agents in the near future. This review presents a comprehensive, chronologic examination of studies addressing adjuvant treatment in RCC, focusing on the key differences between similar approaches. It also discusses the future of adjuvant treatment in RCC.
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Affiliation(s)
- Nazli Dizman
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jacob J Adashek
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, California
| | - JoAnn Hsu
- City of Hope Comprehensive Cancer Center, Duarte, California
| | | | | | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, California
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15
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Bergerot PG, Bergerot CD, Dizman N, Zequi S, Fay A, Dara Y, Maia MC, Cotta BN, Gonçalves EP, Formiga MN, Tariki MS, Clavijo DA, Choueiri TK, Lopes G, Pal SK. Assessment of Treatment Patterns for Metastatic Renal Cell Carcinoma in Brazil. J Glob Oncol 2017; 4:1-8. [PMID: 29281478 PMCID: PMC6180782 DOI: 10.1200/jgo.17.00113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Although multiple therapies have emerged for the treatment of metastatic
renal cell carcinoma (mRCC), it is unclear whether application of these
agents is consistent in developed and developing countries. We sought to
determine patterns of care for mRCC in Brazil as a representative developing
country. Material and Methods A commercial database was used to acquire information pertaining to patients
with mRCC receiving treatment at private or public hospitals in Brazil
between March 2013 and October 2016. Basic clinical and demographic criteria
were available, as well as information to ascertain the International
Metastatic Renal Cell Carcinoma Database Consortium risk. Treatment-related
data across multiple lines of therapy were collected. Results Of 4,379 patients assessed, 3,990 (91%) had metastatic disease, and 26%, 48%,
and 26% of patients had good, intermediate, and poor International
Metastatic Renal Cell Carcinoma Database Consortium risk disease,
respectively. Although 3,149 patients (79%) received first-line therapy,
only 641 (20%) and 152 (5%) received second- and third-line therapy,
respectively. In the first-line setting, vascular endothelial growth
factor–directed agents represented the most commonly used therapy,
whereas in the second-line setting, vascular endothelial growth
factor– and mammalian target of rapamycin–directed agents were
used with similar frequency. Marked differences were seen in receipt of
systemic therapy on the basis of treatment in private or public
hospitals. Conclusion Relative to developed countries, marked attrition is noted between each
subsequent line of therapy in Brazil. Patterns of care also vary greatly in
private and public settings, pointing to financial constraints as a
potential cause for discordances in treatment.
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Affiliation(s)
- Paulo G Bergerot
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Cristiane D Bergerot
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Nazli Dizman
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Stenio Zequi
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Andre Fay
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Yash Dara
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Manuel Caitano Maia
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Brendan N Cotta
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Edna Prado Gonçalves
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Maria Nirvana Formiga
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Milena Shizue Tariki
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Diego Abreu Clavijo
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Toni K Choueiri
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Gilberto Lopes
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
| | - Sumanta K Pal
- Paulo G. Bergerot and Cristiane D. Bergerot, Universidade Federal de Sao Paulo; Stenio Zequi, Maria Nirvana Formiga, and Milena Shizue Tariki, A.C. Camargo Comprehensive Cancer Center; Edna Prado Gonçalves, Close-Up International, Sao Paulo; Andre Fay, PUCRS School of Medicine, Porto Alegre, Brazil; Paulo G. Bergerot, Cristiane D. Bergerot, Nazli Dizman, Yash Dara, Manuel Caitano Maia, Brendan N. Cotta, and Sumanta K. Pal, City of Hope Comprehensive Cancer Center, Duarte, CA; Diego Abreu Clavijo, Pasteur Hospital, Montevideo, Uruguay; Toni K. Choueiri, Dana-Farber Cancer Institute, Boston, MA; and Gilberto Lopes, University of Miami Sylvester Cancer Center, Miami, FL
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