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1.
J Biopharm Stat ; 33(4): 488-501, 2023 Jul 04.
Artículo en Inglés | MEDLINE | ID: mdl-36749067

RESUMEN

Many clinical trials include time-to-event or survival data as an outcome. To compare two survival distributions, the log-rank test is often used to produce a P-value for a statistical test of the null hypothesis that the two survival curves are identical. However, such a P-value does not provide the magnitude of the difference between the curves regarding the treatment effect. As a result, the P-value is often accompanied by an estimate of the hazard ratio from the proportional hazards model or Cox model as a measurement of treatment difference. However, one of the most important assumptions for Cox model is that the hazard functions for the two treatment groups are proportional. When the hazard curves cross, the Cox model could lead to misleading results and the log-rank test could also perform poorly. To address the problem of crossing curves in survival analysis, we propose the use of the win ratio method put forward by Pocock et al. as an estimand for analysing such data. The subjects in the test and control treatment groups are formed into all possible pairs. For each pair, the test treatment subject is labelled a winner or a loser if it is known who had the event of interest such as death. The win ratio is the total number of winners divided by the total number of losers and its standard error can be estimated using Bebu and Lachin method. Using real trial datasets and Monte Carlo simulations, this study investigates the power and type I error and compares the win ratio method with the log-rank test and Cox model under various scenarios of crossing survival curves with different censoring rates and distribution parameters. The results show that the win ratio method has similar power as the log-rank test and Cox model to detect the treatment difference when the assumption of proportional hazards holds true, and that the win ratio method outperforms log-rank test and Cox model in terms of power to detect the treatment difference when the survival curves cross.


Asunto(s)
Modelos de Riesgos Proporcionales , Humanos , Análisis de Supervivencia , Grupos Control , Método de Montecarlo
2.
J Biopharm Stat ; 31(2): 141-155, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-32892707

RESUMEN

In a comparative longitudinal clinical study, multiple clinical events of interest are typically collected in timing and occurrence during the follow-up period. These clinical events are often indicative of disease burden over the study period and provide overall evidence of benefit/risk of one treatment relative to another. While these clinical events are usually used to form a composite endpoint, only the first occurrence of the composite endpoint event is considered in primary efficacy analysis. This type of analysis is commonly performed but it may not be ideal. Most of the existing methods for analyzing multiple event-time data were developed, relying on certain model assumptions. However, the assumptions may greatly affect the inferences for treatment effect. In this paper, we propose a simple, non-parametric estimator of conditional mean survival time for multiple events to quantify treatment effect which has clinically meaningful interpretation. We use simulation studies to evaluate the performance of the new method. Further, we apply this method to analyze the data from a cardiovascular clinical trial as an illustration.


Asunto(s)
Proyectos de Investigación , Simulación por Computador , Humanos , Medición de Riesgo , Análisis de Supervivencia , Tasa de Supervivencia
3.
Oncologist ; 25(2): e328-e334, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32043777

RESUMEN

On May 24, 2019, the Food and Drug Administration approved ruxolitinib for steroid-refractory acute graft-versus-host disease (SR-aGVHD) in adult and pediatric patients 12 years and older. Approval was based on Study INCB 18424-271 (REACH-1; NCT02953678), an open-label, single-arm, multicenter trial that included 49 patients with grades 2-4 SR-aGVHD occurring after allogeneic hematopoietic stem cell transplantation. Ruxolitinib was administered at 5 mg twice daily, with dose increases to 10 mg twice daily permitted after 3 days in the absence of toxicity. The Day-28 overall response rate was 57.1% (95% confidence interval [CI]: 42.2-71.2). The median duration of response was 0.5 months (95% CI: 0.3-2.7), and the median time from Day-28 response to either death or need for new therapy for acute GVHD was 5.7 months (95% CI: 2.2 to not estimable). Common adverse reactions included anemia, thrombocytopenia, neutropenia, infections, edema, bleeding, and elevated transaminases. Ruxolitinib is the first drug approved for treatment of SR-aGVHD. IMPLICATIONS FOR PRACTICE: Ruxolitinib is the first Food and Drug Administration-approved treatment for steroid-refractory acute graft-versus-host disease in adult and pediatric patients 12 years and older. Its approval provides a treatment option for the 60% of those patients who do not respond to steroid therapy.


