Targeted agent use in patients with cancer at the end of life.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 215-215 ◽  
Author(s):  
David Hui ◽  
Meghan Sri Karuturi ◽  
Kimberson Cochien Tanco ◽  
Jung Hye Kwon ◽  
Sun Hyun Kim ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
End Of Life ◽  
Hematologic Malignancies ◽  
Poor Quality ◽  
Chemotherapeutic Agents ◽  
Concurrent Chemotherapy ◽  
Targeted Agents ◽  
Patients With Cancer ◽  
Lung Malignancies ◽  
Targeted Agent

215 Background: Chemotherapy use at the end of life is considered an indicator of poor quality of care. The use of targeted agent has not been well characterized. In this study, we determined the frequency and predictors of targeted therapy use in the last 30 days of life. Methods: All adult patients residing in the Houston area who died of advanced cancer between September 1, 2009 and February 28, 2010 and had contact with our institution within the last three months of life were included. We collected baseline demographics and data on chemotherapy and targeted agents. Results: 816 patients were included: average age 62 (range 21 to 97), female 48% and White 61%. The median interval between the last treatment and death was 47 (interquartile range 21 to 97) days for targeted agents and 57 (26 to 118) days for chemotherapeutic agents. 116 (14%) patients received targeted agents and 147 (18%) received chemotherapy within the last 30 days of life. 43 (5%) patients received targeted agents had concurrent chemotherapy. The most common targeted agents in the last 30 days of life were erlotinib (n=25), bevacizumab (n=20) and rituximab (n=11). In multivariate analysis, younger age, hematologic, and lung malignancies were associated with increased targeted agent use in the last 30 days of life (Table). Conclusions: Targeted agents were used as often as chemotherapy at the end of life, particularly among younger patients and those with hematologic malignancies. Guidelines on targeted therapy use at the end of life are needed. [Table: see text]

Targeted agent (TA) use at the end of life (EOL).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19603-e19603
Author(s):  
Meghan Sri Karuturi ◽  
Kimberson Tanco ◽  
Jung Hye Kwon ◽  
Tao Zhang ◽  
Wadih Rhondali ◽  
...  
Keyword(s):  
Hematologic Malignancies ◽  
Poor Quality ◽  
Concurrent Chemotherapy ◽  
Multivariate Logistic Regression ◽  
Younger Patients ◽  
Younger Age ◽  
Targeted Agent ◽  
Eol Care ◽  
Houston Area

e19603 Background: Chemotherapy in the last days of life has questionable benefit and has been proposed as an indicator of poor quality of EOL care. The use of TAs at the EOL has not been examined. We determined the proportion and predictors of TA use in the last 30 days of life. Methods: All adult patients in the Houston area who died of advanced cancer between 9/1/2009 and 2/28/2010 while under the care of our institution were included. We collected baseline demographics and data on chemotherapy and TAs. Multivariate logistic regression was used to identify predictors of targeted therapy use. Results: 912 patients were included: average age 63 (range 21-98), female 49%, Caucasian 63%. Within the last 30 and 14 days of life, 117 (13%) and 56 (6%) patients received TAs, respectively, while 148 (16%) and 65 (7%) received chemotherapy. The interval between last TA use and death was 49 (21-106) days. Regimens given in the last 30 days of life included a median of 2 (1-2) chemotherapeutic/targeted agents, and the most common TAs were erlotinib (N=22), bevacizumab (N=19), rituximab (N=9), gemtuzumab (N=9) and temsirolimus (N=8). 43/117 (37%) patients who received TAs within the last 30 days of life had concurrent chemotherapy. In multivariate analysis, younger age and hematologic malignancies were associated with increased TA use (Table). Conclusions: TAs were used as often as chemotherapy at the EOL, particularly among younger patients and those with hematologic malignancies. Use of TAs in the last 30 days of life may have implications for quality of EOL care. [Table: see text]

scholarly journals American Society of Clinical Oncology/American Society of Hematology Clinical Practice Guideline Update on the Use of Epoetin and Darbepoetin in Adult Patients With Cancer

2010 ◽  
Vol 28 (33) ◽  
pp. 4996-5010 ◽  
Author(s):  
J. Douglas Rizzo ◽  
Melissa Brouwers ◽  
Patricia Hurley ◽  
Jerome Seidenfeld ◽  
Murat O. Arcasoy ◽  
...  
Keyword(s):  
Clinical Oncology ◽  
Information Storage And Retrieval ◽  
Chemotherapeutic Agents ◽  
Concurrent Chemotherapy ◽  
Information Storage ◽  
Cochrane Library ◽  
Patients With Cancer ◽  
Increased Risk ◽  
American Society ◽  
Meta Analyses

