Comparison of efficacy and toxicity of intravitreal melphalan formulations for retinoblastoma
Intravitreal melphalan injections are commonly used in the treatment for intraocular retinoblastoma. This study compares retinal toxicity and ocular survival between two formulations, with and without propylene glycol (Alkeran vs. Evomela, respectively). A retrospective cohort study of retinoblastom...
Gespeichert in:
| Veröffentlicht in: | PloS one 2020-07, Vol.15 (7), p.e0235016-e0235016 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | e0235016 |
|---|---|
| container_issue | 7 |
| container_start_page | e0235016 |
| container_title | PloS one |
| container_volume | 15 |
| creator | Hsieh, Terry Liao, Albert Francis, Jasmine H Lavery, Jessica A Mauguen, Audrey Brodie, Scott E Abramson, David H |
| description | Intravitreal melphalan injections are commonly used in the treatment for intraocular retinoblastoma. This study compares retinal toxicity and ocular survival between two formulations, with and without propylene glycol (Alkeran vs. Evomela, respectively). A retrospective cohort study of retinoblastoma patients who received intravitreal injections of Alkeran and Evomela at 30 [mu]g from September 2012 to January 2019 at a single tertiary care center were enrolled. Retinal toxicity was measured using electroretinogram (ERG) and compared using a multivariate analysis of 338 injections in 101 eyes of 96 patients. Ocular survival of 163 eyes in 150 patients was compared across formulations using Cox proportional hazards model. Eyes were censored at the time a patient received a dose other than 30 [mu]g. Overall, ERG decline (mean, 95% CI) for each injection was -5.58 [mu]V (-7.17, -3.99). No significant differences in ERG decrement were found between Alkeran (with alcohol) -5.52uV (-6.99, -4.05). and Evomela (without alcohol) -5.65uV (-8.31 to -2.98) formulations (p = 0.93). Ocular survival at 24 months was 93.6% (95% CI 86.2, 97.1) with alcohol and 91.7% (95% CI 53.9, 98.8) without alcohol. The hazard ratio (HR) for without vs with alcohol was 0.50 (95% CI 0.06 to 4.07); no significant difference in ocular survival was found between formulations (p = 0.52) No differences were found in retinal toxicity and ocular survival between 30 [mu]g intravitreal injections of Alkeran or Evomela for intraocular retinoblastoma. Given the increased stability of Evomela, intravitreal treatment could be expanded to centers without the ability to supply Alkeran due to its shorter safety window; however, Alkeran is less expensive. For those with existing infrastructure, Alkeran is a comparable, cost-effective alternative. |
| doi_str_mv | 10.1371/journal.pone.0235016 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_plos_</sourceid><recordid>TN_cdi_plos_journals_2419347956</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A628243364</galeid><doaj_id>oai_doaj_org_article_892e6126834c4639b874f476552b5857</doaj_id><sourcerecordid>A628243364</sourcerecordid><originalsourceid>FETCH-LOGICAL-c669t-7c1b94bca97d07bd34b4bd1c28290e61d6991eb38618e7de37e8f148f2cc4a623</originalsourceid><addsrcrecordid>eNqNk9tq3DAQhk1paNK0b1CooVDai93qZMm6KYSlh4VAoKe7ImRZ2tUiWxtJDtm3r5x1SxxyUXRhWfr0z8zPTFG8gmAJMYMfdn4IvXTLve_1EiBcAUifFGeQY7SgCOCn9_anxfMYdwBUuKb0WXGKEQWcIXpW_F75bi-Djb4vvSm1MVZJdShl35bJ31pl02G8sH0K8samoKUrO-32W-lkXxofusHJZH0fx58y6GR73zgZk-_ki-LESBf1y-l7Xvz8_OnH6uvi8urLenVxuVCU8rRgCjacNEpy1gLWtJg0pGmhQjXiQFPYUs6hbnLysNas1Zjp2kBSG6QUkRTh8-L1UXfvfBSTM1Egkh0gjFc0E-sj0Xq5E_tgOxkOwksr7g582AgZklVOi5qjHBPRGhNFKOZNzYghjFYVaqq6Ylnr4xRtaDrdKj1642ai85vebsXG3wiGcz31mMy7SSD460HHJDoblXbZUe2HY94MEgrGyt48QB-vbqI2Mhdge-NzXDWKiguaXSQYU5Kp5SNUXq3urMptZGw-nz14P3uQmaRv00YOMYr192__z179mrNv77Hb3FJpG70b7tpoDpIjqIKPMWjzz2QIxDgFf90Q4xSIaQrwH5JY-Dg</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2419347956</pqid></control><display><type>article</type><title>Comparison of efficacy and toxicity of intravitreal melphalan formulations for retinoblastoma</title><source>DOAJ Directory of Open Access Journals</source><source>Public Library of Science (PLoS) Journals Open Access</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Free Full-Text Journals in Chemistry</source><creator>Hsieh, Terry ; Liao, Albert ; Francis, Jasmine H ; Lavery, Jessica A ; Mauguen, Audrey ; Brodie, Scott E ; Abramson, David H</creator><contributor>Schaiquevich, Paula</contributor><creatorcontrib>Hsieh, Terry ; Liao, Albert ; Francis, Jasmine