chemotherapy treatment patterns among advanced colon cancer patients pawloski
DESCRIPTION
CancerTRANSCRIPT
2012 HMO RN conference
Presented by: Pamala Pawloski, PharmDHealthPartners Research Foundation, Minneapolis, MN
Chemotherapy Treatment
Patterns Among Advanced
Colon Cancer Patients
3
2012 HMO RN conference
Presentation Objective
Overview
Aims
Methods
Results
4
Comparative Effectiveness Research in Genomics (CERGEN) Overview
5
CERGEN Project Collaborators
Georgetown
Univ. Hawaii
OHSU
U. Washington Colorado Dept. Public Health
KP Georgia
6
Methods
Metastatic colon cancer cases diagnosed between 1/1/2006 to
12/31/2009 were identified from original study cohort.
Diagnosis, demographic, and treatment data was collected via
electronic medical records and chart review.
All chemotherapy data was categorized as meeting or not meeting
NCCN guidelines by two raters, with an inter-rater reliability of 87.6%.
All disagreements were adjudicated by a third reviewer.
Analysis included descriptive statistics, incidence rates, and Cox
proportional hazards regression models.
7
2012 HMO RN conference
Aim 1
To describe chemotherapy treatment patterns for cases
diagnosed at Stage III and IV disease
Hypothesis 1:
- Treatment characteristics differ by:
Geographical site
Patient characteristics
8
2012 HMO RN conference
Results: Types of Metastatic Treatment
0 50 100 150 200
Bevacizumab
EGFR inhibitors
Irinotecan Containing
Platinum Containing
Miscellaneous
FOLFIRI Containing
CapeOX Containing
5FU Containing
Capecitabine Containing
FOLFOX Containing
Therapy After Second Progression
Alone or in Other CombinationPlus Bevacizumab
Plus EGFR inhibitors
0 50 100 150 200
Bevacizumab
EGFRi
Irinotecan Containing
Platinum Containing
Miscellaneous
FOLFIRI Containing
CapeOX Containing
5FU Containing
Capecitabine Containing
FOLFOX Containing
Therapy After First Progression
0 100 200 300 400 500 600
Bevacizumab
EGFR inhibitors
Irinotecan Containing
Platinum Containing
Miscellaneous
FOLFIRI Containing
CapeOX Containing
5FU Containing
Capecitabine Containing
FOLFOX Containing
Initial Therapy
Number of Subjects
9
0% 20% 40% 60% 80% 100%
7
6
5
4
3
2
1
Site
Percent
Chemotherapy by Site
Received Any Chemo
Treatment Characteristics:Site
p=.0003
10
0% 20% 40% 60% 80% 100%
6+
5
4
3
2
1
0
80 +
70 - 79
60 - 69
50 - 59
< 50
No
Yes
Ch
arls
on
Sco
reA
geM
edic
are
Chemotherapy Utilization
Received Any Chemo
p<.0001
p<.0001
p<.0001
Treatment Characteristics:Demographics
11
Aim 2
To compare chemotherapy treatment use for Stage III and
IV colon cancer patients to recommended treatment
guidelines
Hypothesis #2:
- Chemotherapy for Stage III and IV colon cancer is largely consistent with
published guidelines and cases in which guidelines were not followed could be
justified due to patient case status
12
NCCN Treatment Guideline:Non-metastatic Stage III Colon Cancer 2007-2011
13
NCCN Treatment Guideline:Metastatic Stage IV Colon Cancer 2007-2011
14
Results
• 23 (2.6%) patients who received chemotherapy participated in a clinical trial
• 11 for initial therapy
