Patterns of use of systemic chemotherapy for Medicare beneficiaries with urothelial bladder cancer

Porter, Michael P.; Kerrigan, Matthew; Donato, B.M.K.; Ramsey, Scott D.

doi:10.1016/j.urolonc.2009.03.021

Cited by 128 publications

(80 citation statements)

References 14 publications

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“…[12][13][14][15] The overall survival rates are 7% for patients with visceral metastases and 21% for patients without visceral metastases. 15 Although multiple first-and second-line chemotherapy regimens are available, most often using a platin-containing regimen, the efficacy is limited Urothelial carcinoma DNA sequencing and the toxicity is significant.…”

Section: Discussionmentioning

confidence: 99%

“…15 Although multiple first-and second-line chemotherapy regimens are available, most often using a platin-containing regimen, the efficacy is limited Urothelial carcinoma DNA sequencing and the toxicity is significant. [12][13][14][15] The emergence of the significantly less toxic therapies that target the GA driving an individual patient's disease have produced major responses and prolongation of survival for non-small-cell lung cancer and other solid tumor patients, clearly positively impacting the clinical outcome of disease. The purpose of this study was to search for GA that permit the application of targeted therapy in a series of 35 relapsed UC cases with a single comprehensive NGS-based diagnostic assay encompassing the deep sequencing of hundreds of cancer-related genes at a high, uniform depth of coverage.…”

Section: Discussionmentioning

confidence: 99%

“…6,11 Although many patients with metastatic UC respond to the cytotoxic chemotherapy regimens used for this disease, a significant number of relapsed and metastatic UC are either resistant to the non-targeted systemic chemotherapy at the time systemic therapy begins or develop resistance to chemotherapy over time. [12][13][14][15] Characterization of the genomic drivers of UC development and progression has long been of interest to cancer biologists, urologists, genitourinary oncologists and pathologists. [16][17][18][19][20] Protein expression studies mostly performed on formalinfixed, paraffin-embedded (FFPE) specimens using immunohistochemistry (IHC) have been widely used to predict prognosis.…”

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confidence: 99%

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Advanced urothelial carcinoma: next-generation sequencing reveals diverse genomic alterations and targets of therapy

Wang²,

et al. 2014

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Although urothelial carcinoma (UC) of the urinary bladder generally portends a favorable prognosis, metastatic tumors often follow an aggressive clinical course. DNA was extracted from 40 lm of formalin-fixed, paraffinembedded (FFPE) sections from 35 stage IV UCs that had relapsed and progressed after primary surgery and conventional chemotherapy. Next-generation sequencing (NGS) was performed on hybridization-captured, adaptor ligation-based libraries for 3320 exons of 182 cancer-related genes plus 37 introns from 14 genes frequently rearranged in cancer to at an average sequencing depth of 1164 Â and evaluated for all classes of genomic alterations (GAs). Actionable GAs were defined as those impacting the selection of targeted anticancer therapies on the market or in registered clinical trials. A total of 139 GAs were identified, with an average of 4.0 GAs per tumor (range 0-10), of which 78 (56%) were considered actionable, with an average of 2.2 per tumor (range 0-7). Twenty-nine (83%) cases harbored at least one actionable GA including: PIK3CA (9 cases; 26%); CDKN2A/B (8 cases; 23%); CCND1 (5 cases; 14%); FGFR1 (5 cases; 14%); CCND3 (4 cases; 11%); FGFR3 (4 cases; 11%); MCL1 (4 cases; 11%); MDM2 (4 cases; 11%); EGFR (2 cases, 6%); ERBB2 (HER2/neu) (2 cases, 6%); NF1 (2 cases, 6%) and TSC1 (2 cases, 6%). Notable additional alterations included TP53 (19 cases, 54%) and RB1 (6 cases; 17%). Genes involved in chromatin modification were altered by nonsense mutation, splice site mutation or frameshift indel in a mutually exclusive manner in nearly half of all cases including KDM6A (10 cases; 29%) and ARID1A (7 cases; 20%). Comprehensive NGS of 35 UCs of the bladder revealed a diverse spectrum of actionable GAs in 83% of cases, which has the potential to inform treatment decisions for patients with relapsed and metastatic disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Advanced urothelial carcinoma: next-generation sequencing reveals diverse genomic alterations and targets of therapy

Wang²,

et al. 2014

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“…Unfortunately, the use of neoadjuvant chemotherapy in patients undergoing cystectomy is limited, with as few as 17% of patients with T2 or greater disease receiving treatment, even at academic centers. 30,31 These low rates of use can be partially explained by patient comorbidity, especially renal insufficiency, and poor performance status. Some experts advocate for early cystectomy in patients who are unable to tolerate platinum-based chemotherapy regimens, although this remains an area of controversy.…”

