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Goldschmidt JH, Annavarapu S, Venkatasetty D, Wang Y, Santorelli ML, Burke T, Pennell NA. Outcomes for pembrolizumab stratified by pemetrexed maintenance post pembrolizumab-platinum-pemetrexed induction in metastatic non-small-cell lung cancer. Immunotherapy 2024; 16:453-464. [PMID: 38487917 DOI: 10.2217/imt-2023-0313] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Aim: We assessed treatment patterns and outcomes in patients with metastatic nonsquamous non-small-cell lung cancer (mNSCLC) who initiated first-line pembrolizumab-platinum-pemetrexed (induction) in US community oncology settings. Methods: Patients initiating induction were retrospectively identified. Patients continuing pembrolizumab afterward underwent chart review. Clinical outcomes were described by maintenance pemetrexed exposure after inverse probability of treatment weighting (IPTW). Results: Median induction pembrolizumab and pemetrexed durations were 5.1 and 4.2 months. Among patients continuing pembrolizumab after induction, 64% received maintenance pemetrexed. Common discontinuation reasons for induction pemetrexed were completion of planned therapy (79%) and partial response (68%) and progressive disease (38%) and toxicity (29%) for maintenance pemetrexed. After IPTW, median overall survival and real-world progression-free survival were longer in patients continuing pembrolizumab with versus without maintenance pemetrexed (20.3 vs 12.0 months and 10.3 vs 5.8 months, respectively). Conclusion: Patient characteristics and planned treatment decisions affect maintenance pemetrexed utilization in the community oncology setting.
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Fragkoudi A, Rumbold AR, Burke T, Grzeskowiak LE. "A qualitative study of multiple sclerosis specialists' experiences and perspectives in managing family planning in people with multiple sclerosis". Mult Scler Relat Disord 2024; 82:105409. [PMID: 38176286 DOI: 10.1016/j.msard.2023.105409] [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: 09/21/2023] [Revised: 11/02/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Managing multiple sclerosis (MS) in people of reproductive age can be challenging as treatment decisions often need to balance efficacy, safety to reproductive health and an understanding of reproductive intentions. There has been limited examination of how family planning (FP) is approached in people with MS (pwMS) in Australia. This study aimed to explore the experiences and perspectives of Australian MS clinical specialists on managing FP in the context of MS. METHODS We conducted one-on-one semi-structured interviews with nine neurologists and ten MS nurses across Australia who regularly provide care to pwMS of reproductive age. Interview topics examined current approaches to managing FP, availability of FP resources, and opportunities for improvement. Interview recordings were transcribed verbatim and analysed thematically. RESULTS Two main themes emerged. First, 'inconsistent approaches in providing family planning', where neurologists and MS nurses recognised FP provision as essential but revealed differences in the content, timing and extent of FP discussions; conflicts between reproductive considerations and DMT prescriptions according to teratogenic risk; and variable implementation of interdisciplinary approaches. Second, 'barriers in providing family planning' emerged which included a lack of local information resources on FP, lack of contemporary data on safety of DMTs, and a range of patient and professional factors, including time constraints. CONCLUSION MS clinical specialists saw FP as an essential part of the care of their patients and expressed a need for information and service provision consistency in order to improve FP and reproductive care to pwMS.
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Affiliation(s)
- A Fragkoudi
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.
| | - A R Rumbold
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - T Burke
- School of Nursing, University of Notre Dame, Sydney, Australia
| | - L E Grzeskowiak
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Women and Kids Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Gentili N, Balzi W, Foca F, Danesi V, Altini M, Delmonte A, Bronte G, Crinò L, De Luigi N, Mariotti M, Verlicchi A, Burgio MA, Roncadori A, Burke T, Massa I. Healthcare Costs and Resource Utilisation of Italian Metastatic Non-Small Cell Lung Cancer Patients. Cancers (Basel) 2024; 16:592. [PMID: 38339345 PMCID: PMC10854909 DOI: 10.3390/cancers16030592] [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: 12/21/2023] [Revised: 01/12/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
This study evaluated the economic burden of metastatic non-small cell lung cancer patients before and after the availability of an immuno-oncology (IO) regimen as a first-line (1L) treatment. Patients from 2014 to 2020 were categorized according to mutational status into mutation-positive and negative/unknown groups, which were further divided into pre-1L IO and post-1L IO sub-groups depending on the availability of pembrolizumab monotherapy in 1L. Healthcare costs and HCRU for a 1L treatment and overall follow-up were reported as the mean total and per-month cost per patient by groups. Of 644 patients, 125were mutation-positive and 519 negative/unknown (229 and 290 in pre- and post-1L IO, respectively). The mean total per-patient cost in 1L was lower in pre- (EUR 7804) and post-1L IO (EUR 19,301) than the mutation-positive group (EUR 45,247), persisting throughout overall disease follow-up. However, this difference was less when analyzing monthly costs. Therapy costs were the primary driver in 1L, while hospitalization costs rose during follow-up. In both mutation-positive and post-IO 1L groups, the 1L costs represented a significant portion (70.1% and 66.3%, respectively) of the total costs in the overall follow-up. Pembrolizumab introduction increased expenses but improved survival. Higher hospitalisation and emergency room occupation rates during follow-up reflected worsening clinical conditions of the negative/unknown group than the mutation-positive population.
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Affiliation(s)
- Nicola Gentili
- Outcome Research, Healthcare Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (N.G.); (V.D.); (A.R.); (I.M.)
| | - William Balzi
- Outcome Research, Healthcare Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (N.G.); (V.D.); (A.R.); (I.M.)
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Valentina Danesi
- Outcome Research, Healthcare Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (N.G.); (V.D.); (A.R.); (I.M.)
| | - Mattia Altini
- Healthcare Administration, Azienda Unità Sanitaria Locale della Romagna, 48121 Ravenna, Italy;
| | - Angelo Delmonte
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (A.D.); (G.B.); (L.C.); (M.M.); (A.V.); (M.A.B.)
| | - Giuseppe Bronte
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (A.D.); (G.B.); (L.C.); (M.M.); (A.V.); (M.A.B.)
| | - Lucio Crinò
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (A.D.); (G.B.); (L.C.); (M.M.); (A.V.); (M.A.B.)
| | - Nicoletta De Luigi
- Ospedale di Stato della Repubblica di San Marino, 47893 San Marino City, San Marino;
| | - Marita Mariotti
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (A.D.); (G.B.); (L.C.); (M.M.); (A.V.); (M.A.B.)
| | - Alberto Verlicchi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (A.D.); (G.B.); (L.C.); (M.M.); (A.V.); (M.A.B.)
| | - Marco Angelo Burgio
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (A.D.); (G.B.); (L.C.); (M.M.); (A.V.); (M.A.B.)
| | - Andrea Roncadori
- Outcome Research, Healthcare Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (N.G.); (V.D.); (A.R.); (I.M.)
| | - Thomas Burke
- MSD Innovation & Development GmbH, 8004 Zurich, Switzerland
| | - Ilaria Massa
- Outcome Research, Healthcare Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy; (N.G.); (V.D.); (A.R.); (I.M.)
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Tehrani MW, Fortner EC, Robinson ES, Chiger AA, Sheu R, Werden BS, Gigot C, Yacovitch T, Van Bramer S, Burke T, Koehler K, Nachman KE, Rule AM, DeCarlo PF. Characterizing metals in particulate pollution in communities at the fenceline of heavy industry: combining mobile monitoring and size-resolved filter measurements. Environ Sci Process Impacts 2023; 25:1491-1504. [PMID: 37584085 PMCID: PMC10510330 DOI: 10.1039/d3em00142c] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
Exposures to metals from industrial emissions can pose important health risks. The Chester-Trainer-Marcus Hook area of southeastern Pennsylvania is home to multiple petrochemical plants, a refinery, and a waste incinerator, most abutting socio-economically disadvantaged residential communities. Existing information on fenceline community exposures is based on monitoring data with low temporal and spatial resolution and EPA models that incorporate industry self-reporting. During a 3 week sampling campaign in September 2021, size-resolved particulate matter (PM) metals concentrations were obtained at a fixed site in Chester and on-line mobile aerosol measurements were conducted around Chester-Trainer-Marcus Hook. Fixed-site arsenic, lead, antimony, cobalt, and manganese concentrations in total PM were higher (p < 0.001) than EPA model estimates, and arsenic, lead, and cadmium were predominantly observed in fine PM (<2.5 μm), the PM fraction which can penetrate deeply into the lungs. Hazard index analysis suggests adverse effects are not expected from exposures at the observed levels; however, additional chemical exposures, PM size fraction, and non-chemical stressors should be considered in future studies for accurate assessment of risk. Fixed-site MOUDI and nearby mobile aerosol measurements were moderately correlated (r ≥ 0.5) for aluminum, potassium and selenium. Source apportionment analyses suggested the presence of four major emissions sources (sea salt, mineral dust, general combustion, and non-exhaust vehicle emissions) in the study area. Elevated levels of combustion-related elements of health concern (e.g., arsenic, cadmium, antimony, and vanadium) were observed near the waste incinerator and other industrial facilities by mobile monitoring, as well as in residential-zoned areas in Chester. These results suggest potential co-exposures to harmful atmospheric metal/metalloids in communities surrounding the Chester-Trainer-Marcus Hook industrial area at levels that may exceed previous estimates from EPA modeling.
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Affiliation(s)
- Mina W Tehrani
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | | | - Ellis S Robinson
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Andrea A Chiger
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
- Risk Sciences and Public Policy Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Roger Sheu
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | | | - Carolyn Gigot
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Thomas Burke
- Risk Sciences and Public Policy Institute, Johns Hopkins University, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Keeve E Nachman
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
- Risk Sciences and Public Policy Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Ana M Rule
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Peter F DeCarlo
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
- Risk Sciences and Public Policy Institute, Johns Hopkins University, Baltimore, MD, USA
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Han D, Clarke-Deelder E, Miller N, Opondo K, Burke T, Oguttu M, McConnell M, Cohen J. Health care provider decision-making and the quality of maternity care: An analysis of postpartum care in Kenyan hospitals. Soc Sci Med 2023; 331:116071. [PMID: 37450989 PMCID: PMC10410252 DOI: 10.1016/j.socscimed.2023.116071] [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: 02/19/2023] [Revised: 05/17/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
Evidence suggests that health care providers' non-adherence to clinical guidelines is widespread and contributes to poor patient outcomes across low- and middle-income countries. Through observations of maternity care in Kenya, we found limited adherence to guideline-recommended active monitoring of patients for signs of postpartum hemorrhage, the leading cause of maternal mortality, despite providers' having the necessary training and equipment. Using survey vignettes conducted with 144 maternity providers, we documented evidence consistent with subjective risk and perceived uncertainty driving providers' decisions to actively monitor patients. Motivated by these findings, we introduced a simple model of providers' decision-making about whether to monitor a patient, which may depend on their perceptions of risk, diagnostic uncertainty, and the value of new information. The model highlights key trade-offs between gathering diagnostic information through active monitoring versus waiting for signs and symptoms of hemorrhage to manifest. Our work provides a template for understanding provider decision-making and could inform interventions to encourage more proactive obstetric care.
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Affiliation(s)
- Dan Han
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore; Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Emma Clarke-Deelder
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology and Public Health, Swiss TPH and University of Basel, Basel, Switzerland
| | - Nora Miller
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Kennedy Opondo
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Kisumu Medical and Education Trust, Kisumu, Kenya
| | - Thomas Burke
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Global Health Innovation Laboratory, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Margaret McConnell
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jessica Cohen
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Goto Y, Kawamura K, Fukuhara T, Namba Y, Aoe K, Shukuya T, Tsuda T, Santorelli ML, Taniguchi K, Kamitani T, Irisawa M, Kanda K, Abe M, Burke T, Nokihara H. Health Care Resource Use Among Patients with Advanced Non-Small Cell Lung Cancer in Japan, 2017-2019. Curr Ther Res Clin Exp 2023; 99:100712. [PMID: 37519418 PMCID: PMC10372154 DOI: 10.1016/j.curtheres.2023.100712] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023]
Abstract
Background First-line immune checkpoint inhibitor (ICI) monotherapy for advanced non-small cell lung cancer (NSCLC) was introduced in Japan in February 2017. Limited information is available since that time regarding health care resource use for NSCLC in Japan, where the hospitalization burden is high. Objective We evaluated health care resource use from first- through third-line systemic anticancer therapy for patients with advanced NSCLC included in a multicenter, retrospective chart review study. Methods Eligible patients were aged 20 years or older with unresectable locally advanced/metastatic NSCLC with no known actionable genomic alteration who initiated first-line systemic anticancer therapy from July 1, 2017, to December 20, 2018, at 23 Japanese hospitals. We calculated the percentage of patients with a record of each resource used, the total number of each resource, and the resource use per 100 patient-weeks of follow-up from initiation of first-, second-, and third-line therapy, overall and by the 3 most common regimen categories, namely, ICI monotherapy, platinum-doublet chemotherapy (without concomitant ICI), and nonplatinum cytotoxic regimens (nonplatinum). Study follow-up ended September 30, 2019. Results Among 1208 patients (median age = 70 years; 975 [81%] men), 463 patients (38%) received ICI monotherapy, 647 (54%) received platinum-doublet chemotherapy, and 98 (8%) received nonplatinum regimens as first-line therapy. During the study, 621 (51%) patients initiated second-line, and 281 (23%) initiated third-line therapy. The majority of patients experienced ≥1 hospitalization (76%-94%) and ≥1 outpatient visit (85%-90%) during each therapy line. The number of hospitalizations increased from 6.5 per 100 patient-weeks in first-line to 8.0 per 100 patient-weeks in third-line. During first-line therapy, the number of hospitalizations per 100 patient-weeks were 4.8, 8.4, and 6.5 for patients receiving ICI monotherapy, platinum-doublet chemotherapy, and nonplatinum regimens, respectively, and the percentages of hospitalizations categorized as attributable to NSCLC treatment administration (no surgery, procedure, treatment of metastasis, or palliative lung radiation) were 64%, 77%, and 73%, respectively. The number of outpatient visits increased from 43.0 per 100 patient-weeks in first-line to 51.4 per 100 patient-weeks in third-line therapy. During first-line therapy, outpatient visits per 100 patient-weeks were 41.0, 46.7, and 33.0 for patients receiving ICI monotherapy, platinum-doublet chemotherapy, and nonplatinum regimens, respectively, and the percentages of outpatient visits for infusion therapy were 48%, 34%, and 36%, respectively. Conclusions The results of this study, although solely descriptive, showed differing patterns of health care resource use during first-line therapy among the 3 common systemic anticancer therapy regimens for advanced NSCLC in Japan and suggest that further research is needed to investigate these apparent differences by treatment regimen.
