TY - JOUR
T1 - Measuring cardiopulmonary complications of carfilzomib treatment and associated risk factors using the SEER-Medicare database
AU - Fakhri, Bita
AU - Fiala, Mark A.
AU - Shah, Nina
AU - Vij, Ravi
AU - Wildes, Tanya M.
N1 - Funding Information:
This research was made possible by grant K12CA167540 through the National Cancer Institute (NCI) of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Research Resources or the NIH. The Center for Administrative Data Research is supported in part by Washington University Institute of Clinical and Translational Sciences grant UL1 TR002345 from the National Center for Advancing Translational Sciences of the NIH, and grant R24 HS19455 through the Agency for Healthcare Research and Quality. The current study used the linked Surveillance, Epidemiology, and End Results (SEER)–Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program of the NCI; the Office of Research, Development and Information of the Centers for Medicare and Medicaid Services; Information Management Services Inc; and the SEER program tumor registries in the creation of the SEER‐Medicare database.
Funding Information:
This research was made possible by grant K12CA167540 through the National Cancer Institute (NCI) of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Research Resources or the NIH. The Center for Administrative Data Research is supported in part by Washington University Institute of Clinical and Translational Sciences grant UL1 TR002345 from the National Center for Advancing Translational Sciences of the NIH, and grant R24 HS19455 through the Agency for Healthcare Research and Quality. The current study used the linked Surveillance, Epidemiology, and End Results (SEER)–Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program of the NCI; the Office of Research, Development and Information of the Centers for Medicare and Medicaid Services; Information Management Services Inc; and the SEER program tumor registries in the creation of the SEER-Medicare database.
Funding Information:
Nina Shah has acted as a paid consultant for Amgen for work performed as part of the current study and has received research funding grants from Celgene, Janssen, Sutro Biopharma, and Bluebird and has acted as a paid consultant for Genentech, Seattle Genetics, Oncopeptides, Karyopharm Therapeutics Inc, Surface Oncology, Precision Biosciences, GlaxoSmithKline, Nektar, Indapta Therapeutics, and Sanofi for work performed outside of the current study. Tanya M. Wildes has acted as a site principal investigator on a research study for Janssen, has received honorarium for consulting from Carevive, and has acted as a paid consultant for Seattle Genetics for work performed outside of the current study. The other authors made no disclosures.
Publisher Copyright:
© 2019 American Cancer Society
PY - 2020/2/15
Y1 - 2020/2/15
N2 - Background: Carfilzomib improves survival in patients with recurrent myeloma. Given the strict eligibility criteria in clinical trials, the actual frequency of cardiac adverse events (CAEs) and pulmonary adverse events (PAEs) and the risk factors associated with these AEs in the general population need to be established. Methods: The authors extracted myeloma cases in the Surveillance, Epidemiology, and End Results (SEER)–Medicare linked database from 2000 through 2013 and corresponding claims through 2014. They then identified patients who received carfilzomib during their disease course. Subsequently, the International Classification of Diseases, Ninth Revision (ICD-9) was used to identify all the codes for CAEs, PAEs, and respiratory infections associated with carfilzomib use. Preexisting diagnoses corresponding to the CAEs and PAEs of interest were excluded to distinguish toxicity from comorbidity. Multivariate Cox regression was performed to determine those variables independently associated with the development of CAEs and PAEs. Results: Of the 635 patients analyzed, the median age was 72 years (range, 36-94 years); 55% of the patients were male and 79% were white. The median duration of carfilzomib treatment was 58 days (range, 1-716 days). Overall, approximately 66% of the patients had codes for either CAEs or PAEs. In terms of CAEs, approximately 22% of patients developed hypertension, 15% developed peripheral edema, and 14% experienced heart failure. With regard to PAEs, approximately 28% of patients developed dyspnea, 15% developed cough, and 15% developed pneumonia. Only chronic obstructive pulmonary disease (COPD) was found to be independently associated with the development of CAEs. Patients with preexisting COPD were found to have a 40% increase in their hazard of developing CAEs (adjusted hazard ratio, 1.40; 95% CI, 1.03-1.90). Conclusions: In older adults with myeloma who are undergoing treatment with carfilzomib, new cardiac and pulmonary diagnoses were common. Patients with preexisting COPD were found to be at an increased risk of developing CAEs.
AB - Background: Carfilzomib improves survival in patients with recurrent myeloma. Given the strict eligibility criteria in clinical trials, the actual frequency of cardiac adverse events (CAEs) and pulmonary adverse events (PAEs) and the risk factors associated with these AEs in the general population need to be established. Methods: The authors extracted myeloma cases in the Surveillance, Epidemiology, and End Results (SEER)–Medicare linked database from 2000 through 2013 and corresponding claims through 2014. They then identified patients who received carfilzomib during their disease course. Subsequently, the International Classification of Diseases, Ninth Revision (ICD-9) was used to identify all the codes for CAEs, PAEs, and respiratory infections associated with carfilzomib use. Preexisting diagnoses corresponding to the CAEs and PAEs of interest were excluded to distinguish toxicity from comorbidity. Multivariate Cox regression was performed to determine those variables independently associated with the development of CAEs and PAEs. Results: Of the 635 patients analyzed, the median age was 72 years (range, 36-94 years); 55% of the patients were male and 79% were white. The median duration of carfilzomib treatment was 58 days (range, 1-716 days). Overall, approximately 66% of the patients had codes for either CAEs or PAEs. In terms of CAEs, approximately 22% of patients developed hypertension, 15% developed peripheral edema, and 14% experienced heart failure. With regard to PAEs, approximately 28% of patients developed dyspnea, 15% developed cough, and 15% developed pneumonia. Only chronic obstructive pulmonary disease (COPD) was found to be independently associated with the development of CAEs. Patients with preexisting COPD were found to have a 40% increase in their hazard of developing CAEs (adjusted hazard ratio, 1.40; 95% CI, 1.03-1.90). Conclusions: In older adults with myeloma who are undergoing treatment with carfilzomib, new cardiac and pulmonary diagnoses were common. Patients with preexisting COPD were found to be at an increased risk of developing CAEs.
KW - Epidemiology
KW - Surveillance
KW - and End Results (SEER)–Medicare linked database
KW - cardiopulmonary complications
KW - carfilzomib
KW - multiple myeloma
KW - older adults
UR - http://www.scopus.com/inward/record.url?scp=85074997988&partnerID=8YFLogxK
U2 - 10.1002/cncr.32601
DO - 10.1002/cncr.32601
M3 - Article
C2 - 31721140
AN - SCOPUS:85074997988
SN - 0008-543X
VL - 126
SP - 808
EP - 813
JO - Cancer
JF - Cancer
IS - 4
ER -