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Moore M, Gill S, Asmis T, Berry S, Burkes R, Zbuk K, Alcindor T, Jeyakumar A, Chan T, Rao S, Spratlin J, Tang PA, Rothenstein J, Chan E, Bendell J, Kudrik F, Kauh J, Tang S, Gao L, Kambhampati SRP, Nasroulah F, Yang L, Ramdas N, Binder P, Strevel E. Randomized phase II study of modified FOLFOX-6 in combination with ramucirumab or icrucumab as second-line therapy in patients with metastatic colorectal cancer after disease progression on first-line irinotecan-based therapy. Ann Oncol 2016; 27:2216-2224. [PMID: 27733377 DOI: 10.1093/annonc/mdw412] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 03/10/2016] [Revised: 08/02/2016] [Accepted: 08/10/2016] [Indexed: 12/16/2023] Open
Abstract
BACKGROUND Icrucumab and ramucirumab are recombinant human IgG1 monoclonal antibodies that bind VEGF receptors 1 and 2 (VEGFR-1 and -2), respectively. This randomized phase II study evaluated the antitumor activity and safety of icrucumab and ramucirumab each in combination with mFOLFOX-6 in patients with metastatic colorectal cancer after disease progression on first-line therapy with a fluoropyrimidine and irinotecan. PATIENTS AND METHODS Eligible patients were randomly assigned to receive mFOLFOX-6 alone (mFOLFOX-6) or in combination with ramucirumab 8 mg/kg IV (RAM+mFOLFOX-6) or icrucumab 15 mg/kg IV (ICR+mFOLFOX-6) every 2 weeks. Randomization was stratified by prior bevacizumab therapy. The primary end point was progression-free survival (PFS). Secondary end points included overall survival (OS), tumor response, safety, and PK. RESULTS In total, 158 patients were randomized, but only 153 received treatment (49 on mFOLFOX-6, 52 on RAM+mFOLFOX-6, and 52 on ICR+mFOLFOX-6). Median PFS was 18.4 weeks on mFOLFOX-6, 21.4 weeks on RAM+mFOLFOX-6, and 15.9 weeks on ICR+mFOLFOX-6 (RAM+mFOLFOX-6 versus mFOLFOX-6, stratified hazard ratio [HR] 1.116 [95% CI 0.713-1.745], P = 0.623; ICR+mFOLFOX-6 versus mFOLFOX-6, stratified HR 1.603 [95% CI 1.011-2.543], P = 0.044). Median survival was 53.6 weeks on mFOLFOX-6, 41.7 weeks on RAM+mFOLFOX-6, and 42.0 weeks on ICR+mFOLFOX-6. The most frequent adverse events reported on the ramucirumab arm (RAM+mFOLFOX-6) were fatigue, nausea, and peripheral sensory neuropathy; those on the icrucumab arm (ICR+mFOLFOX-6) were fatigue, diarrhea, and peripheral sensory neuropathy. Grade ≥3 serious adverse events occurred at comparable frequency across arms. CONCLUSIONS In this study population, combining ramucirumab or icrucumab with mFOLFOX-6 did not achieve the predetermined improvement in PFS. CLINICALTRIALSGOV NCT01111604.