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Affiliation(s)
- Yasushi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kodai Kawamura
- Division of Respiratory Medicine, Social Welfare Organization Imperial Gift Foundation Inc, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Tatsuro Fukuhara
- Department of Respiratory Medicine, Miyagi Cancer Center, Miyagi, Japan
| | - Yukiko Namba
- Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Keisuke Aoe
- Department of Medical Oncology, National Hospital Organization Yamaguchi-Ube Medical Center, Yamaguchi,Japan
| | - Takehito Shukuya
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takeshi Tsuda
- Department of Respiratory Medicine, Toyama Prefectural Central Hospital, Toyama, Japan
| | | | | | | | | | | | | | - Thomas Burke
- Center for Observational & Real World Evidence, Merck & Co, Inc, Rahway, New Jersey
| | - Hiroshi Nokihara
- Department of Respiratory Medicine and Rheumatology, Tokushima University, Tokushima, Japan
- Current affiliation: Respiratory Medicine, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
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Clarke-Deelder E, Opondo K, Oguttu M, Burke T, Cohen JL, McConnell M. Immediate postpartum care in low- and middle-income countries: A gap in healthcare quality research and practice. Am J Obstet Gynecol MFM 2023; 5:100764. [PMID: 36216312 DOI: 10.1016/j.ajogmf.2022.100764] [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] [Received: 04/29/2022] [Revised: 09/16/2022] [Accepted: 10/03/2022] [Indexed: 11/09/2022]
Abstract
The immediate postpartum period carries significant risks for complications such as postpartum hemorrhage and sepsis. Postpartum monitoring, including taking vital signs and monitoring blood loss, is important for the early identification and management of complications, but many women in low- and middle-income countries receive minimal attention in the period following childbirth to facility discharge. The World Health Organization recently released new guidelines on postnatal care, which include recommendations for immediate postpartum monitoring. In light of the new guidelines, this presented an opportune moment to address the gaps in postpartum monitoring in low- and middle-income countries. In this commentary, we bring attention to the importance of immediate postpartum monitoring. We identified opportunities for strengthening this often overlooked aspect of maternity care through improvements in quality measurement and data availability, research into barriers against high-quality care, and innovations in service delivery design.
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Affiliation(s)
- Emma Clarke-Deelder
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA (Drs Clarke-Deelder, Burke, Cohen, and McConnell); Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland (Dr Clarke-Deelder).
| | - Kennedy Opondo
- Kisumu Medical and Education Trust, Kisumu, Kenya (Mr Opondo and Dr Oguttu); Vayu Global Health Foundation, Boston, MA (Mr Opondo and Dr Burke)
| | - Monica Oguttu
- Kisumu Medical and Education Trust, Kisumu, Kenya (Mr Opondo and Dr Oguttu)
| | - Thomas Burke
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA (Drs Clarke-Deelder, Burke, Cohen, and McConnell); Vayu Global Health Foundation, Boston, MA (Mr Opondo and Dr Burke); Global Health Innovation Laboratory, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (Dr Burke); Harvard Medical School, Boston, MA (Dr Burke)
| | - Jessica L Cohen
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA (Drs Clarke-Deelder, Burke, Cohen, and McConnell)
| | - Margaret McConnell
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA (Drs Clarke-Deelder, Burke, Cohen, and McConnell)
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Clarke-Deelder E, Opondo K, Achieng E, Garg L, Han D, Henry J, Guha M, Lightbourne A, Makin J, Miller N, Otieno B, Borovac-Pinheiro A, Suarez-Rebling D, Menzies NA, Burke T, Oguttu M, McConnell M, Cohen J. Quality of care for postpartum hemorrhage: A direct observation study in referral hospitals in Kenya. PLOS Glob Public Health 2023; 3:e0001670. [PMID: 36963063 PMCID: PMC10022124 DOI: 10.1371/journal.pgph.0001670] [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] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 02/08/2023] [Indexed: 03/06/2023]
Abstract
Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in Kenya. The aim of this study was to measure quality and timeliness of care for PPH in a sample of deliveries in referral hospitals in Kenya. We conducted direct observations of 907 vaginal deliveries in three Kenyan hospitals from October 2018 through February 2019, observing the care women received from admission for labor and delivery through hospital discharge. We identified cases of "suspected PPH", defined as cases in which providers indicated suspicion of and/or took an action to manage abnormal bleeding. We measured adherence to World Health Organization and Kenyan guidelines for PPH risk assessment, prevention, identification, and management and the timeliness of care in each domain. The rate of suspected PPH among the observed vaginal deliveries was 9% (95% Confidence Interval: 7% - 11%). Health care providers followed all guidelines for PPH risk assessment in 7% (5% - 10%) of observed deliveries and all guidelines for PPH prevention in 4% (3% - 6%) of observed deliveries. Lowest adherence was observed for taking vital signs and for timely administration of a prophylactic uterotonic. Providers did not follow guidelines for postpartum monitoring in any of the observed deliveries. When suspected PPH occurred, providers performed all recommended actions in 23% (6% - 40%) of cases. Many of the critical actions for suspected PPH were performed in a timely manner, but, in some cases, substantial delays were observed. In conclusion, we found significant gaps in the quality of risk assessment, prevention, identification, and management of PPH after vaginal deliveries in referral hospitals in Kenya. Efforts to reduce maternal morbidity and mortality from PPH should emphasize improvements in the quality of care, with a particular focus on postpartum monitoring and timely emergency response.
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Affiliation(s)
- Emma Clarke-Deelder
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Kennedy Opondo
- Kisumu Medical and Education Trust, Kisumu, Kenya
- Vayu Global Health Foundation, Boston, MA, United States of America
| | | | - Lorraine Garg
- Department of Emergency Medicine, Global Health Innovation Laboratory, Massachusetts General Hospital, Boston, MA, United States of America
| | - Dan Han
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore, Singapore
| | - Junita Henry
- Economics Department, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Moytrayee Guha
- Department of Emergency Medicine, Global Health Innovation Laboratory, Massachusetts General Hospital, Boston, MA, United States of America
- Brown University, Providence, RI, United States of America
| | - Alicia Lightbourne
- Department of Emergency Medicine, Global Health Innovation Laboratory, Massachusetts General Hospital, Boston, MA, United States of America
- Duke University, Durham, North Carolina, United States of America
| | - Jennifer Makin
- Department of Emergency Medicine, Global Health Innovation Laboratory, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Nora Miller
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
| | | | - Anderson Borovac-Pinheiro
- Department of Emergency Medicine, Global Health Innovation Laboratory, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas (SP), Brazil
| | - Daniela Suarez-Rebling
- Department of Emergency Medicine, Global Health Innovation Laboratory, Massachusetts General Hospital, Boston, MA, United States of America
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
| | - Thomas Burke
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
- Department of Emergency Medicine, Global Health Innovation Laboratory, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | | | - Margaret McConnell
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
| | - Jessica Cohen
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
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Tayler A, Ashworth H, Bou Saba G, Wadhwa H, Dundek M, Ng E, Opondo K, Mkony M, Moshiro R, Burke T. Feasibility of a novel ultra-low-cost bubble CPAP (bCPAP) System for neonatal respiratory support at Muhimbili National Hospital, Tanzania. PLoS One 2022; 17:e0269147. [PMID: 36584229 PMCID: PMC9803298 DOI: 10.1371/journal.pone.0269147] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/03/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Continuous Positive Airway Pressure (CPAP) is recommended in the treatment of respiratory distress syndrome of premature newborns, however there are significant barriers to its implementation in low-resource settings. The objective of this study was to evaluate the feasibility of use and integration of Vayu bCPAP Systems into the newborn unit at Muhimbili National Hospital in Tanzania. STUDY DESIGN A prospective qualitative study was conducted from April 6 to October 6 2021. Demographic and clinical characteristics of patients treated with Vayu bCPAP Systems were collected and analyzed. Healthcare workers were interviewed until thematic saturation. Interviews were transcribed, coded, and analyzed using a framework analysis. RESULTS 370 patients were treated with Vayu bCPAP Systems during the study period. Mean birth weight was 1522 g (500-3800), mean duration of bCPAP treatment was 7.2 days (<1-39 d), and survival to wean was 81.4%. Twenty-four healthcare workers were interviewed and perceived Vayu bCPAP Systems as having become essential for treating neonatal respiratory distress at MNH. Key reasons were that Vayu bCPAP Systems improve patient outcomes, are easy to use, and more patients are now able to receive quality care. Barriers to integration included durability of oxygen tubing material and training. CONCLUSIONS It was feasible to implement and integrate Vayu bCPAP Systems into the care of neonates at Muhimbili National Hospital.
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Affiliation(s)
- Ashtyn Tayler
- Vayu Global Health Foundation, Boston, MA, United States of America
- * E-mail:
| | - Henry Ashworth
- Vayu Global Health Foundation, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Ghassan Bou Saba
- Vayu Global Health Foundation, Boston, MA, United States of America
| | - Hena Wadhwa
- Vayu Global Health Foundation, Boston, MA, United States of America
| | - Michelle Dundek
- Vayu Global Health Foundation, Boston, MA, United States of America
- Global Health Innovation Lab, Massachusetts General Hospital, Boston, MA, United States of America
| | - Ellie Ng
- Vayu Global Health Foundation, Boston, MA, United States of America
| | - Kennedy Opondo
- Vayu Global Health Foundation, Boston, MA, United States of America
| | - Martha Mkony
- Muhimbili National Hospital, Dar es Salaam, Tanzania
- Muhimbili University of Health Allied Sciences, Dar es Salaam, Tanzania
| | - Robert Moshiro
- Muhimbili National Hospital, Dar es Salaam, Tanzania
- Muhimbili University of Health Allied Sciences, Dar es Salaam, Tanzania
| | - Thomas Burke
- Vayu Global Health Foundation, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Global Health Innovation Lab, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard TH Chan School of Public Health, Boston, MA, United States of America
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Henry J, Clarke-Deelder E, Han D, Miller N, Opondo K, Oguttu M, Burke T, Cohen JL, McConnell M. Health care providers’ knowledge of clinical protocols for postpartum hemorrhage care in Kenya: a cross-sectional study. BMC Pregnancy Childbirth 2022; 22:828. [PMID: 36357842 PMCID: PMC9647972 DOI: 10.1186/s12884-022-05128-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
Abstract
Background Postpartum hemorrhage (PPH) remains the leading cause of maternal death worldwide despite its often-preventable nature. Understanding health care providers’ knowledge of clinical protocols is imperative for improving quality of care and reducing mortality. This is especially pertinent in referral and teaching hospitals that train nursing and medical students and interns in addition to managing emergency and referral cases. Methods This study aimed to (1) measure health care providers’ knowledge of clinical protocols for risk assessment, prevention, and management of PPH in 3 referral hospitals in Kenya and (2) examine factors associated with providers’ knowledge. We developed a knowledge assessment tool based on past studies and clinical guidelines from the World Health Organization and the Kenyan Ministry of Health. We conducted in-person surveys with health care providers in three high-volume maternity facilities in Nairobi and western Kenya from October 2018-February 2019. We measured gaps in knowledge using a summative index and examined factors associated with knowledge (such as age, gender, qualification, experience, in-service training attendance, and a self-reported measure of peer-closeness) using linear regression. Results We interviewed 172 providers including consultants, medical officers, clinical officers, nurse-midwives, and students. Overall, knowledge was lowest for prevention-related protocols (an average of 0.71 out of 1.00; 95% CI 0.69–0.73) and highest for assessment-related protocols (0.81; 95% CI 0.79–0.83). Average knowledge scores did not differ significantly between qualified providers and students. Finally, we found that being a qualified nurse, having a specialization, being female, having a bachelor's degree and self-reported closer relationships with colleagues were statistically significantly associated with higher knowledge scores. Conclusion We found gaps in knowledge of PPH care clinical protocols in Kenya. There is a clear need for innovations in clinical training to ensure that providers in teaching referral hospitals are prepared to prevent, assess, and manage PPH. It is possible that training interventions focused on learning by doing and teamwork may be beneficial. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05128-6.
