Zhongyun Zhao

Systemic Therapy for Metastatic Colorectal Cancer: Patterns of Chemotherapy and Biologic Therapy Use in US Medical Oncology Practice

PURPOSEnWith the emergence of new chemotherapies and biologic agents in the treatment of metastatic colorectal cancer (mCRC), the optimal combination and sequencing of these therapies are yet to be determined. This study examined the extent and pattern of chemotherapy and biologic therapy use by line of treatment. Biologic continuation and dose escalation were also examined.nnnMETHODSnThis study used an integrated electronic medical record database of 91 US oncology practices. Records were analyzed for 1,655 adult patients with mCRC who were treated from January 1, 2004 to January 31, 2008 with systemic therapy and could be observed for ≥ 3 months beyond their diagnosis of metastatic disease. Combination and sequence of individual drugs and regimens were examined.nnnRESULTSnFor first-line therapy, the most common chemotherapy backbone was infused fluorouracil, leucovorin, and oxaliplatin (FOLFOX; 40.5% of patients), and the most common treatment regimen was FOLFOX plus bevacizumab (26.2%). For second-line therapy, fluorouracil, leucovorin, and irinotecan (FOLFIRI) was the most common chemotherapy backbone (25.7%), and FOLFIRI plus bevacizumab was the most common treatment regimen (18.3%). Across the study period, 68.6%, 22%, and 7% of patients received bevacizumab, cetuximab, and panitumumab, respectively. Among 412 patients receiving bevacizumab-containing regimens as first-line therapy who then received second-line therapy, 58% continued receiving bevacizumab, with dose escalation observed in 44%.nnnCONCLUSIONnThe most commonly used chemotherapy backbones for mCRC treatment were first-line FOLFOX and second-line FOLFIRI. Bevacizumab was the most frequently administered biologic therapy. Continuation and dose escalation with bevacizumab were frequently observed across lines of therapy.

Characterizing Medical Care by Disease Phase in Metastatic Colorectal Cancer

PURPOSEnTo characterize patterns of medical care by disease phase in patients with newly diagnosed metastatic colorectal cancer (mCRC).nnnMETHODSnPatients with mCRC newly diagnosed between 2004 and 2008 were selected from a large US national commercially insured claims database and were observed from initial mCRC diagnosis to death, disenrollment, or end of study period (July 31, 2009), whichever occurred first. The observation period was divided into three distinct phases of disease: diagnostic, treatment, and death. Within each phase, patterns of medical care were examined by the mutually exclusive service categories of inpatient, emergency room (ER), outpatient office and facility, outpatient pharmacy, chemotherapy, and biologic therapy, as measured by estimation of aggregate and category costs per patient per month.nnnRESULTSnA total of 6,675 patients with newly diagnosed mCRC were analyzed. Mean age was 64.1 years; 55.5% were males. Mean costs per patient per month for diagnostic, treatment, and death phases were

The impact of infusion reactions associated with monoclonal antibodies in metastatic colorectal cancer: a European perspective.

16,895,

PMH24 UTILIZATION ANALYSIS OF HEALTH CARE RESOURCES FOR PATIENTS TREATED WITH ATYPICAL ANTIPSYCHOTICS

8,891, and

Urban Health Care Reform Initiative in China: Findings from Its Pilot Experiment in Zhengjiang City (1)

27,554, respectively. Inpatient care was the primary driver of medical care for both the diagnostic (41.7% of costs) and death (71.4% of costs) phases. The largest category of medical care for the treatment phase was outpatient care (45.0% of costs). Chemotherapy and biologic therapy accounted for 15.6% and 17.6% of costs in the treatment phase, respectively.nnnCONCLUSIONnSubstantial differences in patterns of medical care were found between mCRC disease phases. Inpatient care was the key driver of medical care in the diagnostic and death phases compared with outpatient care in the treatment phase.

Final skin toxicity (ST) and patient-reported outcomes (PRO) results from PRIME: A randomized phase III study of panitumumab (pmab) plus FOLFOX4 (CT) for first-line metastatic colorectal cancer (mCRC).

Background and objectives: Published data on the clinical and economic impact of infusion reactions to monoclonal antibodies are limited. This study investigated oncologists’ and oncology nurses’ opinions about resource use associated with infusion reactions and the impact on patient management in Europe. Methods: Eighty oncologists and nurses from Denmark, France, Germany, Greece, Italy, Spain, Sweden and the UK currently treating patients with metastatic colorectal cancer were interviewed by telephone using a 27-item questionnaire developed for this study. Results: The mean estimated number of staff (physicians and nurses) involved in managing an infusion reaction was 1.97 for a grade 1, 2.35 for a grade 2, 3.6 for a grade 3 and 5.3 for a grade 4 reaction. In respondents’ experiences, most patients with grade 3 infusion reactions (73.4%) were admitted to hospital for treatment; 82.5% of those with grade 4 infusion reactions were treated in intensive care. The estimated duration of hospital treatment was 13.3u2009±u200929u2009h for a grade 3 infusion reaction, increasing to 48.1u2009±u200943.7u2009h for a grade 4 infusion reaction. Conclusions: According to respondents, management of infusion reactions led to substantial resource use, which increased with the severity of the reaction. More severe reactions also led to anxiety in patients and distress to staff.

Cost analysis of schizophrenia treatment with second- generation antipsychotic medications in north Carolina's Medicaid program

= 581) and bipolar disorder (N = 2421) received quetiapine monotherapy for at least 4 months at mean initial daily doses of 237 (standard deviation [SD] = 198) mg and 147 (SD = 171) mg, respectively. Both groups showed negative associations between initial daily dose and subsequent mental health charges. For schizophrenia, the relationship approached statistical significance (P = 0.1097), with a decrease of

Stochastic Cost-Effectiveness Analysis: A Simultaneous Marginal-Effect Approach

1.28 in mental health charges for each additional milligram of quetiapine. For bipolar disorder, the relationship was statistically significant (P = 0.0484), with a decrease of

Hospital Costs of Adverse Events in Patients with Metastatic Colorectal Cancer

1.31 per additional milligram. CONCLUSION: This study shows that, in the treatment of schizophrenia and bipolar disorder, higher doses of quetiapine may lower levels of mental health resource use, suggesting enhanced efficacy.