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Mates M, Bedard P, Hilton J, Gelmon K, Srikanthan A, Awan A, Song X, Lohrisch C, Robinson A, Tu D, Hagerman L, Zhang S, Drummond-Ivars N, Li I, Rastgou L, Edwards J, Bray M, Rushton M, Gaudreau PO. 38MO IND.236: A Canadian Cancer Trial Group (CCTG) phase Ib trial of combined CFI-402257 and weekly paclitaxel (Px) in patients with HER2-negative (HER2-) advanced breast cancer (BC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.01.053] [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] Open
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Tan AD, Willemsma K, MacNeill A, DeVries K, Srikanthan A, McGahan C, Hamilton T, Li H, Blanke CD, Simmons CE. Tyrosine kinase inhibitors significantly improved survival outcomes in patients with metastatic gastrointestinal stromal tumour: a multi-institutional cohort study. ACTA ACUST UNITED AC 2020; 27:e276-e282. [PMID: 32669934 DOI: 10.3747/co.27.5869] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The real-world impact of tyrosine kinase inhibitors (tkis) in clinical practice for gastrointestinal stromal tumour (gist) has not been extensively reported. We sought to assess how outcomes have changed over the eras and to evaluate the effect of access to imatinib and sunitinib on survival in patients with unresectable or metastatic gist in British Columbia. Methods Patients with metastatic or unresectable gist were allocated to one of three eras: pre-2002, 2002-2007, and post-2007 based on treatment availability (pre-imatinib, post-imatinib, and post-sunitinib). Overall survival (os) and progression-free survival (pfs) were compared between eras. Univariate and multivariate analyses were performed to determine the effects of tumour, patient, and treatment characteristics on survival outcomes. Results Of 657 patients diagnosed with gist throughout British Columbia during 1996-2016, 196 had metastatic disease: 23 in the pre-imatinib era, 67 in the post-imatinib era, and 106 in the post-sunitinib era. A significant increase in os, by 53.6 months (p = 0.0007), and pfs, by 29.1 months (p = 0.044), was observed after the introduction of imatinib. The introduction of sunitinib did not significantly affect os or pfs. Conclusions Implementation of tkis has drastically improved survival outcomes for patients with metastatic gist by up to 4.55 years in the real-world setting. Our study demonstrates that implementation of tkis in clinical practice has outperformed their benefit predicted in clinical trials.
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Affiliation(s)
| | | | - A MacNeill
- Surgical Oncology, BC Cancer, Vancouver, BC
| | - K DeVries
- Statistical Sciences, BC Cancer, Vancouver, BC
| | | | - C McGahan
- Statistical Sciences, BC Cancer, Vancouver, BC
| | - T Hamilton
- Surgical Oncology, BC Cancer, Vancouver, BC
| | - H Li
- Medical Oncology, BC Cancer, Vancouver, BC
| | - C D Blanke
- Medical Oncology, ohsu Knight Cancer Institute, Portland, OR, U.S.A
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Smrke A, Leung B, Bates A, Srikanthan A, Ho C. Psychosocial distress of adolescent and young adults with cancer at diagnosis: A case-matched retrospective cohort of 2045 patients in British Columbia. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz265.055] [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: 11/15/2022] Open
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Srikanthan A, Penner N, Chan KKW, Sabharwal M, Grill A. Understanding the reasons for provincial discordance in cancer drug funding-a survey of policymakers. ACTA ACUST UNITED AC 2018; 25:257-261. [PMID: 30111966 DOI: 10.3747/co.25.3993] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 11/15/2022]
Abstract
Background Cancer drug-funding decisions between provinces shows discordance. The pan-Canadian Oncology Drug Review (pcodr) was implemented in 2011 partly to address uneven drug coverage and lack of transparency in the various provincial cancer drug review processes in Canada. We evaluated the underlying reasons for ongoing provincial discordance since the implementation of pcodr. Methods Participation in an online survey was solicited from participating provincial ministries of health (mohs) and cancer agencies (cas). The 4-question survey (with both multiple-choice and free-text responses) was administered between 4 March 2015 and 1 April 2015, inclusive. Anonymity was ensured. Descriptive statistics were used to evaluate responses. Results Data were available from 9 provinces (all Canadian provinces except Quebec), with a response rate of 100%. The 12 responses received each came from a senior policymaker with more than 5 years' experience in cancer drug funding decision-making (5 from mohs, 7 from cas). Responses for 3 provinces came from both a moh representative and a ca representative. The most common reason for funding a drug not recommended by pcodr was political pressure (64%). The most common reason not to fund a drug recommended by pcodr was budget constraints (91%). The most common reason for a province to fund a drug before completion of the pcodr review was also political pressure (57%). Conclusions Political pressure and budgetary constraints continue to affect equity of access to cancer drugs for patients throughout Canada.
