Comparative effectiveness of biologic agents in ethnic minorities with colorectal cancer Abstract This grant proposal seeks to identify and describe the real world impact of the use of the biologic agents when added to cytotoxic chemotherapy for patients with metastatic colorectal cancer (mCRC). Furthermore, aging remains one the most critical risk factors in the pathogenesis of CRC . While CRC can occur in young adults and teenagers, more than 90% of CRC occur in people older than 50 years of age. The median age of diagnosis in the United States is 72 years. The biologic agents include bevacizumab, cetuximab and panitumumab. Cure rates for patients with mCRC are dismal, with a 5 year overall survival (OS) rate of only 12.5% and median OS of 30 months. The addition of biologic agents has led to statistically significant and clinically meaningful improvement in the OS; however little is known if the benefit it is uniformly shared across the various ethnic and racial groups. Over 70% of our patients are ethnic minorities. We conducted a CER study of our patients spanning 2000-2012. In our cohort of 290 patients, the median OS was 15.2 months in the patients that received chemotherapy versus 25.6 months in those that received chemotherapy plus biologics (p=0.0041 by log rank test). Propensity score based analysis overall and across the races showed a persistent benefit overall (HR 1.44; p=0.04), and this was maintained for Whites (HR 2.01, p=0.03) but not for Hispanics (HR 1.42, p=0.37) or Blacks (HR 1.12; p=0.59). We will first seek to validate our findings in the SEER Medicare database. Second, we seek to expand our cohort to include 3 hospitals in Bronx catering to ethnic minorities (Jacobi, Lincoln, and St. Barnabas hospitals). As Hispanics had a HR suggestive of benefit but did not reach statistical significance, with increased numbers available for analysis, we also aim to ascertain if this HR is statistically significant. If our findings are confirmed, this could indeed be practice changing, with the potential to save thousands of patients from the toxicity of these agents and billions of dollars to our ever soaring health care expenditure.
Comparative effectiveness of biologic agents in ethnic minorities with colorectal cancer Abstract We have found that the biologic drugs that have led to great improvement in the survival of patients with advanced colorectal cancer do not benefit the Black and Hispanic patients while they do so for the Whites. In this grant proposal, we seek to confirm our findings in Hispanic patients from other Bronx hospitals and also in the national SEER Medicare database. If this remains true, it could truly change the way we treat these patients in the future, reducing unnecessary side effects and expenditure.
