Rahul Shenolikar1, Emily Durden2, Nicole Meyer2, Gregory Lenhart2, Kathleen Moore3. 1. AstraZeneca, Gaithersburg, MD, USA. Electronic address: rahul.shenolikar@astrazeneca.com. 2. Truven Health Analytics, an IBM Company, Bethesda, MD, USA. 3. University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Abstract
OBJECTIVE: Real-world data on patients with cancer developing secondary malignancies such as myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) are lacking. This study assessed the incidence and impact of select DNA-damaging therapy exposure on risk of secondary MDS and AML in patients with ovarian cancer (OC) or breast cancer (BC). METHODS: Adults with a first observed OC or BC diagnosis (index date) between 1/1/2000 and 6/30/2014 were identified from MarketScan® Commercial and Medicare databases. Patients had ≥12 months of pre-index and ≥1 month of post-index continuous health plan enrollment. Incidence of MDS/AML was evaluated over a variable-length period following the index date for each cancer cohort. Risk factors for secondary MDS/AML, including duration of DNA-damaging therapy exposure, were assessed using Poisson regression. RESULTS: Study selection criteria identified 23,862 patients with OC and 281,473 patients with BC (mean [SD] follow-up: 35.8 [31.4] and 46.0 [37.2] months, respectively). Incidence of MDS/AML was 2.77 and 1.44 per 1000 person-years among patients with OC and BC, respectively. Within both cohorts, incidence of MDS and AML was higher among patients exposed than those not exposed to select DNA-damaging therapy (alkylating agents, antimetabolites, platinum-based antineoplastic agents, and topoisomerase inhibitors). Duration of exposure to DNA-damaging therapy was a significant risk factor for developing MDS/AML during follow-up. CONCLUSIONS: Data suggest that there is likely a background risk of secondary MDS/AML associated with use of DNA-damaging therapies in earlier lines of chemotherapy and it is elevated in subcohorts exposed to select DNA-damaging therapies.
OBJECTIVE: Real-world data on patients with cancer developing secondary malignancies such as myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) are lacking. This study assessed the incidence and impact of select DNA-damaging therapy exposure on risk of secondary MDS and AML in patients with ovarian cancer (OC) or breast cancer (BC). METHODS: Adults with a first observed OC or BC diagnosis (index date) between 1/1/2000 and 6/30/2014 were identified from MarketScan® Commercial and Medicare databases. Patients had ≥12 months of pre-index and ≥1 month of post-index continuous health plan enrollment. Incidence of MDS/AML was evaluated over a variable-length period following the index date for each cancer cohort. Risk factors for secondary MDS/AML, including duration of DNA-damaging therapy exposure, were assessed using Poisson regression. RESULTS: Study selection criteria identified 23,862 patients with OC and 281,473 patients with BC (mean [SD] follow-up: 35.8 [31.4] and 46.0 [37.2] months, respectively). Incidence of MDS/AML was 2.77 and 1.44 per 1000 person-years among patients with OC and BC, respectively. Within both cohorts, incidence of MDS and AML was higher among patients exposed than those not exposed to select DNA-damaging therapy (alkylating agents, antimetabolites, platinum-based antineoplastic agents, and topoisomerase inhibitors). Duration of exposure to DNA-damaging therapy was a significant risk factor for developing MDS/AML during follow-up. CONCLUSIONS: Data suggest that there is likely a background risk of secondary MDS/AML associated with use of DNA-damaging therapies in earlier lines of chemotherapy and it is elevated in subcohorts exposed to select DNA-damaging therapies.
Authors: Roni Nitecki; Alexander Melamed; Allison A Gockley; Jessica Floyd; Kate J Krause; Robert L Coleman; Ursula A Matulonis; Sharon H Giordano; Karen H Lu; J Alejandro Rauh-Hain Journal: Gynecol Oncol Date: 2021-03-15 Impact factor: 5.304
Authors: Nicoletta Colombo; Kathleen Moore; Giovanni Scambia; Ana Oaknin; Michael Friedlander; Alla Lisyanskaya; Anne Floquet; Alexandra Leary; Gabe S Sonke; Charlie Gourley; Susana Banerjee; Amit Oza; Antonio González-Martín; Carol Aghajanian; William H Bradley; Jae-Weon Kim; Cara Mathews; Joyce Liu; Elizabeth S Lowe; Ralph Bloomfield; Paul DiSilvestro Journal: Gynecol Oncol Date: 2021-08-02 Impact factor: 5.304