Incidence of secondary myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) in patients with ovarian or breast cancer in a real-world setting in the United States
Real-world data on patients with cancer developing secondary malignancies such as myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) are lacking. This study assessed the incidence and impact of select DNA-damaging therapy exposure on risk of secondary MDS and AML in patients with ovaria...
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| Veröffentlicht in: | Gynecologic oncology 2018-11, Vol.151 (2), p.190-195 |
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| creator | Shenolikar, Rahul Durden, Emily Meyer, Nicole Lenhart, Gregory Moore, Kathleen |
| description | Real-world data on patients with cancer developing secondary malignancies such as myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) are lacking. This study assessed the incidence and impact of select DNA-damaging therapy exposure on risk of secondary MDS and AML in patients with ovarian cancer (OC) or breast cancer (BC).
Adults with a first observed OC or BC diagnosis (index date) between 1/1/2000 and 6/30/2014 were identified from MarketScan® Commercial and Medicare databases. Patients had ≥12 months of pre-index and ≥1 month of post-index continuous health plan enrollment. Incidence of MDS/AML was evaluated over a variable-length period following the index date for each cancer cohort. Risk factors for secondary MDS/AML, including duration of DNA-damaging therapy exposure, were assessed using Poisson regression.
Study selection criteria identified 23,862 patients with OC and 281,473 patients with BC (mean [SD] follow-up: 35.8 [31.4] and 46.0 [37.2] months, respectively). Incidence of MDS/AML was 2.77 and 1.44 per 1000 person-years among patients with OC and BC, respectively. Within both cohorts, incidence of MDS and AML was higher among patients exposed than those not exposed to select DNA-damaging therapy (alkylating agents, antimetabolites, platinum-based antineoplastic agents, and topoisomerase inhibitors). Duration of exposure to DNA-damaging therapy was a significant risk factor for developing MDS/AML during follow-up.
Data suggest that there is likely a background risk of secondary MDS/AML associated with use of DNA-damaging therapies in earlier lines of chemotherapy and it is elevated in subcohorts exposed to select DNA-damaging therapies.
•Data on secondary MDS or AML and its association to DNA-damaging therapy is lacking.•Secondary MDS or AML was seen in ovarian and breast cancer in chemotherapy users.•DNA-damaging therapy use was associated with increased risk of secondary MDS or AML. |
| doi_str_mv | 10.1016/j.ygyno.2018.09.003 |
| format | Article |
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Adults with a first observed OC or BC diagnosis (index date) between 1/1/2000 and 6/30/2014 were identified from MarketScan® Commercial and Medicare databases. Patients had ≥12 months of pre-index and ≥1 month of post-index continuous health plan enrollment. Incidence of MDS/AML was evaluated over a variable-length period following the index date for each cancer cohort. Risk factors for secondary MDS/AML, including duration of DNA-damaging therapy exposure, were assessed using Poisson regression.
Study selection criteria identified 23,862 patients with OC and 281,473 patients with BC (mean [SD] follow-up: 35.8 [31.4] and 46.0 [37.2] months, respectively). Incidence of MDS/AML was 2.77 and 1.44 per 1000 person-years among patients with OC and BC, respectively. Within both cohorts, incidence of MDS and AML was higher among patients exposed than those not exposed to select DNA-damaging therapy (alkylating agents, antimetabolites, platinum-based antineoplastic agents, and topoisomerase inhibitors). Duration of exposure to DNA-damaging therapy was a significant risk factor for developing MDS/AML during follow-up.
Data suggest that there is likely a background risk of secondary MDS/AML associated with use of DNA-damaging therapies in earlier lines of chemotherapy and it is elevated in subcohorts exposed to select DNA-damaging therapies.
