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Al-Ezzi E, Mittal A, Veitch ZW, Zahralliyali A, Mejia NMD, Abdeljalil O, Alqaisi H, Kumar V, Hansen AR, Fallah-Rad N, Sridhar SS. The Survival Outcomes of the Metastatic Nonclear Cell Renal Cell Carcinoma in the Immunotherapy Era: Princess Margaret Cancer Centre Experience. J Kidney Cancer VHL 2024; 11:41-48. [PMID: 38450000 PMCID: PMC10915653 DOI: 10.15586/jkcvhl.v11i1.307] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/02/2024] [Indexed: 03/08/2024] Open
Abstract
Immunotherapy (IO) with or without targeted therapy (TT) is the standard treatment for patients with metastatic clear cell renal cell carcinoma (RCC). The evidence supporting their use in metastatic nonclear cell renal cell carcinoma (nccRCC) subtypes is based on small prospective trials and retrospective analyses. Here, we report survival outcomes for patients with metastatic nccRCC treated with IO and/or TT at the Princess Margaret Cancer Centre, Toronto, ON, Canada. Demographics, disease characteristics, and survival outcomes were collected retrospectively. Overall (OS), progression-free survival (PFS), and objective response rates (ORR) were calculated. We identified 69 patients with metastatic nccRCC treated with IO and/or TT as the first-line treatment, and 36 (52.1%) patients as the second-line treatment. Median OS of the first line IO recipients (n = 12) and non-IO recipients (n = 57) was not reached (NR) and 17.2 months (95% confidence interval (95% CI): 7.3-27.0; P = 0.23), respectively. Median PFS of first-line IO recipients and non-IO recipients was NR and 4.7 months (95% CI: 3.7-5.6; P = 0.019), respectively. The ORR of IO recipients versus non-IO recipients was 50% versus 12.3% (P = 0.007). Median OS of the second-line IO recipients (n = 8) and non-IO recipients (n = 28) was NR and 6.3 months (95% CI: 3.2-9.3; P = 0.003), respectively. Median PFS of second-line IO recipients and non-IO recipients was 4.8 months (95% CI: 2.7-6.8) and 2.8 months (95% CI: 1.8-3.7; P = 0.014), respectively. ORR of IO recipients and non-IO recipients was 37.5% and 3.5%, respectively; P = 0.028. While the number of patients included in our retrospective review was small, our analysis suggested that patients with nccRCC have improved survival outcomes with IO treatment. Validation of prospective dataset is required before widespread clinical utilization.
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Affiliation(s)
- Esmail Al-Ezzi
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Abhenil Mittal
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Zachary W. Veitch
- Division of Medical Oncology and Hematology, Royal Victoria Hospital, Barrie, ON, Canada
| | - Amer Zahralliyali
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Nely Mercy Diaz Mejia
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Osama Abdeljalil
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Husam Alqaisi
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Vikaash Kumar
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Aaron R. Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Division of Cancer Services, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD 4113, Australia
| | - Nazanin Fallah-Rad
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Srikala S. Sridhar
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Janse van Rensburg HJ, Liu Z, Watson GA, Veitch ZW, Shepshelovich D, Spreafico A, Abdul Razak AR, Bedard PL, Siu LL, Minasian L, Hansen AR. A tailored phase I-specific patient-reported outcome (PRO) survey to capture the patient experience of symptomatic adverse events. Br J Cancer 2023; 129:612-619. [PMID: 37419999 PMCID: PMC10421959 DOI: 10.1038/s41416-023-02307-w] [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] [Received: 10/02/2022] [Revised: 05/08/2023] [Accepted: 06/05/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Patient perspectives are fundamental to defining tolerability of investigational anti-neoplastic therapies in clinical trials. Phase I trials present a unique challenge in designing tools for efficiently collecting patient-reported outcomes (PROs) given the difficulty of anticipating adverse events of relevance. However, phase I trials also offer an opportunity for investigators to optimize drug dosing based on tolerability for future larger-scale trials and in eventual clinical practice. Existing tools for comprehensively capturing PROs are generally cumbersome and are not routinely used in phase I trials. METHODS Here, we describe the creation of a tailored survey based on the National Cancer Institute's PRO-CTCAE for collecting patients' perspectives on symptomatic adverse events in phase I trials in oncology. RESULTS We describe our stepwise approach to condensing the original 78-symptom library into a modified 30 term core list of symptoms which can be efficiently applied. We further show that our tailored survey aligns with phase I trialists' perspectives on symptoms of relevance. CONCLUSIONS This tailored survey represents the first PRO tool developed specifically for assessing tolerability in the phase I oncology population. We provide recommendations for future work aimed at integrating this survey into clinical practice.