Purpose To update American Society of Clinical Oncology/American Society of Hematology recommendations for use of erythropoiesis-stimulating agents (ESAs) in patients with cancer. Methods An Update Committee reviewed data published between January 2007 and January 2010. MEDLINE and the Cochrane Library were searched. Results The literature search yielded one new individual patient data analysis and four literature-based meta-analyses, two systematic reviews, and 13 publications reporting new results from randomized controlled trials not included in prior or new reviews. Recommendations For patients undergoing myelosuppressive chemotherapy who have a hemoglobin (Hb) level less than 10 g/dL, the Update Committee recommends that clinicians discuss potential harms (eg, thromboembolism, shorter survival) and benefits (eg, decreased transfusions) of ESAs and compare these with potential harms (eg, serious infections, immune-mediated adverse reactions) and benefits (eg, rapid Hb improvement) of RBC transfusions. Individual preferences for assumed risk should contribute to shared decisions on managing chemotherapy-induced anemia. The Committee cautions against ESA use under other circumstances. If used, ESAs should be administered at the lowest dose possible and should increase Hb to the lowest concentration possible to avoid transfusions. Available evidence does not identify Hb levels ≥ 10 g/dL either as thresholds for initiating treatment or as targets for ESA therapy. Starting doses and dose modifications after response or nonresponse should follow US Food and Drug Administration–approved labeling. ESAs should be discontinued after 6 to 8 weeks in nonresponders. ESAs should be avoided in patients with cancer not receiving concurrent chemotherapy, except for those with lower risk myelodysplastic syndromes. Caution should be exercised when using ESAs with chemotherapeutic agents in diseases associated with increased risk of thromboembolic complications. Table 1 lists detailed recommendations. This guideline was developed through a collaboration between the American Society of Clinical Oncology and the American Society of Hematology and has been published jointly by invitation and consent in both Journal of Clinical Oncology and Blood. Copyright © 2010 American Society of Clinical Oncology and American Society of Hematology. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by the American Society of Clinical Oncology or the American Society of Hematology.

scholarly journals Rising and Falling Trends in the Use of Chemotherapy and Targeted Therapy Near the End of Life in Older Patients With Cancer

2019 ◽  
Vol 37 (20) ◽  
pp. 1721-1731 ◽  
Author(s):  
Penny Fang ◽  
Reshma Jagsi ◽  
Weiguo He ◽  
Xiudong Lei ◽  
Eric G. Campbell ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
End Of Life ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Intraclass Correlation ◽  
Temporal Trends ◽  
Logistic Models ◽  
Time Points ◽  
Patients With Cancer ◽  
Oncology Practice

PURPOSE End-of-life (EOL) chemotherapy has been described as the most widespread, wasteful, and unnecessary practice in oncology, with benchmarking aimed to reduce physician use of chemotherapy within 14 days of EOL. We evaluated the recent transformation of EOL chemotherapy and targeted therapy practices nationally. METHODS In patients older than 65 years of age who died as a result of breast (n = 19,887), lung (n = 79,613), colorectal (n = 29,844), or prostate (n = 17,910) cancer between 2007 and 2013, we evaluated the guideline-benchmarked measure of chemotherapy use within 14 days of EOL in SEER-Medicare. Comparison outcomes were nonbenchmarked measures of chemotherapy and targeted therapy across time points within 6 months of EOL. Cochran-Armitage test was used to evaluate temporal trends. Multilevel logistic models and intraclass correlation coefficient was used to evaluate variation in EOL chemotherapy use at the physician level. RESULTS From 2007 to 2013, chemotherapy within 14 days of EOL declined from 6.7% to 4.9% of patients ( Ptrend < .001; ∆ = −1.8%). Similar declines occurred for chemotherapy within 1 month ( Ptrend < .001; ∆ = −1.8%) and 2 months ( Ptrend < .001; ∆ = −1.3%) of EOL. In contrast, chemotherapy within 4 to 6 months of EOL rose ( Ptrend ≤ .04; ∆ = 0.7% to 1.7%), and 43.0% of all patients received chemotherapy within 6 months of EOL. Frequency of targeted therapy use across all time points within 6 months of EOL was stable to marginally rising from 2007 to 2013 ( Ptrend = .09 to .82; ∆ = −0.2% to 1.8%); overall, 1.2% received targeted therapy within 14 days and 3.6% within 1 month of EOL. By 2013, 13.2% of patients received any targeted therapy within 6 months of EOL. In a multilevel model, 5.19% (intraclass correlation coefficient) of variation in 14-day EOL chemotherapy was attributed to the physician level. CONCLUSION With national benchmarking, chemotherapy within 14 days of EOL successfully declined to less than 5%, with comprehensive benchmark uptake by physicians. Results may inform current strategies to help to achieve high-value EOL oncology practice.