Asunto(s)
Enfermedad Injerto contra Huésped , Trasplante de Células Madre Hematopoyéticas , Adulto , Niño , Enfermedad Injerto contra Huésped/tratamiento farmacológico , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Nitrilos , Pirazoles/efectos adversos , Pirimidinas , Esteroides/uso terapéutico
4.
Stat Med ; 38(2): 192-209, 2019 01 30.
Artículo en Inglés | MEDLINE | ID: mdl-30281165

RESUMEN

This paper proposes an approach to design and monitor survival trials accounting for complex scenarios such as delayed treatment effect, treatment dilution, and treatment crossover. These scenarios often lead to non-proportional hazards, making study design and monitoring more difficult. We demonstrate that, with event times following piecewise exponential distributions, the log-rank statistic as well as its variance-covariance structure can be easily computed, which greatly simplifies study design and monitoring. As the number of pieces in the exponential distributions can be arbitrary, this approach can handle a wide range of scenarios. Three hypothetical examples are used to demonstrate its potential use.


Asunto(s)
Ensayos Clínicos como Asunto/métodos , Estudios Cruzados , Humanos , Cadenas de Markov , Modelos Estadísticos , Modelos de Riesgos Proporcionales , Análisis de Supervivencia , Factores de Tiempo , Resultado del Tratamiento
5.
J Biopharm Stat ; 29(5): 800-809, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31454294

RESUMEN

In traditional survival analyses, hazard ratio (HR) is commonly used to evaluate treatment effects. However, HR may not be easy to interpret. Restricted mean survival time is a viable alternative to HR, particularly when the proportional hazards assumption is not satisfied. We developed a conditional restricted mean survival time (CRMST) estimator for a time interval of interest using counting process. The variance of CRMST was estimated using a perturbation re-sampling method for asymptotic normality. The utility of our CRMST seems promising based on comprehensive simulation studies and a real data case study.


Asunto(s)
Enfermedades Cardiovasculares/tratamiento farmacológico , Enfermedades Cardiovasculares/mortalidad , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Método Doble Ciego , Estudios de Seguimiento , Humanos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Modelos de Riesgos Proporcionales , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Procesos Estocásticos , Tasa de Supervivencia/tendencias
6.
J Biopharm Stat ; 28(4): 778-796, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29172988

RESUMEN

The win ratio was first proposed in 2012 by Pocock and his colleagues to analyze a composite endpoint while considering the clinical importance order and the relative timing of its components. It has attracted considerable attention since then, in applications as well as methodology. It is not uncommon that some clinical trials require a stratified analysis. In this article, we propose a stratified win ratio statistic in a similar way as the Mantel-Haenszel stratified odds ratio, derive a general form of its variance estimator with a plug-in of existing or potentially new variance/covariance estimators of the number of wins for the two treatment groups, and assess its statistical performance using simulation studies. Our simulations show that our proposed Mantel-Haenszel-type stratified win ratio performs similarly to the Mantel-Haenszel stratified odds ratio for the simplified situation when the win ratio reduces to the odds ratio, and our proposed stratified win ratio is preferred compared to the inverse-variance weighted win ratio and unweighted win ratio particularly when the data are sparse. We also formulate a homogeneity test following Cochran's approach that assesses whether the stratum-specific win ratios are homogeneous across strata, as this method is used frequently in meta-analyses and a better test for the win ratio homogeneity is not available yet.


Asunto(s)
Simulación por Computador/estadística & datos numéricos , Interpretación Estadística de Datos , Determinación de Punto Final/estadística & datos numéricos , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Determinación de Punto Final/métodos , Humanos , Método de Montecarlo , Oportunidad Relativa , Tamaño de la Muestra
7.
J Clin Microbiol ; 55(5): 1350-1368, 2017 05.
Artículo en Inglés | MEDLINE | ID: mdl-28202802