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11
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Liu SV, Hu X, Li Y, Zhao B, Burke T, Velcheti V. Pembrolizumab-combination therapy for previously untreated metastatic nonsquamous NSCLC: Real-world outcomes at US oncology practices. Front Oncol 2022; 12:999343. [PMID: 36324586 PMCID: PMC9618586 DOI: 10.3389/fonc.2022.999343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives The availability of immunotherapies has expanded the options for treating metastatic NSCLC, but information is needed regarding outcomes of immunotherapy for patients treated outside of clinical trials. The aim of this retrospective study was to evaluate the outcomes of therapy with first-line pembrolizumab plus pemetrexed and carboplatin (pembrolizumab-combination) for patients with metastatic nonsquamous NSCLC in the real-world setting of oncology clinics in the United States (US). Methods Using deidentified, longitudinal patient records from a nationwide, electronic health record-derived US database, we identified patients with metastatic nonsquamous NSCLC, without EGFR/ALK/ROS1 genomic alterations, who had received no previous systemic anticancer therapy. Eligible patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 and initiated first-line pembrolizumab-combination therapy from 11-May-2017 to 31-January-2019; data cutoff was 31-August-2020. Patients treated in a clinical trial were excluded. Manual chart review supplemented technology-enabled abstraction to identify disease progression and tumor response. Time-to-event endpoints from initiation of pembrolizumab-combination therapy were determined using Kaplan-Meier. Results Of 377 patients with metastatic nonsquamous NSCLC, 105 (28%), 104 (28%), and 103 (27%) had programmed death-ligand 1 (PD-L1) expression ≥50%, 1–49%, and <1%, respectively; PD-L1 expression was not documented for 65 patients (17%). Median age was 66 years, and 227 patients (60%) were men. Median follow-up time from first-line therapy initiation to data cutoff was 31.2 months (range, 19.0-39.6 months). Median pembrolizumab real-world time on treatment (rwToT) was 5.8 months (95% CI, 5.0-6.7); 12- and 24-month on-treatment rates for pembrolizumab were 28.0% and 14.9%, respectively. Median overall survival (OS) was 17.2 months (95% CI, 13.6-19.9). For patients in PD-L1 expression ≥50%, 1-49%, <1%, and unknown cohorts, the 12-month survival rates were 66.0%, 58.5%, 54.5%, and 58.3%, respectively, and 24-month survival rates were 43.1%, 37.2%, 35.6%, and 42.0%, respectively. Median real-world progression-free survival was 6.2 months (95% CI, 5.5-7.1); and the real-world response rate was 39.3%, with median duration of response of 13.1 months (95% CI, 10.5-16.8). Conclusions These findings demonstrate the benefits of first-line pembrolizumab-combination therapy for patients with EGFR/ALK-wild-type, metastatic nonsquamous NSCLC and good performance status who are treated at US community oncology clinics.
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Affiliation(s)
- Stephen V. Liu
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
- *Correspondence: Stephen V. Liu,
| | - Xiaohan Hu
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Rahway, NJ, United States
| | - Yeran Li
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Rahway, NJ, United States
| | - Bin Zhao
- Clinical Research, Merck & Co., Inc., Rahway, NJ, United States
| | - Thomas Burke
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Rahway, NJ, United States
| | - Vamsidhar Velcheti
- Perlmutter Cancer Center, New York University (NYU) Langone Health, New York, NY, United States
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Resch SC, Suarez S, Omotayo MO, Griffin J, Sessler D, Burke T. Non-anaesthetist-administered ketamine for emergency caesarean section in Kenya: cost-effectiveness analysis. BMJ Open 2022; 12:e051055. [PMID: 36198454 PMCID: PMC9535153 DOI: 10.1136/bmjopen-2021-051055] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Lack of anaesthesia services is a frequent barrier to emergency surgeries such as caesarean delivery in Kenya. This study aimed to estimate the survival gains and cost-effectiveness of scaling up the Every Second Matters (ESM)-Ketamine programme that trains non-anaesthetist providers to administer and monitor ketamine during emergency caesarean deliveries. SETTING Hospitals in Kenyan counties with low rates of caesarean delivery. PARTICIPANTS Patients needing emergency caesarean delivery in settings without availability of standard anaesthesia service. INTERVENTIONS Simulated scales up of the ESM-Ketamine programme over 5 years (2020-24) was compared with status quo. OUTCOME MEASURES Cost of implementing the programme and corresponding additional emergency caesarean deliveries. Maternal and fetal/neonatal deaths prevented, and corresponding life-years gained due to increased provision of emergency caesarean procedures. Cost-effectiveness was assessed by comparing the cost per life-year gained of the ESM-Ketamine programme compared with status quo. RESULTS Over 5 years, the expected gap in emergency caesarean deliveries was 157 000. A US$1.2 million ESM-Ketamine programme reduced this gap by 28 700, averting by 316 maternal and 4736 fetal deaths and generating 331 000 total life-years gained. Cost-effectiveness of scaling up the ESM-Ketamine programme was US$44 per life-year gained in the base case and US$251 in the most pessimistic scenario-a very good value for Kenya at less than 20% of per capita GDP per life-year gained. CONCLUSION In areas of Kenya with significant underprovision of emergency caesarean delivery due to a lack of availability of traditional anaesthesia, an ESM-Ketamine programme is likely to enable a substantial number of life-saving surgeries at reasonable cost.
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Affiliation(s)
- Stephen Charles Resch
- Center for Health Decision Science, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Sebastian Suarez
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Boston University, Boston, Massachusetts, USA
| | - Moshood Olanrewaju Omotayo
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Griffin
- Center for Global Health, RTI International, Research Triangle Park, North Carolina, USA
| | - Daniel Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas Burke
- Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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13
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Danesi V, Massa I, Foca F, Delmonte A, Crinò L, Bronte G, Ragonesi M, Maltoni R, Manunta S, Cravero P, Andrikou K, Priano I, Balzi W, Gentili N, Burke T, Altini M. Real-World Outcomes and Treatments Patterns Prior and after the Introduction of First-Line Immunotherapy for the Treatment of Metastatic Non-Small Cell Lung Cancer. Cancers (Basel) 2022; 14:cancers14184481. [PMID: 36139641 PMCID: PMC9497168 DOI: 10.3390/cancers14184481] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 11/26/2022] Open
Abstract
Simple Summary The advent of immuno-oncology (IO) agents, particularly immune checkpoint inhibitors (ICIs), has changed the treatment landscape of non-small cell lung cancer (NSCLC). We performed a retro-prospective study to describe the patients’ outcomes prior to and after the local regulatory approval of pembrolizumab as a first-line (1L) treatment in the real-world setting of an Italian cancer centre. Analyses were performed of a total of 694 patients with no or unknown oncogene addicted tumour, grouped into Pre- (n = 344) and Post- (n = 350) 1L IO populations. The study provides evidence of improvements in overall survival associated with the introduction of 1L immunotherapy, suggesting that receiving immunotherapy in the first-line rather than in the second- or later lines of treatment may be more favourable. Abstract Background: This study provides insights into the treatment use and outcomes of metastatic non-small cell lung cancer (NSCLC) patients in a real-world setting prior to and after the availability of immuno-oncology (IO) regimens in the first line (1L). Methods: Metastatic NSCLC patients, who initiated systemic 1L anticancer treatment from 2014 to 2020, were identified from health records. Patients were grouped into Pre-1L IO and Post-1L IO, according to the availability of pembrolizumab 1L monotherapy at the date of initiating 1L systemic anticancer treatment. Patient characteristics, treatment patterns and outcomes were assessed by the cohort. Overall survival (OS) and real-world progression-free survival (rwPFS) were calculated using the Kaplan-Meier method. Results: The most common 1L treatment was platinum-based chemotherapy regimens in both groups (≥46%), followed by single-agent chemotherapy (27.0%) in Pre-1L IO and pembrolizumab (26.0%) in Post-1L IO. Median OS was 6.2 (95% CI 5.5–7.4) in Pre- and 8.9 months (95% CI 7.5–10.6) in Post-1L IO, while rwPFS was 3.7 (95% CI 3.3–4.2) and 4.7 months (95% CI 3.9–5.7), respectively. Conclusions: Even if a small proportion of patients received a 1L IO, the data showed an improved survival outcomes in the Post-1L IO group.
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Affiliation(s)
- Valentina Danesi
- Outcome Research, Healthcare Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Ilaria Massa
- Outcome Research, Healthcare Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
- Correspondence:
| | - Angelo Delmonte
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Lucio Crinò
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Giuseppe Bronte
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Maria Ragonesi
- Nursing Service, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Roberta Maltoni
- Outcome Research, Healthcare Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Silvia Manunta
- AULSS5, UOC Oncologia, Ospedale Santa Maria della Misericordia, 45100 Rovigo, Italy
| | - Paola Cravero
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Kalliopi Andrikou
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Ilaria Priano
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - William Balzi
- Outcome Research, Healthcare Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Nicola Gentili
- Outcome Research, Healthcare Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Thomas Burke
- Center for Observational and Real World Evidence, Merck & Co Inc., Kenilworth, NJ 07033, USA
| | - Mattia Altini
- Healthcare Administration, Azienda Unità Sanitaria Locale della Romagna, 48121 Ravenna, Italy
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Goto Y, Tamura A, Matsumoto H, Isobe K, Ozaki T, Santorelli ML, Taniguchi K, Kamitani T, Irisawa M, Kanda K, Abe M, Burke T, Nokihara H. First-Line Pembrolizumab Monotherapy for Advanced NSCLC With Programmed Death-Ligand 1 Expression Greater Than or Equal to 50%: Real-World Study Including Older Patients in Japan. JTO Clin Res Rep 2022; 3:100397. [PMID: 36065450 PMCID: PMC9440307 DOI: 10.1016/j.jtocrr.2022.100397] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Pembrolizumab became available in Japan in February 2017 for first-line monotherapy of unresectable advanced and metastatic NSCLC with programmed death-ligand 1 (PD-L1) tumor proportion score (TPS) greater than or equal to 50%. This retrospective chart review study aimed to describe real-world clinical outcomes of first-line pembrolizumab monotherapy, including for patients 75 years or older, who are under-represented in clinical trials. Methods We identified patients (≥20 y old) at 23 sites initiating first-line pembrolizumab monotherapy from July 1, 2017, to December 20, 2018, for stages IIIB, IIIC, and IV NSCLC with PD-L1 TPS greater than or equal to 50% and Eastern Cooperative Oncology Group performance status of 0 to 2 or unknown. Patients with actionable genomic alterations (EGFR, ALK, ROS1, BRAF) and clinical trial participants were excluded. Time-to-event outcomes were estimated using Kaplan-Meier, with data cutoff on September 30, 2019. Results Of 441 eligible patients (78% men), 303 (69%) were younger than 75 years and 138 (31%) were 75 years or older; median age was 70 years. With median follow-up of 13.5 months, median overall survival (OS) was not reached (NR); 12- and 24-month OS rates were 72% and 58%, respectively. For ages younger than 75 and 75 years or older, median OS was NR and 23.5 months (95% confidence interval: 16.2–NR), respectively; 12-month OS rates were 74% and 67% and 24-month OS rates were 62% and 48%, respectively. Median real-world progression-free survival was similar in the two age groups (10.1 and 9.5 mo, respectively), as was median real-world time on treatment with pembrolizumab (5.7 and 5.6 mo). Conclusions These findings complement clinical trial results, adding real-world evidence supporting benefits of first-line pembrolizumab monotherapy for advanced NSCLC with PD-L1 TPS greater than or equal to 50%, including for patients 75 years or older.
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Affiliation(s)
- Yasushi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo, Japan
- Corresponding author. Address for correspondence: Yasushi Goto, MD, PhD, Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
| | - Atsuhisa Tamura
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Hirotaka Matsumoto
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Kazutoshi Isobe
- Department of Respiratory Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Tomohiro Ozaki
- Division of Medical Oncology, Kishiwada City Hospital, Osaka, Japan
| | - Melissa L. Santorelli
- Center for Observational & Real World Evidence (CORE), Merck & Co., Inc., Rahway, New Jersey
| | | | | | | | | | | | - Thomas Burke
- Center for Observational & Real World Evidence (CORE), Merck & Co., Inc., Rahway, New Jersey
| | - Hiroshi Nokihara
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
- Present Address: Respiratory Medicine, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
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15
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Nokihara H, Kijima T, Yokoyama T, Kagamu H, Suzuki T, Mori M, Santorelli ML, Taniguchi K, Kamitani T, Irisawa M, Kanda K, Abe M, Burke T, Goto Y. Real-World Treatments and Clinical Outcomes in Advanced NSCLC without Actionable Mutations after Introduction of Immunotherapy in Japan. Cancers (Basel) 2022; 14:cancers14122846. [PMID: 35740512 PMCID: PMC9220782 DOI: 10.3390/cancers14122846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/10/2022] [Revised: 06/03/2022] [Accepted: 06/04/2022] [Indexed: 02/04/2023] Open
Abstract
The aims of this study were to describe systemic treatment patterns and clinical outcomes for unresectable advanced/metastatic non-small-cell lung cancer (NSCLC) by first-line regimen type in real-world clinical settings in Japan after the introduction of first-line immune checkpoint inhibitor (ICI) monotherapy in 2017. Using retrospective chart review at 23 study sites, we identified patients ≥20 years old initiating first-line systemic therapy from 1 July 2017 to 20 December 2018, for unresectable stage IIIB/C or IV NSCLC; the data cutoff was 30 September 2019. Eligible patients had recorded programmed death-ligand 1 (PD-L1) tumor proportion score (TPS) and no known actionable EGFR/ALK/ROS1/BRAF genomic alteration. Kaplan-Meier method was used to determine time-to-event endpoints. Of 1208 patients, 647 patients (54%) received platinum doublet, 463 (38%) received ICI monotherapy, and 98 (8%) received nonplatinum cytotoxic regimen as first-line therapy. PD-L1 TPS was ≥50%, 1−49% and <1% for 44%, 30%, and 25% of patients, respectively. Most patients with PD-L1 TPS ≥50% received ICI monotherapy (453/529; 86%). Excluding 26 patients with ECOG performance status of 3−4 from outcome analyses, the median patient follow-up was 11.3 months. With first-line platinum doublet, ICI monotherapy, and nonplatinum cytotoxic regimens, median overall survival (OS) was 16.3 months (95% CI, 14.0−20.1 months), not reached, and 14.4 months (95% CI, 10.3−21.2 months), respectively; 24-month OS was 40%, 58%, and 31%, respectively. Differences in OS relative to historical cohort data reported in Japan are consistent with improvement over time in real-world clinical outcomes for advanced NSCLC.
