Maria Jakobsson

Treatment and overall survival in renal cell carcinoma: a Swedish population-based study (2000-2008).

Background:This retrospective register study assessed overall survival (OS) and influential factors on OS in Swedish renal cell carcinoma (RCC) patients.Methods:Using three merged national health registers, Cox proportional-hazards analysis was conducted and, in three models, it was used to assess the impact of cytokine (interferon-α and tyrosine kinase inhibitor (TKI; sunitinib or sorafenib) treatment on OS in metastatic (m)RCC.Results:From 2000 to 2008, 8009 patients were diagnosed with RCC and 2753 with mRCC (2002–2008). Median OS in RCC patients diagnosed from 2006 to 2008 compared with 2000–2005 was not reached vs 47.9 months (P<0.001), and in mRCC patients diagnosed from 2006 to 2008 compared with 2002–2005, was 12.4 vs 9.6 months, respectively (P=0.004). Factors associated with significantly improved OS in RCC were female gender, lower age, and previous nephrectomy, and, in mRCC female gender, previous nephrectomy, and any TKI prescription (Model 1: median-adjusted OS, 19.4 months (TKI patients) vs 9.7 months (non-TKI patients); hazard ratio, 0.621; P<0.001).Conclusion:OS was improved in Swedish patients diagnosed with RCC and mRCC in the period 2006–2008 compared with 2000–2005 (RCC) and 2002–2005 (mRCC). Although multifactorial in origin, results suggest that increased nephrectomy rates and the use of TKIs contributed to the improvement seen in mRCC patients.

Atlantic Divide or Gulf Stream Convergence: Merger Policies in the European Union and the United States

We collect a sample of EU and US in-depth merger investigation, estimate models of the regulatory decisions and use the models to compare merger policies in the two jurisdictions. The approach used allows us to decompose observed differences between merger decisions into regime effects and case-mix effects. Focusing on dominant-firm mergers, we find that EU is tougher than the US on average and on mergers resulting in low market shares. We also find that US policy is more affected than EU policy by a range of market considerations.

Merger Control in the European Union and the United States: Just the Facts

Using a combination of public and internal information, this paper compares and contrasts European Union (EU) and United States (US) merger policies. Common economic analysis leads both authorities to subject remarkably comparable portfolios of mergers to close scrutiny. Vertical mergers account for less than 10%, and potential competition matters for around 5%, of in-depth merger investigations in both jurisdictions, while purely conglomerate mergers are extremely rare or non-existent. The share of collusion investigations falls over time in both jurisdictions. However, the US relies on collusion theory more than three times as often as the EU, where over 80% of the horizontal cases address dominance. Across both regimes, roughly one eighth of all recent horizontal investigations have been analysed as non-dominance unilateral-effects cases. Only minor differences in the average probability of a merger being challenged are observed when controlling for market share. The 2004 EU reforms seem to be leading towards at least some convergence of enforcement policy.

Treatment and overall survival (OS) in metastatic renal cell carcinoma (mRCC): A Swedish population-based study (2000–2008).

389 Background: This retrospective register study assessed OS in all mRCC patients in Sweden diagnosed before (2000-2005) and after (2006-2008) the introduction of targeted therapies, plus factors and treatment options influencing OS. METHODS Three Swedish national health registers were used: the Swedish Cancer register (diagnosis and death), the National Patient Register (in-/out-patient data), and the Swedish Prescribed Drug Register. From 2000-2008, 3,243 patients were identified with mRCC; 602 were recorded as receiving 1st-line treatment. Cox proportional hazards regression analysis, including estimation of adjusted OS, was used in three models with the covariates: diagnosis period, age, gender, institution size, nephrectomy status, geographic region (all models); mRCC treatments, defined as any tyrosine kinase inhibitor (TKI; Model 1; n=417); sunitinib (SU), sorafenib (SO), and interferon-alfa (IFN-α) in the 1st-line setting (Model 2; n=602 [SU=244, SO=110, IFN-α=248]); and variations of these drugs as 1st- and 2nd-line treatment sequences (Model 3; n=602). RESULTS Amongst mRCC patients diagnosed from 2006-2008 compared with 2000-2005, median adjusted OS was 16.1 vs. 10.9 months, respectively (HR=0.76, 95% CI: 0.69, 0.83; P<0.001). In all three models, factors independently associated with significantly improved OS included female gender, large institution, and prior nephrectomy. Prescription of any TKI (Model 1: HR=0.82, 95% CI: 0.73, 0.93; P=0.002) and 1st-line SU treatment (Model 2: HR=0.79, 95% CI: 0.67, 0.94; P=0.007) were associated with significantly improved OS compared with other or no treatments. A similar significant improvement in OS was also confirmed for patients treated with SU only in Model 3; however, due to a low number of observations, the model had insufficient statistical power to be appropriate for all sequences. CONCLUSIONS An improved OS for mRCC patients was demonstrated for the period 2006-2008 compared with 2000-2005. Although the observed survival advantage is multifactorial in origin, contribution of targeted therapies is highly probable. Of the drugs studied, given design limitations, only SU was associated with improved OS.

Overall survival in Swedish patients with renal cell carcinoma treated in the period 2002 to 2012: Update of the RENCOMP study with subgroup analysis of the synchronous metastatic and elderly populations☆

BACKGROUND This retrospective study investigated overall survival (OS) and factors influencing OS in Swedish patients with metastatic renal cell carcinoma (mRCC) during the pre- (2002-2005), early (2006-2008), and late (2009-2012) targeted therapy (TT) era. METHODS Three national Swedish registries identified patients with mRCC. Median OS was estimated using the Kaplan-Meier method. Multivariate analysis was performed using Cox proportional hazards regression. Subgroup analysis was conducted for patients with synchronous metastases (M1) and the elderly (aged≥75y). RESULTS A total of 4,217 patients with mRCC were identified, including 1,533 patients with M1 and 1,275 elderly patients. For patients with mRCC diagnosed in 2002 to 2005, 2006 to 2008, and 2009 to 2012, median OS was 10.0, 13.0, and 18.0 months. Similarly, median OS improved in the M1 and elderly populations. Elderly patients were less likely to be prescribed TT (≥75 vs.<75y): 18.3 vs. 63.5% (in 2006-2008) and 28.6% vs. 55.9% (in 2009-2012). Diagnosis of mRCC in 2009 to 2012, nephrectomy and TT prescription were associated with improved OS in the total mRCC, M1, and elderly populations. CONCLUSION This real-world study showed continued significant improvement in mRCC OS during the late TT era, including in M1 and elderly populations. TT should be considered for all patients with mRCC based on tolerability, regardless of age.

Overall survival (OS) in Swedish RCC patients treated 2000–2012: Update of the RENCOMP study.

Overall survival (OS) in Swedish RCC patients treated 2000-2012 : Update of the RENCOMP study