Integrated exposure-response analysis of efficacy and safety of lurbinectedin to support the dose regimen in small-cell lung cancer

Purpose

These exposure–response (E–R) analyses integrated lurbinectedin effects on key efficacy and safety variables in relapsed SCLC to determine the adequacy of the dose regimen of 3.2 mg/m² 1-h intravenous infusion every 3 weeks (q3wk).

Methods

Logistic models and Cox regression analyses were applied to correlate lurbinectedin exposure metrics (AUC_tot and AUC_u) with efficacy and safety endpoints: objective response rate (ORR) and overall survival (OS) in SCLC patients (n = 99) treated in study B-005 with 3.2 mg/m² q3wk, and incidence of grade 4 (G4) neutropenia and grade 3–4 (G ≥ 3) thrombocytopenia in a pool of cancer patients from single-agent phase I to III studies (n = 692) treated at a wide range of doses. A clinical utility index was used to assess the appropriateness of the selected dose.

Results

Effect of lurbinectedin AUC_u on ORR best fitted to a sigmoid-maximal response (E_max) logistic model, where E_max was dependent on chemotherapy-free interval (CTFI). Cox regression analysis with OS found relationships with both CTFI and AUC_u. An E_max logistic model for G4 neutropenia and a linear logistic model for G ≥ 3 thrombocytopenia, which retained platelets and albumin at baseline and body surface area, best fitted to AUC_tot and AUC_u. AUC_u between approximately 1000 and 1700 ng·h/L provided the best benefit/risk ratio, and the dose of 3.2 mg/m² provided median AUC_u of 1400 ng·h/L, thus maximizing the proportion of patients within that lurbinectedin target exposure range.

Conclusions

The relationships evidenced in this integrated E–R analysis support a favorable benefit-risk profile for lurbinectedin 3.2 mg/m² q3wk.

Trial registration

Clinicaltrials.gov: NCT02454972; registered May 27, 2015.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00280-021-04366-3.

Comparative evaluation of Indian Diabetes Risk Score and Finnish Diabetes Risk Score for predicting risk of diabetes mellitus type II: A teaching hospital-based survey in Maharashtra

Context:

India is currently becoming capital for diabetes mellitus. This significantly increasing incidence of diabetes putting an additional burden on health care in India. Unfortunately, half of diabetic individuals are unknown about their diabetic status. Hence, there is an emergent need of effective screening instrument to identify “diabetes risk” individuals.

Aims:

The aim is to evaluate and compare the diagnostic accuracy and clinical utility of Indian Diabetes Risk Score (IDRS) and Finnish Diabetes Risk Score (FINDRISC).

Settings and Design:

This is retrospective, record-based study of diabetes detection camp organized by a teaching hospital. Out of 780 people attended this camp voluntarily only 763 fulfilled inclusion criteria of the study.

Subjects and Methods:

In this camp, pro forma included the World Health Organization STEP guidelines for surveillance of noncommunicable diseases. Included primary sociodemographic characters, physical measurements, and clinical examination. After that followed the random blood glucose estimation of each individual.

Statistical Analysis Used:

Diagnostic accuracy of IDRS and FINDRISC compared by using receiver operative characteristic curve (ROC). Sensitivity, specificity, likelihood ratio, positive predictive and negative predictive values were compared. Clinical utility index (CUI) of each score also compared. SPSS version 22, Stata 13, R3.2.9 used.

Results:

Out of 763 individuals, 38 were new diabetics. By IDRS 347 and by FINDRISC 96 people were included in high-risk category for diabetes. Odds ratio for high-risk people in FINDRISC for getting affected by diabetes was 10.70. Similarly, it was 4.79 for IDRS. Area under curves of ROCs of both scores were indifferent (P = 0.98). Sensitivity and specificity of IDRS was 78.95% and 56.14%; whereas for FINDRISC it was 55.26% and 89.66%, respectively. CUI was excellent (0.86) for FINDRISC while IDRS it was “satisfactory” (0.54). Bland-Altman plot and Cohen's Kappa suggested fair agreement between these score in measuring diabetes risk.

Conclusions:

Diagnostic accuracy and clinical utility of FINDRISC is fairly good than IDRS.