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Affiliation(s)
- Hiroshi Nokihara
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan
- Correspondence: ; Tel.: +81-3-3202-7181
| | - Takashi Kijima
- Department of Respiratory Medicine and Hematology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya 663-8501, Japan;
| | - Toshihide Yokoyama
- Department of Respiratory Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan;
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka 350-1298, Japan;
| | - Takuji Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan;
| | - Masahide Mori
- Department of Thoracic Oncology, National Hospital Organization, Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka 560-8552, Japan;
| | - Melissa L. Santorelli
- Center for Observational & Real World Evidence (CORE), Merck & Co., Inc., 126 East Lincoln Ave., P.O. Box 2000, Rahway, NJ 07065, USA; (M.L.S.); (T.B.)
| | - Kazuko Taniguchi
- MSD K.K., Kitanomaru Square, 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo 102-8667, Japan; (K.T.); (T.K.); (M.I.); (K.K.); (M.A.)
| | - Tetsu Kamitani
- MSD K.K., Kitanomaru Square, 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo 102-8667, Japan; (K.T.); (T.K.); (M.I.); (K.K.); (M.A.)
| | - Masato Irisawa
- MSD K.K., Kitanomaru Square, 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo 102-8667, Japan; (K.T.); (T.K.); (M.I.); (K.K.); (M.A.)
| | - Kingo Kanda
- MSD K.K., Kitanomaru Square, 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo 102-8667, Japan; (K.T.); (T.K.); (M.I.); (K.K.); (M.A.)
| | - Machiko Abe
- MSD K.K., Kitanomaru Square, 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo 102-8667, Japan; (K.T.); (T.K.); (M.I.); (K.K.); (M.A.)
| | - Thomas Burke
- Center for Observational & Real World Evidence (CORE), Merck & Co., Inc., 126 East Lincoln Ave., P.O. Box 2000, Rahway, NJ 07065, USA; (M.L.S.); (T.B.)
| | - Yasushi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan;
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Burke T, Ersche K. I can’t wait! An investigation into time processing in cocaine use disorder. Eur Psychiatry 2022. [PMCID: PMC9566885 DOI: 10.1192/j.eurpsy.2022.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Almost all definitions of impulsivity include the notion of distorted time perception such as impaired awareness of the future or premature responses. Preclinical evidence suggests that stimulant drugs speed up the internal clock, making time pass faster than it actually is. However, stimulant-addicted humans, who are drug-abstinent seem to over-estimate long time intervals. Objectives The present study aims to investigate time processing in actively using patients with cocaine use disorder (CUD). We hypothesise that active cocaine use will be associated with an under-estimation of long time intervals. Methods We recruited 48 men with a chronic history of cocaine use, meeting the DSM-5 criteria for CUD, and 42 healthy men without a history of substance use disorders. All participants completed a time reproduction task in which they were presented four times with six different time durations and were subsequently asked to reproduce them by pressing the space bar for the same time duration of the target interval they had just seen. Participants also completed the Barratt Impulsiveness Scale (BIS-11). Results Overall precision in time reproduction was significantly reduced in CUD patients (F6,81=3.97,p=0.002), which was particularly evident for longer time delays. CUD patients’ estimated-to-target-duration ratios were marginally shorter for the 11000ms (F1,86=3.1,p=0.084) and significantly shorter for the 18000ms and 24000ms time intervals (both p<0.05). Time reproduction performance correlated with self-reported attentional impulsivity on the BIS-11 in both CUD patients and healthy controls (all p<0.05). Conclusions Consistent with preclinical work, the inner clock of humans with regular cocaine use seems to be accelerated. Disclosure No significant relationships.
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Begum F, Beyeza J, Burke T, Evans C, Hanson C, Lalonde A, Meseret Y, Oguttu M, Varmask P, West F, Wright A. FIGO and the International Confederation of Midwives endorse WHO guidelines on prevention and treatment of postpartum hemorrhage. Int J Gynaecol Obstet 2022; 158 Suppl 1:6-10. [PMID: 35762805 PMCID: PMC9328291 DOI: 10.1002/ijgo.14199] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
FIGO and the International Confederation of Midwives produced two joint statements endorsing WHO guidelines on prevention and treatment of postpartum hemorrhage.
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Affiliation(s)
| | - Ferdousi Begum
- BIRDEM Hospital, Dhaka, Bangladesh.,South Asian Federation of Obstetrics and Gynaecology (SAFOG), Dhaka, Bangladesh
| | - Jolly Beyeza
- Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda
| | - Thomas Burke
- Global Health Innovation Lab, Boston, Massachusetts, USA
| | - Cherrie Evans
- Helping Mothers Survive, Technical Leadership and Innovations, Jhpiego, Baltimore, Maryland, USA
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Andre Lalonde
- Department of Obstetrics and Gynecology, McGill University, Montreal, Canada.,Department of Obstetrics and Gynecology, Ottawa University, Ottawa, Canada
| | - Yodit Meseret
- Ethiopian Midwives Association, Addis Ababa, Ethiopia
| | | | - Poonam Varmask
- Department of Obstetrics and Gynecology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | - Florence West
- International Confederation of Midwives, The Hague, the Netherlands
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Velcheti V, Hu X, Yang L, Pietanza MC, Burke T. Long-Term Real-World Outcomes of First-Line Pembrolizumab Monotherapy for Metastatic Non-Small Cell Lung Cancer With ≥50% Expression of Programmed Cell Death-Ligand 1. Front Oncol 2022; 12:834761. [PMID: 35402266 PMCID: PMC8990758 DOI: 10.3389/fonc.2022.834761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/13/2021] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Immune checkpoint inhibitors (ICIs) of programmed cell death 1/programmed cell death ligand 1 (PD-1/PD-L1) have been rapidly adopted in US clinical practice for first-line therapy of metastatic non-small cell lung cancer (NSCLC) since regulatory approval in October 2016, and a better understanding is needed of long-term outcomes of ICI therapy administered in real-world settings outside of clinical trials. Our aim was to describe long-term outcomes of first-line pembrolizumab monotherapy at US oncology practices for patients with metastatic NSCLC, PD-L1 expression ≥50%, and good performance status. Methods This retrospective two-cohort study used technology-enabled abstraction of deidentified electronic health records (EHR cohort) plus enhanced manual chart review (spotlight cohort) to study adult patients with stage IV NSCLC, PD-L1 expression ≥50%, no documented EGFR/ALK/ROS1 genomic aberration, and ECOG performance status 0-1 who initiated first-line pembrolizumab monotherapy from 1-November-2016 to 31-March-2020 (EHR cohort, with data cutoff 31-March-2021) or from 1-December-2016 to 30-November-2017 (spotlight cohort, with data cutoff 31-August-2020). Kaplan-Meier analysis was used to determine overall survival (OS; both cohorts) and, for the spotlight cohort, real-world progression-free survival (rwPFS) and real-world tumor response (rwTR). Results The EHR cohort included 566 patients (298 [53%] men); the spotlight cohort included 228 (105 [46%] men); median age in both cohorts was 71. Median follow-up from pembrolizumab initiation to data cutoff was 35.1 months (range, 12.0-52.7) and 38.4 months (range, 33.1-44.9) in EHR and spotlight cohorts, respectively. Median OS was 19.6 months (95% CI, 16.6-24.3) and 21.1 months (95% CI, 16.2-28.9), respectively; 3-year OS rates were 36.2% and 38.2% in EHR and spotlight cohorts, respectively. In the spotlight cohort, median rwPFS was 7.3 months (95% CI, 5.7-9.2); 88 patients (38.6%; 95% CI, 32.2-45.2) experienced rwTR of complete or partial response. For 151/228 patients (66%) who discontinued pembrolizumab, the most common reasons were disease progression (70 [46%]) and therapy-related adverse effects (35 [23%]). Conclusions Real-world outcomes remain consistent with outcomes observed in clinical trials, supporting long-term benefits of first-line pembrolizumab monotherapy for patients with metastatic NSCLC, PD-L1 expression ≥50%, and good performance status.
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Affiliation(s)
- Vamsidhar Velcheti
- Perlmutter Cancer Center, New York University, New York, NY, United States
| | - Xiaohan Hu
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, United States
| | - Lingfeng Yang
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, United States
| | | | - Thomas Burke
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, United States
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West H, Hu X, Burke T, Walker M, Wang Y, Samkari A. 90P Disease-free survival (DFS) as a predictor of overall survival (OS) in completely resected early stage non-small cell lung cancer (NSCLC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.100] [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: 12/01/2022] Open
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West H, Hu X, Burke T, Walker M, Wang Y, Samkari A. 89P Treatment patterns, overall survival (OS), and disease-free survival (DFS) in early stage non-small cell lung cancer (NSCLC) following complete resection. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.099] [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: 11/01/2022] Open
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Escobar MF, Nassar AH, Theron G, Barnea ER, Nicholson W, Ramasauskaite D, Lloyd I, Chandraharan E, Miller S, Burke T, Ossanan G, Andres Carvajal J, Ramos I, Hincapie MA, Loaiza S, Nasner D. FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynaecol Obstet 2022; 157 Suppl 1:3-50. [PMID: 35297039 PMCID: PMC9313855 DOI: 10.1002/ijgo.14116] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Maria Fernanda Escobar
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,Tygerberg Hospital, Cape Town, South Africa
| | - Eythan R Barnea
- Society for Investigation or Early Pregnancy (SIEP), New York, New York, USA
| | - Wanda Nicholson
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Diana Ramasauskaite
- Center of Obstetrics and Gynecology, Vilnius University Medical Faculty, Vilnius, Lithuania
| | - Isabel Lloyd
- Department of Obstetrics and Gynecology, Universidad de Panamá, Panama City, Panamá.,Hospital Santo Tomas, Panama City, Panamá
| | - Edwin Chandraharan
- Department of Obstetrics and Gynecology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Thomas Burke
- Division of Global Health and Human Rights, Massachusetts General Hospital, Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, USA
| | - Gabriel Ossanan
- Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Javier Andres Carvajal
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Isabella Ramos
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Maria Antonia Hincapie
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Sara Loaiza
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Daniela Nasner
- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
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- Obstetric High Complexity Unit, Fundación Valle del Lili, Cali, Colombia
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Williams P, Burke T, Norquist JM, Daskalopoulou C, Speck RM, Samkari A, Eremenco S, Coons SJ. Non-Small Cell Lung Cancer Symptom Assessment Questionnaire (NSCLC-SAQ): Measurement Properties and Estimated Clinically Meaningful Thresholds from a Phase 3 Study. JTO Clin Res Rep 2022; 3:100298. [PMID: 35400081 PMCID: PMC8983345 DOI: 10.1016/j.jtocrr.2022.100298] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction The NSCLC Symptom Assessment Questionnaire (NSCLC-SAQ) was developed to assess NSCLC symptom severity in accordance with Food and Drug Administration evidentiary expectations leading to Food and Drug Administration qualification in 2018. This study evaluated the NSCLC-SAQ’s measurement properties within a clinical trial. Methods The KEYNOTE-598 phase 3 study of participants with stage IV metastatic NSCLC with programmed death-ligand 1 tumor proportion score greater than or equal to 50% was used to assess the NSCLC-SAQ’s reliability, construct validity, responsiveness, and estimate clinically meaningful within-person change. Other patient-reported outcome measures included patient global impression items of severity and change in lung cancer symptoms, and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire core 30 and lung cancer module, LC13. Results Participants (N = 560) were mostly men (70%), had a mean age of 64 years, and had Eastern Cooperative Oncology Group performance status of 1 (64%) or 0 (36%). Internal consistency at baseline (Cronbach’s α = 0.74) and test-retest reliability after 3 weeks (intraclass correlation coefficient = 0.79) were satisfactory. NSCLC-SAQ items, domains, and total score correlated moderately to highly with patient-reported outcome measures capturing similar content, and the total score differentiated among patient global impression of severity groups (p < 0.001). The total score detected improvement over time and the estimated clinically meaningful within-person change threshold for improvement ranged from three to five points on the 0 to 20 scale. Few participants exhibited symptom worsening (n = 38), limiting inferences in this group. Conclusions The NSCLC-SAQ was found to be reliable, valid, responsive, and interpretable for assessing symptom improvement in NSCLC. Further evaluation is recommended in trial participants whose symptoms worsen over time.