H ; Lavery, Jessica A ; Mauguen, Audrey ; Brodie, Scott E ; Abramson, David H ; Schaiquevich, Paula</creatorcontrib><description>Intravitreal melphalan injections are commonly used in the treatment for intraocular retinoblastoma. This study compares retinal toxicity and ocular survival between two formulations, with and without propylene glycol (Alkeran vs. Evomela, respectively). A retrospective cohort study of retinoblastoma patients who received intravitreal injections of Alkeran and Evomela at 30 [mu]g from September 2012 to January 2019 at a single tertiary care center were enrolled. Retinal toxicity was measured using electroretinogram (ERG) and compared using a multivariate analysis of 338 injections in 101 eyes of 96 patients. Ocular survival of 163 eyes in 150 patients was compared across formulations using Cox proportional hazards model. Eyes were censored at the time a patient received a dose other than 30 [mu]g. Overall, ERG decline (mean, 95% CI) for each injection was -5.58 [mu]V (-7.17, -3.99). No significant differences in ERG decrement were found between Alkeran (with alcohol) -5.52uV (-6.99, -4.05). and Evomela (without alcohol) -5.65uV (-8.31 to -2.98) formulations (p = 0.93). Ocular survival at 24 months was 93.6% (95% CI 86.2, 97.1) with alcohol and 91.7% (95% CI 53.9, 98.8) without alcohol. The hazard ratio (HR) for without vs with alcohol was 0.50 (95% CI 0.06 to 4.07); no significant difference in ocular survival was found between formulations (p = 0.52) No differences were found in retinal toxicity and ocular survival between 30 [mu]g intravitreal injections of Alkeran or Evomela for intraocular retinoblastoma. Given the increased stability of Evomela, intravitreal treatment could be expanded to centers without the ability to supply Alkeran due to its shorter safety window; however, Alkeran is less expensive. For those with existing infrastructure, Alkeran is a comparable, cost-effective alternative.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0235016</identifier><identifier>PMID: 32609726</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Alcohol ; Alcohols ; Biology and Life Sciences ; Cancer ; Chemotherapy ; Cost benefit analysis ; Drug dosages ; Drug therapy ; Electroretinograms ; Epidemiology ; Ethanol ; Eye ; Eye (anatomy) ; Medicine and Health Sciences ; Melphalan ; Metabolites ; Multivariate analysis ; Oncology ; Patient outcomes ; Patients ; Physical Sciences ; Propylene ; Propylene glycol ; Retina ; Retinoblastoma ; Statistical models ; Survival ; Toxicity ; Tumors</subject><ispartof>PloS one, 2020-07, Vol.15 (7), p.e0235016-e0235016</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Hsieh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Hsieh et al 2020 Hsieh et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c669t-7c1b94bca97d07bd34b4bd1c28290e61d6991eb38618e7de37e8f148f2cc4a623</citedby><cites>FETCH-LOGICAL-c669t-7c1b94bca97d07bd34b4bd1c28290e61d6991eb38618e7de37e8f148f2cc4a623</cites><orcidid>0000-0002-7405-308X ; 0000-0002-2746-5647</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329086/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329086/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids></links><search><contributor>Schaiquevich, Paula</contributor><creatorcontrib>Hsieh, Terry</creatorcontrib><creatorcontrib>Liao, Albert</creatorcontrib><creatorcontrib>Francis, Jasmine H</creatorcontrib><creatorcontrib>Lavery, Jessica A</creatorcontrib><creatorcontrib>Mauguen, Audrey</creatorcontrib><creatorcontrib>Brodie, Scott E</creatorcontrib><creatorcontrib>Abramson, David H</creatorcontrib><title>Comparison of efficacy and toxicity of intravitreal melphalan formulations for retinoblastoma</title><title>PloS one</title><description>Intravitreal melphalan injections are commonly used in the treatment for intraocular retinoblastoma. This study compares retinal toxicity and ocular survival between two formulations, with and without propylene glycol (Alkeran vs. Evomela, respectively). A retrospective cohort study of retinoblastoma patients who received intravitreal injections of Alkeran and Evomela at 30 [mu]g from September 2012 to January 2019 at a single tertiary care center were enrolled. Retinal toxicity was measured using electroretinogram (ERG) and compared using a multivariate analysis of 338 injections in 101 eyes of 96 patients. Ocular survival of 163 eyes in 150 patients was compared