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Evaluation of the effect of incidental beta blocker use on clinical response to the EGFR TKI, afatinib
Proposal
1140
Title of Proposed Research
Evaluation of the effect of incidental beta blocker use on clinical response to the EGFR TKI, afatinib
Lead Researcher
John Heymach, MD, PhD
Affiliation
MD Anderson Cancer Center
Funding Source
Self-funded, The University of Texas MD Anderson Cancer Center
Potential Conflicts of Interest
No collaborations or engagements with sponsor companies that are tangentially related to this research proposal.
Data Sharing Agreement Date
18 March 2015
Lay Summary
Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death. Epidermal growth factor receptor (EGFR) inhibitors such as afatinib are particularly effective in a subset of lung cancer patients. However, resistance inevitably occurs and remains a major hurdle. If this resistance could be better understood, therapies could be developed to target these pathways and in doing so improve outcomes.
Chronic stress, which is common in cancer patients, causes a rise in epinephrine and norepinephrine as well as “stress” receptors, termed adrenergic receptors. This process has also been shown to reduce survival in cancer patients, and to accelerate disease progression in mouse models. We have demonstrated that treatment of NSCLC cells with stress hormones renders them resistant to epidermal growth factor inhibitors such as afatinib. This effect can be attenuated with beta blockers.
Based on these findings, our current study assesses the relationship between beta blocker use and response to afatinib. We hypothesize that beta blocker use will delay resistance and improve response to drugs such as afatinib. In this proposal, we will compare clinical response to afatinib in patients who did or did not take beta blockers. Findings from this study have direct clinical implications as a number of specific, well tolerated, and relatively inexpensive beta blockers are clinically available.
Study Data Provided
[{ "PostingID": 2382, "Title": "BI-1200.32", "Description": "BIBW 2992 (Afatinib) Versus Chemotherapy as First Line Treatment in NSCLC With EGFR Mutation
Medicine: afatinib , Condition: Carcinoma, Non-Small-Cell Lung; Adenocarcinoma, Phase: 3, Clinical Study ID: 1200.32, Sponsor: Boehringer Ingelheim" }]
Statistical Analysis Plan
Patient and tumor characteristics will be grouped according to beta blocker use during afatinib treatment. Between group comparisons will be made using Pearson's chi-square or Fisher's exact test. The Kaplan-Meier method will be used to estimate the survival outcomes according to the use of beta-blockers or not, and the groups will be compared with log-rank statistics. Cox proportional hazard models will be fitted to determine the association of beta blocker intake with survival outcomes in both univariate analyses and multivariate analyses. The results will be expressed as hazard ratios (HRs) with 95% confidence intervals (CIs). A P value of <0.05 will be considered to indicate statistical significance; all tests will be two-sided.
Publication Citation
https://clinicalstudydatarequest.com/Approved-Requests-DataSharingAgreement-Published.aspx
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