Andreas Nearchou

Financial Relationships in Economic Analyses of Targeted Therapies in Oncology

PURPOSE A potential financial relationship between investigators and pharmaceutical manufacturers has been associated with an increased likelihood of reporting favorable conclusions about a sponsors proprietary agent in pharmacoeconomic studies. The purpose of this study is to investigate whether there is an association between financial relationships and outcome in economic analyses of new targeted therapies in oncology. MATERIALS AND METHODS We searched PubMed (last update June 2011) for economic analyses of targeted therapies (including monoclonal antibodies, tyrosine-kinase inhibitors, and mammalian target of rapamycin inhibitors) in oncology. The trials were qualitatively rated regarding the cost assessment as favorable, neutral, or unfavorable on the basis of prespecified criteria. RESULTS Overall, 81 eligible studies were identified. Economic analyses that were funded by pharmaceutical companies were more likely to report favorable qualitative cost estimates (28 [82%] of 34 v 21 [45%] of 47; P = .003). The presence of an author affiliated with manufacturer was not associated with study outcome. Furthermore, if only studies including a conflict of interest statement were included (66 of 81), studies that reported any financial relationship with manufacturers (author affiliation and/or funding and/or other financial relationship) were more likely to report favorable results of targeted therapies compared with studies without financial relationship (32 [71%] of 45 v nine [43%] of 21; P = .025). CONCLUSION Our study reveals a potential threat for industry-related bias in economic analyses of targeted therapies in oncology in favor of analyses with financial relationships between authors and manufacturers. A more balanced funding of economic analyses from other sources may allow greater confidence in the interpretation of their results.

High versus low radioiodine activity in patients with differentiated thyroid cancer : A meta-analysis

Abstract Background. The purpose of the meta-analysis was to estimate the effectiveness and toxicity of low activity radioiodine ablation versus high activity in patients with differentiated thyroid cancer (DTC). Design. A systematic review and meta-analysis was performed by including all randomized trials of low activity versus high activity radioiodine ablation after thyroidectomy. Standard meta-analytic procedures were used to analyze the study outcomes. Results. Ten trials were considered eligible and were further analyzed. The pooled risk ratio (RR) of having a successful ablation for an activity of 1100 MBq versus 3700 MBq (seven trials, 1772 patients) was 0.94 (95% CI 0.85–1.04, p-value = 0.21). The RR for successful ablation when only thyroid hormone withdrawal was used (five trials, 1116 patients) was 0.87 (95% CI 0.72–1.06, p-value = 0.17) and it was comparable to RR when only recombinant-human TSH (rec-hTSH) (two trials, 812 patients) was used (1.00, 95% CI 0.93–1.07, p-value = 0.92). Salivary dysfunction, nausea, and neck pain were significantly more frequent among patients with higher dose for ablation. Conclusion. Our meta-analysis provides some evidence from randomized trials that a lower activity of radioiodine ablation is as effective as higher dose after surgery in patients with DTC with lower toxicity.

Metastatic papillary renal cell carcinoma: A retrospective study from two large academic centers in Sweden.

535 Background: Non-clear cell renal cell carcinoma (nccRCC) constitute about 10-15% of all metastatic renal cell carcinoma (mRCC) and typically include papillary, chromophobe and collecting duct histologies. Despite differences in clinical behavior between subtypes they are often grouped as one due to small patient numbers. Hence, there is a lack of knowledge on type-specific prognosis and treatment options. Methods: Patients diagnosed with metastatic nncRRC (56 out of 526 patients; 10.8%) during the years 2005-2013 were retrospectively identified using data from medical records at two large academic centers in Sweden. The characteristics and outcome of those with papillary subtype (n = 44; 79% of nccRCC) was analyzed. Results: Metastatic papillary RCC patients were more often male (82%), had a median age of 69 years and 48% had M1 disease. 9% were type I, 41% type II, 4% mixed and 41% papillary NOS. 89% had a nephrectomy and 56% received at least one line of systemic therapy. The median overall survival...

Acquired hypothyroidism as a predictive marker of outcome in patients with metastatic renal cell carcinoma (mRCC) treated with tyrosine-kinase inhibitors (TKIs): A literature-based meta-analysis.

Acquired hypothyroidism as a predictive marker of outcome in patients with metastatic renal cell carcinoma (mRCC) treated with tyrosine-kinase inhibitors (TKIs) : A literature-based meta-analysis.

Conflict of interest in economic analyses of targeted therapies in oncology.

6120 Background: A potential financial relationship between investigators and pharmaceutical manufacturers has been associated with an increased likelihood of reporting favorable conclusions about a sponsors proprietary agent in pharmacoeconomic studies. The purpose of this study is to investigate whether there is an association between conflict of interest and outcome in economic analyses of new targeted therapies in oncology. METHODS We searched Pubmed (last update 1/2011) for economic analyses of targeted therapies (including monoclonal antibodies, tyrosine-kinase inhibitors, mTOR inhibitors) in oncology. Two investigators independently extracted information from each of the included studies. The trials were qualitatively rated regarding the cost assessment as favorable, neutral or unfavorable, based on pre-specified criteria. RESULTS Overall, 75 eligible studies were identified. Economic analyses which were funded by pharmaceutical companies were more likely to report favorable qualitative cost estimates (27/31 [87%] vs. 21/44 [48%], p-value = 0.001). The presence of author affiliated with manufacturer was not associated with study outcome. Furthermore, if only studies including a conflict of interest statement were included (61 out of 75), studies that reported any conflict of interest with manufacturers (author affiliation and/or funding and/or other conflict of interest) were more likely to report favorable results of targeted therapies compared to studies without conflict of interest (31/40 [78%] vs. 9/21 [43%], p-value = 0.007). Sponsorship from other non-profit sources had no significant impact on study outcome. CONCLUSIONS Our study reveals a potential threat for industry-related bias in economic analyses of targeted therapies in oncology in favor of analyses with conflict of interests between authors and manufacturers. A more balanced funding of pharmacoeconomic analyses from other sources may limit the skepticism about the role of pharmaceutical companies on cost analyses.