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Affiliation(s)
- Helena J Janse van Rensburg
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Zhihui Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Geoffrey A Watson
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Zachary W Veitch
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Daniel Shepshelovich
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
- Medicine D, Tel-Aviv Medical Center and the Sackler School of Medicine, Tel Aviv, Israel
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Albiruni R Abdul Razak
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Philippe L Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lillian L Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lori Minasian
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
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3
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Ribnikar D, Horvat VJ, Ratosa I, Veitch ZW, Grcar Kuzmanov B, Novakovic S, Langerholc E, Amir E, Seruga B. Association between PIK3CA activating mutations and outcomes in early-stage invasive lobular breast carcinoma treated with adjuvant systemic therapy. Radiol Oncol 2023; 57:220-228. [PMID: 37341201 DOI: 10.2478/raon-2023-0027] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/18/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND The aim of the study was to evaluate the independent prognostic role of PIK3CA activating mutations and an association between PIK3CA activating mutations and efficacy of adjuvant endocrine therapy (ET) in patients with operable invasive lobular carcinoma (ILC). PATIENTS AND METHODS A single institution study of patients with early-stage ILC treated between 2003 and 2008 was performed. Clinicopathological parameters, systemic therapy exposure and outcomes (distant metastasis-free survival [DMFS] and overall survival [OS]) were collected based on presence or absence of PIK3CA activating mutation in the primary tumor determined using a quantitative polymerase chain reaction (PCR)-based assay. An association between PIK3CA mutation status and prognosis in all patient cohort was analyzed by Kaplan-Meier survival analysis, whereas an association between PIK3CA mutation and ET was analyzed in estrogen receptors (ER) and/or progesterone receptors (PR)-positive group of our patients by the Cox proportional hazards model. RESULTS Median age at diagnosis of all patients was 62.8 years and median follow-up time was 10.8 years. Among 365 patients, PIK3CA activating mutations were identified in 45%. PIK3CA activating mutations were not associated with differential DMFS and OS (p = 0.36 and p = 0.42, respectively). In patients with PIK3CA mutation each year of tamoxifen (TAM) or aromatase inhibitor (AI) decreased the risk of death by 27% and 21% in comparison to no ET, respectively. The type and duration of ET did not have significant impact on DMFS, however longer duration of ET had a favourable impact on OS. CONCLUSIONS PIK3CA activating mutations are not associated with an impact on DMFS and OS in early-stage ILC. Patients with PIK3CA mutation had a statistically significantly decreased risk of death irrespective of whether they received TAM or an AI.
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Affiliation(s)
- Domen Ribnikar
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | | | - Ivica Ratosa
- Faculty of Medicine Ljubljana, University of Ljubljana, Ljubljana, Slovenia
- Department of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Zachary W Veitch
- Division of Medical Oncology and Hematology, Royal Victoria Hospital, Bariie, Ontario, USA
| | | | - Srdjan Novakovic
- Department of Molecular Diagnostics, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Erik Langerholc
- Institute of Biostatistics and informatics, Faculty of Medicine Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Eitan Amir
- Division of Medical Oncology and Hematology, University of Toronto and Princess Margaret Cancer Centre, Toronto, Canada
| | - Bostjan Seruga
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine Ljubljana, University of Ljubljana, Ljubljana, Slovenia
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4
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Watson GA, Veitch ZW, Shepshelovich D, Liu ZA, Spreafico A, Abdul Razak AR, Bedard PL, Siu LL, Minasian L, Hansen AR. Evaluation of the patient experience of symptomatic adverse events on Phase I clinical trials using PRO-CTCAE. Br J Cancer 2022; 127:1629-1635. [PMID: 36008705 PMCID: PMC9596492 DOI: 10.1038/s41416-022-01926-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/20/2022] [Revised: 06/28/2022] [Accepted: 07/14/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Adverse event (AE) reporting in early-phase clinical trials is essential in determining the tolerability of experimental anticancer therapies. The patient-reported outcome version of the CTCAE (PRO-CTCAE) evaluates AE components such as severity and interference in daily life. The aim of this study was to correlate the grade of clinician-reported AEs with patients' reported experience of these toxicities using PRO-CTCAE. METHODS Patients with advanced solid tumours enrolled on Phase I clinical trials were surveyed using the PRO-CTCAE. Symptomatic AEs were recorded by physicians using the CTCAE. A logistic regression model was used to assess associations between CTCAE grade and PRO responses. RESULTS Of 219 evaluable patients, 81 experienced a high-grade (3/4) clinician-reported symptom, and of these, only 32 (40%) and 26 (32%) patients concordantly reported these as either severe or very severe, and interfering with daily life either 'quite a bit' or 'very much', respectively. Of the 137 patients who experienced a low-grade (1/2) clinician-reported AE as their worst symptom, 98 (72%) and 118 (86%) patients concordantly reported these as either mild-moderate severity and minimally interfering with daily life, respectively. There was a statistically significant association between clinician-reported AE grade and interference. Interference scores were also associated with dose reductions. CONCLUSION This is the first study to explore patient-reported severity and interference from symptomatic toxicities and compare clinician grading of the same toxicities. The study provided further evidence to support the added value of the PRO-CTCAE in Phase I oncology trials, which would make AE reporting patient-centred. Further work is needed to determine how this would affect the assessment of tolerability.