RESUMEN

Eleven laboratories collaborated to determine the periodic prevalence of Salmonella in a population of dogs and cats in the United States visiting veterinary clinics. Fecal samples (2,965) solicited from 11 geographically dispersed veterinary testing laboratories were collected in 36 states between January 2012 and April 2014 and tested using a harmonized method. The overall study prevalence of Salmonella in cats (3 of 542) was <1%. The prevalence in dogs (60 of 2,422) was 2.5%. Diarrhea was present in only 55% of positive dogs; however, 3.8% of the all diarrheic dogs were positive, compared with 1.8% of the nondiarrheic dogs. Salmonella-positive dogs were significantly more likely to have consumed raw food (P = 0.01), to have consumed probiotics (P = 0.002), or to have been given antibiotics (P = 0.01). Rural dogs were also more likely to be Salmonella positive than urban (P = 0.002) or suburban (P = 0.001) dogs. In the 67 isolates, 27 unique serovars were identified, with three dogs having two serovars present. Antimicrobial susceptibility testing of 66 isolates revealed that only four of the isolates were resistant to one or more antibiotics. Additional characterization of the 66 isolates was done using pulsed-field gel electrophoresis and whole-genome sequencing (WGS). Sequence data compared well to resistance phenotypic data and were submitted to the National Center for Biotechnology Information (NCBI). This study suggests an overall decline in prevalence of Salmonella-positive dogs and cats over the last decades and identifies consumption of raw food as a major risk factor for Salmonella infection. Of note is that almost half of the Salmonella-positive animals were clinically nondiarrheic.


Asunto(s)
Enfermedades Transmitidas por los Alimentos/epidemiología , Enfermedades Transmitidas por los Alimentos/veterinaria , Salmonelosis Animal/epidemiología , Salmonella/aislamiento & purificación , Alimentación Animal/microbiología , Animales , Antibacterianos/uso terapéutico , Gatos , Estudios Transversales , Perros , Heces/microbiología , Femenino , Enfermedades Transmitidas por los Alimentos/microbiología , Masculino , Pruebas de Sensibilidad Microbiana , Salmonella/efectos de los fármacos , Salmonelosis Animal/tratamiento farmacológico , Salmonelosis Animal/microbiología , Estados Unidos
8.
Stat Med ; 36(15): 2452-2465, 2017 07 10.
Artículo en Inglés | MEDLINE | ID: mdl-28343373

RESUMEN

To analyze prioritized outcomes, Buyse (2010) and Pocock et al. (2012) proposed the win loss approach. In this paper, we first study the relationship between the win loss approach and the traditional survival analysis on the time to the first event. We then propose the weighted win loss statistics to improve the efficiency of the unweighted methods. A closed-form variance estimator of the weighted win loss statistics is derived to facilitate hypothesis testing and study design. We also calculated the contribution index to better interpret the results of the weighted win loss approach. Simulation studies and real data analysis demonstrated the characteristics of the proposed statistics. Copyright © 2017 John Wiley & Sons, Ltd.


Asunto(s)
Ensayos Clínicos como Asunto/estadística & datos numéricos , Síndrome Coronario Agudo/tratamiento farmacológico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Bioestadística , Simulación por Computador , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Interpretación Estadística de Datos , Determinación de Punto Final/estadística & datos numéricos , Inhibidores del Factor Xa/uso terapéutico , Humanos , Modelos Estadísticos , Modelos de Riesgos Proporcionales , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Rivaroxabán/uso terapéutico , Análisis de Supervivencia , Resultado del Tratamiento
9.
Drug Metab Dispos ; 43(9): 1392-407, 2015 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26153274

RESUMEN

Thirty-three Collies (14 male and 19 female) were used in a dose-escalation study to determine the impact of ABCB1 genotype on loperamide pharmacokinetics (PK) and pharmacodynamics (PD). Loperamide was orally administered in four ascending doses (0.01, 0.05, 0.1, or 0.2 mg/kg) over a 4-wk period to fasted Collies. Comparisons were made within each dose to genotype, phenotype, and whether Collies received three (3D) or four (4D) loperamide doses. The 3D and 4D groupings had statistically significant differences in systemic drug exposure (defined by the area under the concentration-versus-time profile estimated from time zero to the last quantifiable drug concentration, AUC0-last). In contrast, statistical differences in AUC0-last only occurred in the comparison between wild-type (WT) Collies versus homozygous mutant (Mut) Collies administered 0.1 mg/kg. Statistical differences in the proportionality relationship were observed when comparing 3D to 4D Collies, and the WT to Mut Collies. Intersubject variability in drug exposure tended to be twice as high between Mut and WT Collies. Associations were observed between systemic drug exposure and ataxia or depression but not between systemic drug exposure and mydriasis or salivation. Thus, Collies expressing the greatest sensitivity to CNS-associated effects of loperamide (Mut) tended to have higher drug exposure compared with those less sensitive to the adverse effects of loperamide. Genotype and phenotype only partially explained differences in loperamide PK and PD, suggesting this relationship may not be straightforward and that other factors need to be considered. Accordingly, the PD and PK of one P-glycoprotein substrate only partially predicted the likelihood of adverse responses to unrelated substrates.