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Affiliation(s)
- M Moore
- British Columbia Cancer Agency, Vancouver Cancer Centre, Vancouver
| | - S Gill
- British Columbia Cancer Agency, Vancouver Cancer Centre, Vancouver
| | - T Asmis
- The Ottawa Hospital Cancer Centre, Ottawa
| | - S Berry
- Sunnybrook Odette Cancer Centre, Toronto
| | | | - K Zbuk
- Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton
| | - T Alcindor
- Department of Oncology, McGill University, Montréal
| | - A Jeyakumar
- Atlantic Clinical Cancer Research Unit, QEII Health Sciences Centre, Nova Scotia Cancer Centre, Halifax
| | - T Chan
- Fraser Valley Cancer Centre, British Columbia Cancer Agency, Surrey
| | - S Rao
- Kelowna Cancer Centre, British Columbia Cancer Agency, Kelowna
| | | | - P A Tang
- Tom Baker Cancer Centre, Calgary
| | - J Rothenstein
- RSM Durham Regional Cancer Centre, Lakeridge Health Oshawa, Oshawa, Canada
| | - E Chan
- Vanderbilt-Ingram Cancer Center, Nashville
| | - J Bendell
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville
| | - F Kudrik
- South Carolina Oncology Associates, Sarah Cannon Research Institute, Columbia
| | - J Kauh
- Eli Lilly and Company, Indianapolis, USA
| | - S Tang
- Eli Lilly and Company, Indianapolis, USA
| | - L Gao
- Eli Lilly and Company, Indianapolis, USA
| | | | | | - L Yang
- Eli Lilly and Company, Indianapolis, USA
| | - N Ramdas
- Eli Lilly and Company, Indianapolis, USA
| | - P Binder
- Eli Lilly and Company, Indianapolis, USA
| | - E Strevel
- Trillium Health Partners, Mississauga, Canada
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Berry SR, Neumann PJ, Bell C, Nadler E, Evans WC, Palmer J, Strevel E, Ubel PA. What price for a year of life? A survey of U.S. and Canadian oncologists. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.6565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6565 Background: New cancer drugs are increasingly expensive and raise difficult questions about the magnitude of therapeutic benefit needed to justify their incremental cost. In this context, it is unclear whether oncologists endorse standard thresholds of $50,000 to $100,000 per year of life. Methods: We surveyed 1,379 U.S. and 356 Canadian (Cdn) oncologists and asked how much longer a patient would need to survive metastatic cancer to justify the expense of a new treatment. To determine the stability of attitudes towards cost-effectiveness (CE) we randomized oncologists to receive two different versions of the scenario in which the price of the new treatment was varied (higher versus lower drug cost). In the U.S. survey, oncologists were also randomized to receive surveys in which we varied the provision of contextual information about the CE of several familiar interventions. Both U.S. and Cdn oncologists were asked to indicate what they “thought was ‘good value for money’ expressed as cost per life-year gained (LYG).” Results: Response rate was 57% in the U.S. and 48% in Canada. CE ratios implied by oncologists’ responses differed significantly between the groups randomized to the higher versus lower price of the hypothetical treatment (p < 0.001 U.S., p < 0.0001 Canada), but were independent of randomization to varying contextual information (p > 0.1). The median willingness to pay for a quality-adjusted year of life ranged from $150,000 (for oncologists considering the lower priced drug) to $250,000 (for those considering the more expensive drug) in both countries. Among those who considered the more expensive drug, 25% of respondents implicitly endorsed a CE ratio greater than $600,000 (U.S.) and $500,000 (Canada). In contrast, when asked directly to indicate CE ratios that were good value for the money outside of the clinical scenario, 70% (U.S.) and 64% (Canada) of respondents indicated values of less than $100,000 per LYG. Conclusions: Oncologists responding to our survey provided inconsistent views on how much benefit expensive new drugs should provide to be worthwhile. This suggests that means of eliciting input from physicians that reflect more stable attitudes need to be developed to appropriately inform decision-makers. No significant financial relationships to disclose.
