Bikov Kaloyan A, Mullins C Daniel, Hung Anna, Seal Brian, Onukwugha Eberechukwu, Hanna Nader
Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland, USA
Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland, USA.
Oncologist. 2016 Jun;21(6):676-83. doi: 10.1634/theoncologist.2015-0199. Epub 2016 Apr 28.
We explored biologics receipt in metastatic colon cancer.
We used Surveillance, Epidemiology, and End Results-Medicare data of 4,545 elderly patients diagnosed with incident metastatic colon cancer from 2003 to 2009, treated with chemotherapy and/or biologics, and followed up through 2010.
A total of 2,504 (55%) patients received a biologics-containing regimen. Treatment with biologics fluctuated between 46% and 63% of first-line regimens and 67% and 73% of second-line regimens. Bevacizumab accounted for 95% of first-line and 68% of second-line biologics use. Cetuximab accounted for 33% of second-line and 48% of third-line use. Panitumumab accounted for 5% of second-line and 27% of third-line use. The adjusted odds of biologics receipt decreased rapidly with age, resulting in a threefold difference between the youngest and the oldest study participants in the sample (odds ratio [OR] 0.35, p < .01). African Americans (OR 0.77, p = .03) and patients with Charlson Comorbidity Index of 1 (OR 0.83, p = .02) or >1 (OR 0.75, p < .01) were considerably less likely to receive biologics therapy. Medicare state buy-in was associated with 2% lower odds of receiving biologics (OR 0.98, p = .04).
After controlling for sociodemographic and clinical differences, age, race, comorbidities, and low income had a statistically significantly negative effect on the likelihood of receiving biologics among treated patients. Use of biologics varied over time, across the treatment continuum, and by chemotherapy regimen. Bevacizumab was most frequently used in both first- and second-line treatment. Cetuximab was the second most prescribed biologic. Panitumumab use was mostly limited to third-line treatment.
It is well-known that patients in the "real world" receive cancer treatments that do not reflect the strict treatment protocols of clinical trials. This is particularly true for complex and elderly patients with metastatic disease, who are frequently underrepresented in clinical trials. Although this article does not provide any additional evidence about the effectiveness of one treatment regimen or treatment sequence over another, it enhances our understanding of oncology practice outside of the clinical trial setting and provides useful information for future health services and health economics research in metastatic colon cancer.
我们探讨了转移性结肠癌患者生物制剂的使用情况。
我们使用了监测、流行病学和最终结果 - 医疗保险数据，这些数据来自2003年至2009年被诊断为初发转移性结肠癌的4545名老年患者，他们接受了化疗和/或生物制剂治疗，并随访至2010年。
共有2504名（55%）患者接受了含生物制剂的治疗方案。生物制剂在一线治疗方案中的使用比例在46%至63%之间波动，在二线治疗方案中的使用比例在67%至73%之间波动。贝伐单抗占一线生物制剂使用的95%，二线使用的68%。西妥昔单抗占二线使用的33%，三线使用的48%。帕尼单抗占二线使用的5%，三线使用的27%。接受生物制剂治疗的校正后几率随年龄迅速下降，导致样本中最年轻和最年长的研究参与者之间相差三倍（比值比[OR] 0.35，p < 0.01）。非裔美国人（OR 0.77，p = 0.03）以及Charlson合并症指数为1（OR 0.83，p = 0.02）或>1（OR 0.75，p < 0.01）的患者接受生物制剂治疗的可能性显著降低。医疗保险州买断与接受生物制剂治疗的几率降低2%相关（OR 0.98，p = 0.04）。
在控制了社会人口统计学和临床差异后，年龄、种族、合并症和低收入对接受治疗的患者使用生物制剂的可能性具有统计学上的显著负面影响。生物制剂的使用随时间、治疗阶段以及化疗方案而有所不同。贝伐单抗在一线和二线治疗中使用最为频繁。西妥昔单抗是第二常用的生物制剂。帕尼单抗的使用主要限于三线治疗。
众所周知，“现实世界”中的患者接受的癌症治疗并不反映临床试验的严格治疗方案。对于患有转移性疾病的复杂老年患者尤其如此，他们在临床试验中的代表性往往不足。尽管本文没有提供关于一种治疗方案或治疗顺序优于另一种的额外证据，但它增进了我们对临床试验环境之外肿瘤学实践的理解，并为未来转移性结肠癌的卫生服务和卫生经济学研究提供了有用信息。
