Potential survival benefits from optimized chemotherapy implementation in advanced ovarian cancer: Projections from a microsimulation model

English version

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
prolekare.web.journal.doi_sk: 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:

Biology and life sciences – Physical sciences – Research and analysis methods – Population biology – Mathematics – Medicine and health sciences – Population metrics – Pharmacology – Statistics – Mathematical and statistical techniques – Statistical methods – Metaanalysis – Clinical medicine – Pharmaceutics – Drug therapy – Public and occupational health – Oncology – Cancer treatment – Cancers and neoplasms – Gynecological tumors – Surgical and invasive medical procedures – Cancer chemotherapy – Clinical oncology – Chemotherapy – Routes of administration – Ovarian cancer – Life expectancy – Intravenous injections

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