American Society of Hematology/American Society of Clinical Oncology clinical practice guideline update on the use of epoetin and darbepoetin in adult patients with cancer

Blood ◽  
2010 ◽  
Vol 116 (20) ◽  
pp. 4045-4059 ◽  
Author(s):  
J. Douglas Rizzo ◽  
Melissa Brouwers ◽  
Patricia Hurley ◽  
Jerome Seidenfeld ◽  
Murat O. Arcasoy ◽  
...  
Keyword(s):  
Clinical Oncology ◽  
Chemotherapeutic Agents ◽  
Concurrent Chemotherapy ◽  
Cochrane Library ◽  
Patients With Cancer ◽  
Increased Risk ◽  
American Society ◽  
Meta Analyses ◽  
Dose Modifications ◽  
The Cochrane Library

Abstract Purpose: To update American Society of Hematology/American Society of Clinical Oncology recommendations for use of erythropoiesis-stimulating agents (ESAs) in patients with cancer. Methods: An Update Committee reviewed data published between January 2007 and January 2010. MEDLINE and the Cochrane Library were searched. Results: The literature search yielded one new individual patient data analysis and four literature-based meta-analyses, two systematic reviews, and 13 publications reporting new results from randomized controlled trials not included in prior or new reviews. Recommendations: For patients undergoing myelosuppressive chemotherapy who have a hemoglobin (Hb) level less than 10 g/dL, the Update Committee recommends that clinicians discuss potential harms (eg, thromboembolism, shorter survival) and benefits (eg, decreased transfusions) of ESAs and compare these with potential harms (eg, serious infections, immune-mediated adverse reactions) and benefits (eg, rapid Hb improvement) of RBC transfusions. Individual preferences for assumed risk should contribute to shared decisions on managing chemotherapy-induced anemia. The Committee cautions against ESA use under other circumstances. If used, ESAs should be administered at the lowest dose possible and should increase Hb to the lowest concentration possible to avoid transfusions. Available evidence does not identify Hb levels ≥ 10 g/dL either as thresholds for initiating treatment or as targets for ESA therapy. Starting doses and dose modifications after response or nonresponse should follow US Food and Drug Administration–approved labeling. ESAs should be discontinued after 6 to 8 weeks in nonresponders. ESAs should be avoided in patients with cancer not receiving concurrent chemotherapy, except for those with lower risk myelodysplastic syndromes. Caution should be exercised when using ESAs with chemotherapeutic agents in diseases associated with increased risk of thromboembolic complications. Table 1 lists detailed recommendations.

Three lines of targeted therapy for metastatic renal cell carcinoma (mRCC): A viable strategy?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15581-e15581
Author(s):  
Tomas Buchler ◽  
Zbynek Bortlicek ◽  
Alexandr Poprach ◽  
Katerina Kubackova ◽  
Igor Kiss ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Kinase Inhibitors ◽  
Progression Free Survival ◽  
Sequential Therapy ◽  
National Database ◽  
Rank Test ◽  
Targeted Agents ◽  
Line Therapy ◽  
Targeted Agent

e15581 Background: Sequential therapy with tyrosine kinase inhibitors (TKIs) and the mTOR inhibitor everolimus has been proposed for mRCC. The aim of the present retrospective analysis was to compare the efficacy of everolimus used after one versus two prior TKIs and to assess the progress of a defined cohort of patients (pts) through sequential lines of therapy. Methods: In the national database of mRCC pts treated with targeted agents 368 pts received everolimus as the 2nd (N=269) or 3rd (N=99) targeted agents following TKIs sunitinib or sorafenib. Survival was calculated using the Kaplan-Meier method, and the differences were assessed using the Log-rank test. Furthermore, the treatment course was evaluated in 331 mRCC pts starting 1st line therapy with sunitinib or sorafenib in 2010. The data cut-off date was October 8, 2012. Results: Progression-free survival (PFS) for everolimus in the 2nd versus the 3rd line of targeted therapy was 6.5 months (95% confidence interval [95% CI] 5.3-7.7 months) versus 6.1 months (95% CI 4.0-8.3 months), respectively (P=0.159). The incidence and profile of adverse events were similar in both lines. PFS from the start of the first targeted agent to progression on the third targeted agent was similar for pts receiving three lines of therapy using the TKI-TKI-mTOR (N=99) and TKI-mTOR-TKI (N=17) sequence: 28.5 months (95% CI 25.2-31.7 months) versus 27.2 months (95% CI 24.0-30.4 months), respectively (P=0.281). The median follow-up for the initial cohort of 331 pts treated with sunitinib or sorafenib was 20.1 months. 152 pts (46%) subsequently received a 2nd line therapy, and 82 pts (25%) died before reaching the 2nd line. Of the 152 pts receiving the 2nd line therapy, only 38 pts (11%) went on to the 3rd line, and 46 pts (14%) died before reaching the 3rd line of therapy. The remaining pts still continued on 1st line (N=50; 15%) or 2nd line therapy (N=34; 10%), were lost to follow-up (N=30; 9%), or were alive but not receiving antineoplastic treatment (N=51; 15%). Conclusions: Everolimus has similar efficacy and toxicity whether used in the 2nd or the 3rd line of targeted therapy for mRCC. A minority of mRCC pts starting the 1st line targeted treatment can be expected to reach the 3rd line therapy.