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Affiliation(s)
- Geoffrey A Watson
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Zachary W Veitch
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Daniel Shepshelovich
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Medicine D, Tel-Aviv Medical Center, and the Sackler School of Medicine, Tel Aviv, Israel
| | - Zhihui Amy Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Albiruni R Abdul Razak
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Philippe L Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lillian L Siu
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lori Minasian
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
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Hilton J, Gelmon K, Bedard PL, Tu D, Xu H, Tinker AV, Goodwin R, Laurie SA, Jonker D, Hansen AR, Veitch ZW, Renouf DJ, Hagerman L, Lui H, Chen B, Kellar D, Li I, Lee SE, Kono T, Cheng BYC, Yap D, Lai D, Beatty S, Soong J, Pritchard KI, Soria-Bretones I, Chen E, Feilotter H, Rushton M, Seymour L, Aparicio S, Cescon DW. Results of the phase I CCTG IND.231 trial of CX-5461 in patients with advanced solid tumors enriched for DNA-repair deficiencies. Nat Commun 2022; 13:3607. [PMID: 35750695 PMCID: PMC9232501 DOI: 10.1038/s41467-022-31199-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [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: 10/19/2021] [Accepted: 06/07/2022] [Indexed: 12/12/2022] Open
Abstract
CX-5461 is a G-quadruplex stabilizer that exhibits synthetic lethality in homologous recombination-deficient models. In this multicentre phase I trial in patients with solid tumors, 40 patients are treated across 10 dose levels (50–650 mg/m2) to determine the recommended phase II dose (primary outcome), and evaluate safety, tolerability, pharmacokinetics (secondary outcomes). Defective homologous recombination is explored as a predictive biomarker of response. CX-5461 is generally well tolerated, with a recommended phase II dose of 475 mg/m2 days 1, 8 and 15 every 4 weeks, and dose limiting phototoxicity. Responses are observed in 14% of patients, primarily in patients with defective homologous recombination. Reversion mutations in PALB2 and BRCA2 are detected on progression following initial response in germline carriers, confirming the underlying synthetic lethal mechanism. In vitro characterization of UV sensitization shows this toxicity is related to the CX-5461 chemotype, independent of G-quadruplex synthetic lethality. These results establish clinical proof-of-concept for this G-quadruplex stabilizer. Clinicaltrials.gov NCT02719977. G-quadruplex stabilizers, including CX-5461, exhibit synthetic lethality with loss of BRCA1/2 in preclinical models. Here the authors report the results of a phase I study of CX-5461 in patients with solid tumors enriched for DNA-repair deficiencies.
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Affiliation(s)
- John Hilton
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Karen Gelmon
- BC Cancer - Vancouver Centre, Vancouver, BC, V5Z 1L3, Canada
| | - Philippe L Bedard
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dongsheng Tu
- Canadian Cancer Trials Group, 10 Stuart Street, Kingston, ON, K7L 3N6, Canada
| | - Hong Xu
- Molecular Oncology, BC Cancer Research Institute, Vancouver, BC, V5Z 1L3, Canada
| | - Anna V Tinker
- BC Cancer - Vancouver Centre, Vancouver, BC, V5Z 1L3, Canada
| | | | | | - Derek Jonker
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Aaron R Hansen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zachary W Veitch
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel J Renouf
- BC Cancer - Vancouver Centre, Vancouver, BC, V5Z 1L3, Canada
| | - Linda Hagerman
- Canadian Cancer Trials Group, 10 Stuart Street, Kingston, ON, K7L 3N6, Canada
| | - Hongbo Lui
- Canadian Cancer Trials Group, 10 Stuart Street, Kingston, ON, K7L 3N6, Canada
| | - Bingshu Chen
- Canadian Cancer Trials Group, 10 Stuart Street, Kingston, ON, K7L 3N6, Canada
| | - Deb Kellar
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Irene Li
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sung-Eun Lee
- BC Cancer - Vancouver Centre, Vancouver, BC, V5Z 1L3, Canada
| | - Takako Kono
- Molecular Oncology, BC Cancer Research Institute, Vancouver, BC, V5Z 1L3, Canada
| | - Brian Y C Cheng
- Molecular Oncology, BC Cancer Research Institute, Vancouver, BC, V5Z 1L3, Canada
| | - Damian Yap
- Molecular Oncology, BC Cancer Research Institute, Vancouver, BC, V5Z 1L3, Canada
| | - Daniel Lai
- Molecular Oncology, BC Cancer Research Institute, Vancouver, BC, V5Z 1L3, Canada
| | - Sean Beatty
- Molecular Oncology, BC Cancer Research Institute, Vancouver, BC, V5Z 1L3, Canada
| | | | | | | | - Eric Chen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Harriet Feilotter
- Canadian Cancer Trials Group, 10 Stuart Street, Kingston, ON, K7L 3N6, Canada
| | - Moira Rushton
- Canadian Cancer Trials Group, 10 Stuart Street, Kingston, ON, K7L 3N6, Canada
| | - Lesley Seymour
- Canadian Cancer Trials Group, 10 Stuart Street, Kingston, ON, K7L 3N6, Canada.
