COMPARATIVE EFFECTIVENESS OF BIOLOGIC AGENTS IN ETHNIC MINORITIES WITH COLORECTAL CANCER

生物制剂在少数民族结直肠癌中的比较疗效

• 批准号: 9432615
• 负责人: Sanjay Goel
• 金额: $ 21.58万
• 依托单位: MONTEFIORE MEDICAL CENTER (BRONX, NY)
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-06-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9432615
• 关键词: Adverse effects; Age; Age-Years; Aging; Applications Grants; Caucasians; Cetuximab; Clinical; Colorectal Cancer; County; Cytotoxic Chemotherapy; Data; Databases; Diagnosis; Elderly; Ethnic group; Expenditure; Felis catus; Future; Health Expenditures; Hispanics; Hospitals; Medicare; Minority; Pathogenesis; Patients; Pharmaceutical Preparations; Population; Race; Risk Factors; Suggestion; Survival Rate; Teenagers; Testing; Toxic effect; United States; base; bevacizumab; chemotherapy; cohort; comparative effectiveness; ethnic minority population; metastatic colorectal; panitumumab; young adult

Comparative effectiveness of biologic agents in ethnic minorities with colorectal cancer Abstract This grant proposal seeks to identify and describe the real world impact of the use of the biologic agents when added to cytotoxic chemotherapy for patients with metastatic colorectal cancer (mCRC). Furthermore, aging remains one the most critical risk factors in the pathogenesis of CRC . While CRC can occur in young adults and teenagers, more than 90% of CRC occur in people older than 50 years of age. The median age of diagnosis in the United States is 72 years. The biologic agents include bevacizumab, cetuximab and panitumumab. Cure rates for patients with mCRC are dismal, with a 5 year overall survival (OS) rate of only 12.5% and median OS of 30 months. The addition of biologic agents has led to statistically significant and clinically meaningful improvement in the OS; however little is known if the benefit it is uniformly shared across the various ethnic and racial groups. Over 70% of our patients are ethnic minorities. We conducted a CER study of our patients spanning 2000-2012. In our cohort of 290 patients, the median OS was 15.2 months in the patients that received chemotherapy versus 25.6 months in those that received chemotherapy plus biologics (p=0.0041 by log rank test). Propensity score based analysis overall and across the races showed a persistent benefit overall (HR 1.44; p=0.04), and this was maintained for Whites (HR 2.01, p=0.03) but not for Hispanics (HR 1.42, p=0.37) or Blacks (HR 1.12; p=0.59). We will first seek to validate our findings in the SEER Medicare database. Second, we seek to expand our cohort to include 3 hospitals in Bronx catering to ethnic minorities (Jacobi, Lincoln, and St. Barnabas hospitals). As Hispanics had a HR suggestive of benefit but did not reach statistical significance, with increased numbers available for analysis, we also aim to ascertain if this HR is statistically significant. If our findings are confirmed, this could indeed be practice changing, with the potential to save thousands of patients from the toxicity of these agents and billions of dollars to our ever soaring health care expenditure.

生物学毒剂在结直肠癌少数民族中的比较有效性 抽象的 该赠款提案旨在识别和描述使用的现实世界的影响 生物学毒剂在转移性结直肠癌患者的细胞毒性化学疗法中添加时 癌症（MCRC）。此外，衰老仍然是最关键的风险因素 CRC的发病机理 。虽然CRC可能发生在年轻人和青少年中，但超过90％ CRC发生在50岁以上的人中。联合诊断的中位年龄 国家是72年。 生物学剂包括贝伐单抗，西妥昔单抗和潘尼托蛋白单抗。 MCRC患者的治疗率很沮丧，总生存率（OS）仅为5年 12.5％和30个月的中位OS。生物剂的增加导致了统计学上的 OS的显着和临床有意义的改进；然而，鲜为人知是否有利 它在各个种族和种族群体中均匀共享。超过70％的患者是 少数民族。我们对跨越2000-2012的患者进行了CER研究。在我们的队列中 在290名患者中，接受化疗的患者中位OS为15.2个月 在接受化学疗法加生物制剂的患者中为25.6个月（p = 0.0041按日志等级 测试）。基于倾向得分的整体分析整体和整个种族都显示出持续的好处 总体（HR 1.44; P = 0.04），这是白人（HR 2.01，p = 0.03）的维持 西班牙裔（HR 1.42，p = 0.37）或黑色（HR 1.12； p = 0.59）。我们将首先寻求验证我们的 Seer Medicare数据库中的发现。其次，我们试图将我们的队列扩展到包括3 布朗克斯的医院迎合了少数民族（雅各比，林肯和圣巴纳巴斯医院）。作为 西班牙裔人的人力资源有益于福利，但没有达到统计意义， 增加数量可用于分析，我们还旨在确定此HR是否在统计上 重要的。如果我们的发现得到确认，这确实可以改变， 有可能从这些特工的毒性中节省数千名患者，并为数十亿美元 我们曾经飞涨的医疗保健支出。