Use of targeted therapy in cancer patients in the end-of-life period.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 129-129
Author(s):  
Alysson Wann ◽  
David M. Ashley ◽  
Mustafa Khasraw
Keyword(s):  
Targeted Therapy ◽  
End Of Life ◽  
Targeted Therapies ◽  
Performance Status ◽  
Limited Data ◽  
Single Centre ◽  
Prior Therapy ◽  
End Of Treatment ◽  
Targeted Agent ◽  
Gender Type

129 Background: There is limited data on the use of these targeted therapies in patients at the end of life. This study reviews the pattern of use of targeted and potentially futile, toxic and costly therapies at the end of life at an Australian cancer centre. Methods: A retrospective single-centre review covering 12 month period of patients who died < 3 months of starting a targeted agent. We extracted demographics, types of cancers, types of therapy, median age and lines of prior therapy. Results: 478 patients were on targeted therapies during this period. 54 patients, (11.3%) died < 3 months. Of those, the median age was 69 years, men 65%, women 35%. 27 had haematological malignancies (mostly lymphoma and multiple myeloma), 21 had solid tumours (mostly colon and lung cancer). Ten agents were represented with erlotinib, bevacizumab, and rituximab having higher total number of deaths and none on transtuzumab. Treatment lines were first in 64.8%, second in 20.4% and 14.8% had > 2 lines of treatment. Performance status was only documented in 9.3% at start and 11.1% at end of treatment. Symptoms at the start of treatment that can be used to track improvement were only documented in 25 patients (46.3%). Gender, type of cancer, age was found to have no influence on death < 3 months of targeted treatment. Unfortunately we were unable to extract QoL data. Conclusions: In this small single centre descriptive study, the use of targeted therapy in the end of life population was common, mostly in first line treatment. No factors have shown correlation with dying < 3 months of targeted therapies. There is a need to better document performance status and QoL data and also to analyse indicators of when it is appropriate to cease targeted therapies.

Determinants of Aggressive End-of-Life Care for Taiwanese Cancer Decedents, 2001 to 2006

2009 ◽  
Vol 27 (27) ◽  
pp. 4613-4618 ◽  
Author(s):  
Siew Tzuh Tang ◽  
Shiao-Chi Wu ◽  
Yen-Ni Hung ◽  
Jen-Shi Chen ◽  
Ean-Wen Huang ◽  
...  
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Hematologic Malignancies ◽  
Primary Care Providers ◽  
Composite Score ◽  
Care Providers ◽  
Health Care Resources ◽  
Patients With Cancer ◽  
Patient Demographics ◽  
Eol Care

Purpose To assess the association between aggressiveness of end-of-life (EOL) care and patient demographics, disease characteristics, primary physician's specialty, hospital characteristics, and availability of health care resources at the hospital and regional levels in Taiwan for a cohort of 210,976 cancer decedents in 2001 to 2006. Methods This retrospective cohort study examined administrative data. Aggressiveness of EOL care was examined by a composite measure adapted from Earle et al. Scores range from 0 to 6, with higher scores indicating more aggressive EOL care. Results The mean composite score for aggressiveness of EOL care was 2.04 (mean) ± 1.26 (standard deviation), increasing from 1.96 ± 1.26 in 2001 to 2.10 ± 1.26 in 2006. Each successive year of death significantly increased the composite score. Cancer decedents received more aggressive EOL care if they were male, younger, single, had a higher level of comorbidity, had more malignant and extensive diseases or hematologic malignancies, were cared for by oncologists, and received care in a hospital with a greater density of beds. Conclusion Controlling for patient demographics and cormorbidity burden, EOL care in Taiwan was more aggressive for patients with cancer with highly malignant and extensive diseases, for patients with oncologists as primary care providers, or in hospitals with abundant health care resources. Health policies should aim to ensure that all patients receive treatments that best meet their individual needs and interests and that resources are devoted to care that produces the greatest health benefits.

