Alternative Trastuzumab Dosing Schedules Are Associated With Reductions in Health Care Greenhouse Gas Emissions.
| Autor: | Jacobson SI; Yale College, New Haven, CT., Kacew AJ; University of Chicago Pritzker School of Medicine, Chicago, IL., Knoebel RW; Department of Pharmacy, University of Chicago, Medicine, Chicago, IL., Hsieh PH; Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, IL.; United States Food and Drug Administration, Silver Spring, MD., Ratain MJ; Committee on Clinical Pharmacology and Pharmacogenomics, University of Chicago, Chicago, IL.; Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL.; Center for Personalized Therapeutics, The University of Chicago, Chicago, IL., Strohbehn GW; University of Michigan Rogel Cancer Center, Ann Arbor, MI.; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI.; Division of Medical Oncology, LTC Charles S Kettles VA Medical Center, Ann Arbor, MI.; Division of Hematology/Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI.; Center for Global Health Equity, University of Michigan, Ann Arbor, MI. |
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| Jazyk: | angličtina |
| Zdroj: | JCO oncology practice [JCO Oncol Pract] 2023 Sep; Vol. 19 (9), pp. 799-807. Date of Electronic Publication: 2023 Jul 14. |
| DOI: | 10.1200/OP.23.00227 |
| Abstrakt: | Purpose: Cancer care-related greenhouse gas (GHG) emissions harm human health. Many cancer drugs are administered at greater-than-necessary doses, frequencies, and durations. Alternative dosing strategies may enable reductions in cancer care GHG emissions without compromising patient outcomes. Materials and Methods: We used streamlined life-cycle analysis in a case-control simulation to estimate the relative reductions in GHG emissions that would be expected to result from using each of three alternative dosing strategies of trastuzumab (6-month adjuvant treatment duration, once every 4-week dosing, and both) in human epidermal growth factor receptor 2 (HER2)+ breast cancer. Using primary data and conversion factors from the environmental science literature, we estimated per-patient relative reduction in GHG emissions and, using SEER data, health impacts (in terms of disability-adjusted life-years [DALYs] and excess mortality per kg CO Results: Compared with the trastuzumab dosing strategy commonly used at baseline (12-month duration of adjuvant therapy and once every 3-week dosing in all settings), adoption of both 6-month adjuvant trastuzumab and once every 4-week trastuzumab dosing would reduce GHG emissions by 4.5%, 18.7%, and 14.6% in the neoadjuvant, adjuvant, and metastatic settings, respectively. We estimate that US-based adoption of alternative trastuzumab dosing would reduce annual DALYs and excess lives lost due to environmental impact of US-based trastuzumab therapy for HER2+ breast cancer by 1.5 and 0.9, respectively. Conclusion: Alternative dosing strategies may materially reduce the population health impacts of cancer care by reducing environmental impact. Regulatory decision making and health technology assessments should consider a treatment's environmental and population health impacts. Clinical trials of alternative dosing strategies are justified on the basis of environmental and population health impacts. |
| Databáze: | MEDLINE |
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