| | - Samuel Aparicio
- Molecular Oncology, BC Cancer Research Institute, Vancouver, BC, V5Z 1L3, Canada.,Pathology and Laboratory Medicine, UBC, Vancouver, BC, Canada
| | - David W Cescon
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Alqaisi HA, Stecca C, Veitch ZW, Riromar J, Kaiser J, Fallah-Rad N, Jiang DM, North S, Samnani S, Alimohamed N, Sridhar SS. The prognostic impact of bone metastasis in patients with metastatic urothelial carcinoma treated with first-line platinum-based chemotherapy. Ther Adv Med Oncol 2022; 14:17588359221094879. [PMID: 35520101 PMCID: PMC9066632 DOI: 10.1177/17588359221094879] [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: 01/17/2022] [Accepted: 03/31/2022] [Indexed: 12/24/2022] Open
Abstract
Background: In metastatic urothelial cancer (mUC), bone metastasis (BM) are associated with significant morbidity and mortality, yet their role as an independent prognostic variable remains unclear. We aimed to determine the impact of BM on overall survival (OS) in patients with mUC treated with first-line platinum-based chemotherapy (PBC). Methods: mUC patients receiving PBC at the Princess Margaret Cancer Center, Tom Baker Cancer Center, or Cross Cancer Institute from January 2005 to January 2018 were identified retrospectively using central pharmacy database records. Patient disease, treatment, and response characteristics were collected. Progression-free survival (PFS) and OS were estimated using the Kaplan–Meier method. Variables reaching significance (p < 0.05) in univariable analysis (UVA) of survival (OS) were included in multivariable analysis (MVA) (Cox). Results: Overall, 376 patients with a median follow-up of 16.8 (range: 2.2–218.3) months were included. Median age was 67 (range: 28–91) years, 76% were male, 63% had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0–1, and 41% had BM. All patients received first-line PBC. Patients with BM had inferior median PFS (4.9 months (95% CI 3.6–6.2) versus 6.5 months (95% CI 5.4–7.6), p = 0.03) and median OS (8.8 months (95% CI 7.8–9.7) versus 10.8 months (95% CI 9.1–12.5), p = 0.002). In UVA, ECOG PS 2–3 (p < 0.001), presence of BM (p = 0.002), and WBC count ⩾ 11,000 cells/mm3 (p = 0.001) were associated with inferior survival. Prior cystectomy (p < 0.001) and lack of progression (stable disease, partial or complete response) on treatment was associated with improved OS (p < 0.001). These variables maintained significance in MVA. Conclusion: In this retrospective study, mUC patients with BM had worse OS suggesting that BM may be an independent negative prognostic factor and including BM as a stratification factor in future mUC clinical trial designs may be warranted. A greater focus must be placed on novel therapeutic strategies to better manage BM to reduce both morbidity and mortality.
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Affiliation(s)
- Husam A. Alqaisi
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Carlos Stecca
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Zachary W. Veitch
- Division of Medical Oncology and Hematology, St. Michael’s Hospital, Toronto, ON, Canada
| | - Jamila Riromar
- National Oncology Center (NOC) Royal Hospital, Muscat, Oman
| | - Jeenan Kaiser
- Division of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Nazanin Fallah-Rad
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Di Maria Jiang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Scott North
- Division of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | - Sunil Samnani
- Division of Medical Oncology and Hematology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Nimira Alimohamed
- Division of Medical Oncology and Hematology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Srikala S. Sridhar
- Professor of Medicine, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 700 University Avenue, Toronto, ON M5G 1Z5, Canada
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7
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Veitch ZW, Shepshelovich D, Gallagher C, Wang L, Abdul Razak AR, Spreafico A, Bedard PL, Siu LL, Minasian L, Hansen AR. Underreporting of Symptomatic Adverse Events in Phase I Clinical Trials. J Natl Cancer Inst 2021; 113:980-988. [PMID: 33616650 DOI: 10.1093/jnci/djab015] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/04/2020] [Accepted: 01/04/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Clinician reporting of symptomatic adverse events (AEs) in phase I trials uses the Common Terminology Criteria for Adverse Events (CTCAE). The utility of the patient-reported outcomes (PROs) version of the CTCAE (PRO-CTCAE) in this setting is unknown. This prospective, observational study compared patient- and clinician-reported symptomatic AEs in phase I patients. METHODS Phase I study-eligible patients at Princess Margaret were surveyed with the PRO-CTCAE full-item library (78 symptomatic AEs) at baseline (BL), mid-cycle 1, and mid-cycle 2 (C2). Patient and trial characteristics, best response, and survival data were collected. Presence or absence of patient- (PRO-CTCAE) or clinician-reported symptomatic AEs were compared (kappa) at defined timepoints and overall (BL+ mid-cycle 1 + C2). RESULTS Of 292 patients approached from May 2017 to January 2019, a total of 265 (90.8%) were consented, with 243 (91.7%) evaluable and 552 PRO-CTCAE surveys (completion rate = 98.7%) included in analyses. Evaluation of overall patient-reported symptomatic AEs identified 50 PRO-CTCAE and 11 CTCAE items with 10% or greater reporting frequency. Nineteen CTCAE items were reported as 1% or less despite matched PRO-CTCAE items reporting as 10% or greater. Underreported categories included sexual health, bodily emissions, and cognition. Clinician- relative to patient-reporting frequency (ratio) demonstrated 9 symptomatic AEs with a 50-fold or more lower clinician reporting rate. Overall patient-clinician agreement for individual symptomatic AEs ranged from poor (κ = 0.00-0.19) to moderate (κ = 0.40-0.59), with discordance driven by lack of clinician reporting. Dyspnea (κ = 0.54) and peripheral neuropathy (κ = 0.63) at BL and limb edema (κ = 0.55) at C2 demonstrated the highest patient-clinician agreement. CONCLUSIONS Poor to moderate patient-clinician agreement for symptomatic AEs suggests clinician underreporting in phase I trials. Analyses of severity and interference PRO categories are ongoing.