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Affiliation(s)
- A Srikanthan
- Division of Medical Oncology, BC Cancer, and.,Department of Medicine, University of British Columbia, Vancouver, BC
| | - N Penner
- pan-Canadian Oncology Drug Review, Canadian Agency for Drugs and Technologies in Health, and
| | - K K W Chan
- Division of Medical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON.,Canadian Centre for Applied Research in Cancer Control, Vancouver, BC
| | - M Sabharwal
- pan-Canadian Oncology Drug Review, Canadian Agency for Drugs and Technologies in Health, and
| | - A Grill
- Department of Family and Community Medicine, University of Toronto, Toronto, ON
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Srikanthan A, Mai H, Penner N, Amir E, Laupacis A, Sabharwal M, Chan KKW. Impact of the pan-Canadian Oncology Drug Review on provincial concordance with respect to cancer drug funding decisions and time to funding. ACTA ACUST UNITED AC 2017; 24:295-301. [PMID: 29089796 DOI: 10.3747/co.24.3648] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 12/24/2022]
Abstract
BACKGROUND The pan-Canadian Oncology Drug Review (pcodr) was implemented in 2011 to address uneven drug coverage and lack of transparency with respect to the various provincial cancer drug review processes in Canada. We evaluated the impact of the pcodr on provincial decision concordance and time from Notice of Compliance (noc) to drug funding. METHODS In a retrospective review, Health Canada's Drug Product Database was used to identify new indications for cancer drugs between January 2003 and May 2014, and provincial formulary listings for drug-funding dates and decisions between 1 January 2003 and 31 December 2014 were retrieved. Multiple linear models and quantile regressions were used to evaluate changes in time to decision-making before and after the implementation of the pcodr. Agreement of decisions between provinces was evaluated using kappa statistics. RESULTS Data were available from 9 provinces (all Canadian provinces except Quebec), identifying 88 indications that represented 51 unique cancer drugs. Two provinces lacked available data for all 88 indications at the time of data collection. Interprovincial concordance in drug funding decisions significantly increased after the pcodr's implementation (Brennan-Prediger coefficient: 0.54 pre-pcodr vs. 0.78 post-pcodr; p = 0.002). Nationwide, the median number of days from Health Canada's noc date to the date of funding significantly declined (to 393 days from 522 days, p < 0.001). Exploratory analyses excluding provinces with incomplete data did not change the results. CONCLUSIONS After the implementation of the pcodr, greater concordance in cancer drug funding decisions between provinces and decreased time to funding decisions were observed.
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Affiliation(s)
- A Srikanthan
- Division of Medical Oncology, BC Cancer Agency, Vancouver, BC; and
| | - H Mai
- Pan-Canadian Oncology Drug Review, Canadian Agency for Drugs and Technologies in Health
| | - N Penner
- Pan-Canadian Oncology Drug Review, Canadian Agency for Drugs and Technologies in Health
| | - E Amir
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, and Department of Medicine, University of Toronto.,Institute of Health Policy, Management and Evaluation, University of Toronto
| | - A Laupacis
- Institute of Health Policy, Management and Evaluation, University of Toronto.,Li Ka Shing Knowledge Institute, St. Michael's Hospital
| | - M Sabharwal
- Pan-Canadian Oncology Drug Review, Canadian Agency for Drugs and Technologies in Health
| | - K K W Chan
- Division of Medical Oncology, Sunnybrook Odette Cancer Centre; and.,Canadian Centre for Applied Research in Cancer Control, Toronto, ON
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Abstract
BACKGROUND Concerns have been raised about the potential influence of political pressures on drug funding decisions. We evaluated the temporal relationship between cancer drug funding and provincial elections in 9 Canadian provinces. METHODS New indications for cancer drugs between January 2003 and December 2012 were identified, and the dates of official provincial funding dates and election dates between 1 January 2003 and 31 December 2014 were retrieved. The probability of drug funding announcements in the 60-day period preceding a provincial election was evaluated using binomial probability distribution analysis. RESULTS Data from 9 provinces (all Canadian provinces except Quebec) were available. During the period of interest, 69 new indications for 39 individual drugs were identified. Variation in the availability of funding dates was identified. At the time of data collection, 2 provinces did not have data available for all 69 indications. For the 9 provinces, the number of funded indications during the 60-day period preceding an election ranged from 0 to 3; however, no differences in the proportion of indications funded pre-election were identified. Additional analyses also failed to demonstrate any significant associations with the 90-day period before an election, or the 60- and 90-day periods after an election. CONCLUSIONS We observed no clear temporal relationship between provincial election dates and funding decisions in this recent Canadian sample of new indications for cancer drugs.
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Affiliation(s)
- A Srikanthan
- Division of Medical Oncology, BC Cancer Agency, Vancouver Centre, Vancouver, BC
| | - S S Gill
- Department of Medicine, Queen's University, Kingston, ON
| | - K K W Chan
- Division of Medical Oncology, Sunnybrook Odette Cancer Centre, and the Canadian Centre for Applied Research in Cancer Control, Toronto, ON
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Srikanthan A, Amir E, Warner E. Abstract P6-12-02: Association between a dedicated program for young breast cancer patients and discussion about fertility preservation. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-12-02] [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
Purpose: To assess whether a dedicated program, including a nurse navigator, improves the frequency of: a) documentation of fertility discussion and b) referrals for fertility preservation (FP).
