Potential survival benefits from optimized chemotherapy implementation in advanced ovarian cancer: Projections from a microsimulation model
Autoři:
Anna P. Lietz aff001; Davis T. Weaver aff001; Alexander Melamed aff002; Jose Alejandro Rauh-Hain aff003; Jason D. Wright aff004; Alexi A. Wright aff005; Amy B. Knudsen aff001; Pari V. Pandharipande aff001
Působiště autorů:
Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, United States of America
aff001; Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States of America
aff002; Gynecologic Oncology and Reproductive Medicine Department, University of Texas MD Anderson Cancer Center, Houston TX, United States of America
aff003; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, United States of America
aff004; Dana-Farber Cancer Institute, Boston, MA, United States of America
aff005; Harvard Medical School, Boston, MA, United States of America
aff006
Vyšlo v časopise:
PLoS ONE 14(9)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0222828
Souhrn
Background
Ovarian cancer is often diagnosed in advanced stages, when survival is poor. Treatment advances have been made, but are inconsistently implemented. Our purpose was to project the maximum life expectancy gains that could be achieved in women with stage IIIC epithelial ovarian cancer if the implementation of available chemotherapy regimens could be optimized.
Methods
We used a microsimulation model to estimate life expectancy benefits associated with “optimized” implementation of four post-operative chemotherapy options: standard intravenous chemotherapy; intraperitoneal + intravenous chemotherapy; bevacizumab + intravenous chemotherapy; and hyperthermic intraperitoneal chemotherapy + intravenous chemotherapy. Optimized implementation was defined as follows. Patients triaged to primary cytoreductive surgery received intraperitoneal + intravenous chemotherapy if optimally or completely cytoreduced, and bevacizumab + intravenous chemotherapy if suboptimally cytoreduced. Patients triaged to neoadjuvant chemotherapy received hyperthermic intraperitoneal chemotherapy at interval cytoreductive surgery if optimally or completely cytoreduced, and standard IV chemotherapy if suboptimally cytoreduced. Life expectancy associated with optimized implementation was compared with that of current utilization practices, estimated using published literature and the National Cancer Database. Effects of model uncertainty were evaluated in sensitivity analyses.
Results
Life expectancy associated with optimized implementation vs. current practice was 76.7 vs. 64.5 months (life expectancy gain = 12.2 months). Providing intraperitoneal + intravenous chemotherapy to all eligible patients was the largest driver of life expectancy gains, due to both the potential benefit conferred by intraperitoneal + intravenous chemotherapy and the proportion of eligible women who do not receive intraperitoneal + intravenous chemotherapy in current practice.
Conclusion
Population-level life expectancy in stage IIIC epithelial ovarian cancer could be substantially improved through greater uptake of available chemotherapy regimens.
Klíčová slova:
Medicine and health sciences – Pharmaceutics – Drug therapy – Chemotherapy – Public and occupational health – Life expectancy – Oncology – Cancer treatment – Cancer chemotherapy – Clinical oncology – Cancers and neoplasms – Gynecological tumors – Ovarian cancer – Clinical medicine – Surgical and invasive medical procedures – Pharmacology – Routes of administration – Intravenous injections – Biology and life sciences – Population biology – Population metrics – Research and analysis methods – Mathematical and statistical techniques – Statistical methods – Metaanalysis – Physical sciences – Mathematics – Statistics
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PLOS One
2019 Číslo 9
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