Asunto(s)
Subfamilia B de Transportador de Casetes de Unión a ATP/genética , Antidiarreicos/farmacología , Antidiarreicos/farmacocinética , Perros/genética , Loperamida/farmacología , Loperamida/farmacocinética , Animales , Relación Dosis-Respuesta a Droga , Femenino , Genotipo , Masculino
10.
Clin Cancer Res ; 29(19): 3835-3840, 2023 10 02.
Artículo en Inglés | MEDLINE | ID: mdl-37212825

RESUMEN

On November 14, 2022, the FDA granted accelerated approval to mirvetuximab soravtansine-gynx for treatment of adult patients with folate receptor-α (FRα)-positive, platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer who have received one to three prior systemic therapies. The VENTANA FOLR1 (FOLR-2.1) RxDx Assay was approved as a companion diagnostic device to select patients for this indication. Approval was based on Study 0417 (SORAYA, NCT04296890), a single-arm, multicenter trial. In 104 patients with measurable disease who received mirvetuximab soravtansine-gynx, the overall response rate was 31.7% [95% confidence interval (CI), 22.9-41.6] with a median duration of response of 6.9 months (95% CI, 5.6-9.7). Ocular toxicity was included as a Boxed Warning in the U.S. Prescribing Information (USPI) to alert providers of the risks of developing severe ocular toxicity including vision impairment and corneal disorders. Pneumonitis and peripheral neuropathy were additional important safety risks included as Warnings and Precautions in the USPI. This is the first approval of a targeted therapy for FRα-positive, platinum-resistant ovarian cancer and the first antibody-drug conjugate approved for ovarian cancer. This article summarizes the favorable benefit-risk assessment leading to FDA's approval of mirvetuximab soravtansine-gynx.


Asunto(s)
Inmunoconjugados , Neoplasias Ováricas , Adulto , Humanos , Femenino , Neuropatía Óptica Tóxica/tratamiento farmacológico , Resistencia a Antineoplásicos , Carcinoma Epitelial de Ovario/tratamiento farmacológico , Neoplasias Ováricas/tratamiento farmacológico , Inmunoconjugados/efectos adversos , Receptor 1 de Folato
11.
J AOAC Int ; 106(1): 73-87, 2022 Dec 22.
Artículo en Inglés | MEDLINE | ID: mdl-36103709

RESUMEN

BACKGROUND: Oxytetracycline (OTC), chlortetracycline (CTC), and tetracycline (TC) are approved antibiotics used to treat bacterial infections in cattle. To ensure human food safety, a tolerance has been established for the sum of these three TC residues as 12 parts per million in bovine kidney in the United States The current official regulatory method for quantifying these antibiotics in the target organ is a labor-intensive microbiological assay. OBJECTIVE: Our laboratory developed and validated a fast, selective, and less laborious method utilizing LC-tandem mass spectrometry for the determination and confirmation of the three tetracyclines (TET) in bovine kidney. METHODS: Briefly, homogenized kidney tissue was spiked with an internal standard (ISTD), and then was extracted with 1% phosphate buffer. The crude extract was cleaned up using solid-phase extraction cartridges before instrumental analysis. RESULTS: Accuracies for quantifying these three drugs in fortified kidney homogenate were between 99.9 and 110% at multiple concentrations, with respective CVs all below 9.5%. Quantitative correlation between the two methods (bridging) was evaluated with incurred bovine kidney samples for each of the three tetracyclines separately. The results were statistically evaluated using a measurement model called Functional Relationship Estimation by Maximum Likelihood. CONCLUSION: A linear quantitative relationship was demonstrated between the two methods within the concentration range of regulatory relevance. HIGHLIGHTS: This instrumental method is in addition to the established microbial assay for the detection of tetracyclines residue in beef kidney to ensure the food safety of cattle products.


