Glioblastoma treatment patterns, survival, and healthcare resource use in real-world clinical practice in the USA

Girvan, Allicia C.; Carter, Gebra C; Li, Li; Kaltenboeck, Anna; Ivanova, Jasmina; Koh, Maria; Stevens, Jessi; Hayes‐Larson, Eleanor; Lahn, Michael

doi:10.7573/dic.212274

Cited by 15 publications

(7 citation statements)

References 33 publications

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“…A later study using retrospective chart data from patients with GBM diagnosed between 2010 and 2012 reported that 76.5% received temozolomide as their first systemic therapy after diagnosis. 28 As 94.8% of these patients had received RT after diagnosis, these findings are consistent with those reported in the present study.…”

Section: ■■ Conclusionsupporting

confidence: 92%

A Real-World Claims Analysis of Costs and Patterns of Care in Treated Patients with Glioblastoma Multiforme in the United States

Norden

Korytowsky

You

et al. 2019

JMCP

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BACKGROUND: Patients with glioblastoma multiforme (GBM) have a poor prognosis and high likelihood of recurrence. Routine care for incident cases in the United States involves surgical resection, followed by radiation therapy (RT) with concurrent and adjuvant temozolomide. Real-world data reporting the treatments and health care burden associated with GBM are limited. OBJECTIVE: To assess patterns of care, health care resource utilization (HCRU), and costs associated with treatment of GBM in the United States.METHODS: This study is a retrospective claims database analysis. Adult patients with a GBM diagnosis (index date) between January 1, 2010, and June 30, 2016, who had undergone brain surgery within 90 days of the index date, had received temozolomide and/or RT up to 90 days after index date, and had at least 6 months of continuous enrollment before the index date, were identified. Patients were excluded if they had (a) another primary cancer within 6 months pre-index, (b) secondary brain metastases, or (c) received temozolomide and/or RT pre-index. Baseline characteristics, treatments, HCRU, and costs were reported. First-line therapy began upon first receipt of RT and/or temozolomide after index date; second-line therapy began when a new drug was added > 28 days after initiation of first-line therapy or when there was a treatment gap > 90 days. Treatment regimens, duration of treatment (corrected group prognosis method), HCRU, and costs were reported descriptively in the 0-to 6-month and 7-to 12-month periods following initiation of first-line and second-line therapy.RESULTS: Baseline characteristics were comparable between patients receiving temozolomide and/or RT. Patients receiving RT without chemotherapy tended to be older, be retired, and have more baseline comorbidities. Of the 4,071 patients receiving first-line therapy for GBM, most (73.0%) received temozolomide + RT; 24.4% received RT; and 2.5% received temozolomide monotherapy. Of those receiving first-line therapy, 1,283 (31.5%) patients subsequently received second-line therapy: 39.4% received bevacizumab monotherapy; 28.9% received bevacizumab combination therapy (temozolomide, 45.2% of patients; irinotecan, 24.3%; and temozolomide + lomustine, 15.4%); 15.5% received temozolomide monotherapy; and 13.7% received other systemic cancer therapies. The proportion of patients with hospitalizations increased from 2.9% (4-6 months pre-index) to 20.8% in the 3 months before the index date (likely due to diagnostic procedures) and 28.1% in the first 6 months after index (likely due to surgery) and then decreased to 13.

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Section: ■■ Conclusionsupporting

confidence: 92%

A Real-World Claims Analysis of Costs and Patterns of Care in Treated Patients with Glioblastoma Multiforme in the United States

Norden

Korytowsky

You

et al. 2019

JMCP

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“…However, there are few real‐world studies evaluating survival outcomes among patients with recurrent glioblastoma. A recent retrospective, online chart‐abstraction study examined patterns of treatment, outcomes, and use of cancer‐related health‐care resource for 503 patients with glioblastoma treated in real‐world clinical practices in the United States, but only 11 patients (2.2%) had recurrent disease . We retrospectively reviewed treatment patterns, survival, and safety outcomes for patients with recurrent glioblastoma receiving bevacizumab‐containing regimens outside of a clinical protocol at a large specialist brain cancer center in the United States.…”

Section: Introductionmentioning

confidence: 99%

Single‐institution retrospective review of patients with recurrent glioblastoma treated with bevacizumab in clinical practice