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Affiliation(s)
- S. R. Berry
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; Tufts Medical Center, Boston, MA; St. Michael's Hospital, Toronto, ON, Canada; Baylor Sammons Cancer Center, Waco, TX; Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada; Peel Regional Cancer Centre, U of Toronto, Mississauga, ON, Canada; Center for Decision and Behavioral Sciences, University of Michigan, Ann Arbor, MI
| | - P. J. Neumann
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; Tufts Medical Center, Boston, MA; St. Michael's Hospital, Toronto, ON, Canada; Baylor Sammons Cancer Center, Waco, TX; Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada; Peel Regional Cancer Centre, U of Toronto, Mississauga, ON, Canada; Center for Decision and Behavioral Sciences, University of Michigan, Ann Arbor, MI
| | - C. Bell
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; Tufts Medical Center, Boston, MA; St. Michael's Hospital, Toronto, ON, Canada; Baylor Sammons Cancer Center, Waco, TX; Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada; Peel Regional Cancer Centre, U of Toronto, Mississauga, ON, Canada; Center for Decision and Behavioral Sciences, University of Michigan, Ann Arbor, MI
| | - E. Nadler
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; Tufts Medical Center, Boston, MA; St. Michael's Hospital, Toronto, ON, Canada; Baylor Sammons Cancer Center, Waco, TX; Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada; Peel Regional Cancer Centre, U of Toronto, Mississauga, ON, Canada; Center for Decision and Behavioral Sciences, University of Michigan, Ann Arbor, MI
| | - W. C. Evans
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; Tufts Medical Center, Boston, MA; St. Michael's Hospital, Toronto, ON, Canada; Baylor Sammons Cancer Center, Waco, TX; Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada; Peel Regional Cancer Centre, U of Toronto, Mississauga, ON, Canada; Center for Decision and Behavioral Sciences, University of Michigan, Ann Arbor, MI
| | - J. Palmer
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; Tufts Medical Center, Boston, MA; St. Michael's Hospital, Toronto, ON, Canada; Baylor Sammons Cancer Center, Waco, TX; Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada; Peel Regional Cancer Centre, U of Toronto, Mississauga, ON, Canada; Center for Decision and Behavioral Sciences, University of Michigan, Ann Arbor, MI
| | - E. Strevel
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; Tufts Medical Center, Boston, MA; St. Michael's Hospital, Toronto, ON, Canada; Baylor Sammons Cancer Center, Waco, TX; Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada; Peel Regional Cancer Centre, U of Toronto, Mississauga, ON, Canada; Center for Decision and Behavioral Sciences, University of Michigan, Ann Arbor, MI
| | - P. A. Ubel
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; Tufts Medical Center, Boston, MA; St. Michael's Hospital, Toronto, ON, Canada; Baylor Sammons Cancer Center, Waco, TX; Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada; Peel Regional Cancer Centre, U of Toronto, Mississauga, ON, Canada; Center for Decision and Behavioral Sciences, University of Michigan, Ann Arbor, MI
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Neumann P, Berry SR, Nadler E, Evans WC, Palmer J, Bell C, Strevel E, Fang H, Ubel PA. A survey of U.S. and Canadian oncologists’ attitudes toward the cost, cost-effectiveness (CE), and reimbursement of cancer drugs. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.9502] [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: 11/20/2022] Open
Abstract
9502 Background: Drug costs and reimbursement issues offer significant challenges to U.S. and Canadian oncologists even though they practice in substantially different health care systems. However, little is known about the attitudes of American and Canadian oncologists towards these issues. Methods: We surveyed 1,379 U.S. and 356 Cdn oncologists to assess their attitudes to cancer drug costs, CE and reimbursement policies. Results: Response rate was 57% in the U.S. and 48% in Canada. Oncologists in both countries stated that patients' “out-of-pocket” drug costs influenced their treatment recommendations (84% U.S., 80% Cdn respondents). Most respondents felt that every patient should have access to effective cancer treatments regardless of cost (66% US; 54% Cdn), while 59% of U.S. and 72% of Cdn and respondents believed that patients should only have access to effective cancer treatments that provided “good value for money.” 70% of U.S. and 64% Cdn respondents felt that <$100,000 per life year gained was a reasonable definition of “good value for money” but less than half of respondents (42% US, 49% Cdn) felt well prepared to interpret and use CE information in their treatment decisions. A majority of respondents (57% US, 69% Cdn) felt government price controls for cancer drugs are needed while a minority felt that more cost-sharing by patients was needed (29% US, 37% Cdn). Most oncologists felt that evaluating whether a drug provides “good value” should be overseen by an independent non-profit agency (57% US, 71% Cdn) or physicians (61% US and Cdn); in contrast, few believed that government (21% US, 33% Cdn), patients (36% US, 37% Cdn) or insurance companies (6% US, 10% Cdn) should determine “good value”. 79% of U.S. and 69% of Cdn respondents felt more use of CE data in coverage and reimbursement decisions is needed. Conclusions: Oncologists in the U.S. and Canada share many similar attitudes to cancer drug costs, CE, and reimbursement policies despite differences in their health care systems. In both countries, oncologists favor more use of CE information. No significant financial relationships to disclose.
