Patients rank toxicity against progression free survival in second-line treatment of advanced renal cell carcinoma

Wong, Michael K.; Mohamed, Ateesha F.; Hauber, A. Brett; Yang, Jui; Liu, Zhimei; Rogerio, Jaqueline Willemann; Garay, Carlos A.

doi:10.3111/13696998.2012.708689

Cited by 35 publications

(51 citation statements)

References 18 publications

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“…Indeed, it was considered 30–40 % more important than the method of administration and time to an SSE. Consistent with many studies conducted in cancer [16, 17, 25, 26], method of administration held only a modest association with medication choice. Oral administration was most positively associated with choice, while a 1-h IV infusion every 3 weeks was most negatively associated with choice.…”

Section: Discussionsupporting

confidence: 78%

“…Although symptomatic events (pain, SSEs, etc.) have been extremely important to patients with solid tumors [16], most studies conducted in cancer have found patients value OS or progression-free survival as the most important attribute when considering treatment options [17, 24–26]. It is possible that the differences between our findings and those of the literature could be a function of tumor type (CRPC vs. other tumors), geography (Japan vs. the West), or another aspect of the methods (e.g., a more restricted range of OS levels vs. a wider range of OS levels; older, late-stage patients vs. younger, earlier-stage patients).…”

Section: Discussionmentioning

confidence: 99%

“…Studies in the United States and Europe have been conducted to explore patient preferences among patients with PC, with a focus on the treatment of bone metastases [15–17]. The results from these studies suggest that patients place substantial value on the delay of bone complications; indeed, in one study, patients were willing to sacrifice 3–5 months of survival in the interest of avoiding them [15].…”

Section: Introductionmentioning

confidence: 99%

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Patient preferences for treatment of castration-resistant prostate cancer in Japan: a discrete-choice experiment

et al. 2016

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BackgroundUp to a fifth of patients diagnosed with prostate cancer (PC) will develop castration-resistant prostate cancer (CRPC), which has been associated with a poor prognosis. The aim of this study was to consider the patient perspective as part of the overall treatment decision-making process for CRPC, given that an alignment between patient preference and prescribing has been shown to benefit patient outcomes. This study examines preferences of patients with CRPC in Japan for treatment features associated with treatments like RA-223, abiraterone, and docetaxel and to examine the extent to which treatment preferences may vary between symptomatic and asymptomatic patients.MethodsA two-phase research approach was implemented. In Phase 1, N = 8 patients with CRPC were recruited from a single hospital to complete a qualitative interview to provide feedback on the draft survey. In Phase 2, N = 134 patients with CRPC were recruited from five hospitals to complete a paper survey. The survey included 6 treatment choice questions, each asking patients to choose between two hypothetical treatments for their CRPC. Each treatment alternative was defined by the following attributes: length of overall survival (OS), time to a symptomatic skeletal event (SSE), method of administration, reduction in the risk of bone pain, treatment-associated risk of fatigue and lost work days. A hierarchical Bayesian logistic regression was used to estimate relative preference weights for each attribute level and mean relative importance.ResultsA total of N = 133 patients with CRPC completed the survey and were included in the final analysis. Patients had a mean age of 75.4 years (SD = 7.4) and had been diagnosed with PC a mean of 6.5 years prior (SD = 4.4). Over the attribute levels shown, fatigue (relative importance [RI] = 24.9 %, 95 % CI: 24.7 %, 25.1 %) was the most important attribute, followed by reduction in the risk of bone pain (RI = 23.2 %, 95 % CI: 23.0 %, 23.5 %), and OS (RI = 19.2 %, 95 % CI: 19.0 %, 19.4 %). Although symptomatic patients placed significantly more importance on delaying an SSE (p < .05), no other preference differences were observed.ConclusionsCRPC patients were more concerned about reduced quality of life from side effects of treatment rather than extension of survival, which may have implications for shared decision-making between patients and physicians.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patient preferences for treatment of castration-resistant prostate cancer in Japan: a discrete-choice experiment

et al. 2016

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“…These two sets of observations suggest that if higher overall dose levels can be maintained, alternate scheduling may permit greater daily sunitinib exposure, which may help the individual patient derive greater benefit from sunitinib. Additionally, proliferation of endothelial cells is proportionate to the time off of systemic therapy [9], and unfavorable prognosis is linked to rate of tumor growth while off therapy, generating a hypothesis that shorter breaks are in the patient's best interest.…”