Methods: A retrospective chart review and prospective survey were undertaken of a cohort of young breast cancer patients diagnosed between 2011-2013 at two academic centres in Toronto, Ontario. The Odette Cancer Center (OCC) has a dedicated program for young breast cancer patients while Princess Margaret Cancer Centre (PM) does not. Documentation of fertility discussion prior to receipt of systemic therapy was extracted from patient records. Prospective surveys were administered to the same cohort to corroborate data collected. Descriptive statistics were used to characterize baseline patient variables. Chi-squared was used to compare categorical variables and t-tests for continuous variables between the two cancer centres. Statistical significance was defined as p<0.05.
Results: At OCC and PM respectively, 91 and 81 patient charts were reviewed while 54 and 49 women returned surveys for response rates of 59% and 60% . Chart reviews demonstrated no difference in the frequency of documentation of fertility discussion (80% versus 75% for OCC and PM, p=0.44); however, surveys demonstrated higher recall of fertility discussion rates at OCC (96% versus 83%, p=0.046). A greater proportion of women were offered FP referrals at OCC, as observed in both chart reviews (53% versus 41%, p=0.18) and surveys (70% versus 46%, p=0.02). Time to initiation of chemotherapy did not significantly differ between women who underwent FP and those who did not.
Conclusion: A dedicated program for young women with breast cancer including a nurse navigator is associated with a higher frequency of FP referrals without delaying systemic therapy.
Citation Format: Srikanthan A, Amir E, Warner E. Association between a dedicated program for young breast cancer patients and discussion about fertility preservation. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-12-02.
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Affiliation(s)
- A Srikanthan
- Princess Margaret Cancer Centre, Toronto, ON, Canada; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - E Amir
- Princess Margaret Cancer Centre, Toronto, ON, Canada; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - E Warner
- Princess Margaret Cancer Centre, Toronto, ON, Canada; Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
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Srikanthan A, Bedard PL, Goldstein S, Templeton A, Amir E. Abstract P2-08-05: Association between the neutrophil-to-lymphocyte ratio (NLR) and the 21-gene recurrence score. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-08-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: A high neutrophil-to-lymphocyte ratio (NLR) has been reported to be a poor prognostic indicator in several malignancies including breast cancer. It is unknown whether the prognosis associated with high NLR can be explained by other prognostic factors such as proliferation or estrogen receptor signalling. Here we explore the association between NLR and the 21-gene recurrence score (RS).
Methods: The associations between RS, NLR, tumor size, histologic grade, and estrogen receptor (ER) and progesterone receptor (PgR) expression (assessed by immunohistochemistry) were explored in sequential women with early-stage, lymph node-negative (or with lymph node micrometastases), ER-positive and HER2-negative breast cancer treated at Princess Margaret Cancer Centre in Toronto, Canada and in whom results of the RS were available. NLR was measured prior to surgery. Patients with a documented history of pre-existing infectious/inflammatory condition were excluded. Associations were explored using simple linear regression and statistical significance was defined as p<0.05.
Results: A total of 130 women diagnosed between January 2006 and April 2015 were included in the analysis. Median age was 55 (range 32-79), 87% were lymph node negative and 13% had nodal micrometastases. The median NLR was 2.2 (range 0.9-9.1) and was collected at a median of 12 days prior to surgery (range 0-60). The median RS was 18 (range 0-41). There was no association between RS and NLR (R=-0.10, p=0.31), grade (R=0.13, p=0.15), age (R=-0.05, p=0.58) or tumor size (R=0.06, p=0.48). RS was negatively associated with the magnitude of expression of both ER (R=-0.22, p=0.01) and PgR (R=-0.44, p<0.001). There was no association between NLR and grade (R=0.20, p=0.15), age (R=-0.13, p=0.17), tumor size (R=0.14, p=0.93), ER (R=0.01, p=0.94) or PgR (R=0.13, p=0.23)
Conclusion: The poor outcomes associated with high NLR are unlikely explained by proliferation of estrogen receptor signalling.
Citation Format: Srikanthan A, Bedard PL, Goldstein S, Templeton A, Amir E. Association between the neutrophil-to-lymphocyte ratio (NLR) and the 21-gene recurrence score. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-08-05.
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Affiliation(s)
- A Srikanthan
- Princess Margaret Cancer Centre, Toronto, ON, Canada; Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - PL Bedard
- Princess Margaret Cancer Centre, Toronto, ON, Canada; Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - S Goldstein
- Princess Margaret Cancer Centre, Toronto, ON, Canada; Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - A Templeton
- Princess Margaret Cancer Centre, Toronto, ON, Canada; Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - E Amir
- Princess Margaret Cancer Centre, Toronto, ON, Canada; Kantonsspital St. Gallen, St. Gallen, Switzerland
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Srikanthan A, Vera-Badillo F, Ethier J, Goldstein R, Templeton A, Ocana A, Seruga B, Amir E. Evolution in the eligibility criteria of randomized controlled trials for systemic cancer therapies. Cancer Treat Rev 2016; 43:67-73. [DOI: 10.1016/j.ctrv.2015.12.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 11/25/2022]
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