Asunto(s)
Clortetraciclina , Residuos de Medicamentos , Oxitetraciclina , Humanos , Bovinos , Animales , Tetraciclina/análisis , Oxitetraciclina/análisis , Clortetraciclina/análisis , Espectrometría de Masas en Tándem/métodos , Antibacterianos/análisis , Tetraciclinas/análisis , Cromatografía Liquida/métodos , Riñón , Residuos de Medicamentos/análisis
12.
Clin Cancer Res ; 28(3): 441-445, 2022 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-34417198

RESUMEN

On March 10, 2021, the FDA granted regular approval to tivozanib for treatment of patients with relapsed or refractory (R/R) advanced renal cell carcinoma (RCC) following two or more prior systemic therapies. Approval was based on the TIVO-3 study, a randomized trial of tivozanib versus sorafenib in patients with R/R advanced RCC. In TIVO-3, patients were randomized to receive either tivozanib 1.34 mg orally once daily for 21 consecutive days of every 28-day cycle or sorafenib 400 mg orally twice daily continuously. The primary endpoint was progression-free survival (PFS) per RECIST v1.1. Tivozanib demonstrated efficacy compared with sorafenib with an improvement in PFS [HR, 0.73; 95% confidence interval (CI), 0.56-0.95; P = 0.016]. The estimated median PFS was 5.6 months and 3.9 months in the tivozanib and sorafenib arms, respectively. There was no evidence of a detrimental effect on overall survival: HR, 0.97 (95% CI, 0.75-1.24). The most common grade 3 to 4 adverse reaction on the tivozanib arm was hypertension (24%). Compared with sorafenib, tivozanib was associated with lower rates of grade 3 to 4 diarrhea, rash, and palmar-plantar erythrodysesthesia. Patients receiving tivozanib in TIVO-3 had lower rates of dose reduction, interruption, or permanent discontinuation than those receiving sorafenib.


Asunto(s)
Carcinoma de Células Renales/tratamiento farmacológico , Aprobación de Drogas , Neoplasias Renales/tratamiento farmacológico , Compuestos de Fenilurea/uso terapéutico , Quinolinas/uso terapéutico , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Renales/mortalidad , Femenino , Humanos , Neoplasias Renales/mortalidad , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Compuestos de Fenilurea/administración & dosificación , Compuestos de Fenilurea/efectos adversos , Quinolinas/administración & dosificación , Quinolinas/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Sorafenib/administración & dosificación , Sorafenib/uso terapéutico , Tasa de Supervivencia , Resultado del Tratamiento
13.
Clin Cancer Res ; 28(8): 1487-1492, 2022 04 14.
Artículo en Inglés | MEDLINE | ID: mdl-34916216

RESUMEN

On December 16, 2020, the FDA granted regular approval to margetuximab-cmkb (MARGENZA), in combination with chemotherapy, for the treatment of adult patients with HER2-positive (HER2+) metastatic breast cancer who have received two or more prior anti-HER2 regimens, at least one of which was for metastatic disease. Approval was based on data from SOPHIA, a multicenter, randomized, open-label, active controlled study comparing margetuximab with trastuzumab, in combination with chemotherapy. The primary efficacy endpoint was progression-free survival (PFS) by blinded independent central review. SOPHIA demonstrated a 0.9-month difference in median PFS between the two treatment arms [5.8 vs. 4.9 months, respectively; stratified HR, 0.76 (95% confidence interval: 0.59-0.98; P = 0.0334)]. Overall survival (OS) was immature at the data cut-off date of September 10, 2019. Infusion-related reactions (IRR) are an important safety signal associated with margetuximab plus chemotherapy. In SOPHIA, 13% of patients treated with margetuximab plus chemotherapy reported IRRs, of which 1.5% were grade 3. The most commonly reported adverse drug reactions (>10%) with margetuximab in combination with chemotherapy were fatigue/asthenia, nausea, diarrhea, vomiting, constipation, headache, pyrexia, alopecia, abdominal pain, peripheral neuropathy, arthralgia/myalgia, cough, decreased appetite, dyspnea, IRR, palmar-plantar erythrodysesthesia, and extremity pain. Overall, the favorable risk-benefit profile for margetuximab when added to chemotherapy supported its approval for the intended indication.