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Affiliation(s)
- P. Neumann
- Tufts Medical Center, Boston, MA; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; Baylor Sammons Cancer Center, Waco, TX; Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada; St. Michael's Hospital, Toronto, ON, Canada; Peel Regional Cancer Centre, University of Toronto, Mississauga, ON, Canada; Center for Decision and Behavioral Sciences, University of Michigan, Ann Arbor, MI
| | - S. R. Berry
- Tufts Medical Center, Boston, MA; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; Baylor Sammons Cancer Center, Waco, TX; Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada; St. Michael's Hospital, Toronto, ON, Canada; Peel Regional Cancer Centre, University of Toronto, Mississauga, ON, Canada; Center for Decision and Behavioral Sciences, University of Michigan, Ann Arbor, MI
| | - E. Nadler
- Tufts Medical Center, Boston, MA; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; Baylor Sammons Cancer Center, Waco, TX; Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada; St. Michael's Hospital, Toronto, ON, Canada; Peel Regional Cancer Centre, University of Toronto, Mississauga, ON, Canada; Center for Decision and Behavioral Sciences, University of Michigan, Ann Arbor, MI
| | - W. C. Evans
- Tufts Medical Center, Boston, MA; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; Baylor Sammons Cancer Center, Waco, TX; Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada; St. Michael's Hospital, Toronto, ON, Canada; Peel Regional Cancer Centre, University of Toronto, Mississauga, ON, Canada; Center for Decision and Behavioral Sciences, University of Michigan, Ann Arbor, MI
| | - J. Palmer
- Tufts Medical Center, Boston, MA; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; Baylor Sammons Cancer Center, Waco, TX; Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada; St. Michael's Hospital, Toronto, ON, Canada; Peel Regional Cancer Centre, University of Toronto, Mississauga, ON, Canada; Center for Decision and Behavioral Sciences, University of Michigan, Ann Arbor, MI
| | - C. Bell
- Tufts Medical Center, Boston, MA; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; Baylor Sammons Cancer Center, Waco, TX; Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada; St. Michael's Hospital, Toronto, ON, Canada; Peel Regional Cancer Centre, University of Toronto, Mississauga, ON, Canada; Center for Decision and Behavioral Sciences, University of Michigan, Ann Arbor, MI
| | - E. Strevel
- Tufts Medical Center, Boston, MA; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; Baylor Sammons Cancer Center, Waco, TX; Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada; St. Michael's Hospital, Toronto, ON, Canada; Peel Regional Cancer Centre, University of Toronto, Mississauga, ON, Canada; Center for Decision and Behavioral Sciences, University of Michigan, Ann Arbor, MI
| | - H. Fang
- Tufts Medical Center, Boston, MA; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; Baylor Sammons Cancer Center, Waco, TX; Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada; St. Michael's Hospital, Toronto, ON, Canada; Peel Regional Cancer Centre, University of Toronto, Mississauga, ON, Canada; Center for Decision and Behavioral Sciences, University of Michigan, Ann Arbor, MI
| | - P. A. Ubel
- Tufts Medical Center, Boston, MA; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; Baylor Sammons Cancer Center, Waco, TX; Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada; St. Michael's Hospital, Toronto, ON, Canada; Peel Regional Cancer Centre, University of Toronto, Mississauga, ON, Canada; Center for Decision and Behavioral Sciences, University of Michigan, Ann Arbor, MI
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