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Affiliation(s)
- Paul Williams
- Patient-Centered Solutions, IQVIA, Paris, France
- Corresponding author. Address for correspondence: Paul Williams, MPH, Patient-Centered Solutions, IQVIA, Tour D2, 17 bis place des Reflets, TSA 64567, 92099 La Defense Cedex, France.
| | - Thomas Burke
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, New Jersey
| | | | | | - Rebecca M. Speck
- Clinical Outcome Assessment Program, Critical Path Institute, Tucson, Arizona
| | - Ayman Samkari
- Clinical Research, Merck & Co., Inc., Kenilworth, New Jersey
| | - Sonya Eremenco
- Clinical Outcome Assessment Program, Critical Path Institute, Tucson, Arizona
| | - Stephen Joel Coons
- Clinical Outcome Assessment Program, Critical Path Institute, Tucson, Arizona
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Halmos B, Burke T, Kalyvas C, Insinga R, Vandormael K, Frederickson A, Piperdi B. Indirect comparison of pembrolizumab monotherapy versus nivolumab + ipilimumab in first-line metastatic lung cancer. Immunotherapy 2022; 14:295-307. [PMID: 35073727 DOI: 10.2217/imt-2021-0273] [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] [Indexed: 11/21/2022] Open
Abstract
Aim: This study indirectly compared the effectiveness of pembrolizumab monotherapy versus nivolumab + ipilimumab in metastatic non-small-cell lung cancer. Materials and methods: A matching-adjusted indirect comparison was conducted using pooled individual patient data from KEYNOTE-024 and KEYNOTE-042 and published aggregate data from CheckMate 227 Part 1A, with platinum doublet chemotherapy as the anchor. Results: After matching, estimated hazard ratios (95% CI) of pembrolizumab monotherapy versus nivolumab + ipilimumab for overall survival and progression-free survival were 1.07 (0.82, 1.39) and 1.16 (0.93, 1.45), respectively. For objective response rate, the estimated risk ratio (95% CI) was 0.93 (0.71, 1.22) and the risk difference (95% CI) was -2.86%(-11.38, 5.67). Conclusion: Matching-adjusted indirect comparison results demonstrated comparable effectiveness between pembrolizumab monotherapy and nivolumab + ipilimumab as first-line therapies for metastatic non-small-cell lung cancer with PD-L1 tumor-proportion score ≥1%.
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Affiliation(s)
- Balazs Halmos
- Department of Oncology, Montefiore/Albert Einstein Cancer Center, 2nd floor, 1695 Eastchester Rd, Bronx, NY 10461, USA
| | - Thomas Burke
- Center for Observational & Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Chrysostomos Kalyvas
- Biostatistics & Research Decision Sciences, MSD Europe, Inc., Brussels, 1200, Belgium
| | - Ralph Insinga
- Center for Observational & Real World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Kristel Vandormael
- Biostatistics & Research Decision Sciences, MSD Europe, Inc., Brussels, 1200, Belgium
| | | | - Bilal Piperdi
- Clinical Development, Merck & Co., Inc., Kenilworth, NJ, USA
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Qiao N, Insinga R, Burke T, Lopes G. Cost-Minimization Analysis of Pembrolizumab Monotherapy Versus Nivolumab in Combination with Ipilimumab as First-Line Treatment for Metastatic PD-L1-Positive Non-small Cell Lung Cancer: A US Payer Perspective. Pharmacoecon Open 2021; 5:765-778. [PMID: 34292540 PMCID: PMC8611160 DOI: 10.1007/s41669-021-00288-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Pembrolizumab monotherapy and nivolumab in combination with ipilimumab are US FDA-approved first-line (1L) regimens for patients with metastatic non-small cell lung cancer (NSCLC) without epidermal growth factor receptor or anaplastic lymphoma kinase genomic aberrations and with a programmed death ligand 1 (PD-L1) tumor proportion score (TPS) of ≥ 1%. A published matching-adjusted indirect comparison found the two regimens yield comparable overall and progression-free survival outcomes. OBJECTIVE The aim of this study was to compare direct medical costs of pembrolizumab and nivolumab plus ipilimumab for PD-L1-positive metastatic NSCLC treatment within the first 3 years following treatment initiation from a US payer perspective. METHODS A cost-minimization model was built to estimate and compare treatment, disease management, and adverse event costs based on KEYNOTE-024 and -042, and CheckMate 227 Part 1a trial survival and adverse event data. RESULTS 1L pembrolizumab generates $54,343, $75,744, and $76,259 per patient cost savings compared with 1L nivolumab plus ipilimumab for patients with NSCLC with PD-L1 TPS ≥ 1% within 1, 2, and 3 years of treatment initiation, respectively. CONCLUSION Pembrolizumab is cost saving as 1L treatment for PD-L1-positive metastatic NSCLC in comparison with nivolumab plus ipilimumab, at least for the short term.
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Affiliation(s)
- Nan Qiao
- Biostatistics and Research Decision Sciences, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033 USA
| | - Ralph Insinga
- Biostatistics and Research Decision Sciences, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033 USA
| | - Thomas Burke
- Center for Observational and Real-World Evidence, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033 USA
| | - Gilberto Lopes
- Sylvester Comprehensive Cancer Center at the University of Miami, 1120 NW 14th St, Suite 650J, Miami, FL 33136 USA
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O'Donnell K, Healy A, Staines A, Corrigan C, Burke T, McGettrick G, Waldron B. Pathways through rehabilitation for traumatic brain injury: preliminary results from an Irish study. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.753] [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: 11/14/2022] Open
Abstract
Abstract
Background
Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. In Ireland, little data exists on the number of TBI survivors or the availability of brain injury rehabilitation services. To address this, we examined nationally representative data to estimate the number of moderate to severe TBI survivors and to learn of their rehabilitation experiences.
Methods
A two-year mixed-methods, observational, cohort study was used to investigate the rehabilitation pathways of moderate to severe TBI survivors (N = 120). Participants were surveyed on two occasions six months apart using a range of standardised instruments (EQ-5D-3L, WHOQOL BREF and EBIQ). Preliminary findings from first surveys are reported.
Results
Fifty percent of participants reported having received some rehabilitation during their initial hospitalization. Following discharge, inpatient rehabilitation was recommended in 55.8% of cases (N = 67); 62.5% (N = 75) in an outpatient setting and 52.1% (N = 62) in a specialised brain injury community-based setting. Rehabilitation was not recommended in 9.2% (N = 11) of cases. Univariant analyses showed statistically significant differences between the experiences of males (N = 87) and females (N = 33) in three main elements; Isolation: males (M), mean 1.88, SD .488, females (F) mean 1.64, SD .476, (p = .015); Communication: M mean 1.85, SD .565, F mean 1.57, SD .469 (p = .012); Cognitive difficulties: M mean 1.81, SD .456, F mean 1.59, SD .426 (p = .020).
Discussion
Referrals to rehabilitation services varied substantially in this cohort of TBI survivors with evidence to suggest that, overall, males experience greater impacts on quality of life than do females. These findings support the need to, a) increase political priority and resource allocation for rehabilitation services for TBI survivors in Ireland and b) further study gender differences in TBI survivor outcome.
Key messages
Survivors of moderate to severe brain injury in Ireland have very divergent, and often inadequate experiences of rehabilitation. There is some evidence that male survivors of moderate to severe traumatic brain injury face more challenges than do female survivors.
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Affiliation(s)
- K O'Donnell
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - A Healy
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - A Staines
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - C Corrigan
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - T Burke
- School of Psychology, Dublin City University, Dublin, Ireland
| | | | - B Waldron
- Acquired Brain Injury Ireland, Dublin, Ireland
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Jemielita T, Li XN, Burke T, Liaw KL, Zhou W, Chen C. Augmenting Real-World Data Through Modeling Key Clinical Trial Eligibility Criteria: An Example of Patients With Non-small-Cell Lung Cancer Treated With Pembrolizumab. JCO Clin Cancer Inform 2021; 5:849-858. [PMID: 34415774 DOI: 10.1200/cci.21.00042] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare and characterize baseline characteristics and overall survival (OS) differences by key oncology eligibility criteria for real-world patients from the Flatiron Health database with advanced non-small-cell lung cancer (NSCLC) who received pembrolizumab monotherapy. METHODS Real world data (RWD) were from the Flatiron Health advanced NSCLC database and include patients who initiated pembrolizumab monotherapy (first, second, or third line of therapy) by November 30, 2019. At the data cutoff (May 31, 2020), the median survival follow-up time was 8.4 months. Eligible patients satisfy the criteria of Eastern Cooperative Oncology Group performance status of 0/1 and laboratory values indicative of adequate organ function. RWD were analyzed for all patients and patients with a programmed cell death ligand-1 tumor proportion score ≥ 1%. Patients were divided into three categories: ineligible, eligible, and unknown (who satisfy all observed criteria, with at least one missing). An augmented population was also formed, which combines the latter two groups through a propensity-based adjustment. RESULTS At the data cutoff, N = 3,877 patients with NSCLC received pembrolizumab monotherapy (1L = 2,682, 2L = 946, and 3L = 249). OS was consistently lower for the ineligible with similar survival for the eligible and augmented. Among all patients, the median OS in months (95% CI) was 8.2 (7.5 to 9.6), 16.3 (14.5 to 18.4), 16.4 (15.1 to 19.3), and 16.8 (15.6 to 18.5) for the ineligible (47%, n = 1,827), unknown (27%, n = 1,045), eligible (26%, n = 1,005), and augmented, respectively. The results were similar for patients with a programmed cell death ligand-1 tumor proportion score ≥ 1%. CONCLUSION Real-world patients who received pembrolizumab monotherapy and meet key clinical eligibility criteria exhibited similar baseline characteristics and OS profiles as the unknown and augmented patient groups. Population augmentation is a feasible approach for improving the power of RWD analysis.
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Eamranond PP, Bhukhen A, DiPalma D, Kunuakaphun S, Burke T, Rodis J, Grey M. Interprofessional, multitiered daily rounding management in a high-acuity hospital. Int J Health Care Qual Assur 2021; ahead-of-print. [PMID: 32918544 DOI: 10.1108/ijhcqa-09-2019-0158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/17/2022]
Abstract
PURPOSE The purpose of this explanatory case study is to explain the implementation of interprofessional, multitiered lean daily management (LDM) and to quantitatively report its impact on hospital safety. DESIGN/METHODOLOGY/APPROACH This case study explained the framework for LDM implementation and changes in quality metrics associated with the interprofessional, multitiered LDM, implemented at Saint Francis Hospital and Medical Center (SFHMC) at the end of 2018. Concepts from lean, Total Quality Management (TQM) and high reliability science were applied to develop the four tiers and gemba rounding components of LDM. A two-tailed t-test analysis was utilized to determine statistical significance for serious safety events (SSEs) comparing the intervention period (January 2019-December 2019) to the baseline period (calendar years 2017 and 2018). Other quality and efficiency metrics were also tracked. FINDINGS LDM was associated with decreased SSEs in 2019 compared to 2017 and 2018 (p ≤ 0.01). There were no reportable central line-associated blood stream infection (CLABSI) or catheter-associated urinary tract infection (CAUTI) for first full calendar quarter in the hospital's history. Hospital-acquired pressure injuries were at 0.2 per 1,000 patient days, meeting the annual target of <0.5 per 1,000 patient days. Outcomes for falls with injury, hand hygiene and patient experience also trended toward target. These improvements occurred while also observing a lower observed to expected length of stay (O/E LOS), which is the organizational marker for hospital's efficiency. RESEARCH LIMITATIONS/IMPLICATIONS LDM may contribute greatly to improve safety outcomes. This observational study was performed in an urban, high-acuity, low cost hospital which may not be representative of other hospitals. Further study is warranted to determine whether this model can be applied more broadly to other settings. PRACTICAL IMPLICATIONS LDM can be implemented quickly to achieve an improvement in hospital safety and other health-care quality outcomes. This required a redistribution of time for hospital staff but did not require any significant capital or other investment. SOCIAL IMPLICATIONS As hospital systems move from a volume-based to value-based health-care delivery model, dynamic interventions using LDM can play a pivotal role in helping all patients, particularly in underserved settings where lower cost care is required for sustainability, given limited available resources. ORIGINALITY/VALUE While many hospital systems promote organizational rounding as a routine quality improvement process, this study shows that a dynamic, intense LDM model can dramatically improve safety within months. This was done in a challenging urban environment for a high-acuity population with limited resources.