• 12 for therapy after first progression
13% treated with bevacizumab alone
13% treated with an EGFR inhibitors
first line (preceded guideline change
in 2011)
15
2012 HMO RN conference
Limitations
Identification of progression from stage III to
stage IV disease not easily identified Limited analysis to pre- and post-metastatic disease
Stage III cases included in analysis if
progression to metastatic disease occurred in
study period
16
2012 HMO RN conference
Summary
Initial treatment primarily consisted of FOLFOX-containing
regimens followed by irinotecan-containing regimens after first
progression
No single common treatment regimen identified following
second progression
The proportion of patients receiving any chemotherapy for
metastatic disease differed significantly by site and patient
characteristics
Approximately 2/3 patients treated received chemotherapy
consistent with recommended guidelines
17
2012 HMO RN conference
Treatment Characteristics Analysis Group
Gwen Alexander, HFHS Kristin Muessig, KPNW
Ajay Behl, HPRF Adedayo Onitilo, MCRF
Jessica Engel, MCRF Brian Owens, HPRF
Heather Feigelson, KPCO Pamala Pawloski, HPRF
Katrina Goddard, KPNW Jennifer Webster, KPNW
Clara Hwang, HFHS Andrew Williams, KPHI
Tia Kauffman, KPNW
18
CERGEN Study Team
Co-PIs
Katrina Goddard, KPNW
Lawrence Kushi, KPNC
Evelyn Whitlock, KPNW
Project Leads
Jennifer Lin, KPNW
Michael Maciosek, HPRF
Heather Feigelson, KPCO
Carol Somkin, KPNC
Additional Site PIs
Gwen Alexander, HFHS
Deanna Cross, MCRF
Stacey Honda, KPHI
Pamala Pawloski, HPRF
Co-Investigators
Robert Davis, KPG
Thomas Delate, KPCO
Thomas Flottemesch, HPRF
Jared Freml, KPCO
Catherine McCarty, MCRF
Richard Meenan, KPNW
Andrew Nelson, HPRF
Suzanne O’Neill, GU
Alanna Rahm, KPCO
Andrew Williams, KPHI
Consultants
Ned Colange, DPH CO
Loic LeMarchand, UH
C. Sue Richards, OHSU
David Veenstra, UW
Oncologists/Clinicians
Adedayo Onitilo, MCRF
Christopher Cold, MCRF
Nagendra Tirumali, KPNW
Clara Hwang, HFHS
Tatjana Kolevska, KPNC
Alex Menter, KPCO
Staff
Chris Anderson, HPRF
Ajay Behl, HPRF
Kris Bennett, KPNW
Kathleen Bow, KPHI
YeeHwa Daida, KPHI
Padmavati Dandamudi, KPNW
Teri Defor, HPRF
Jessica Engel, MCRF
Rene Faryniarz, HFHS
Mamie Ford, KPNC
Kellyan Funk, KPCO
Joan Garhy, HFHS
Staff cont.
Julie Harris, KPNC
Mia Hemmes, KPG
Paul Hitz, MCRF
Rebecca Holmes, KPNW
Stephen Houston, KPNW
Karl Huang, KPNC
Sheng-Fang Jiang, KPNC
Tia Kauffman, KPNW
Terrie Kitchner, MCRF
Richard Krajenta HFHS
Smyth Lai, KPNW
Anh Q Le, KPCO
Petra Liljestrand, KPNC
Celeste Machen, KPNW
Jennifer McCance, KPCO
Jill Mesa, KPNW
Paul Meier, HFHS
Anousheh Mirabedi, KPNC
Judith Morse, KPNC
Kristin Muessig, KPNW
Carsie Nyirenda, KPCO
Maureen O’Keeffe Rosetti, KPNW
Kim Olson, KPNW
Brian Owens, HPRF
Denise Schwarzkopf, KPNW
Staff cont.
Caitlin Senger, KPNW
Amy Stone-Murai, KPHI
Simrandeep Tiwana, HPRF
Laurie VanArman, HPRF
Aleli Vinoya, KPHI
Carmel Wax, KPNW
Elizabeth Webber, KPNW
Jennifer Webster, KPNW
Carmen Wong, KPHI
Chan Zeng, KPCO
Sarah Zuber, KPNW
Funded by a grant from the National
Cancer Institute, RC2-CA148471.
19
Thank You