Asunto(s)
Neoplasias de la Mama , Adulto , Anticuerpos Monoclonales/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias de la Mama/patología , Aprobación de Drogas , Femenino , Humanos , Receptor ErbB-2/uso terapéutico , Trastuzumab/efectos adversos
14.
Clin Cancer Res ; 27(8): 2126-2129, 2021 04 15.
Artículo en Inglés | MEDLINE | ID: mdl-33188141

RESUMEN

On June 29, 2020, the FDA approved pertuzumab, trastuzumab, and hyaluronidase-zzxf subcutaneous injection (Phesgo) for the treatment of patients with HER2-positive early-stage and metastatic breast cancer. Patients should be selected for therapy based on an FDA-approved companion diagnostic test. Approval was primarily based on the FeDeriCa trial, a randomized, open-label, multicenter comparability study of pertuzumab, trastuzumab, and hyaluronidase-zzxf subcutaneous injection compared with intravenous pertuzumab and intravenous trastuzumab administered in the neoadjuvant and adjuvant settings with chemotherapy for the treatment of patients with early breast cancer. The pharmacokinetic endpoints were, first, to demonstrate that the exposure of subcutaneous pertuzumab was not inferior to that of intravenous pertuzumab, and then to demonstrate that the exposure of subcutaneous trastuzumab was not inferior to that of intravenous trastuzumab. The primary endpoints were met with the observed lower limit of the two-sided 90% confidence intervals above the prespecified noninferiority margins. The most common adverse reactions were alopecia, nausea, diarrhea, anemia, and asthenia. The totality of the evidence demonstrated comparability of the subcutaneous product to intravenous, allowing for extrapolation and approval of all breast cancer indications for which intravenous trastuzumab and pertuzumab are approved.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Neoplasias de la Mama/terapia , Terapia Neoadyuvante/métodos , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales Humanizados/administración & dosificación , Anticuerpos Monoclonales Humanizados/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias de la Mama/patología , Quimioterapia Adyuvante/efectos adversos , Quimioterapia Adyuvante/métodos , Esquema de Medicación , Aprobación de Drogas , Femenino , Humanos , Hialuronoglucosaminidasa/administración & dosificación , Hialuronoglucosaminidasa/efectos adversos , Inyecciones Subcutáneas , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Terapia Neoadyuvante/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Receptor ErbB-2/análisis , Receptor ErbB-2/metabolismo , Trastuzumab/administración & dosificación , Trastuzumab/efectos adversos , Resultado del Tratamiento , Estados Unidos , United States Food and Drug Administration
15.
Clin Cancer Res ; 27(16): 4478-4485, 2021 08 15.
Artículo en Inglés | MEDLINE | ID: mdl-33753456

RESUMEN

On December 20, 2019, the FDA granted accelerated approval to fam-trastuzumab deruxtecan-nxki [DS-8201a; T-DXd; tradename ENHERTU (Daiichi Sankyo)] for the treatment of adult patients with unresectable or metastatic HER2-positive breast cancer who have received two or more prior anti-HER2-based regimens in the metastatic setting. Approval was based on data from study DS8201-A-U201 (DESTINY-Breast01) with supportive safety data from study DS8201-A-J101. The primary efficacy endpoint in DESTINY-Breast01 was overall response rate (ORR) based on confirmed responses by blinded independent central review (ICR) using RECIST v1.1 in all participants who were assigned to receive the recommended dose of 5.4 mg/kg while secondary endpoints included duration of response (DoR). The confirmed ORR based on ICR in these 184 patients was 60.3% [95% confidence interval (CI): 52.9-67.4] and the median DoR was 14.8 months (95% CI: 13.8-16.9). Interstitial lung disease, including pneumonitis, was experienced in patients treated with T-DXd and can be severe, life threatening, or fatal. In addition, neutropenia and left ventricular dysfunction were included as Warnings and Precautions in labeling. Other important common adverse reactions were nausea, fatigue, vomiting, alopecia, constipation, decreased appetite, anemia, diarrhea, and thrombocytopenia. Overall, the totality of efficacy and safety data supported the accelerated approval of T-DXd for the intended indication.


Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Camptotecina/análogos & derivados , Aprobación de Drogas , Inmunoconjugados/uso terapéutico , Trastuzumab/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/química , Camptotecina/uso terapéutico , Femenino , Humanos , Persona de Mediana Edad , Receptor ErbB-2/análisis , Estados Unidos
16.
Clin Cancer Res ; 27(7): 1842-1849, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33168657

RESUMEN

On May 24, 2019, the FDA granted regular approval to alpelisib in combination with fulvestrant for postmenopausal women, and men, with hormone receptor (HR)-positive, HER2-negative, phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA)-mutated, advanced or metastatic breast cancer as detected by an FDA-approved test following progression on or after an endocrine-based regimen. Approval was based on the SOLAR-1 study, a randomized, double-blind, placebo-controlled trial of alpelisib plus fulvestrant versus placebo plus fulvestrant. The primary endpoint was investigator-assessed progression-free survival (PFS) per RECIST v1.1 in the cohort of trial participants whose tumors had a PIK3CA mutation. The estimated median PFS by investigator assessment in the alpelisib plus fulvestrant arm was 11 months [95% confidence interval (CI), 7.5-14.5] compared with 5.7 months (95% CI, 3.7-7.4) in the placebo plus fulvestrant arm (HR, 0.65; 95% CI, 0.50-0.85; two-sided P = 0.001). The median overall survival was not yet reached for the alpelisib plus fulvestrant arm (95% CI, 28.1-NE) and was 26.9 months (95% CI, 21.9-NE) for the fulvestrant control arm. No PFS benefit was observed in trial participants whose tumors did not have a PIK3CA mutation (HR, 0.85; 95% CI, 0.58-1.25). The most common adverse reactions, including laboratory abnormalities, on the alpelisib plus fulvestrant arm were increased glucose, increased creatinine, diarrhea, rash, decreased lymphocyte count, increased gamma glutamyl transferase, nausea, increased alanine aminotransferase, fatigue, decreased hemoglobin, increased lipase, decreased appetite, stomatitis, vomiting, decreased weight, decreased calcium, decreased glucose, prolonged activated partial thromboplastin time, and alopecia.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Fosfatidilinositol 3-Quinasa Clase I/genética , Fulvestrant/administración & dosificación , Mutación , Tiazoles/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/genética , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Método Doble Ciego , Aprobación de Drogas , Femenino , Fulvestrant/efectos adversos , Fulvestrant/farmacología , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Medición de Resultados Informados por el Paciente , Receptor ErbB-2/análisis , Receptores de Estrógenos/análisis , Tiazoles/efectos adversos , Tiazoles/farmacología
17.
J Toxicol Environ Health A ; 73(1): 74-91, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-19953421

RESUMEN

Perchloroethylene (PCE) is a widely distributed pollutant in the environment, and is the primary chemical used in dry cleaning. PCE-induced liver cancer was observed in mice, and central nervous system (CNS) effects were reported in dry-cleaning workers. To support reconstruction of human PCE exposures, including the potential for CNS effects, an existing physiologically based pharmacokinetic (PBPK) model for PCE in the human (Covington et al., 2007) was modified by adding a brain compartment. A Bayesian approach, using Markov chain Monte Carlo (MCMC) analysis, was employed to re-estimate the parameters in the modified model by combining information from prior distributions for the model parameters and experimental data. Experimental data were obtained from five different human pharmacokinetic studies of PCE inhalation exposures ranging from 150 ppm to as low as 0.495 ppm. The data include alveolar or exhaled breath concentrations of PCE, blood concentrations of PCE and trichloroacetic acid (TCA), and urinary excretion of TCA. The PBPK model was used to predict target tissue dosimetry of PCE and its key metabolite, TCA, during and after the inhalation exposures. Posterior analysis was performed to see whether convergence criteria for each parameter were satisfied and whether the model with posterior distributions may be used to make accurate predictions of human kinetic data. With posteriors, the trend of percent of PCE metabolized in the liver at low concentrations was predicted under different exposure conditions. The 95th percentile for the fraction PCE metabolized at a concentration of 1 ppb was estimated to be 1.89%.