Section: Neoadjuvant Chemotherapymentioning

confidence: 99%

Quality Indicators in the Management of Bladder Cancer

Montgomery¹,

Miller²,

Weizer³

2013

J Natl Compr Canc Netw

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Bladder cancer is predominantly seen in elderly patients. With the aging United States population, the incidence and prevalence of bladder cancer are on the rise, heightening the relevance of this disease as a public health issue. Despite having one of the greatest average cancer treatment costs per patient, improvements in disease-specific survival have been subtle. Clinical guidelines based predominantly on expert opinion and randomized controlled studies offer some guidance, but adherence to these guidelines is lacking. Building awareness of quality indicators to optimize patient care represents an opportunity to improve bladder cancer outcomes. Although quality indicators exist for other disease states, widely accepted quality indicators for the management of bladder cancer have not yet been established. This article proposes an initial set of quality indicators for both non-muscle-invasive and muscle-invasive bladder cancer based on established clinical guidelines and the available literature. (JNCCN 2013;11:492-500) NCCN: Continuing Education Accreditation StatementThis activity has been designated to meet the educational needs of physicians and nurses involved in the management of patients with cancer. There is no fee for this article. No commercial support was received for this article. The National Comprehensive Cancer Network (NCCN) is accredited by the ACCME to provide continuing medical education for physicians.NCCN designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.NCCN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center`s Commission on Accreditation.This activity is approved for 1.0 contact hour. Approval as a provider refers to recognition of educational activities only; accredited status does not imply endorsement by NCCN or ANCC of any commercial products discussed/displayed in conjunction with the educational activity. Kristina M. Gregory, RN, MSN, OCN, is our nurse planner for this educational activity.All clinicians completing this activity will be issued a certificate of participation. To participate in this journal CE activity: 1) review the learning objectives and author disclosures; 2) study the education content; 3) take the posttest with a 70% minimum passing score and complete the evaluation at http://education.nccn.org/ node/17316; and 4) view/print certificate.Release date: April 11, 2013; Expiration date: April 11, 2014. Learning ObjectivesUpon completion of this activity, participants will be able to:• Identify proposed quality indicators for non-muscleinvasive and muscle-invasive bladder cancer.• Discuss treatment recommendations and guidelines for non-muscle-invasive and muscle-invasive bladder cancer. Ms. Harrold has disclosed that she has no relevant financial relationships. Kristina M. Gregory, RN, MSN, OCN, Vice President, Clinical Information OperationsMs. Grego...

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“…In contrast, little is known about regional patterns of prescription drug utilization beyond focused studies of prescribing patterns for antibiotics [1], chemotherapy [22], cholinesterase therapy [23], psychiatric medications [24], and statin cholesterol lowering agents [25]. Such patterns have been found to reflect the nature and complexity of health status of patient populations [26,27], patient socioeconomic factors [28][29][30][31], provider preferences with self-reinforcing regional influences [32][33][34], social network influence (i.e.…”

Section: Introductionmentioning

confidence: 99%

Visualizing nationwide variation in Medicare Part D prescribing patterns

Rosenberg

Fucile

White

et al. 2017

Preprint

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Objective To characterize the regional and national variation in prescribing patterns in the Medicare Part D program using machine learning and dimensional reduction visualization methods. Methods Using publicly available Medicare Part D claims data, we identified regional and national provider prescribing profile variation with unsupervised clustering and t-distributed stochastic neighbor embedding (t-SNE) dimensional reduction techniques. Additionally, we examined differences between regionally representative prescribing patterns for major metropolitan areas. Results Distributions of prescribing volume and medication diversity were highly skewed among over 800,000 Medicare Part D providers, and medical specialties had characteristic prescribing patterns. Although the number of Medicare providers in each state was highly correlated with the number of Medicare Part D enrollees, some states were enriched for providers with >10,000 prescription claims annually. Hierarchical clustering and t-SNE dimension-reduction visualization of drug-or drug-class prescribing patterns revealed that providers cluster strongly based on specialty and sub-specialty, with large regional variations in prescribing patterns. Major metropolitan areas had distinct prescribing patterns that tended to group by major geographical divisions. Conclusions There is substantial prescribing variation among providers in Medicare Part D both between and within specialties. Large regional variations in prescribing patterns, particularly among major metropolitan areas, were also seen. Unsupervised clustering and t-SNE dimension-reduction are an effective means to examine variation in provider prescribing patterns, including substantial regional and medical specialty variation.

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Patterns of use of systemic chemotherapy for Medicare beneficiaries with urothelial bladder cancer

Cited by 128 publications

References 14 publications

Advanced urothelial carcinoma: next-generation sequencing reveals diverse genomic alterations and targets of therapy

Advanced urothelial carcinoma: next-generation sequencing reveals diverse genomic alterations and targets of therapy

Quality Indicators in the Management of Bladder Cancer

Visualizing nationwide variation in Medicare Part D prescribing patterns

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