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Affiliation(s)
- Pracha Peter Eamranond
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | - Donna DiPalma
- Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | | | - Thomas Burke
- Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - John Rodis
- Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
| | - Michael Grey
- Department of Internal Medicine, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA.,University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Dada S, Ashworth H, Sobitschka A, Raguveer V, Sharma R, Hamilton RL, Burke T. Experiences with implementation of continuous positive airway pressure for neonates and infants in low-resource settings: A scoping review. PLoS One 2021; 16:e0252718. [PMID: 34115776 PMCID: PMC8195417 DOI: 10.1371/journal.pone.0252718] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background Continuous positive airway pressure (CPAP) is the gold standard of care in providing non-invasive positive pressure support to neonates in respiratory distress in high-resource settings. While safety has been demonstrated in low-resource settings, there is a lack of knowledge on the barriers and facilitators to proper implementation. Objective To identify and describe the barriers, facilitators, and priorities for future implementation of CPAP for neonates and infants in low-resource settings. Methods A systematic search (database inception to March 6, 2020) was performed on MEDLINE, Embase, Web of Science, CINAHL, Global Health, and the WHO Global Index Medicus using PRISMA-ScR guidelines. Original research articles pertaining to implementation of CPAP devices in low-resource settings, provider or parent perspectives and experiences with CPAP, cost-benefit analyses, and cost-effectiveness studies were included. Inductive content analysis was conducted. Findings 1385 article were screened and 54 studies across 19 countries met inclusion criteria. Six major themes emerged: device attributes, patient experiences, parent experiences, provider experiences, barriers, and facilitators. Nasal trauma was the most commonly reported complication. Barriers included unreliable electricity and lack of bioengineering support. Facilitators included training, mentorship and empowerment of healthcare providers. Device design, supply chain infrastructure, and training models were imperative to the adoption and sustainability of CPAP. Conclusion Sustainable implementation of CPAP in low resource settings requires easy-to-use devices, ready access to consumables, and holistic, user-driven training. Further research is necessary on standardizing metrics, interventions that support optimal provider performance, and conditions needed for successful long-term health system integration.
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Affiliation(s)
- Sara Dada
- Vayu Global Health Foundation Boston, Boston, Massachusetts, United States of America
- * E-mail:
| | - Henry Ashworth
- Vayu Global Health Foundation Boston, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Alina Sobitschka
- Vayu Global Health Foundation Boston, Boston, Massachusetts, United States of America
- University of Göttingen, Göttingen, Germany
| | - Vanitha Raguveer
- Vayu Global Health Foundation Boston, Boston, Massachusetts, United States of America
- University of Illinois College of Medicine, Chicago, Illinois, United States of America
| | - Rupam Sharma
- Vayu Global Health Foundation Boston, Boston, Massachusetts, United States of America
- University of California Los Angeles Kern Medical Center, Bakersfield, California, United States of America
| | - Rebecca L. Hamilton
- Massachusetts General Hospital, Department of Anesthesiology, Boston, Massachusetts, United States of America
- Karolinska Institute, Department of Cell and Molecular Biology, Solna, Sweden
| | - Thomas Burke
- Vayu Global Health Foundation Boston, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Massachusetts General Hospital, Global Health Innovation Lab, Department of Emergency Medicine, Boston, Massachusetts, United States of America
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Escobar MF, Valencia P, Jaimes LM, Hincapié LC, Pulgarín EE, Nasner D, Carvajal J, Echavarría MP, Burke T, Prada S. Resource use decrease after implementation of care bundles for treatment of postpartum hemorrhage. J Matern Fetal Neonatal Med 2021; 35:7874-7881. [PMID: 34112062 DOI: 10.1080/14767058.2021.1937989] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate whether the implementation of care bundles has an impact on resource utilization in the care of patients with postpartum hemorrhage (PPH). METHODS Retrospective, cross-sectional, observational study of 404 patients with stage II or greater PPH. Periods 2011-2014 and 2015-2017, before and after the introduction of care bundles, were compared. Billing reports were analyzed, and all services provided to treat these events were extracted. Use of resources within the two periods was computed. RESULTS The amount billed per episode decreased 18.66% from the first to the second period. Most PPH cases used fewer resources after introduction of care bundles. The greatest reduction was in the use of medications, with a decrease of charges by 56.3%. Diagnostic procedure charges decreased by 47.6% and consultation charges decreased by (37.7%). CONCLUSIONS The use of PPH care bundles may be associated with lower resource use and fewer interventions.
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Affiliation(s)
- María Fernanda Escobar
- Department of Obstetrics and Gynecology, High Complexity Obstetric Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Paola Valencia
- Department of Obstetrics and Gynecology, High Complexity Obstetric Unit, Fundación Valle del Lili, Cali, Colombia
| | | | | | | | - Daniela Nasner
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Javier Carvajal
- Department of Obstetrics and Gynecology, High Complexity Obstetric Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - María Paula Echavarría
- Department of Obstetrics and Gynecology, High Complexity Obstetric Unit, Fundación Valle del Lili, Cali, Colombia.,Department of Obstetrics and Gynecology, School of Medicine, Universidad Icesi, Cali, Colombia
| | - Thomas Burke
- Department of Emergency Medicine Global Health Innovation Laboratory, Massachusetts General Hospital, Boston, MA, USA.,Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Sergio Prada
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia.,Centro PROESA, Universidad Icesi, Cali, Colombia
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Moser SS, Apter L, Arunachalam A, Burke T, Shalev V, Chodick G, Siegelmann-Danieli N. Real-world study of PD-L1 testing patterns and treatment distribution in patients with metastatic non-small-cell lung cancer in Israel. Immunotherapy 2021; 13:851-861. [PMID: 34034511 DOI: 10.2217/imt-2020-0347] [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] [Indexed: 11/21/2022] Open
Abstract
Aim: We describe PD-L1 testing patterns and first-line treatment for patients with metastatic non-small-cell lung cancer in a 2.3 million-member state-mandated health service in Israel. Materials & methods: Newly diagnosed stage IV non-small-cell lung cancer patients initiating systemic anticancer treatment from 1 January 2017 until 31 December 2018 were identified from the national cancer registry and Maccabi Healthcare Service database and followed until 30 June 2019. Results: The cohort consisted of 410 patients; 58% males, median age 68 years, 70% current/former smokers, 81% adenocarcinoma, 14% had brain metastases, and Eastern Cooperative Oncology Group performance status was 46/17/37% for 0-1/2-4/unknown, respectively. A total of 80% tested for PD-L1 expression, of which 47% had tumor proportion score (TPS) ≥ 50%. A total of 95% with TPS ≥ 50% and no known tumor aberrations (including EGFR mutations, and translocations in ALK and ROS1) received first-line PD-1/PD-L1-inhibitor monotherapy, and 80% of untested/TPS < 50% received platinum doublets. Conclusion: Fast uptake of testing was observed, and treatment patterns showed high adherence to guidelines.
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Affiliation(s)
- Sarah Sharman Moser
- Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, 6812509, Israel
| | - Lior Apter
- Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, 6812509, Israel.,Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, 84105, Israel
| | | | | | - Varda Shalev
- Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, 6812509, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Israel
| | - Gabriel Chodick
- Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, 6812509, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Israel
| | - Nava Siegelmann-Danieli
- Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, 6812509, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Israel
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Pérol M, Quantin X, Lena H, Filleron T, Chouaid C, Valette CA, Kaderbhai C, Chenuc G, Santorelli M, Bensimon L, Burke T, Simon G, Martin AL, Debieuvre D, Gervais R, Schott R, Carton M, Courtinard C, Girard N. 110P Real-world evaluation of pembrolizumab monotherapy for previously treated PD-L1 positive (TPS>1%) advanced NSCLC in France. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01952-3] [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: 11/27/2022]
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Dodd P, McEvoy J, Lockhart K, Burke T, O'Keeffe L, Guerin S. An exploratory study of self-reported complicated grief symptoms in parentally bereaved adults with intellectual disability. J Intellect Disabil Res 2021; 65:297-305. [PMID: 33426748 DOI: 10.1111/jir.12812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Complicated grief involves the experience of grief-related symptoms at a time, and severity, beyond which could be considered adaptive, while persistent complex bereavement disorder (PCBD) has been identified as a condition that requires further study in the typical population. The aims of this study are to (1) explore the symptoms of complicated grief associated with parental bereavement as self-reported by adults with intellectual disabilities (IDs) who have experienced a parental bereavement and (2) conduct an initial examination of how the existing criteria for PCBD apply to this group. METHODS This study uses a comparative group design, assessing self and staff (proxy) reports for a group of parentally bereaved individuals and a matched group of non-bereaved individuals using the Complicated Grief Questionnaire - ID Self-Report. Participants were 46 individuals with ID, 30 (65%) of whom who had experienced a parental bereavement within the previous 2 years. The age range was 23-67 years (mean = 43.8; SD = 10.3). RESULTS The results highlight the presence of a range of symptoms of complicated grief in individuals' self-reports, although there was some evidence that separation distress-related symptoms were more apparent. An analysis of individual symptoms showed patterns of higher reports among the bereaved group as would be expected. Comparing staff and self-reports, key criteria showed higher levels in self-reports among the bereaved group. CONCLUSIONS This study has demonstrated the capacity of people with ID to self-report personal experience of symptoms of complicated grief, when appropriate and accessible assessment tools are used. Some symptoms were more evident among bereaved individuals (compared with non-bereaved participants), and they tended to be from separation distress criteria. This may indicate the relevance of these symptoms for people with ID and question the existing criteria for PCBD in this population, which may have clinical implications for supporting people with ID experiencing a more complicated bereavement response.
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Affiliation(s)
- P Dodd
- Department of Psychiatry, St Michael's House Disability Services, Dublin, Ireland
- UCD Centre for Disability Studies, University College Dublin, Dublin, Ireland
| | - J McEvoy
- UCD Centre for Disability Studies, University College Dublin, Dublin, Ireland
- Prosper Services, Dublin, Ireland
- UCD School of Psychology, University College Dublin, Dublin, Ireland
| | - K Lockhart
- Department of Psychiatry, St Michael's House Disability Services, Dublin, Ireland
- UCD School of Psychology, University College Dublin, Dublin, Ireland
| | - T Burke
- UCD School of Psychology, University College Dublin, Dublin, Ireland
- KARE Services, Kildare, Ireland
| | - L O'Keeffe
- UCD Centre for Disability Studies, University College Dublin, Dublin, Ireland
- UCD School of Psychology, University College Dublin, Dublin, Ireland
| | - S Guerin
- UCD Centre for Disability Studies, University College Dublin, Dublin, Ireland
- UCD School of Psychology, University College Dublin, Dublin, Ireland
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Liu S, Hu X, Li Y, Burke T, Piperdi B. 108P Real-world time on treatment (rwToT) analysis for first-line pembrolizumab combination therapy in advanced nonsquamous NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01950-x] [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: 10/21/2022]
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Pérol M, Filleron T, Quantin X, Chouaid C, Valette CA, Lena H, Kaderbhai C, Fabre C, Santorelli M, Bensimon L, Burke T, Couch D, Nguyen E, Courtinard C. 109P Real-world evaluation of pembrolizumab monotherapy for PD-L1 positive (TPS>50%) metastatic NSCLC in France. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01951-1] [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: 10/21/2022]
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Halmos B, Burke T, Kalyvas C, Vandormael K, Frederickson A, Piperdi B. Pembrolizumab+chemotherapy versus atezolizumab+chemotherapy+/-bevacizumab for the first-line treatment of non-squamous NSCLC: A matching-adjusted indirect comparison. Lung Cancer 2021; 155:175-182. [PMID: 33839603 DOI: 10.1016/j.lungcan.2021.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 10/23/2020] [Revised: 03/05/2021] [Accepted: 03/25/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Multiple immunotherapy and chemotherapy combinations are approved for the management of advanced NSCLC which have not been directly compared in randomized clinical trials. This study indirectly compared the effectiveness of pembrolizumab + chemotherapy versus atezolizumab + chemotherapy+/-bevacizumab for previously untreated non-squamous NSCLC patients without EGFR/ALK aberrations. MATERIALS AND METHODS A matching-adjusted indirect comparison (MAIC) was conducted using individual patient data (IPD) from KEYNOTE-021 Cohort G (KN021 G) (pembrolizumab + carboplatin + pemetrexed; N = 59) and KEYNOTE-189 (KN189) (pembrolizumab + pemetrexed + platinum chemotherapy; N = 410) and published aggregate data from IMpower 130 (atezolizumab + carboplatin + nab-paclitaxel; N = 451) and IMpower 150 (atezolizumab + carboplatin + paclitaxel + bevacizumab; N = 356). To adjust for cross-trial differences in baseline characteristics, data from patients randomized to pembrolizumab + chemotherapy in KN021 G/KN189 were reweighted to match the baseline characteristics of patients randomized to atezolizumab + chemotherapy from IMpower 130 or atezolizumab + chemotherapy + bevacizumab from IMpower 150. Outcomes included overall survival (OS), blinded independent review-assessed progression-free survival (PFS) and objective response rate (ORR). OS and PFS follow-up were truncated to the trial with shorter follow-up. Sensitivity analyses were conducted without truncation of follow-up of OS and PFS. RESULTS After matching for cross-trial differences, the effective sample size of pembrolizumab + chemotherapy was 428 and 389 for the IMpower 130 and IMpower 150 comparisons, respectively. The estimated HRs (95 % CIs) of pembrolizumab + chemotherapy versus atezolizumab + chemotherapy were 0.80 (0.67,0.95) and 0.79 (0.67,0.93) with regard to OS and PFS, respectively. For pembrolizumab + chemotherapy versus atezolizumab + chemotherapy + bevacizumab, the estimated HR (95 % CIs) was 0.86 (0.72,1.03) for OS and 0.81 (0.68,0.96) for PFS. For ORR, the estimated risk ratio (95 % CI) and the risk difference (95 % CI) was 0.9 (0.8,1.1) and -3.5 % (-10.0,3.1) for pembrolizumab + chemotherapy versus atezolizumab + chemotherapy, respectively, and 0.8 (0.7,0.9) and -12.2 % (-19.6,-4.8) for pembrolizumab + chemotherapy versus atezolizumab + chemotherapy + bevacizumab, respectively. Findings were consistent across sensitivity analyses for both outcomes. CONCLUSION MAIC results showed a significantly better OS and PFS for pembrolizumab + chemotherapy compared with atezolizumab + chemotherapy and a significantly better PFS for pembrolizumab + chemotherapy compared with atezolizumab + chemotherapy + bevacizumab.