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Affiliation(s)
- Zachary W Veitch
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Daniel Shepshelovich
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Department of Internal Medicine, Sackler School of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Christina Gallagher
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lisa Wang
- Department of Biostatistics, University of Toronto, Toronto, ON, Canada
| | | | - Anna Spreafico
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Philippe L Bedard
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lillian L Siu
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lori Minasian
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Aaron R Hansen
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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8
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Ribnikar D, Goldvaser H, Veitch ZW, Ocana A, Templeton AJ, Šeruga B, Amir E. Efficacy, safety and tolerability of drugs studied in phase 3 randomized controlled trials in solid tumors over the last decade. Sci Rep 2021; 11:10843. [PMID: 34035370 PMCID: PMC8149406 DOI: 10.1038/s41598-021-90403-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/30/2021] [Indexed: 01/08/2023] Open
Abstract
Data suggest that for newly approved cancer drugs safety and tolerability are worse than in control arms of registration trials. Less is known about the balance between efficacy and toxicity of drugs studied in unselected phase 3 randomized controlled trials (RCTs) including those not resulting in regulatory approval. We searched Clinicaltrials.gov to identify phase 3 RCTs in patients with advanced breast, colorectal, lung, or prostate cancer completed between January 2005 and October 2016. We extracted efficacy and safety data from publications. For efficacy hazard ratios (HRs) for progression-free survival (PFS) and overall survival (OS) were extracted. For safety, we computed odds ratios (ORs) and 95% confidence intervals (CIs) for toxic death, treatment discontinuation without progression and commonly reported grade 3/4 adverse events (AEs). Data were then pooled in a meta-analysis. Of 377 RCTs identified initially, 143 RCTs comprising 88,603 patients were included in the analysis. Of these, 79 (57%) trials met their primary endpoint. Compared to control groups, both PFS (HR 0.80; 95% CI 0.78–0.82) and OS (HR 0.87; 95% CI 0.85–0.89) were improved with experimental drugs. Toxic death (OR 1.14; 95% CI 1.03–1.27), treatment discontinuation without progression (OR 1.64; 95% CI 1.56–1.71) and grade 3/4 AEs were also more common with experimental drugs compared to respective control group therapy. Just over half of phase 3 RCTs in common solid tumors met their primary endpoint and in nearly half, experimental therapy had worse safety compared to control arms.
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Affiliation(s)
- Domen Ribnikar
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.,Division of Medical Oncology and Hematology, University of Toronto and Princess Margaret Cancer Centre, 610 University Ave, 700U, 7-721, Toronto, ON, M5G 2M9, Canada
| | - Hadar Goldvaser
- Division of Medical Oncology and Hematology, University of Toronto and Princess Margaret Cancer Centre, 610 University Ave, 700U, 7-721, Toronto, ON, M5G 2M9, Canada.,Rabin Medical Center, Davidoff Cancer Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zachary W Veitch
- Division of Medical Oncology and Hematology, University of Toronto and Princess Margaret Cancer Centre, 610 University Ave, 700U, 7-721, Toronto, ON, M5G 2M9, Canada
| | - Alberto Ocana
- Drug Development Program, Hospital Clinico San Carlos and CIBERONC, Madrid, Spain.,Translational Oncology Laboratory. Regional Center for Biomedical Research (CRIB), Castilla La Mancha University, Albacete, Spain
| | - Arnoud J Templeton
- Department of Oncology, St. Claraspital Basel, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Boštjan Šeruga
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Eitan Amir
- Division of Medical Oncology and Hematology, University of Toronto and Princess Margaret Cancer Centre, 610 University Ave, 700U, 7-721, Toronto, ON, M5G 2M9, Canada.
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9
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Veitch ZW, Fasih S, Griffin AM, Al-Ezzi EM, Gupta AA, Ferguson PC, Wunder JS, Abdul Razak AR. Clinical outcomes of non-osteogenic, non-Ewing soft-tissue sarcoma of bone--experience of the Toronto Sarcoma Program. Cancer Med 2020; 9:9282-9292. [PMID: 33063945 PMCID: PMC7774718 DOI: 10.1002/cam4.3531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/24/2020] [Revised: 09/09/2020] [Accepted: 09/18/2020] [Indexed: 01/10/2023] Open
Abstract
Non‐osteogenic, non‐Ewing soft‐tissue sarcoma (NONE‐STS) of bone is a rare presentation of primary bone cancers. Optimal treatments and outcomes for this heterogenous group are poorly described. We evaluated the factors associated with long‐term outcomes in patients with this disease. Patients with localized NONE‐STS of bone treated at the Toronto Sarcoma Program from 1987 to 2017 were identified. Clinical characteristics, treatment, and survival information were collected. Kaplan‐Meier (log‐rank) survival estimates from the time of definitive surgery, with uni‐/multivariate analyses (Cox) of sarcoma‐specific survival were performed. A total of 106 patients (60.4% male; median age 46 years) with NONE‐STS of bone were identified. Common histologies included undifferentiated pleomorphic sarcoma [UPS]/malignant fibrous histiocytoma [MFH] (UPS/MFH, 41.5%), leiomyosarcoma (LMS, 20.8%), and fibrosarcoma (FS, 11.3%). Tumors were often high grade (59.4%) and involved the extremities (88.7%), with most receiving chemotherapy (67.9%) with cisplatin/doxorubicin‐based regimens (73.6%). In the full cohort, 10‐year DFS (45.7%, [95%CI: 35.7‐55.8%]), OS (53.4%, [95%CI: 41.7‐62.2%]), and SSS (63.9%, [95%CI: 53.9‐72.5%]) were moderate. Histology specific, 10‐year SSS was 70.7% [95%CI: 56.1‐85.5%] for UPS/MFH, 51.8% [95%CI: 29.8‐73.8%] for LMS, and 72.2% [95%CI: 45.1‐99.2%] for FS. Only UPS/MFH (n = 4) showed sarcoma‐related death >10 years. Multivariate analysis identified axial location (HR = 35.5, [95%CI: 3.4‐369.6]), high grade (HR = 16.9, [95%CI: 1.6‐185.1]), and disease relapse (HR = 485.1, [95%CI: 36.3‐6482.6]) as risk factors for death (p < 0.05). Treatment with chemotherapy (HR = 0.1, [95%CI: 0.01‐0.86]) and necrosis ≥85% (HR = 0.2, [95%CI: 0.04‐0.99]) showed improved survival (p < 0.05). NONE‐STS of bone has favorable long‐term survival similar to osteosarcoma. Patients receiving chemotherapy derive benefit in retrospective analyses. UPS/MFH histologies show sarcoma‐related death beyond 10 years. Further data on histologic subgroups are needed.