Desjardins

Herndon

McSherry³

et al. 2019

Health Science Reports

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Background and aims This retrospective review of patients with recurrent glioblastoma treated at the Preston Robert Tisch Brain Tumor Center investigated treatment patterns, survival, and safety with bevacizumab in a real‐world setting. Methods Adult patients with glioblastoma who initiated bevacizumab at disease progression between January 1, 2009, and May 14, 2012, were included. A Kaplan‐Meier estimator was used to describe overall survival (OS), progression‐free survival (PFS), and time to greater than or equal to 20% reduction in Karnofsky Performance Status (KPS). The effect of baseline demographic and clinical factors on survival was examined using a Cox proportional hazards model. Adverse event (AE) data were collected. Results Seventy‐four patients, with a median age of 59 years, were included in this cohort. Between bevacizumab initiation and first failure, defined as the first disease progression after bevacizumab initiation, biweekly bevacizumab and bevacizumab/irinotecan were the most frequently prescribed regimens. Median duration of bevacizumab treatment until failure was 6.4 months (range, 0.5‐58.7). Median OS and PFS from bevacizumab initiation were 11.1 months (95% confidence interval [CI], 7.3‐13.4) and 6.4 months (95% CI, 3.9‐8.5), respectively. Median time to greater than or equal to 20% reduction in KPS was 29.3 months (95% CI, 13.8‐∞). Lack of corticosteroid usage at the start of bevacizumab therapy was associated with both longer OS and PFS, with a median OS of 13.2 months (95% CI, 8.6‐16.6) in patients who did not initially require corticosteroids versus 7.2 months (95% CI, 4.8‐12.5) in those who did ( P = 0.0382, log‐rank), while median PFS values were 8.6 months (95% CI, 4.6‐9.7) and 3.7 months (95% CI, 2.7‐6.6), respectively ( P = 0.0243, log‐rank). Treatment failure occurred in 70 patients; 47 of whom received salvage therapy, and most frequently bevacizumab/carboplatin (7/47; 14.9%). Thirteen patients (18%) experienced a grade 3 AE of special interest for bevacizumab. Conclusions Treatment patterns and outcomes for patients with recurrent glioblastoma receiving bevacizumab in a real‐world setting were comparable with those reported in prospective clinical trials.

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“…Glioblastoma Multiforme (GBM) is the most aggressive, lethal, and prevalent brain malignancy with over 10,000 new cases diagnosed in the United States each year [1, 2] GBM is specifically a grade IV astrocytoma histologically defined by abnormal cellularity, mitotic activity, vascular proliferation, and necrosis leading to a highly mobile and invasive phenotype capable of infiltrating surrounding brain tissue [3]. Consequently, GBM is characterized by poor prognosis, restricted disease management potential, and a less than 1 year median survival rate [4].…”

Section: Introductionmentioning

confidence: 99%

Hyaluronic acid-conjugated liposome nanoparticles for targeted delivery to CD44 overexpressing glioblastoma cells

2016

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Glioblastoma Multiforme (GBM) is a highly prevalent and deadly brain malignancy characterized by poor prognosis and restricted disease management potential. Despite the success of nanocarrier systems to improve drug/gene therapy for cancer, active targeting specificity remains a major hurdle for GBM. Additionally, since the brain is a multi-cell type organ, there is a critical need to develop an approach to distinguish between GBM cells and healthy brain cells for safe and successful treatment. In this report, we have incorporated hyaluronic acid (HA) as an active targeting ligand for GBM. To do so, we employed HA conjugated liposomes (HALNPs) to study the uptake pathway in key cells in the brain including primary astrocytes, microglia, and human GBM cells. We observed that the HALNPs specifically target GBM cells over other brain cells due to higher expression of CD44 in tumor cells. Furthermore, CD44 driven HALNP uptake into GBM cells resulted in lysosomal evasion and increased efficacy of Doxorubicin, a model anti-neoplastic agent, while the astrocytes and microglia cells exhibited extensive HALNP-lysosome co-localization and decreased antineoplastic potency. In summary, novel CD44 targeted lipid based nanocarriers appear to be proficient in mediating site-specific delivery of drugs via CD44 receptors in GBM cells, with an improved therapeutic margin and safety.

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Glioblastoma treatment patterns, survival, and healthcare resource use in real-world clinical practice in the USA

Cited by 15 publications

References 33 publications

A Real-World Claims Analysis of Costs and Patterns of Care in Treated Patients with Glioblastoma Multiforme in the United States

A Real-World Claims Analysis of Costs and Patterns of Care in Treated Patients with Glioblastoma Multiforme in the United States

Single‐institution retrospective review of patients with recurrent glioblastoma treated with bevacizumab in clinical practice

Hyaluronic acid-conjugated liposome nanoparticles for targeted delivery to CD44 overexpressing glioblastoma cells

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