across formulations using Cox proportional hazards model. Eyes were censored at the time a patient received a dose other than 30 [mu]g. Overall, ERG decline (mean, 95% CI) for each injection was -5.58 [mu]V (-7.17, -3.99). No significant differences in ERG decrement were found between Alkeran (with alcohol) -5.52uV (-6.99, -4.05). and Evomela (without alcohol) -5.65uV (-8.31 to -2.98) formulations (p = 0.93). Ocular survival at 24 months was 93.6% (95% CI 86.2, 97.1) with alcohol and 91.7% (95% CI 53.9, 98.8) without alcohol. The hazard ratio (HR) for without vs with alcohol was 0.50 (95% CI 0.06 to 4.07); no significant difference in ocular survival was found between formulations (p = 0.52) No differences were found in retinal toxicity and ocular survival between 30 [mu]g intravitreal injections of Alkeran or Evomela for intraocular retinoblastoma. Given the increased stability of Evomela, intravitreal treatment could be expanded to centers without the ability to supply Alkeran due to its shorter safety window; however, Alkeran is less expensive. For those with existing infrastructure, Alkeran is a comparable, cost-effective alternative.</description><subject>Alcohol</subject><subject>Alcohols</subject><subject>Biology and Life Sciences</subject><subject>Cancer</subject><subject>Chemotherapy</subject><subject>Cost benefit analysis</subject><subject>Drug dosages</subject><subject>Drug therapy</subject><subject>Electroretinograms</subject><subject>Epidemiology</subject><subject>Ethanol</subject><subject>Eye</subject><subject>Eye (anatomy)</subject><subject>Medicine and Health Sciences</subject><subject>Melphalan</subject><subject>Metabolites</subject><subject>Multivariate analysis</subject><subject>Oncology</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Physical Sciences</subject><subject>Propylene</subject><subject>Propylene glycol</subject><subject>Retina</subject><subject>Retinoblastoma</subject><subject>Statistical models</subject><subject>Survival</subject><subject>Toxicity</subject><subject>Tumors</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk9tq3DAQhk1paNK0b1CooVDai93qZMm6KYSlh4VAoKe7ImRZ2tUiWxtJDtm3r5x1SxxyUXRhWfr0z8zPTFG8gmAJMYMfdn4IvXTLve_1EiBcAUifFGeQY7SgCOCn9_anxfMYdwBUuKb0WXGKEQWcIXpW_F75bi-Djb4vvSm1MVZJdShl35bJ31pl02G8sH0K8samoKUrO-32W-lkXxofusHJZH0fx58y6GR73zgZk-_ki-LESBf1y-l7Xvz8_OnH6uvi8urLenVxuVCU8rRgCjacNEpy1gLWtJg0pGmhQjXiQFPYUs6hbnLysNas1Zjp2kBSG6QUkRTh8-L1UXfvfBSTM1Egkh0gjFc0E-sj0Xq5E_tgOxkOwksr7g582AgZklVOi5qjHBPRGhNFKOZNzYghjFYVaqq6Ylnr4xRtaDrdKj1642ai85vebsXG3wiGcz31mMy7SSD460HHJDoblXbZUe2HY94MEgrGyt48QB-vbqI2Mhdge-NzXDWKiguaXSQYU5Kp5SNUXq3urMptZGw-nz14P3uQmaRv00YOMYr192__z179mrNv77Hb3FJpG70b7tpoDpIjqIKPMWjzz2QIxDgFf90Q4xSIaQrwH5JY-Dg</recordid><startdate>20200701</startdate><enddate>20200701</enddate><creator>Hsieh, Terry</creator><creator>Liao, Albert</creator><creator>Francis, Jasmine H</creator><creator>Lavery, Jessica A</creator><creator>Mauguen, Audrey</creator><creator>Brodie, Scott E</creator><creator>Abramson, David H</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-7405-308X</orcidid><orcidid>https://orcid.org/0000-0002-2746-5647</orcidid></search><sort><creationdate>20200701</creationdate><title>Comparison of efficacy and toxicity of intravitreal melphalan formulations for retinoblastoma</title><author>Hsieh, Terry ; Liao, Albert ; Francis, Jasmine H ; Lavery, Jessica A ; Mauguen, Audrey ; Brodie, Scott E ; Abramson, David H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c669t-7c1b94bca97d07bd34b4bd1c28290e61d6991eb38618e7de37e8f148f2cc4a623</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Alcohol</topic><topic>Alcohols</topic><topic>Biology and Life Sciences</topic><topic>Cancer</topic><topic>Chemotherapy</topic><topic>Cost benefit analysis</topic><topic>Drug dosages</topic><topic>Drug therapy</topic><topic>Electroretinograms</topic><topic>Epidemiology</topic><topic>Ethanol</topic><topic>Eye</topic><topic>Eye (anatomy)</topic><topic>Medicine and Health Sciences</topic><topic>Melphalan</topic><topic>Metabolites</topic><topic>Multivariate analysis</topic><topic>Oncology</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Physical Sciences</topic><topic>Propylene</topic><topic>Propylene glycol</topic><topic>Retina</topic><topic>Retinoblastoma</topic><topic>Statistical models</topic><topic>Survival</topic><topic>Toxicity</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hsieh, Terry</creatorcontrib><creatorcontrib>Liao, Albert</creatorcontrib><creatorcontrib>Francis, Jasmine