•Data on secondary MDS or AML and its association to DNA-damaging therapy is lacking.•Secondary MDS or AML was seen in ovarian and breast cancer in chemotherapy users.•DNA-damaging therapy use was associated with increased risk of secondary MDS or AML.</description><identifier>ISSN: 0090-8258</identifier><identifier>EISSN: 1095-6859</identifier><identifier>DOI: 10.1016/j.ygyno.2018.09.003</identifier><identifier>PMID: 30268525</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute myeloid leukemia ; Antineoplastic Agents - adverse effects ; Breast cancer ; Breast Neoplasms - drug therapy ; DNA Damage - drug effects ; Female ; Humans ; Incidence ; Leukemia, Myeloid, Acute - chemically induced ; Leukemia, Myeloid, Acute - epidemiology ; Myelodysplastic syndrome ; Myelodysplastic Syndromes - chemically induced ; Myelodysplastic Syndromes - epidemiology ; Neoplasms, Second Primary - epidemiology ; Olaparib ; Ovarian cancer ; Ovarian Neoplasms - drug therapy ; Real world</subject><ispartof>Gynecologic oncology, 2018-11, Vol.151 (2), p.190-195</ispartof><rights>2018</rights><rights>Copyright © 2018. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c359t-dccf8d4b87a495b505949553393c9d7396409d1ed90204ca2c201e341fa9f6023</citedby><cites>FETCH-LOGICAL-c359t-dccf8d4b87a495b505949553393c9d7396409d1ed90204ca2c201e341fa9f6023</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0090825818311764$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30268525$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shenolikar, Rahul</creatorcontrib><creatorcontrib>Durden, Emily</creatorcontrib><creatorcontrib>Meyer, Nicole</creatorcontrib><creatorcontrib>Lenhart, Gregory</creatorcontrib><creatorcontrib>Moore, Kathleen</creatorcontrib><title>Incidence of secondary myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) in patients with ovarian or breast cancer in a real-world setting in the United States</title><title>Gynecologic oncology</title><addtitle>Gynecol Oncol</addtitle><description>Real-world data on patients with cancer developing secondary malignancies such as myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) are lacking. This study assessed the incidence and impact of select DNA-damaging therapy exposure on risk of secondary MDS and AML in patients with ovarian cancer (OC) or breast cancer (BC).
Adults with a first observed OC or BC diagnosis (index date) between 1/1/2000 and 6/30/2014 were identified from MarketScan® Commercial and Medicare databases. Patients had ≥12 months of pre-index and ≥1 month of post-index continuous health plan enrollment. Incidence of MDS/AML was evaluated over a variable-length period following the index date for each cancer cohort. Risk factors for secondary MDS/AML, including duration of DNA-damaging therapy exposure, were assessed using Poisson regression.
Study selection criteria identified 23,862 patients with OC and 281,473 patients with BC (mean [SD] follow-up: 35.8 [31.4] and 46.0 [37.2] months, respectively). Incidence of MDS/AML was 2.77 and 1.44 per 1000 person-years among patients with OC and BC, respectively. Within both cohorts, incidence of MDS and AML was higher among patients exposed than those not exposed to select DNA-damaging therapy (alkylating agents, antimetabolites, platinum-based antineoplastic agents, and topoisomerase inhibitors). Duration of exposure to DNA-damaging therapy was a significant risk factor for developing MDS/AML during follow-up.
Data suggest that there is likely a background risk of secondary MDS/AML associated with use of DNA-damaging therapies in earlier lines of chemotherapy and it is elevated in subcohorts exposed to select DNA-damaging therapies.
•Data on secondary MDS or AML and its association to DNA-damaging therapy is lacking.•Secondary MDS or AML was seen in ovarian and breast cancer in chemotherapy users.•DNA-damaging therapy use was associated with increased risk of secondary MDS or AML.</description><subject>Acute myeloid leukemia</subject><subject>Antineoplastic Agents - adverse effects</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - drug therapy</subject><subject>DNA Damage - drug effects</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>Leukemia, Myeloid, Acute - chemically induced</subject><subject>Leukemia, Myeloid, Acute - epidemiology</subject><subject>Myelodysplastic syndrome</subject><subject>Myelodysplastic Syndromes - chemically induced</subject><subject>Myelodysplastic Syndromes - epidemiology</subject><subject>Neoplasms, Second Primary - epidemiology</subject><subject>Olaparib</subject><subject>Ovarian cancer</subject><subject>Ovarian Neoplasms - drug therapy</subject><subject>Real world</subject><issn>0090-8258</issn><issn>1095-6859</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc9u1DAQhy0EokvhCZCQj9tDwthOtvGBQ1X-VdqKQ-nZ8tqT1ktiL7bTKg_FO-KwhSOnkUbfzM-ej5C3DGoGbPN-X893sw81B9bVIGsA8YysGMi22nStfE5WABKqjrfdCXmV0h4KAYy_JCcCeEF4uyK_rrxxFr1BGnqa0ARvdZzpOOMQ7JwOg07ZGZpmb2MYka6vP96cUe0t1WbKeASdpQNOP3B0mq4vrrdn1Hl60Nmhz4k-unxPw4OOTnsaIt1FLEup0SU1LqSmpTNUjyEOtrwhZ-fvln6-R3rrXUZLb7LOmF6TF70eEr55qqfk9vOn75dfq-23L1eXF9vKiFbmyhrTd7bZdee6ke2uhVaW2gohhZH2XMhNA9IytBI4NEZzU26IomG9lv0GuDgl6-PeQww_J0xZjS4ZHAbtMUxJccZa3hUQCiqOqIkhpYi9OkQ3lhMqBmrxpPbqjye1eFIgVbFQpt49BUy7Ee2_mb9iCvDhCGD55oPDqJJxiybrIpqsbHD_DfgNRYumzQ</recordid><startdate>201811</startdate><enddate>201811</enddate><creator>Shenolikar, Rahul</creator><creator>Durden, Emily</creator><creator>Meyer, Nicole</creator><creator>Lenhart, Gregory</creator><creator>Moore, Kathleen</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201811</creationdate><title>Incidence