Henaine A M, Paubel N, Ducray F, Diebold G, Frappaz D, Guyotat J, Cartalat-Carel S, Aulagner G, Hartmann D, Honnorat J, Armoiry X
Université de Lyon, Claude Bernard Lyon 1, Lyon, France.
UMR CNRS 5510 MATEIS, Lyon, France.
J Clin Pharm Ther. 2016 Feb;41(1):47-53. doi: 10.1111/jcpt.12346. Epub 2016 Jan 8.
Trends in the care of glioblastoma in actual practice settings are poorly described. In a previous pharmacoepidemiologic study, we highlighted changes in the management of patients with glioblastoma (GBM) newly diagnosed between 2004 and 2008. Our aim was to complete and to extend the previous report with a study of a cohort of patients diagnosed in 2011 to emphasize the trends in the pharmacotherapy of GBM over the last decade.
A single-centre study was undertaken of three historic cohorts of GBM patients newly diagnosed during years 2004, 2008 and 2011 (corresponding to groups 1, 2 and 3, respectively) but limited to patients eligible for radiotherapy after initial diagnosis. The type of medical management was described and compared, as well as overall survival and total cost from diagnosis to death or the last follow-up date. Cost analysis was performed from the French sickness fund perspective using tariffs from 2014.
Two hundred and seventeen patients (49 in Group 1, 73 in Group 2, 95 in Group 3) were selected with similar baseline characteristics. Fluorescence-guided surgery using 5-ALA was increasingly used over the three periods. There was a strong trend towards broader use of temozolomide radiochemotherapy (39%, 73% and 83% of patients, respectively) as first-line treatment as well as bevacizumab regimen at recurrence (6%, 48% and 58% of patients, respectively). The increase in overall survival between Group 2 and Group 1 was confirmed for patients in Group 3 (17·5 months vs. 10 months in Group 1). The mean total cost per patient was 53368 € in Group 1, 70 201 € in Group 2 and 78355 € in Group 3. Hospital care represented the largest expenditure (75%, 59% and 60% in groups 1, 2 and 3, respectively) followed by chemotherapy drug costs (11%, 30% and 29%, respectively).
This is the first study to report on changes in the management of GBM in real-life practice. The ten-year study indicates an improvement in overall survival but also an increase in total cost of care. The data should be useful for informing the care of GBM patients in settings similar to ours.
在实际临床环境中，胶质母细胞瘤的治疗趋势鲜有描述。在之前的一项药物流行病学研究中，我们强调了2004年至2008年期间新诊断的胶质母细胞瘤（GBM）患者管理方面的变化。我们的目的是通过对2011年诊断的一组患者进行研究来完善并扩展之前的报告，以强调过去十年中GBM药物治疗的趋势。
对三个历史队列的GBM患者进行了单中心研究，这些患者分别于2004年、2008年和2011年新诊断（分别对应第1组、第2组和第3组），但仅限于初始诊断后符合放疗条件的患者。描述并比较了医疗管理类型以及从诊断到死亡或最后随访日期的总生存期和总成本。从法国疾病基金的角度，使用2014年的费率进行成本分析。
选择了217例患者（第1组49例，第2组73例，第3组95例），他们具有相似的基线特征。在这三个时期，使用5-氨基乙酰丙酸（5-ALA）的荧光引导手术使用得越来越多。一线治疗中使用替莫唑胺同步放化疗（分别为39%、73%和83%的患者）以及复发时使用贝伐单抗方案（分别为6%、48%和58%的患者）的趋势越来越明显。第3组患者证实了第2组和第1组之间总生存期的增加（第3组为17.5个月，第1组为10个月）。第1组患者的平均总成本为53368欧元，第2组为70201欧元，第3组为78355欧元。医院护理是最大的支出（第1组、第2组和第3组分别为75%、59%和60%），其次是化疗药物成本（分别为11%、30%和29%）。
这是第一项报告GBM实际临床管理变化的研究。这项十年研究表明总生存期有所改善，但护理总成本也有所增加。这些数据应有助于为与我们类似环境中的GBM患者护理提供参考。
