F Gatta

Patient preferences for treatments to delay bone metastases.

Most patients with advanced prostate cancer (PCa) develop bone metastases (BM) and present with bone complications like fracture. Bone‐targeted agents that prevent metastasis‐induced bone complications can cause adverse events. Understanding how patients view treatment options may optimize care. This study aimed to quantify how PCa patients value a hypothetical treatment that delays BM but can cause osteonecrosis of the jaw (ONJ). The study also assessed the value patients place on avoiding metastasis‐induced bone complications versus increased survival.

Physician preferences for bone metastasis drug therapy in Canada

BACKGROUND Currently in Canada, several bone-targeted agents (btas) with varying characteristics are available for the prevention of skeletal-related events (sres) in patients with bone metastasis secondary to solid tumours. In the present study, we evaluated the preferences of physicians in Canada for the various attributes of the available btas. METHODS Physicians treating patients with bone metastasis from solid tumours were invited to complete an online discrete-choice experiment. Respondents were asked to choose between pairs of hypothetical medications for virtual patients. Each hypothetical medication was described based on predefined key attributes: time until first sre, time until worsening of pain, medication-related annual risk of osteonecrosis of the jaw (onj), medication-related annual risk of renal impairment, and mode of administration. A random-parameters logit model was used to analyze the choices between hypothetical medications and thus infer physician preferences for medication attributes. RESULTS Responses from the 200 physicians who completed the discrete-choice experiment suggested that months until first sre, risk of renal impairment, and months until worsening of pain were considered the most important attributes affecting choice of bta. The annual risk of onj was considered the least important attribute. CONCLUSIONS When making treatment decisions about the choice of bta for patients with bone metastasis from solid tumours, delaying sres and worsening of pain, and reducing the risk of renal impairment are primary considerations for physicians in Canada.

Bone-targeted agent treatment patterns and the impact of bone metastases on patients with advanced breast cancer in real-world practice in six European countries

Background Bone metastases (BMs) are common in patients with breast cancer and can lead to skeletal-related events (SREs), which are associated with increased pain and reduced quality of life (QoL). Bone-targeted agents (BTAs), like zoledronic acid and denosumab, reduce the incidence of SREs and delay progression of bone pain. Materials and methods We evaluated the management of BMs and pain in six European countries (Belgium, France, Germany, Italy, Spain, and UK) using the Adelphi Breast Cancer Disease Specific Programme, which included a physician survey and patient-reported outcomes (PROs) to assess the impact of BMs on pain and QoL. Results 301 physicians completed patient record forms for 2984 patients with advanced breast cancer; 1408 with BMs and 1136 with metastases at sites other than bone (non-BMs). Most patients with BMs (88%) received a BTA, with 81% receiving treatment during 3 months following BM diagnosis. For those who did not receive a BTA, the main reasons given were: very recent BM diagnosis, perceived low risk of bone complications, and short life expectancy. Most patients with BMs (68%) were experiencing bone pain and, of these, 97% were taking analgesics (including 28% receiving strong opioids). Despite this, moderate to severe pain was reported in 20% of patients who were experiencing pain. PROs were assessed in 766 patients with advanced breast cancer (392 with BMs, 374 with non-BMs). Overall, patients with BMs reported worse pain and QoL outcomes than those with non-BMs, those not receiving a BTA reported worse pain. Conclusion Despite the large proportion of patients receiving BTAs in this study, some patients with BMs are still not receiving early treatment to prevent SREs or to manage pain. Improving physicians’ understanding of the role of BTAs and the importance of early treatment following BM diagnosis has the potential to improve patient care.

Results From a Time and Motion Study of Denosumab Subcutaneous Injection and Zoledronic Acid Intravenous Infusion in Patients with Metastatic Bone Disease From Italian Sites

1 Fondazione IRCCS Policlinico “San Matteo”, Pavia, Italy; 2 Fondazione IRCCS Istituto Nazionale Tumori , Milano, Italy; 3 Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy; 4 Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, Messina, Italy; 5 A.S.L. AT, Asti, Italy; 6 CHU Brugmann, ULB, Brussels, Belgium; 7 Amgen Spa, Milan, Italy; 8 United BioSource Corporation, Barcelona, Spain; 9 United BioSource Corporation, Montreal, Canada; 10 United BioSource Corporation, London, UK; 11 Amgen (Europe) GmbH, Zug, Switzerland.

Bone Pain And Bone Targeting Agent (Bta) Treatment Pattern In Patients With Bone Metastases (Bms) From Prostate Cancer (Pc) In Real World Setting In Europe.

Objectives: To examine bone pain and BTA utilization in patients with BMs from PC in real-world setting in Europe. Methods: This study was conducted using the Adelphi Prostate Cancer Disease Specific Programme (DSP) 2015 database, a multi-country cross-sectional survey of 241 oncologists and 103 urologists in 6 European countries (UK, Germany, France, Italy, Spain, and Belgium). Patients’ current pain state, current analgesic use, BTA treatment, and reasons for BTA treatment data were extracted from the patient record forms (PRFs) completed by the physicians. Results: A total of 3608 PRFs were collected including 1931 on PC patients with BMs. At the time of survey (an average of 15.2 months from BMs diagnosis), 41% patients experienced mild pain; and 29% had moderate/severe bone pain. The majority of the patients (96%) with pain took analgesics to manage pain, including 29% (n=387) patients who were treated with strong opioids (e.g. morphine, oxycodone etc.). Of these patients, 73% (284/387) still had moderate/severe pain. Among the patients with BMs, 74% (n=1437) were treated with a BTA, and BTA treatment occurred within 3 months of BMs diagnosis in 72% (n=1036) of them. Reasons for BTA treatment initiation within 3 months of BMs were “bone pain” (40%), “high risk of bone complications” (29%), “number of BMs” (11%), “location of BMs” (8%) and “prior history of bone complications” (5%). Reasons for not treating patients with BTA were “recent diagnosis” (36%), “low bone complication risk” (22%), and “focus on treating primary tumor” (8%). Conclusions: Bone pain is the major symptom encountered by patients with BMs from PC. The majority of these patients treated with strong opioids still experienced moderate/severe bone pain. Approximately three quarters of patients with BMs received BTAs; primary treatment goals were reductions of the risk of bone complications and associated bone pain.

The Clinical and Economic Burden of Skeletal Related Events in Austria, Czech Republic, Germany, Greece, Italy, Spain and Switzerland: a Comparison Between the use of Denosumab and Zoledronic Acid In Patients with Prostate Cancer And Bone Metastases

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Preferences for treatment to delay bone metastases (BM) in patients with castration-resistant prostate cancer (CRPC) at high risk of developing BM.

117 Background: Limited treatments are available for patients with non-metastatic CRPC. Prophylactic treatment may be associated with adverse events (AE). We evaluated patient preferences for a medication delaying bone metastases (BM) with a risk of AE.Methods: UK and Swedish adults with CRPC at high risk for BM (on androgen-deprivation or hormone therapy for ≥ 3 yrs) completed an online discrete-choice experiment with 10 choice questions. Patients were asked if they would prefer to receive a hypothetical prophylactic medication (HPM) with a risk of osteonecrosis of the jaw (ONJ) to prevent BM or to decline HPM thus not receiving any treatment benefit or risk. HPMs were defined by delay in BM (0-23 months) and risk of ONJ (0-9%). The proportion of patients who chose HPM with different combinations of BM delay and ONJ risk was calculated. To further evaluate the impact of BM to patients, time tradeoff was used to assess patients’ willingness to trade off between life years with and without bone complicatio...