Sanjay Goel1, Abdissa Negassa2, Ashish Khot3, Dharmendra Goyal3, Shuang Guo4, Amara Nandikolla3, Kamila Bakirhan3, Rahul Polineni4, Umang Shah5, Imran Chaudhary3, Mohammad H Ghalib3, Lakshmi Rajdev6, Andreas Kaubisch6, Jennifer Chuy6, Santiago Aparo6. 1. Department of Medical Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY. Electronic address: sgoel@montefiore.org. 2. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY. 3. Department of Medical Oncology, Montefiore Medical Center, Bronx, NY. 4. Department of Medicine, Montefiore Medical Center, Bronx, NY. 5. Department of Medical Oncology, Albert Einstein College of Medicine, Bronx, NY. 6. Department of Medical Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.
Abstract
BACKGROUND: 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. PATIENTS AND METHODS: 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). RESULTS: 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. CONCLUSION: 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.
BACKGROUND: 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. PATIENTS AND METHODS: 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). RESULTS: 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. CONCLUSION: 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.
Authors: M Larissa Avilés-Santa; Laura Hsu; Tram Kim Lam; S Sonia Arteaga; Ligia Artiles; Sean Coady; Lawton S Cooper; Jennifer Curry; Patrice Desvigne-Nickens; Holly L Nicastro; Adelaida Rosario Journal: Front Public Health Date: 2020-08-28
Authors: Valentina A Zavala; Paige M Bracci; John M Carethers; Luis Carvajal-Carmona; Nicole B Coggins; Marcia R Cruz-Correa; Melissa Davis; Adam J de Smith; Julie Dutil; Jane C Figueiredo; Rena Fox; Kristi D Graves; Scarlett Lin Gomez; Andrea Llera; Susan L Neuhausen; Lisa Newman; Tung Nguyen; Julie R Palmer; Nynikka R Palmer; Eliseo J Pérez-Stable; Sorbarikor Piawah; Erik J Rodriquez; María Carolina Sanabria-Salas; Stephanie L Schmit; Silvia J Serrano-Gomez; Mariana C Stern; Jeffrey Weitzel; Jun J Yang; Jovanny Zabaleta; Elad Ziv; Laura Fejerman Journal: Br J Cancer Date: 2020-09-09 Impact factor: 9.075