Broder Michael S, Chang Eunice, Reddy Sheila R, Neary Maureen P
From *Partnership for Health Analytic Research, LLC, Beverly Hills, CA; and †Novartis Pharmaceuticals Corporation, East Hanover, NJ.
Pancreas. 2017 Aug;46(7):891-897. doi: 10.1097/MPA.0000000000000872.
The aim of this study was to characterize treatment patterns and burden of pancreatic neuroendocrine tumors (PNET).
Using 2 claims databases, we identified patients with PNET initiating targeted therapy (everolimus, sunitinib) or chemotherapy from 2009 to 2012. The first targeted/cytotoxic therapy was considered index treatment. Treatment patterns were graphically evaluated from index treatment initiation until enrollment or study end, whichever occurred first. Disease burden was examined by index group for first follow-up year.
In treatment pattern analyses (582 newly treated patients with PNET), 72.2% received chemotherapy index treatment, 16.2% everolimus, and 11.7% received sunitinib. Median index treatment duration was 242, 146, and 126 days for everolimus, sunitinib, and cytotoxics (P < 0.01). Sunitinib initiators switched most often followed by everolimus and cytotoxic initiators. In disease burden analyses, 338 patients met inclusion criteria, with mean age of 54.5 (standard deviation, 9.9) years, 45.6% were female, and there were no significant between-group differences. Targeted therapy initiators had more prior somatostatin analog use versus cytotoxics (53.4% vs 25.1%, P < 0.001); 72.5% had comorbidities after treatment initiation; 42.9% had 1 or more inpatient hospitalization; and 47.9% had 1 or more emergency department visit.
Pancreatic neuroendocrine tumor treatment patterns varied; cytotoxics were more often used as early therapy than targeted agents, but for less time. Patients had high health care utilization, irrespective of treatment, potentially from burdensome symptoms and comorbidities.
本研究旨在描述胰腺神经内分泌肿瘤（PNET）的治疗模式及负担。
利用两个理赔数据库，我们识别出2009年至2012年开始接受靶向治疗（依维莫司、舒尼替尼）或化疗的PNET患者。首次靶向/细胞毒性治疗被视为索引治疗。从索引治疗开始直至入组或研究结束（以先发生者为准），以图表形式评估治疗模式。按索引组对首个随访年的疾病负担进行检查。
在治疗模式分析中（582例新接受治疗的PNET患者），72.2%接受化疗索引治疗，16.2%接受依维莫司治疗，11.7%接受舒尼替尼治疗。依维莫司、舒尼替尼和细胞毒性药物的索引治疗中位持续时间分别为242天、146天和126天（P<0.01）。舒尼替尼起始治疗者转换治疗最为频繁，其次是依维莫司起始治疗者和细胞毒性药物起始治疗者。在疾病负担分析中，338例患者符合纳入标准，平均年龄54.5岁（标准差9.9岁），45.6%为女性，组间无显著差异。与细胞毒性药物相比，靶向治疗起始者先前使用生长抑素类似物的比例更高（53.4%对25.1%，P<0.001）；72.5%在开始治疗后患有合并症；42.9%有1次或更多次住院治疗；47.9%有1次或更多次急诊就诊。
胰腺神经内分泌肿瘤的治疗模式各不相同；细胞毒性药物比靶向药物更常被用作早期治疗，但使用时间较短。无论接受何种治疗，患者的医疗保健利用率都很高，这可能是由于症状负担重和合并症所致。