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Affiliation(s)
- Balazs Halmos
- Department of Oncology, Montefiore/Albert Einstein Cancer Center, 2nd Floor, 1695 Eastchester Rd, Bronx, NY, 10461, USA.
| | - Thomas Burke
- Center for Observational & Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, 07033, USA.
| | - Chrysostomos Kalyvas
- Biostatistics and Research Decision Sciences, MSD Europe, Inc., Brussels, 1200, Belgium.
| | - Kristel Vandormael
- Biostatistics and Research Decision Sciences, MSD Europe, Inc., Brussels, 1200, Belgium.
| | | | - Bilal Piperdi
- Oncology Clinical Development, Merck & Co., Inc., Kenilworth, NJ, 07033, USA.
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Apter L, Moser SS, Arunachalam A, Burke T, Shalev V, Chodick G, Siegelmann-Danieli N. P09.39 PD-L1 Testing Patterns and Treatment in Patients With Metastatic Non-Small Cell Lung Cancer in Israel – Analysis of Real-World Data. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.467] [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: 10/21/2022]
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Jemielita T, Li XN, Piperdi B, Zhou W, Burke T, Chen C. Overall Survival With Second-Line Pembrolizumab in Patients With Non-Small-Cell Lung Cancer: Randomized Phase III Clinical Trial Versus Propensity-Adjusted Real-World Data. JCO Clin Cancer Inform 2021; 5:56-65. [PMID: 33439727 DOI: 10.1200/cci.20.00099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To compare and characterize overall survival (OS) differences between clinical trial data from the KEYNOTE-010 trial and real-world data (RWD) from the Flatiron Health database in patients with programmed death ligand 1 (PD-L1)-expressing advanced non-small-cell lung cancer (NSCLC) who received second-line pembrolizumab monotherapy. METHODS Clinical trial data were from the randomized phase II/III KEYNOTE-010 trial that enrolled patients from August 28, 2013, to February 27, 2015. At data cutoff for KEYNOTE-010, the median survival follow-up time for pembrolizumab patients was 11.2 months. RWD were from Flatiron Health advanced NSCLC database and included patients who initiated second-line pembrolizumab from January 26, 2015, to February 28, 2019. At data cutoff for Flatiron, the median survival follow-up time for pembrolizumab-treated patients was 6.1 months. Clinical trial data from KEYNOTE-010 and RWD from Flatiron were analyzed without adjustment, with propensity adjustment, and filtered per the main KEYNOTE-010 eligibility criteria (EC) of histologically/cytologically confirmed PD-L1-positive NSCLC, Eastern Cooperative Oncology Group performance status of 0/1, no prior therapy with docetaxel for NSCLC, and laboratory values indicative of adequate organ function in addition to prior line of therapy requirements. RESULTS Among 243 patients from KEYNOTE-010 and 782 from Flatiron, median age was 63 v 68 years, and 64% v 54% were male, respectively. OS data from KEYNOTE-010 and Flatiron were similar without any adjustment (n = 782; hazard ratio [HR], 0.96; 95% CI, 0.80 to 1.15) and after both filtering and propensity adjustment (n = 221; HR, 0.99; 95% CI, 0.73 to 1.34). CONCLUSION Without any adjustment, as well as after applying similar EC and appropriate statistical methods, RWD demonstrated similar effectiveness for pembrolizumab in second-line NSCLC as observed in randomized clinical trials.
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Affiliation(s)
- Thomas Jemielita
- Biostatistics and Research Decision Sciences (BARDS), Merck & Co, Inc, Kenilworth, NJ
| | - Xiaoyun Nicole Li
- Biostatistics and Research Decision Sciences (BARDS), Merck & Co, Inc, Kenilworth, NJ
| | - Bilal Piperdi
- Oncology Clinical Development, Merck & Co, Inc, Kenilworth, NJ
| | - Wei Zhou
- Center for Observational and Real World Evidence (CORE), Merck & Co, Inc, Kenilworth, NJ
| | - Thomas Burke
- Center for Observational and Real World Evidence (CORE), Merck & Co, Inc, Kenilworth, NJ
| | - Cong Chen
- Biostatistics and Research Decision Sciences (BARDS), Merck & Co, Inc, Kenilworth, NJ
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Halmos B, Burke T, Kalyvas C, Insinga R, Vandormael K, Frederickson A, Piperdi B. MO01.18 An indirect Comparison of Pembrolizumab+Chemo vs Ipilimumab+Nivolumab as First-Line Therapies in Patients with PD-L1 TPS≥1% Metastatic NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2020.10.066] [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: 10/22/2022]
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Halmos B, Burke T, Kalyvas C, Insinga R, Vandormael K, Frederickson A, Piperdi B. MO01.19 An Indirect Comparison of Pembrolizumab Monotherapy Versus Ipilimumab+Nivolumab for First-Line Metastatic NSCLC with PD-L1 TPS≥1%. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2020.10.067] [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: 10/22/2022]
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Velcheti V, Hu X, Chen X, Piperdi B, Burke T. 1328P Clinical outcomes of pembrolizumab plus chemotherapy in non-squamous metastatic NSCLC patients aged 75 years or older at US oncology practices. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Marvel FA, Mathews L, Stewart KJ, Broderick A, Landgren D, Burke T, Bush A, Chudnovsky A, Benjamin P, Shah L, Gao Y, Shan R, Huynh PP, Weng D, Osuji N, Duffy E, Gallagher J, Spaulding EM, Lee M, Demo R, Sham J, Martin SS. A Framework for Providing Virtual Cardiac Rehabilitation Services in Response to COVID-19: Frontline Experience from Johns Hopkins Cardiac Rehabilitation Centers. Am J Prev Cardiol 2020. [DOI: 10.1016/j.ajpc.2020.100063] [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: 10/23/2022] Open
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Anurudran A, Yared L, Comrie C, Harrison K, Burke T. Domestic violence amid COVID‐19. Int J Gynaecol Obstet 2020; 150:255-256. [PMID: 32472696 PMCID: PMC9087628 DOI: 10.1002/ijgo.13247] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/15/2020] [Accepted: 05/25/2020] [Indexed: 11/10/2022]
Abstract
This manuscript highlights the risk that shelter‐in‐place instructions during COVID‐19 places on victims of domestic violence and serves as a call‐to‐action to address this crisis.
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Affiliation(s)
- Ashri Anurudran
- Department of Public Health and Primary Care University of Cambridge Cambridge UK
| | - Leah Yared
- Global Health Laboratory Department of Emergency Medicine Massachusetts General Hospital Boston MA USA
| | | | - Katherine Harrison
- Global Health Laboratory Department of Emergency Medicine Massachusetts General Hospital Boston MA USA
| | - Thomas Burke
- Global Health Laboratory Department of Emergency Medicine Massachusetts General Hospital Boston MA USA
- Department of Emergency Medicine Harvard Medical School Boston MA USA
- Department of Global Health and Population Harvard T. H. Chan School of Public Health Boston MA USA
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Choynowski J, Pirner M, Mickelson C, Mantua J, Sowden WJ, Burke T, Capaldi VF, McKeon AB. 0188 Mood Disorders Moderate the Relationship Between Sleep Quality and Leadership Development for U.S. Army Officer Candidates During ROTC Advanced Camp. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.186] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
U.S. Army Reserve Officer Training Corps (ROTC) Cadets are college students training to be Army Officers. During a month-long capstone course (Advanced Camp), Cadets are rated on their leadership ability. Little work has been done to determine predictors of leadership ability at Advanced Camp. This study examined the effect of poor sleep and mood disorders -- two prevalent factors among college students -- on leadership ability.
Methods
Metrics on leadership, sleep quality, anxiety, and depression, were assessed in 159 ROTC Cadets (22.06±2.49 years; 23.90%female) at Days 1 (Baseline), 14 (Mid), and 29 (Post) of Advanced Camp. Leadership ratings were determined by ROTC Instructors over the course of Advanced Camp (1–5 score; higher score indicates poorer leadership). Predictors were the Pittsburgh Sleep Quality Index, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-9. The relationships between the predictors and leadership scores were tested using linear regression. The interaction between mood disorders and sleep quality on leadership was tested using SPSS Process (Model 1).
Results
Poorer sleep quality at the Post time point (reflecting the prior 2 weeks of sleep) predicted poorer leadership (B=.05,p=.03), while sleep quality from Baseline (B=.03,p=.14) and Mid (B=.01,p=.67) did not. Higher anxiety and depression scores from all time points predicted poorer leadership (p-values<.03). There was an interaction: higher anxiety and high depression predicted poorer leadership only in the context of poor sleep quality (not good or average sleep quality) [anxiety: R2=.04,F(1,159)=6.04,p=.02; interaction: R2=.03,F(1,155)=5.30,p=.02].
Conclusion
The current study identified a relationship between sleep quality and leadership ratings in ROTC cadets. This relationship was moderated by anxiety and depression. ROTC instructors should encourage ROTC Cadets to take advantage of sleep opportunities at Advanced Camp in order to maximize leadership potential.
Support
Support for this study came from the Military Operational Medicine Research Program (MOMRP) of the United States Army Medical Research and Development Command (USAMRDC).
Disclaimer: The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the US Army or of the US
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Affiliation(s)
- J Choynowski
- Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD
| | - M Pirner
- Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD
| | - C Mickelson
- Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD
| | - J Mantua
- Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD
| | - W J Sowden
- Tripler Army Medical Center, Honolulu, HI
| | - T Burke
- Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD
| | - V F Capaldi
- Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD
| | - A B McKeon
- Walter Reed Army Institute of Research (WRAIR), Silver Spring, MD
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Resch S, Guha M, Ward Z, Suarez Zarate S, Borovac-Pinheiro A, Omotayo M, Garg L, Hansel S, Burke T. Cost-effectiveness of postpartum haemorrhage first response bundle and non-surgical interventions for refractory postpartum haemorrhage in India: an ex-ante modelling study. The Lancet Global Health 2020. [DOI: 10.1016/s2214-109x(20)30183-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Garassino MC, Gadgeel S, Esteban E, Felip E, Speranza G, Domine M, Hochmair MJ, Powell S, Cheng SYS, Bischoff HG, Peled N, Reck M, Hui R, Garon EB, Boyer M, Wei Z, Burke T, Pietanza MC, Rodríguez-Abreu D. Patient-reported outcomes following pembrolizumab or placebo plus pemetrexed and platinum in patients with previously untreated, metastatic, non-squamous non-small-cell lung cancer (KEYNOTE-189): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Oncol 2020; 21:387-397. [PMID: 32035514 DOI: 10.1016/s1470-2045(19)30801-0] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pembrolizumab plus pemetrexed-platinum led to superior overall survival and progression-free survival, and a higher proportion of patients with a confirmed complete or partial response over placebo plus pemetrexed-platinum in the KEYNOTE-189 study. We aimed to evaluate prespecified exploratory patient-reported outcomes (PROs) in patients in KEYNOTE-189. METHODS In the multicentre, double-blind, randomised, placebo-controlled, phase 3 KEYNOTE-189 study done at 126 cancer centres in 16 countries, eligible patients aged 18 years or older with histologically or cytologically confirmed metastatic non-squamous non-small-cell lung cancer without sensitising EGFR or ALK alterations, measurable disease as per Response Evaluation Criteria in Solid Tumors (version 1.1), and an Eastern Cooperative Oncology Group performance status of 0 or 1 were enrolled. Patients were randomly assigned (2:1) to receive intravenous pembrolizumab (200 mg) or saline placebo every 3 weeks for up to 2 years (35 cycles); all patients received four cycles of intravenous pemetrexed (500 mg/m2) with carboplatin (5 mg/mL per min) or cisplatin (75 mg/m2; investigator's choice) every 3 weeks for four cycles, followed by pemetrexed maintenance therapy every 3 weeks. Permuted block randomisation (block size six) was done with an interactive voice-response system and stratified by PD-L1 expression, choice of platinum, and smoking status. Patients, investigators, and other study personnel were unaware of treatment assignment. The European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire-Core 30 (QLQ-C30) and Lung Cancer 13 (QLQ-LC13) were administered at cycles 1-5, every three cycles thereafter during year 1, and every four cycles during years 2-3. The primary endpoints (overall survival and progression-free survival) have been published previously. Key PRO endpoints were change from baseline to week 12 (during chemotherapy) and week 21 (following chemotherapy) in QLQ-C30 global health status/quality of life (GHS/QOL) score, and time to deterioration in cough, chest pain, or dyspnoea. PROs were analysed in all randomly assigned patients who received at least one dose of study medication and who completed at least one PRO assessment, and the results are provided with two-sided, nominal p values. This ongoing study is registered with ClinicalTrials.gov, number NCT02578680. FINDINGS Between Feb 26, 2016, and March 6, 2017, 616 patients were enrolled; median follow-up was 10·5 months (range 0·2-20·4) as of data cutoff on Nov 8, 2017. 402 (99%) of 405 patients in the pembrolizumab plus pemetrexed-platinum group and 200 (99%) of 202 patients in the placebo plus pemetrexed-platinum-treated group completed at least one PRO assessment. At baseline, 359 (89%) of 402 patients in the pembrolizumab plus pemetrexed-platinum group and 180 (90%) of 200 in the placebo plus pemetrexed-platinum group were compliant with QLQ-C30; at week 12, 319 (90%) of 354 and 149 (89%) of 167 patients were compliant, respectively; and at week 21, 249 (76%) of 326 and 91 (64%) of 143 patients were compliant, respectively. From baseline to week 12, GHS/QOL scores were maintained with both pembrolizumab plus pemetrexed-platinum (least-squares mean change: 1·0 point [95% CI -1·3 to 3·2] increase) and placebo plus pemetrexed-platinum (-2·6 points [-5·8 to 0·5] decrease; between-group difference: 3·6 points [-0·1 to 7·2]; p=0·053). From baseline to week 21, GHS/QOL scores were better maintained with pembrolizumab plus pemetrexed-platinum (least-squares mean change: 1·3 points [95% CI -1·2 to 3·6] increase) than with placebo plus pemetrexed-platinum (-4·0 points [-7·7 to -0·3] decrease; between-group difference: 5·3 points [1·1 to 9·5]; p=0·014). Median time to deterioration in cough, chest pain, or dyspnoea was not reached (95% CI 10·2 months to not reached) with pembrolizumab plus pemetrexed-platinum, and was 7·0 months (4·8 months to not reached) with placebo plus pemetrexed-platinum (hazard ratio 0·81 [95% CI 0·60-1·09], p=0·16). INTERPRETATION The addition of pembrolizumab to standard chemotherapy maintained GHS/QOL, with improved GHS/QOL scores at week 21 in the pembrolizumab plus chemotherapy group compared with the placebo plus chemotherapy group. These data further support use of pembrolizumab plus pemetrexed-platinum as first-line therapy for patients with metastatic non-squamous non-small-cell lung cancer. FUNDING Merck Sharp & Dohme.