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Affiliation(s)
- Zachary W Veitch
- Toronto Sarcoma Program at Mount Sinai Hospital, Toronto, Canada.,Princess Margaret Cancer Centre, Toronto, Canada
| | - Samir Fasih
- Toronto Sarcoma Program at Mount Sinai Hospital, Toronto, Canada.,Princess Margaret Cancer Centre, Toronto, Canada
| | - Anthony M Griffin
- Toronto Sarcoma Program at Mount Sinai Hospital, Toronto, Canada.,The Hospital for Sick Children, Toronto, Canada
| | - Esmail M Al-Ezzi
- Toronto Sarcoma Program at Mount Sinai Hospital, Toronto, Canada.,Princess Margaret Cancer Centre, Toronto, Canada
| | | | - Peter C Ferguson
- Toronto Sarcoma Program at Mount Sinai Hospital, Toronto, Canada.,Princess Margaret Cancer Centre, Toronto, Canada.,University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Jay S Wunder
- Toronto Sarcoma Program at Mount Sinai Hospital, Toronto, Canada.,Princess Margaret Cancer Centre, Toronto, Canada.,University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Albiruni R Abdul Razak
- Toronto Sarcoma Program at Mount Sinai Hospital, Toronto, Canada.,Princess Margaret Cancer Centre, Toronto, Canada
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10
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Veitch ZW, Cescon DW, Denny T, Yonemoto LM, Fletcher G, Brokx R, Sampson P, Li SW, Pugh TJ, Bruce J, Bray MR, Slamon DJ, Mak TW, Wainberg ZA, Bedard PL. Safety and tolerability of CFI-400945, a first-in-class, selective PLK4 inhibitor in advanced solid tumours: a phase 1 dose-escalation trial. Br J Cancer 2019; 121:318-324. [PMID: 31303643 PMCID: PMC6738068 DOI: 10.1038/s41416-019-0517-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 04/04/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 11/24/2022] Open
Abstract
Background CFI-400945 is a first-in-class oral inhibitor of polo-like kinase 4 (PLK4) that regulates centriole duplication. Primary objectives of this first-in-human phase 1 trial were to establish the safety and tolerability of CFI-400945 in patients with advanced solid tumours. Secondary objectives included pharmacokinetics, pharmacodynamics, efficacy, and recommended phase 2 dose (RP2D). Methods Continuous daily oral dosing of CFI-400945 was evaluated using a 3+3 design guided by incidence of dose-limiting toxicities (DLTs) in the first 28-day cycle. Safety was assessed by CTCAE v4.0. ORR and CBR were evaluated using RECIST v1.1. Results Forty-three patients were treated in dose escalation from 3 to 96 mg/day, and 9 were treated in 64 mg dose expansion. After DLT occurred at 96 and 72 mg, 64 mg was established as the RP2D. Neutropenia was a common high-grade (19%) treatment-related adverse event at ≥ 64 mg. Half-life of CFI-400945 was 9 h, with Cmax achieved 2–4 h following dosing. One PR (45 cycles, ongoing) and two SD ≥ 6 months were observed (ORR = 2%; CBR = 6%). Conclusions CFI-400945 is well tolerated at 64 mg with dose-dependent neutropenia. Favourable pharmacokinetic profiles were achieved with daily dosing. Response rates were low without biomarker pre-selection. Disease-specific and combination studies are ongoing. Trial Registration Clinical Trials Registration Number – NCT01954316 (Oct 1st, 2013)
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Affiliation(s)
- Zachary W Veitch
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - David W Cescon
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Trisha Denny
- Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lisa-Maria Yonemoto
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Graham Fletcher
- Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Richard Brokx
- Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Peter Sampson
- Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sze-Wan Li
- Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Trevor J Pugh
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jeffrey Bruce
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Mark R Bray
- Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Dennis J Slamon
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Tak W Mak
- Campbell Family Institute for Breast Cancer Research, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Zev A Wainberg
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Philippe L Bedard
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
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11
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Veitch ZW, Bedard P, Tang PA, Conway JL, Ribnikar D, Albaba H, King K, Lupichuk S, Cescon D. Abstract P6-17-29: Withdrawn. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-17-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
Citation Format: Veitch ZW, Bedard P, Tang PA, Conway JL, Ribnikar D, Albaba H, King K, Lupichuk S, Cescon D. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-29.
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Affiliation(s)
- ZW Veitch
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Princess Margaret Cancer Centre, University of Toronto, Edmonton, AB, Canada; Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - P Bedard
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Princess Margaret Cancer Centre, University of Toronto, Edmonton, AB, Canada; Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - PA Tang
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Princess Margaret Cancer Centre, University of Toronto, Edmonton, AB, Canada; Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - JL Conway
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Princess Margaret Cancer Centre, University of Toronto, Edmonton, AB, Canada; Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - D Ribnikar
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Princess Margaret Cancer Centre, University of Toronto, Edmonton, AB, Canada; Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - H Albaba
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Princess Margaret Cancer Centre, University of Toronto, Edmonton, AB, Canada; Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - K King
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Princess Margaret Cancer Centre, University of Toronto, Edmonton, AB, Canada; Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - S Lupichuk
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Princess Margaret Cancer Centre, University of Toronto, Edmonton, AB, Canada; Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - D Cescon
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada; Princess Margaret Cancer Centre, University of Toronto, Edmonton, AB, Canada; Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
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12
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Veitch ZW, Khan OF, Tilley D, Kostaras X, King K, Lupichuk S, Tang P. Abstract P3-12-11: Disparities in adjuvant hormone adherence in breast cancer patients within a universal healthcare model. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-12-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Patient adherence to adjuvant hormonal therapy for breast cancer (BC) is correlated with improved survival. Recent publications have demonstrated ethnic disparities in adjuvant hormone adherence (AHA) for privatized healthcare models.
