Chapman Suzannah J, McKavanagh Daniel, Burge Matthew E, McPherson Ian, Walpole Euan, Hollingworth Samantha A
Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
Asia Pac J Clin Oncol. 2017 Oct;13(5):e253-e261. doi: 10.1111/ajco.12518. Epub 2016 Jul 20.
Metastatic colorectal cancer has a large burden of disease in Australia. Medical therapy is fundamental to extending survival and improving quality of life. The benefits of two costly medicines, bevacizumab and cetuximab, used in Australia remain unclear. The aim of this study was to retrospectively examine the use of these two medicines in metastatic colorectal cancer across five public hospitals in south east Queensland and to compare clinical outcomes to those of published clinical trials.
We extracted data from the chemotherapy prescribing database for patients planned for bevacizumab or cetuximab therapy between 2009 and 2013. Median overall survival was estimated using Kaplan-Meier methods.
There were 490 bevacizumab-containing protocols planned and 292 patients received at least one dose of bevacizumab. Median overall survival was 17.2 months (95% confidence interval [CI], 15.4-19.3). Of 208 planned cetuximab-containing protocols, 134 patients received at least one dose of cetuximab. Median overall survival was 9.1 months (95% CI, 7.6-12.0). Thirty-day mortality rates from date of first dose were 0.7% for bevacizumab and 7.5% for cetuximab.
Overall survival of patients receiving bevacizumab and cetuximab was consistent with clinical trials, providing some assurance that benefits seen in trials are observed in usual practice. This study provides a methodology of using routinely collected health data for clinical monitoring and research. Because of the high cost of these medicines and the lack of toxicity data in this study, further analysis in the postmarketing setting should be explored.
在澳大利亚，转移性结直肠癌的疾病负担沉重。药物治疗对于延长生存期和改善生活质量至关重要。在澳大利亚使用的两种昂贵药物贝伐单抗和西妥昔单抗的益处仍不明确。本研究的目的是回顾性研究昆士兰州东南部五家公立医院中这两种药物在转移性结直肠癌中的使用情况，并将临床结果与已发表的临床试验结果进行比较。
我们从化疗处方数据库中提取了2009年至2013年计划接受贝伐单抗或西妥昔单抗治疗的患者的数据。使用Kaplan-Meier方法估计中位总生存期。
计划了490个含贝伐单抗的治疗方案，292例患者接受了至少一剂贝伐单抗。中位总生存期为17.2个月（95%置信区间[CI]，15.4 - 19.3）。在208个计划的含西妥昔单抗的治疗方案中，134例患者接受了至少一剂西妥昔单抗。中位总生存期为9.1个月（95%CI，7.6 - 12.0）。从首次给药日期起的30天死亡率，贝伐单抗为0.7%，西妥昔单抗为7.5%。
接受贝伐单抗和西妥昔单抗治疗的患者的总生存期与临床试验一致，这为在常规实践中观察到试验中所见的益处提供了一定保证。本研究提供了一种利用常规收集的健康数据进行临床监测和研究的方法。由于这些药物成本高昂且本研究缺乏毒性数据，应探索上市后环境中的进一步分析。
