Real-world dosing and drug costs with everolimus or axitinib as second targeted therapies for advanced renal cell carcinoma: a retrospective chart review in the US

Objective:

To describe dosing patterns and to compare the drug costs per month spent in progression-free survival (PFS) among patients with advanced renal cell carcinoma (aRCC) treated with everolimus or axitinib following a first tyrosine kinase inhibitor (TKI).

Methods:

A medical record retrospective review was conducted among medical oncologists and hematologists/oncologists in the US. Patient eligibility criteria included: (1) age ≥18 years; (2) discontinuation of first TKI (sunitinib, sorafenib, or pazopanib) for medical reasons; (3) initiation of axitinib or everolimus as a second targeted therapy during February 2012–January 2013. Real-world dosing patterns were summarized. Dose-specific drug costs (as of October 2014) were based on wholesale acquisition costs from RED BOOK Online. PFS was compared between everolimus and axitinib using a multivariable Cox proportion hazards model. Everolimus and axitinib drug costs per month of PFS were compared using multivariable gamma regression models.

Results:

A total of 325 patients received everolimus and 127 patients received axitinib as second targeted therapy. Higher proportions of patients treated with axitinib vs everolimus started on a higher than label-recommended starting dose (14% vs 2%) or experienced dose escalation (11% vs 1%) on second targeted therapy. The PFS did not differ significantly between patients receiving everolimus or axitinib (adjusted hazard ratio (HR)?=?1.16; 95% confidence interval [CI]?=?0.73–1.82). After baseline characteristics adjustment, axitinib was associated with 17% ($1830) higher drug costs per month of PFS compared to everolimus ($12,467 vs $10,637; p?<?0.001).

Limitations:

Retrospective observational study design and only drug acquisition costs considered in drug costs estimates.

Conclusions:

Patients with aRCC receiving axitinib as second targeted therapy were more likely to initiate at a higher than label-recommended dose and were more likely to dose escalate than patients receiving everolimus. With similar observed durations of PFS, drug costs were significantly higher—by 17% per month of PFS—with axitinib than with everolimus.     

Machine-Part Cell Formation Problem Using a Group Based League Championship Algorithm

This article proposes a new algorithm for grouping problems that is a grouping version of league championship algorithm (GLCA). We compare the performance of GLCA with several well-known algorithms published in the present literature and select a set of 20 most widely used benchmarks of cell formation sample problems posing as a grouping problem. We used a truncated geometric algorithm to find the number of initial cells. Our computations reveal that GLCA can reach the best-known solution for 17 of the 20 benchmark problems, and improve the solution of three others with a 1.4% average gap.     

桂皮醛抗念珠菌的敏感性及对细胞壁的影响

为了研发靶向抗真菌药物,研究桂皮醛对念珠菌抗菌活性及对白念珠菌细胞壁的影响.参照CLSI的M27-A3方案,采用微量液基稀释法,测定桂皮醛对念珠菌(白念珠菌、热带念珠菌、克柔氏念珠菌)的抗菌作用.将白念珠菌的菌悬液(1×108 cfu/mL)加入到RPMI 1640液体培养基内,置于37℃孵育48 h后,离心、制片,在...     

氢燃料电池汽车全球技术法规研究

《氢燃料电池汽车全球技术法规》规定了氢燃料电池汽车的通用要求及其关键系统的安全性能要求、型式试验方法和型式认证要求,其颁布实施后将对我国氢燃料电池汽车和压缩氢气储存系统的发展产生重大影响。文章简要介绍了该法规草案的主要内容和特点,以及我同氢燃料电池汽车和压缩氢气储存系统发展面临的挑战,并提出了若干建议。     

开设光伏专业(太阳电池制造工工种)的实践与探索

太阳电池制造工在光伏企业有着大量的用工需求,但目前职业教育对该工种尚无技能鉴定标准,本文就此问题提出了解决的办法,同时就如何培养出适合企业所需要的复合型人才,做了相应的实践和探索。     

强化小康社会的经济细胞--简论企业核心竞争力

企业是国民经济的细胞，也是小康社会的经济细胞，增强这个细胞的关键是培育和强化企业的核心竞争力。企业核心竞争力是企业自身拥有的、具有垄断性的、不可模仿的、持久的、高创利的市场竞争能力或能力合成。培育和形成企业核心竞争力有基础要素、前沿要素和终端要素。目前我国企业在培育核心竞争力中存在诸多误区。企业要把核心竞争力的培育放在企业战略重点的位置，从体制、技术和管理创新等方面持续投入。     