Objective: To identify disparities in AHA for BC patients within a universal healthcare system in Alberta, Canada.
Methods: Patients diagnosed from 2007-2014 with stage I-III, ER+/HER2- BC receiving adjuvant FECD or DC chemotherapy and at least one month of adjuvant hormonal therapy in Alberta, Canada were retrospectively assessed. Hormone monotherapy (tamoxifen, AI), switch strategies (tam to AI), and treatment duration were collected. Compliance was assessed with central pharmacy data. Patient ethnicity was identified using patient first/last and parental last name via Onolytics® ethnographic software. Ethnicity was further verified using a centrally collected place of birth. Age, AJCC stage, psychiatric diagnoses (mood, bipolar), and comorbidity were collected. Log rank and Chi squared were used to assess difference between adjuvant hormonal therapy for variables at 1, 2, and 5 years. Log rank p-values at 2 years are reported.
Results: A total of 2,399 ER+ patients were included for analysis. AHA was non-significant for ethnicity (p=0.797), comorbidity (p=0.623), psychiatric disorders (p=0.145), or elderly cohorts (p= 0.814). AHA by stage was significant with stage III > II > I (p=0.004) having the highest compliance rates. AHA was highest for planned hormonal switch strategies (p=0.004) compared to monotherapy.
Hormone Adherence RatesCharacteristicsNo. of Patients% AdherenceEthnicity Caucasian211891.6Asian15293.4Middle Eastern/African9593.7Hispanic2491.7Age <65207791.8>6534192.1Comorbidity 096191.21-3134392.2>311493Psychiatric Dx Yes31189.7No210792.1Stage I45388.3II151292.1III45394.5Hormone Strategy Monotherapy173190.9Switch68794.2
Conclusion: AHA is not dependent on ethnicity, age, comorbidity, or psychiatric diagnosis in a universal healthcare model. Conversely, higher rates of AHA are seen with planned switch strategy compared to monotherapy, contradictory to the BIG I-98 trial. Patients with higher stage, and thus higher risk of BC recurrence have increased adherence compared to their low risk counterparts. Reinforcement of AHA for low/moderate risk BC patients, in addition to tamoxifen to AI switch strategies may improve overall adherence.
Citation Format: Veitch ZW, Khan OF, Tilley D, Kostaras X, King K, Lupichuk S, Tang P. Disparities in adjuvant hormone adherence in breast cancer patients within a universal healthcare model [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-12-11.
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Affiliation(s)
- ZW Veitch
- Tom Baker Cancer Centre - University of Calgary, Calgary, AB, Canada; Alberta Health Services - Cancer Control, Edmonton, AB, Canada; Cross Cancer Institute - University of Alberta, Edmonton, AB, Canada
| | - OF Khan
- Tom Baker Cancer Centre - University of Calgary, Calgary, AB, Canada; Alberta Health Services - Cancer Control, Edmonton, AB, Canada; Cross Cancer Institute - University of Alberta, Edmonton, AB, Canada
| | - D Tilley
- Tom Baker Cancer Centre - University of Calgary, Calgary, AB, Canada; Alberta Health Services - Cancer Control, Edmonton, AB, Canada; Cross Cancer Institute - University of Alberta, Edmonton, AB, Canada
| | - X Kostaras
- Tom Baker Cancer Centre - University of Calgary, Calgary, AB, Canada; Alberta Health Services - Cancer Control, Edmonton, AB, Canada; Cross Cancer Institute - University of Alberta, Edmonton, AB, Canada
| | - K King
- Tom Baker Cancer Centre - University of Calgary, Calgary, AB, Canada; Alberta Health Services - Cancer Control, Edmonton, AB, Canada; Cross Cancer Institute - University of Alberta, Edmonton, AB, Canada
| | - S Lupichuk
- Tom Baker Cancer Centre - University of Calgary, Calgary, AB, Canada; Alberta Health Services - Cancer Control, Edmonton, AB, Canada; Cross Cancer Institute - University of Alberta, Edmonton, AB, Canada
| | - P Tang
- Tom Baker Cancer Centre - University of Calgary, Calgary, AB, Canada; Alberta Health Services - Cancer Control, Edmonton, AB, Canada; Cross Cancer Institute - University of Alberta, Edmonton, AB, Canada
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13
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Veitch ZW, Khan OF, Tilley D, Kostaras X, Tang PA, King K, Lupichuk S. Abstract P5-20-12: Adjuvant DCH vs TCH for low-risk (node negative); and FECDH vs TCH for high-risk (node positive) HER2+ breast cancer – A retrospective provincial analysis. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-20-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Chemotherapy plus trastuzumab for early HER2+ breast cancer (BC) is associated with improved survival. Optimal regimens for low-risk (node negative) and high-risk (node positive) HER2+ breast cancers are unknown and choice of regimen varies in real-world clinical practice.