of secondary myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) in patients with ovarian or breast cancer in a real-world setting in the United States</title><author>Shenolikar, Rahul ; Durden, Emily ; Meyer, Nicole ; Lenhart, Gregory ; Moore, Kathleen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-dccf8d4b87a495b505949553393c9d7396409d1ed90204ca2c201e341fa9f6023</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Acute myeloid leukemia</topic><topic>Antineoplastic Agents - adverse effects</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - drug therapy</topic><topic>DNA Damage - drug effects</topic><topic>Female</topic><topic>Humans</topic><topic>Incidence</topic><topic>Leukemia, Myeloid, Acute - chemically induced</topic><topic>Leukemia, Myeloid, Acute - epidemiology</topic><topic>Myelodysplastic syndrome</topic><topic>Myelodysplastic Syndromes - chemically induced</topic><topic>Myelodysplastic Syndromes - epidemiology</topic><topic>Neoplasms, Second Primary - epidemiology</topic><topic>Olaparib</topic><topic>Ovarian cancer</topic><topic>Ovarian Neoplasms - drug therapy</topic><topic>Real world</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shenolikar, Rahul</creatorcontrib><creatorcontrib>Durden, Emily</creatorcontrib><creatorcontrib>Meyer, Nicole</creatorcontrib><creatorcontrib>Lenhart, Gregory</creatorcontrib><creatorcontrib>Moore, Kathleen</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gynecologic oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shenolikar, Rahul</au><au>Durden, Emily</au><au>Meyer, Nicole</au><au>Lenhart, Gregory</au><au>Moore, Kathleen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence of secondary myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) in patients with ovarian or breast cancer in a real-world setting in the United States</atitle><jtitle>Gynecologic oncology</jtitle><addtitle>Gynecol Oncol</addtitle><date>2018-11</date><risdate>2018</risdate><volume>151</volume><issue>2</issue><spage>190</spage><epage>195</epage><pages>190-195</pages><issn>0090-8258</issn><eissn>1095-6859</eissn><abstract>Real-world data on patients with cancer developing secondary malignancies such as myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) are lacking. This study assessed the incidence and impact of select DNA-damaging therapy exposure on risk of secondary MDS and AML in patients with ovarian cancer (OC) or breast cancer (BC).
Adults with a first observed OC or BC diagnosis (index date) between 1/1/2000 and 6/30/2014 were identified from MarketScan® Commercial and Medicare databases. Patients had ≥12 months of pre-index and ≥1 month of post-index continuous health plan enrollment. Incidence of MDS/AML was evaluated over a variable-length period following the index date for each cancer cohort. Risk factors for secondary MDS/AML, including duration of DNA-damaging therapy exposure, were assessed using Poisson regression.
Study selection criteria identified 23,862 patients with OC and 281,473 patients with BC (mean [SD] follow-up: 35.8 [31.4] and 46.0 [37.2] months, respectively). Incidence of MDS/AML was 2.77 and 1.44 per 1000 person-years among patients with OC and BC, respectively. Within both cohorts, incidence of MDS and AML was higher among patients exposed than those not exposed to select DNA-damaging therapy (alkylating agents, antimetabolites, platinum-based antineoplastic agents, and topoisomerase inhibitors). Duration of exposure to DNA-damaging therapy was a significant risk factor for developing MDS/AML during follow-up.
Data suggest that there is likely a background risk of secondary MDS/AML associated with use of DNA-damaging therapies in earlier lines of chemotherapy and it is elevated in subcohorts exposed to select DNA-damaging therapies.
•Data on secondary MDS or AML and its association to DNA-damaging therapy is lacking.•Secondary MDS or AML was seen in ovarian and breast cancer in chemotherapy users.•DNA-damaging therapy use was associated with increased risk of secondary MDS or AML.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30268525</pmid><doi>10.1016/j.ygyno.2018.09.003</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0090-8258 |
| ispartof | Gynecologic oncology, 2018-11, Vol.151 (2), p.190-195 |
| issn | 0090-8258 1095-6859 |
| language | eng |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Acute myeloid leukemia Antineoplastic Agents - adverse effects Breast cancer Breast Neoplasms - drug therapy DNA Damage - drug effects Female Humans Incidence Leukemia, Myeloid, Acute - chemically induced Leukemia, Myeloid, Acute - epidemiology Myelodysplastic syndrome Myelodysplastic Syndromes - chemically induced Myelodysplastic Syndromes - epidemiology Neoplasms, Second Primary - epidemiology Olaparib Ovarian cancer Ovarian Neoplasms - drug therapy Real world |
| title | Incidence of secondary myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) in patients with ovarian or breast cancer in a real-world setting in the United States |
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