Tumor Molecular Profiling: Pediatric Results of the ProfiLER Study

2020 ◽  
pp. 785-795
Author(s):  
Sarah Benezech ◽  
Pierre Saintigny ◽  
Valery Attignon ◽  
Daniel Pissaloux ◽  
Sandrine Paindavoine ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Genomic Alteration ◽  
Comparative Genomic ◽  
Tumor Subtypes ◽  
Patients With Cancer ◽  
Targeted Agent ◽  
Tumor Genome ◽  
Immunologic Profile ◽  
Recommended Therapy ◽  
Generation Sequencing

PURPOSE The Program to Establish the Genetic and Immunologic Profile of Patient's Tumor for All Types of Advanced Cancer study (ClinicalTrials.gov identifier: NCT01774409 ) analyzed the genome of refractory cancers to identify a potential molecular-based recommended therapy (MBRT). The objectives of the pediatric substudy were to describe the incidence of genomic mutations, the MBRT, and the treatments undertaken with a molecular-targeted agent in a pediatric cohort. METHODS The tumor genome was analyzed within a 69-gene next-generation sequencing panel and an array comparative genomic hybridization assay. The results were evaluated by a multidisciplinary molecular board, and the targeted therapies were provided in the setting of a clinical trial or through compassionate use programs, when indicated. RESULTS Between November 2013 and June 2017, 50 patients younger than 19 years who were treated for a high-risk or relapsing tumor were included. Sarcomas (n = 24; 47%), CNS tumors (n = 14; 29%), and neuroblastomas (n = 5; 10%) were the most frequent tumor subtypes. Seven patients (14%) were excluded because no DNA could be recovered. Among the 43 remaining patients, 10 exhibited at least one targetable genomic alteration. Ultimately, four patients (8%) were treated with the recommended targeted therapy. CONCLUSION The results of this study confirm treatment with a targeted therapy for pediatric patients with cancer is still limited at present, as also is reported for adults.

scholarly journals LGG-03. LONG-TERM FOLLOW UP OF TARGETED THERAPY IN PEDIATRIC LOW-GRADE GLIOMAS: THE DANA-FARBER/BOSTON CHILDREN’S EXPERIENCE

2021 ◽  
Vol 23 (Supplement_1) ◽  
pp. i31-i31
Author(s):  
Jessica Tsai ◽  
Jayne Vogelzang ◽  
Cecilia Sousa ◽  
Kee Kiat Yeo ◽  
Keith Ligon ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Natural History ◽  
Low Grade ◽  
Targeted Agents ◽  
First Line ◽  
Therapy Initiation ◽  
Line Therapy ◽  
History Of ◽  
Targeted Agent

Abstract Background Pediatric low grade gliomas (pLGGs) are the most common central nervous system (CNS) tumor in children and characterized by alterations in the MAPK pathway. Standard of care is not well defined, and treatment has evolved over the last decade to include molecular targeted therapies. The impact of targeted agents on the natural history of pLGGs remains unknown. We present a retrospective review of patients receiving targeted agents integrated with molecular profiling. Methods We performed an IRB-approved, retrospective chart review of pLGGs treated with off-label use of dabrafenib, vemurafenib, everolimus, and trametinib at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center from 2010 to 2020. Results Forty-nine patients were identified (dabrafenib n=9, everolimus n=27, trametinib n=10, and vemurafenib n=3). All patients receiving BRAF inhibitors harbored BRAF V600E mutation. Targeted agent was used as first-line therapy for 25% of patients, while for 31% of patients, targeted agent was second-line therapy. The median time from diagnosis to targeted therapy initiation was 4.76 years (0.10 – 23.77), median duration of targeted therapy was 0.79 years (0.01 – 4.87), median time to subsequent therapy post first-line targeted therapy was 0.2 years (0.01 – 3.33), and overall median follow-up for the entire cohort was 3.09 years (0.36 – 11.87). The 1-year, 3-year, and 5-year EFS from targeted therapy initiation was 58.0%, 32.2%, and 26.9%, respectively. Survival analyses by molecular subgroup and agent were performed. Reasons for cessation of targeted therapy included toxicities, progression, and/or planned end of therapy. Conclusions Further efforts are ongoing to perform volumetric analysis of growth rates before, during, and after treatment. While targeted molecular therapies show great promise, it will be critical to understand how these agents alter the natural history of pLGGs, particularly in the context of genomic profiling.

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