Asunto(s)
Tetracloroetileno/farmacocinética , Animales , Teorema de Bayes , Humanos , Exposición por Inhalación , Hígado/química , Masculino , Cadenas de Markov , Ratones , Método de Montecarlo , Tetracloroetileno/análisis , Tetracloroetileno/sangre
18.
Ther Innov Regul Sci ; 54(6): 1436-1443, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32514737

RESUMEN

The US Food and Drug Administration (FDA) has shown scientific discretion in interpreting the substantial evidence requirement for the approval of new drugs with its considerations on the use of single controlled or uncontrolled trials (Federal Food, Drug, and Cosmetic Act § 505(d), 21 USC 355(d), 1962). With the passage of the 21st Centuries Cures Act (21st Century Cures-patients. House, Energy and Commerce Committee, Washington, DC, 2019 available at: https://energycommerce.house.gov/sites/republicans.energycommerce.house.gov/files/analysis/21stCenturyCures/20140516PatientsWhitePaper.pdf ), the FDA is mandated to expand the role of real-world evidence (RWE) in support of drug approval. This mandate further broadens the scope of scientific discretion to include data collected outside clinical trials. We summarize the agency's past acceptance of real-world data (RWD) sources for supporting drug approval in new indications which have been reflected in US labels. In our summary, we focus on the type of RWD and statistical methodologies presented in these labels. Furthermore, two labels were selected for in-depth assessment of the RWE presented in these labels. Through these examples, we demonstrate the issues that can be raised in data collection that could affect interpretation. In addition, a brief discussion of statistical methods that can be used to incorporate RWE to clinical development is presented.


Asunto(s)
Aprobación de Drogas , Etiquetado de Productos , Recolección de Datos , Humanos , Estados Unidos , United States Food and Drug Administration
19.
AAPS J ; 18(3): 619-34, 2016 05.
Artículo en Inglés | MEDLINE | ID: mdl-26896256

RESUMEN

A Bayesian approach with frequentist validity has been developed to support inferences derived from a "Level A" in vivo-in vitro correlation (IVIVC). Irrespective of whether the in vivo data reflect in vivo dissolution or absorption, the IVIVC is typically assessed using a linear regression model. Confidence intervals are generally used to describe the uncertainty around the model. While the confidence intervals can describe population-level variability, it does not address the individual-level variability. Thus, there remains an inability to define a range of individual-level drug concentration-time profiles across a population based upon the "Level A" predictions. This individual-level prediction is distinct from what can be accomplished by a traditional linear regression approach where the focus of the statistical assessment is at a marginal rather than an individual level. The objective of this study is to develop a hierarchical Bayesian method for evaluation of IVIVC, incorporating both the individual- and population-level variability, and to use this method to derive Bayesian tolerance intervals with matching priors that have frequentist validity in evaluating an IVIVC. In so doing, we can now generate population profiles that incorporate not only variability in subject pharmacokinetics but also the variability in the in vivo product performance.


Asunto(s)
Teorema de Bayes , Modelos Teóricos
20.
Ying Yong Sheng Tai Xue Bao ; 13(12): 1713-5, 2002 Dec.
Artículo en Zh | MEDLINE | ID: mdl-12682989

RESUMEN

Aromatic hydrocarbons are biological xenobiotics. Indigenous microorganism groups turn from being unfamiliar with into active response to environmental changes by their adaptability to environment. There are changes in their genetic background, and then, the biodiversity turns into being. This paper reviewed the microorganism groups resources, biocharacters, genetic background, evolvement and their adaptability to environment; described the genetic information, expression and regulatory for some species in detail; and pointed out that the degradation of aromatic hydrocarbons depended mainly on new microorganisms formed by genetic engineering and on their highly efficient metabolic regulatory.


Asunto(s)
Ecosistema , Hidrocarburos Aromáticos/metabolismo , Microbiología del Suelo , Bacterias/metabolismo , Biodegradación Ambiental
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