自焙电解槽清洁生产工艺研究

提出利用现有的 60kA自焙‘电解槽改建成 75kA预焙电解槽清洁生产工艺方案。将改建前后产品产量、排污、能耗进行对比 ,结果表明 ,改建方案可操作性强 ,原铝产量提高 2 9.4% ,主要污染物削减 78.6% ,厂界环境空气氟化物浓度由改建前的 3 6.4μg/m3 降至 2 .8μg/m3 ,年节电 1 870× 1 0 4kWh。因此 ,清洁生产工艺方案不仅适合我国国情 ,而且还具有提高产量、改善环境和作业环境质量、节能等显著的经济和社会效益。     

替西罗莫司联合索拉非尼治疗晚期肾癌的效果及对患者血清基质金属蛋白酶-9与金属蛋白酶组织抑制剂-1水平的影响

目的探讨替西罗莫司联合索拉非尼治疗晚期肾癌的效果及对患者血清基质金属蛋白酶-9(MMP-9)、金属蛋白酶组织抑制剂-1(TIMP-1)水平的影响。方法选取2011年3月至2016年6月惠东县人民医院收治的晚期肾癌患者72例作为研究对象,按照入院先后顺序编号,应用随机信封法将所有患者分为对照组与观察组,各36例。对照组患者给予索拉非尼,观察组在对照组治疗基础上辅以替西罗莫司治疗。比较两组患者生命质量、临床疗效、血清MMP-9和TIMP-1水平、不良反应及生存期。结果治疗后,两组患者生命质量各维度评分明显提高,且观察组患者生命质量各维度评分明显高于对照组(P<0.05);观察组患者治疗有效率为30.56%,明显高于对照组11.11%(χ^2=4.126,P=0.042);观察组患者疾病控制率为83.33%,显著高于对照组(χ^2=4.431,P=0.035);治疗后,两组患者血清MMP-9和TIMP-1水平明显降低,且观察组患者血清MMP-9和TIMP-1水平显著低于对照组(P<0.05);治疗期间,两组患者皮疹、腹泻、手足皮肤反应、食欲不振、脱发、恶心呕吐、耳鸣及发热发生率比较,差异无统计学意义(P>0.05);观察组患者3年生存率为41.67%,明显高于对照组的19.44%(χ^2=4.189,P=0.041)。结论替西罗莫司联合索拉非尼治疗晚期肾癌,可有效提高临床疗效,改善患者生命质量,下调血清MMP-9和TIMP-1水平,延长患者生存期,安全性好。     

Canada’s Stem Cell Corporation: Aggregate Concerns and the Question of Public Trust

This paper examines one nascent entrepreneurial endeavour intended by Canada’s Stem Cell Network to catalyze the commercialization of stem cell research: the creation of a company called “Aggregate Therapeutics”. We argue that this initiative, in its current configuration, is likely to result in a breach of public trust owing to three inter-related concerns: conflicts of interest; corporate influence on the university research agenda; and the failure to provide some form of direct return for the public’s substantial tax dollar investment. These concerns are common to many efforts to commercialize academic science but are rendered particularly acute in this case given the therapeutic promise of stem cell research and the considerable number of resources related to stem cell research in Canada, which Aggregate Therapeutics is expected to pool. We do, however, believe that the company can be altered to guard against a violation of the public’s trust, and so we present concrete modifications to its structure, which we contend should be given immediate consideration. Matthew Herder is a candidate for the Master of the Science of Law (JSM) degree at Stanford University. Prior to undertaking his studies at Stanford, Matthew completed LLM and LLB degrees at Dalhousie University, clerked at the Federal Court of Canada and articled at McCarthy Tetrault LLP in Toronto, Ontario. Matthew is also a member of the Novel Tech Ethics research team at Dalhousie University. Jennifer Dyck Brian is a Ph.D. student in the Bioethics, Policy, and Law program at the Center for Biology & Society at Arizona State University. Previously, Jennifer worked as research assistant at the Consortium for Science, Policy, and Outcomes at ASU, Wellesley College, and with the Novel Tech Ethics research team at Dalhousie University. Jennifer completed her undergraduate degree at the University of Western Ontario.