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Affiliation(s)
| | - Shirish Gadgeel
- Department of Medical Oncology 1, University of Michigan, Ann Arbor, MI, USA
| | - Emilio Esteban
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Enriqueta Felip
- Vall d'Hebron University, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Giovanna Speranza
- Centre Intégré de Cancérologie de la Montérégie, Hôpital Charles-Le Moyne, Greenfield Park, QC, Canada
| | - Manuel Domine
- Hospital Universitario Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain
| | - Maximilian J Hochmair
- Department of Respiratory and Critical Care Medicine and Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology, Vienna, Austria
| | | | | | | | - Nir Peled
- Clalit Health Services, Soroka Medical Center, Beer-Sheeva, Israel
| | - Martin Reck
- LungenClinic, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany
| | - Rina Hui
- Westmead Hospital and University of Sydney, Sydney, NSW, Australia
| | - Edward B Garon
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | | | | | | | - Delvys Rodríguez-Abreu
- Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Greenberg M, Burke T, Goldstein B, Jackson R, Samet J. Endangering the Health of All: Destroying a Half Century of Health Leadership Along With America's Environment. Am J Public Health 2020; 110:284-285. [PMID: 32023106 DOI: 10.2105/ajph.2019.305533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Michael Greenberg
- Michael Greenberg is an AJPH associate editor and is with the Edward J. Bloustein School, Rutgers University, New Brunswick, NJ. Thomas Burke is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Bernard Goldstein is with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Richard Jackson is with the Fielding School of Public Health, University of California, Los Angeles, CA. Jonathan Samet is with the Colorado School of Public Health, Aurora, CO
| | - Thomas Burke
- Michael Greenberg is an AJPH associate editor and is with the Edward J. Bloustein School, Rutgers University, New Brunswick, NJ. Thomas Burke is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Bernard Goldstein is with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Richard Jackson is with the Fielding School of Public Health, University of California, Los Angeles, CA. Jonathan Samet is with the Colorado School of Public Health, Aurora, CO
| | - Bernard Goldstein
- Michael Greenberg is an AJPH associate editor and is with the Edward J. Bloustein School, Rutgers University, New Brunswick, NJ. Thomas Burke is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Bernard Goldstein is with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Richard Jackson is with the Fielding School of Public Health, University of California, Los Angeles, CA. Jonathan Samet is with the Colorado School of Public Health, Aurora, CO
| | - Richard Jackson
- Michael Greenberg is an AJPH associate editor and is with the Edward J. Bloustein School, Rutgers University, New Brunswick, NJ. Thomas Burke is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Bernard Goldstein is with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Richard Jackson is with the Fielding School of Public Health, University of California, Los Angeles, CA. Jonathan Samet is with the Colorado School of Public Health, Aurora, CO
| | - Jonathan Samet
- Michael Greenberg is an AJPH associate editor and is with the Edward J. Bloustein School, Rutgers University, New Brunswick, NJ. Thomas Burke is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Bernard Goldstein is with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Richard Jackson is with the Fielding School of Public Health, University of California, Los Angeles, CA. Jonathan Samet is with the Colorado School of Public Health, Aurora, CO
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Huang M, Lopes GDL, Insinga RP, Burke T, Ejzykowicz F, Zhang Y, Feliciano JL. Cost–effectiveness of pembrolizumab versus chemotherapy as first-line treatment in PD-L1-positive advanced non-small-cell lung cancer in the USA. Immunotherapy 2019; 11:1463-1478. [DOI: 10.2217/imt-2019-0178] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: This analysis aimed to evaluate the cost–effectiveness of pembrolizumab monotherapy as first-line treatment in advanced non-small-cell lung cancer patients with a programmed death ligand 1 (PD-L1) tumor proportion score ≥1% from a US payer perspective. Materials & methods: A partitioned survival model was developed using efficacy and safety data from the KEYNOTE-042 trial and projected over 20 years. Costs accounted for treatment, toxicity and disease management. Quality-adjusted life-years (QALYs) and incremental cost–effectiveness ratios were reported. Results: Pembrolizumab resulted in an expected gain of 0.60 life years and 0.49 QALYs compared with platinum-based chemotherapy. The incremental cost–effectiveness ratio was US$130,155/QALY. Conclusion: Pembrolizumab is projected to be cost-effective compared with platinum-based chemotherapy as first-line treatment for advanced non-small-cell lung cancer with PD-L1 tumor proportion score ≥1%.
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Affiliation(s)
- Min Huang
- Center for Observational & Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Gilberto de Lima Lopes
- Sylvester Comprehensive Cancer Center, University of Miami & the Miller School of Medicine, Miami, FL 33136, USA
| | - Ralph P Insinga
- Center for Observational & Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Thomas Burke
- Center for Observational & Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Flavia Ejzykowicz
- Center for Observational & Real World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Ying Zhang
- HTA Statistics Europe, Merck Sharp & Dohme, 1200 Brussels, Belgium
| | - Josephine L Feliciano
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD 21287, USA
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Velcheti V, Chandwani S, Chen X, Pietanza MC, Piperdi B, Burke T. Outcomes of first-line pembrolizumab monotherapy for PD-L1-positive (TPS ≥50%) metastatic NSCLC at US oncology practices. Immunotherapy 2019; 11:1541-1554. [PMID: 31774363 DOI: 10.2217/imt-2019-0177] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 02/07/2023] Open
Abstract
Aim: To determine real-world outcomes with first-line pembrolizumab monotherapy for metastatic non-small-cell lung cancer with PD-L1 tumor expression ≥50%. Methods: This retrospective study included adults with ECOG 0-1 initiating first-line pembrolizumab monotherapy on/after 24 October 2016 (EHR cohort) or from 1 December 2016 through 30 November 2017 (spotlight cohort) with ≥6-month follow-up. We estimated Kaplan-Meier overall survival (OS, both cohorts), and, for spotlight, real-world progression-free survival (rwPFS) by Kaplan-Meier and real-world tumor response (rwTR). Results: For 423 patients in the EHR cohort and 188 in spotlight, median OS was 18.9 months (95% CI: 14.9-25.5) and 19.1 months (12.6-not reached), respectively. For spotlight, median rwPFS was 6.8 months (5.3-8.1); rwTR of complete/partial response was 48% (41-56%). Conclusion: Observed OS, rwPFS and rwTR were consistent with clinical trial findings.
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Affiliation(s)
- Vamsidhar Velcheti
- NYU Langone, Perlmutter Cancer Center, 160 E 34th St, New York, NY 10016, USA
| | - Sheenu Chandwani
- Merck & Co., Inc., 2000 Galloping Hill Rd., Kenilworth, NJ 07033, USA
| | - Xin Chen
- Merck & Co., Inc., 2000 Galloping Hill Rd., Kenilworth, NJ 07033, USA
| | | | - Bilal Piperdi
- Merck & Co., Inc., 2000 Galloping Hill Rd., Kenilworth, NJ 07033, USA
| | - Thomas Burke
- Merck & Co., Inc., 2000 Galloping Hill Rd., Kenilworth, NJ 07033, USA
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Mazieres J, Kowalski D, Luft A, Vicente D, Tafreshi A, Gümüş M, Laktionov K, Hermes B, Cicin I, Rodríguez-Cid J, Wilson J, Kato T, Ramlau R, Novello S, Reddy S, Kopp HG, Piperdi B, Li X, Burke T, Paz-Ares L. Health-Related Quality of Life With Carboplatin-Paclitaxel or nab-Paclitaxel With or Without Pembrolizumab in Patients With Metastatic Squamous Non-Small-Cell Lung Cancer. J Clin Oncol 2019; 38:271-280. [PMID: 31751163 DOI: 10.1200/jco.19.01348] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [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
PURPOSE In the phase 3 KEYNOTE-407 study, the addition of pembrolizumab to carboplatin-paclitaxel/nab-paclitaxel significantly improved overall survival, progression-free survival, and objective response rate in patients with previously untreated metastatic squamous non-small-cell lung cancer (NSCLC), with little impact on severe toxicity. We present patient-reported outcomes (PROs) from KEYNOTE-407. METHODS Patients were randomly assigned to receive 4 cycles of pembrolizumab 200 mg or placebo once every 3 weeks plus carboplatin plus paclitaxel or nab-paclitaxel, followed by pembrolizumab or placebo for an additional 31 cycles. Health-related quality of life (HRQoL) was evaluated using the European Organisation for Research and Treatment of Cancer Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30) and Quality of Life Questionnaire-Lung Cancer Module 13 (QLQ-LC13). Key PRO endpoints were change from baseline to weeks 9 and 18 (during and after platinum therapy) in the QLQ-C30 global health status/quality of life (GHS/QoL) score and time to deterioration in the composite endpoint of cough, chest pain, or dyspnea from the QLQ-C30 and QLQ-LC13. Two-sided, nominal P values are provided. RESULTS A total of 554 and 553 patients completed ≥ 1 QLQ-C30 or ≥ 1 QLQ-LC13 assessment, respectively. GHS/QoL score improved for the pembrolizumab-combination group (least squares [LS] mean [95% CI] change from baseline: week 9, 1.8 [-0.9 to 4.4]; week 18, 4.3 [1.7 to 6.9]) and deteriorated in the placebo-combination group (week 9, -1.8 [-4.4 to 0.7]; week 18, -0.57 [-3.3 to 2.2]). Between-group differences were improved for the pembrolizumab-combination group (difference in LS mean scores: week 9, 3.6 [95% CI, 0.3 to 6.9], nominal P = .0337; week 18, 4.9 [1.4 to 8.3], nominal P = .0060). Median time to deterioration in cough, chest pain, or dyspnea was not reached in either group (hazard ratio, 0.79; 95% CI, 0.58 to 1.06]; nominal P = .125). CONCLUSION Addition of pembrolizumab to chemotherapy maintained or improved HRQoL measurements relative to baseline and improved HRQoL versus chemotherapy alone at weeks 9 and 18. These results support use of pembrolizumab plus chemotherapy as first-line therapy for metastatic squamous NSCLC.
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Affiliation(s)
- Julien Mazieres
- Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France
| | | | - Alexander Luft
- Leningrad Regional Clinical Hospital, St Petersburg, Russia
| | - David Vicente
- Hospital Universitario Virgen Macarena, Seville, Spain
| | - Ali Tafreshi
- Wollongong Oncology and University of Wollongong, Wollongong, NSW, Australia
| | - Mahmut Gümüş
- Istanbul Medeniyet University Hospital, Istanbul, Turkey
| | | | | | | | | | | | | | - Rodryg Ramlau
- Poznan University of Medical Sciences, Poznan, Poland
| | | | | | - Hans-Georg Kopp
- Robert-Bosch Cancer Center, Klinik Schillerhöhe, Gerlingen, Germany
| | | | | | | | - Luis Paz-Ares
- Hospital Universitario 12 de Octubre, CNIO-H12o Lung Cancer Unit, Universidad Complutense and Ciberonc, Madrid, Spain
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