Objective: (1) For low-risk breast cancer, to compare DCH (4 cycles) and TCH (6 cycles) in terms of disease free (DFS) and overall survival (OS). (2) For high-risk breast cancer, to compare FECDH (6 cycles) and TCH (6 cycles) in terms of DFS and OS.
Methods: All women diagnosed from 2007-2014 with stage I-III, hormone receptor (HR) +/-, HER2+ BC receiving adjuvant chemotherapy plus trastuzumab (n=986) in Alberta, Canada were included. Patients with low-risk (node negative) disease were stratified into DCH (n=104) or TCH (n=360) cohorts for DFS/OS comparison (Kaplan-Meier). Patients with high-risk (node positive) disease were stratified into FECDH (n=145) or TCH (n=314) cohorts. Subgroup analysis of the high-risk cohorts by HR+/HER2+ and HR-/HER2+ for FECDH vs TCH were performed. Chi-square was used to evaluate for difference between cohort variables.
Low- Risk Cohort DCH TCH n (104)%n (360)%Age (mean)55.3 53.0 Hormone Status ER+ or PR+8682.727676.7ER and PR-1817.38423.3Grade 121.951.423230.88523.637067.327075.0Surgery lumpectomy525010830.5mastectomy525024669.5
High-Risk Cohort FECDH TCH n (145)%n (314)%Age (mean)50.2 53.6 Hormone Status ER+ or PR+11579.323875.8ER and PR-3020.77624.2Grade 10051.6229206119.631168014678.8Surgery lumpectomy3927.19831.2mastectomy10572.921668.8Node Status N18357.219461.8N24128.37323.2N32114.54715
Results: Median follow-up was 58.1 months in the low-risk cohort and 63.1 months in the high-risk cohort. In the low-risk group, patients receiving TCH had more mastectomy (69.5%) than lumpectomy (30.5%; p<0.001) compared to those receiving DCH (50%; 50%). No significant difference was seen in DFS (p=0.153) or OS (p=0.409) for patients in the DCH (92.3%; 95.2%) vs TCH (95.2%; 96.9%) cohorts. In the high-risk group, no significant difference was seen in DFS (p=0.226) or OS (p=0.164) for FECDH (92.4; 95.2%) or TCH (88.5%; 91.4%) respectively. In subgroup analysis of high-risk HR+/HER2+ BC, patients receiving FECDH demonstrated superior OS (98.3%; p=0.014) and a trend towards superior DFS (94.8%; p=0.069) relative to TCH patients (OS = 91.6%; DFS= 88.7%). Conversely, analysis of high-risk HR-/HER2+ BC, patients demonstrated higher DFS and OS for TCH (88.2%; 90.8%) relative to FECDH (83.3%; 83.3%); although this was non-significant (p=0.516; p=0.298) and likely underpowered. Nodal status was balanced between all groups (p=0.602).
Conclusion: In low-risk HER2+ BC, 4 cycles of DCH chemotherapy has high survival with similar outcomes to 6 cycles of TCH. In high-risk HER2+ BC, FECDH has comparable outcomes to TCH consistent with BCIRG-006. This study suggests that women with HR+/HER2+ breast cancer have improved OS with anthracycline containing regimens, such as FECDH. Although non-significant, patients with HR-/HER2+ BC may have some improvement in DFS and OS with TCH, a carboplatin containing regimen.
Citation Format: Veitch ZW, Khan OF, Tilley D, Kostaras X, Tang PA, King K, Lupichuk S. Adjuvant DCH vs TCH for low-risk (node negative); and FECDH vs TCH for high-risk (node positive) HER2+ breast cancer – A retrospective provincial analysis [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-20-12.
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Affiliation(s)
- ZW Veitch
- Tom Baker Cancer Centre - University of Calgary, Calgary, AB, Canada; Alberta Health Services - Cancer Control, Edmonton, AB, Canada; Cross Cancer Institute - University of Alberta, Edmonton, AB, Canada
| | - OF Khan
- Tom Baker Cancer Centre - University of Calgary, Calgary, AB, Canada; Alberta Health Services - Cancer Control, Edmonton, AB, Canada; Cross Cancer Institute - University of Alberta, Edmonton, AB, Canada
| | - D Tilley
- Tom Baker Cancer Centre - University of Calgary, Calgary, AB, Canada; Alberta Health Services - Cancer Control, Edmonton, AB, Canada; Cross Cancer Institute - University of Alberta, Edmonton, AB, Canada
| | - X Kostaras
- Tom Baker Cancer Centre - University of Calgary, Calgary, AB, Canada; Alberta Health Services - Cancer Control, Edmonton, AB, Canada; Cross Cancer Institute - University of Alberta, Edmonton, AB, Canada
| | - PA Tang
- Tom Baker Cancer Centre - University of Calgary, Calgary, AB, Canada; Alberta Health Services - Cancer Control, Edmonton, AB, Canada; Cross Cancer Institute - University of Alberta, Edmonton, AB, Canada
| | - K King
- Tom Baker Cancer Centre - University of Calgary, Calgary, AB, Canada; Alberta Health Services - Cancer Control, Edmonton, AB, Canada; Cross Cancer Institute - University of Alberta, Edmonton, AB, Canada
| | - S Lupichuk
- Tom Baker Cancer Centre - University of Calgary, Calgary, AB, Canada; Alberta Health Services - Cancer Control, Edmonton, AB, Canada; Cross Cancer Institute - University of Alberta, Edmonton, AB, Canada
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