H</creatorcontrib><creatorcontrib>Lavery, Jessica A</creatorcontrib><creatorcontrib>Mauguen, Audrey</creatorcontrib><creatorcontrib>Brodie, Scott E</creatorcontrib><creatorcontrib>Abramson, David H</creatorcontrib><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agricultural Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hsieh, Terry</au><au>Liao, Albert</au><au>Francis, Jasmine H</au><au>Lavery, Jessica A</au><au>Mauguen, Audrey</au><au>Brodie, Scott E</au><au>Abramson, David H</au><au>Schaiquevich, Paula</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of efficacy and toxicity of intravitreal melphalan formulations for retinoblastoma</atitle><jtitle>PloS one</jtitle><date>2020-07-01</date><risdate>2020</risdate><volume>15</volume><issue>7</issue><spage>e0235016</spage><epage>e0235016</epage><pages>e0235016-e0235016</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Intravitreal melphalan injections are commonly used in the treatment for intraocular retinoblastoma. This study compares retinal toxicity and ocular survival between two formulations, with and without propylene glycol (Alkeran vs. Evomela, respectively). A retrospective cohort study of retinoblastoma patients who received intravitreal injections of Alkeran and Evomela at 30 [mu]g from September 2012 to January 2019 at a single tertiary care center were enrolled. Retinal toxicity was measured using electroretinogram (ERG) and compared using a multivariate analysis of 338 injections in 101 eyes of 96 patients. Ocular survival of 163 eyes in 150 patients was compared across formulations using Cox proportional hazards model. Eyes were censored at the time a patient received a dose other than 30 [mu]g. Overall, ERG decline (mean, 95% CI) for each injection was -5.58 [mu]V (-7.17, -3.99). No significant differences in ERG decrement were found between Alkeran (with alcohol) -5.52uV (-6.99, -4.05). and Evomela (without alcohol) -5.65uV (-8.31 to -2.98) formulations (p = 0.93). Ocular survival at 24 months was 93.6% (95% CI 86.2, 97.1) with alcohol and 91.7% (95% CI 53.9, 98.8) without alcohol. The hazard ratio (HR) for without vs with alcohol was 0.50 (95% CI 0.06 to 4.07); no significant difference in ocular survival was found between formulations (p = 0.52) No differences were found in retinal toxicity and ocular survival between 30 [mu]g intravitreal injections of Alkeran or Evomela for intraocular retinoblastoma. Given the increased stability of Evomela, intravitreal treatment could be expanded to centers without the ability to supply Alkeran due to its shorter safety window; however, Alkeran is less expensive. For those with existing infrastructure, Alkeran is a comparable, cost-effective alternative.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>32609726</pmid><doi>10.1371/journal.pone.0235016</doi><tpages>e0235016</tpages><orcidid>https://orcid.org/0000-0002-7405-308X</orcidid><orcidid>https://orcid.org/0000-0002-2746-5647</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2020-07, Vol.15 (7), p.e0235016-e0235016 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2419347956 |
| source | DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Alcohol Alcohols Biology and Life Sciences Cancer Chemotherapy Cost benefit analysis Drug dosages Drug therapy Electroretinograms Epidemiology Ethanol Eye Eye (anatomy) Medicine and Health Sciences Melphalan Metabolites Multivariate analysis Oncology Patient outcomes Patients Physical Sciences Propylene Propylene glycol Retina Retinoblastoma Statistical models Survival Toxicity Tumors |
| title | Comparison of efficacy and toxicity of intravitreal melphalan formulations for retinoblastoma |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-28T13%3A14%3A22IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Comparison%20of%20efficacy%20and%20toxicity%20of%20intravitreal%20melphalan%20formulations%20for%20retinoblastoma&rft.jtitle=PloS%20one&rft.au=Hsieh,%20Terry&rft.date=2020-07-01&rft.volume=15&rft.issue=7&rft.spage=e0235016&rft.epage=e0235016&rft.pages=e0235016-e0235016&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0235016&rft_dat=%3Cgale_plos_%3EA628243364%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2419347956&rft_id=info:pmid/32609726&rft_galeid=A628243364&rft_doaj_id=oai_doaj_org_article_892e6126834c4639b874f476552b5857&rfr_iscdi=true |