Comparative Effectiveness Research: The Impact of Biologic Agents in Ethnic Minorities With Metastatic Colorectal Cancer
| Autor: | Ashish Khot, Santiago Aparo, Abdissa Negassa, Andreas Kaubisch, Amara G. Nandikolla, M. H. Ghalib, Sanjay Goel, Jennifer W. Chuy, Rahul Polineni, Umang Shah, Shuang Guo, Kamila Bakirhan, Lakshmi Rajdev, Imran Chaudhary, Dharmendra Goyal |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Comparative Effectiveness Research medicine.medical_specialty Colorectal cancer medicine.medical_treatment Comparative effectiveness research Subgroup analysis White People Cohort Studies Biological Factors 03 medical and health sciences 0302 clinical medicine Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans 030212 general & internal medicine Aged Aged 80 and over Univariate analysis Chemotherapy business.industry Medical record Gastroenterology Hispanic or Latino Middle Aged Models Theoretical medicine.disease Carcinoembryonic Antigen Surgery Black or African American Survival Rate Clinical trial Treatment Outcome Oncology 030220 oncology & carcinogenesis Cohort Female Colorectal Neoplasms business |
| Zdroj: | Clinical Colorectal Cancer. 16:286-292 |
| ISSN: | 1533-0028 |
| DOI: | 10.1016/j.clcc.2017.03.004 |
| Popis: | Biologic agents have improved the outcomes of patients with metastatic colorectal cancer (mCRC). However, the clinical trials included a predominately white population (85%), with Hispanic and black patients underrepresented. Thus, the real world benefit for the latter remains unknown. Comparative effectiveness research is a tool allowing for this exploration.The demographic and clinical characteristics of patients treated for mCRC from 2000 to 2011 were extracted from the medical records of Montefiore Medical Center. A semiparametric accelerated failure time model was used to assess the survival differences between patients receiving chemotherapy (CT) alone versus CT plus biologic agents (CBT).Of the 290 patients (black, 45.9%; Hispanic, 26.2%; and white, 27.9%), 53.8% received biologic agents. The median overall survival was 15.2 months in the CT-alone group and 25.6 months in CBT group (P = .004). On univariate analysis, a lower number of metastatic sites, carcinoembryonic antigen 41 ng/mL, and more lines of CT were associated with improved overall survival. In a propensity score-based analysis of the entire cohort, CBT offered a survival benefit compared with CT alone (increased median survival, 1.44-fold; 95% confidence interval [CI], 1.11-1.86; P = .038). The results of the subgroup analysis suggested a survival benefit for white patients (2.01; 95% CI, 1.26-3.23; P = .031) but not for Hispanic (1.42; 95% CI, 0.91-2.20; P = .370) or black (1.12; 95% CI, 0.76-1.66; P = .596) patients.In the present cohort, CBT was associated with longer survival, with the effect mainly driven by the outcomes for white patients, with black patients not appearing to benefit. These data are provocative and warrant further confirmation. Efforts to increase ethnic minority patients' enrollment in clinical trials is required to prospectively define the benefit from novel therapies. |
| Databáze: | OpenAIRE |
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