TOXview: a novel graphical presentation of cancer treatment toxicity profiles

Abstract

Background: Toxicity profiles play a crucial role in the choice between specific palliative chemotherapy regimens. To optimize the quality of life for cancer patients, patients should be adequately informed about potential toxicities before undergoing chemotherapy. Therefore, we constructed TOXviews, a novel graphical presentation and overview of toxicity profiles to improve information provision about adverse events. As an example, we analyzed first-line chemotherapy regimens for advanced esophagogastric cancer (AEGC). Methods: We searched PubMed, EMBASE, CENTRAL, ASCO and ESMO for prospective phase II or III randomized controlled trials (RCTs) on palliative first-line systemic treatment for AEGC until February 2017. We extracted proportions of Common Terminology Criteria for Adverse Events grade 1-2 (mild) and 3-4 (severe) adverse events from each chemotherapy arm and pooled these by using single-arm meta-analysis. Toxicity profiles per chemotherapy regimen were visualized in bidirectional bar charts with pooled proportions plus 95% confidence intervals. For comparative analysis, chemotherapy regimens were grouped in singlets, doublets and triplets. Results: We included 92 RCTs with a total of 16,963 patients. TOXviews for 3 fluoropyrimidine singlets, 5 cisplatin-containing doublets (C-doublets), 10 fluoropyrimidine non-cisplatin containing doublets (Fdoublets), 4 anthracycline-containing triplets (A-triplets) and 5 taxane-containing triplets (T-triplets) were constructed. C-doublets, A-triplets and T-triplets all showed an increased incidence of grade 3-4 adverse events and clinically relevant grade 1-2 adverse events compared to F-doublets. Conclusion: TOXview provides a new graphical presentation and overview of chemotherapy toxicities. TOXviews can be used to educate physicians about the incidences of AEs of systemic therapy and improve informed decision-making.

Informing Patients With Esophagogastric Cancer About Treatment Outcomes by Using a Web-Based Tool and Training: Development and Evaluation Study

“…The side effects component displays bar charts for various toxicities ( Figure 4 ), as the meta-analysis provided static probabilities for each of the adverse events [ 7 ]. Each side effect was visualized by two stacked bars, one for mild side effects and one for severe side effects on the Common Terminology Criteria for Adverse Events scale [ 69 ].…”

“…The side effects (toxicity) of chemotherapy treatment are based on TOXView meta-analyses [ 7 ]. These models establish the probability of adverse events such as nausea, alopecia, and neuropathy, stratified by mild or severe grade toxicity (according to the Common Terminology Criteria for Adverse Events [ 47 ]), for various chemotherapy regimens.…”

“…Various options exist for metastasized cancers, with chemotherapy yielding the best survival rates. However, palliative radiotherapy and best supportive care may also be valuable options for specific groups of patients [4,5,[7][8][9][10].…”

COMplot, A Graphical Presentation of Complication Profiles and Adverse Effects for the Curative Treatment of Gastric Cancer: A Systematic Review and Meta-Analysis

“…In this article, we have presented a novel overview of toxicity and surgical complications for the curative treatment of gastric cancer. The method in this paper is based on an article we published earlier on the toxicity profiles of first line chemotherapy in advanced gastroesophageal cancer (64). We conducted multiple random effect meta-analyses, based on individual treatment arms from RCTs.…”

Can we do without chemotherapy? A perspective on the combinations nivolumab-chemotherapy and nivolumab–ipilimumab in metastatic gastric and esophageal cancer

“…Given the side effects of cytotoxic treatment regimens in general, and for metastatic gastric and esophageal cancer in particular, 9 chemotherapy-free regimen for patients with metastatic disease is an appealing approach. For some patients, a treatment regimen with lower chances of survival may still be their treatment of choice if in this way they can avoid treatment-related adverse events.…”