Section: Discussionmentioning

confidence: 99%

“…The results from these studies together led to the recommended phase II dose of 50 mg on discontinuous schedules. In a study by Wong et al, fatigue and diarrhea were the most troublesome toxicities for patients, and patients were willing to forego 4.4 months of PFS to ameliorate their symptoms from severe to mild-to-moderate [9]. Interestingly, with the standard 4-week treatment followed by a 2-week break, a cyclic scoring pattern is observed in patient-reported quality-of-life indicators; with improvement in mean scores after the 2-week treatment break [5].…”

Section: Introductionmentioning

confidence: 99%

Alternate sunitinib schedules in patients with metastatic renal cell carcinoma

2015

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Comparative Survival Associated With Use of Targeted vs Nontargeted Therapy in Medicare Patients With Metastatic Renal Cell Carcinoma

Jahnke

Pettit

et al. 2019

JAMA Netw Open

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IMPORTANCE Targeted therapies for advanced renal cell carcinoma (RCC) have shown increased tolerability and survival advantages over older treatments in clinical trials, but understanding of realworld survival improvements is still emerging. OBJECTIVE To compare overall and RCC-specific survival associated with use of targeted vs nontargeted therapy for metastatic RCC. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used Surveillance, Epidemiology, and End Results-Medicare data from 2000 to 2013 to examine patients with stage IV (distant) clear cell RCC at the time of diagnosis who received any targeted or nontargeted therapy. A 2-stage residual inclusion model was fitted to estimate the survival advantages of targeted treatments using an instrumental variable approach to account for both measured and unmeasured group differences. Data analyses were conducted from July 24, 2017, to April 4, 2019. EXPOSURES Targeted therapy (study group) or nontargeted therapy (control group). MAIN OUTCOMES AND MEASURES Overall survival and RCC-specific survival, defined as the interval between the date of first drug treatment and date of death or end of the observation period. RESULTS The final sample included 1015 patients (mean [SD] age, 71.2 [8.1] years; 392 [39%] women); 374 (37%) received nontargeted therapy and 641 (63%) received targeted therapy. The targeted therapy group had a greater percentage of disabled patients (ie, those <65 years old who were eligible for Medicare because of disability) and older patients (ie, those Ն75 years old) and higher comorbidity index and disability scores compared with the nontargeted therapy group. Unadjusted Kaplan-Meier survival curves showed higher overall survival for targeted vs nontargeted therapy (log-rank test, χ 2 1 = 5.79; P = .02); median survival was not statistically significantly different (8.7 months [95% CI, 7.3-10.2 months] vs 7.2 months [95% CI, 5.8-8.8 months]; P = .14). According to the instrumental variable analysis, the median overall survival advantage was 3.0 months (95% CI, 0.7-5.3 months), and overall survival improvements associated with targeted therapy vs nontargeted therapy were statistically significant: 8% at 1 year (44% [95% CI, 39%-50%] vs 36% [95% CI, 30%-42%]; P = .01), 7% at 2 years (25% [95% CI, 20%-30%] vs 18% [95% CI, 13%-23%]; P = .009), and 5% at 3 years (15% [95% CI, 11%-19%] vs 10% [95% CI, 6%-13%]; P = .01). Receipt of targeted therapy was associated with a lower hazard of death compared with nontargeted therapy (overall survival hazard ratio, 0.78 [95% CI, 0.65-0.94]; RCC-specific survival hazard ratio, 0.77 [95% CI, 0.62-0.96]).

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Patients rank toxicity against progression free survival in second-line treatment of advanced renal cell carcinoma

Abstract: This study provides information to physicians about patient priorities when reviewing and selecting RCC therapies with patients.

Cited by 35 publications

References 18 publications

Patient preferences for treatment of castration-resistant prostate cancer in Japan: a discrete-choice experiment

Patient preferences for treatment of castration-resistant prostate cancer in Japan: a discrete-choice experiment

Alternate sunitinib schedules in patients with metastatic renal cell carcinoma

Comparative Survival Associated With Use of Targeted vs Nontargeted Therapy in Medicare Patients With Metastatic Renal Cell Carcinoma

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