224 Malignancy associated pericardial effusion- do we need to drain them all?

On Behalf

Cardiac Team, Department of Medicine, Queen Elizabeth Hospital

Background

Management of significant pericardial effusion in cancer patients is controversial. These patients have poor prognosis, and avoiding unnecessary intervention is important. Close monitoring of symptoms and echocardiogram is often a reasonable option, but inherits risk of cardiac tamponade. Whether pericardial drainage by means of percutaneous pericardiocentesis or surgical pericardiotomy could prevent future deterioration or affect survival is unknown.

Purpose

To evaluate the benefit of elective pericardial drainage in malignancy associated pericardial effusion without echocardiographic or clinical evidence of tamponade effect.

Methods

From 1st Jul 2014 to 31st Dec 2017, all patients with new onset malignancy-associated pericardial effusion with size more than 1cm were retrospectively analyzed. Patients with clinical or echocardiographic evidence of cardiac tamponade were excluded. We compared pericardial drainage versus monitoring for short-term (30-day), mid-term (90-day) and long term (1 year) survival without need for drainage.

Results

101 patients were retrospectively analyzed. 40 (39.6%) patients underwent drainage. Overall median survival free from drainage was 4 months. There were no significant difference in short-term (30-day), mid-term (90-day) and long term (1-year) survival free from drainage or mortality between treatment and monitoring group. Size of pericardial effusion did not predict mortality or future need of drainage. Chemotherapy was associated with improved 30-day mortality (RR 0.53 CI 0.32-0.87 p = 0.025) but not survival free from drainage or longer term mortality.

Conclusion

Close monitoring could be a feasible strategy in cancer patients with significant pericardial effusion without tamponade effect.

Baseline characteristics Factor Drainage (n = 40) monitoring (n = 61) p-value method of drainage pericardiocentesis alone 17 NA pericardiotomy alone 13 both 10 Male 19 (47.5%) 27 (44.3%) 0.749 mean size (cm) 1.93 2.77 <0.001 mean age 60.9 63.1 0.357 on chemotherapy 27 (67.5%) 38 (62.3%) 0.593

Abstract 224 Figure. Survival free from drainage

P101 Cardiac rehabilitation program for end-stage heart failure patients with left ventricular assist devices in Hong Kong

Background

Implantation of modern durable left ventricular assist device (LVAD) in advanced heart failure (HF) patients is associated with increased survival and improved quality of life. Exercise-based cardiac rehabilitation (EBCR) has been demonstrated to exercise capacity in HF patients but data on effect of EBCR in advanced HF patients with LVAD are limited.

Objectives

To evaluate the effect of EBCR program  on the functional capacity of advanced heart failure patients with LVAD

Methods

Out of  the current 64 LVAD recipients in Hong Kong, 43 patients who have had LVAD implanted and survived 1 year were screened.  The EBCRP consisted of cardiorespiratory and strength training exercise once a week for a total of 24 sessions (6 months). The functional rehabilitation outcome  was evaluated by 6 minute walk test (6MWT) at baseline, before LVAD implantation, pre-EBCR and by end of EBCP ( 6 months). The muscle strength was evaluated by an isokinetic knee extension strength test defined by 10 repetitive maximum (RM) torque of quadriceps strength before starting EBCR and at 6 months upon termination of EBCR.

Results

A total of 33 LVAD patients were recruited into our EBCR program. There were 27 (82%) men with mean age of 48.7± 13.6 years. Average duration from LVAD surgery to commencement of EBCR was 5.3 months. Baseline 6MWT could not be performed in 21 patients due to extreme poor functional class (NYHA class IV) with prolonged hospitalizations requiring inotropes and circulatory support. For the other 12 patients, there were no significant differences in 6 MWT at baseline and post LVAD before starting EBCP. Overall 6MWT significantly improved by end of EBCR (pre- EBCR mean 382.2, ±95.2m vs  post -EBCR mean 440.8 ±88.2m  p= 0.001). There were significant improvement in quadriceps strength by the end of EBCRP program. (pre- CRP 1.8 ± 2.5 kg vs post CRP 3.5 ± 3.5 kg p < 0.001).

Conclusions

LVAD patients show high level of impairment of functional capacity despite after LVAD imaplntation with improved circulatory output. EBCR program allowed greater improvement in exercise capacity evolution and peripheral physiology such as muscle strengthening.

Favorable outcomes with chemoradiation and surgery for locally advanced non-small cell lung cancer: The BC Cancer Agency Vancouver experience

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Background: The role of surgery following concurrent platinum-based chemotherapy and radiation for locally advanced non-small cell lung cancer (NSCLC) remains controversial, with high surgical mortality rates reported in a large randomized clinical trial. In this retrospective study, we evaluated the safety and efficacy of concurrent chemoradiation with or without surgery over an 11 period at the BC Cancer Agency. Methods: Patients were identified by the Vancouver Centre Pharmacy database. Charts were reviewed and data extracted included patient characteristics, weight loss, performance status, and method of mediastinal staging. Outcome measures were overall survival, pathological response rate, and treatment-associated morbidity and mortality. Results: Between January 1999-2010, 177 patients were identified with locally advanced NSCLC (stage IIIA/B) treated with platinum and etoposide and ≥40Gy radiation therapy, with or without surgical resection. The majority of treatment plans were reached by a multidisciplinary conference consensus. 74% (n=131) of patients received chemoradiation alone (bimodality therapy) and 36% (n=46) received chemoradiation followed by surgical resection (trimodality therapy). Among the trimodality therapy group, 16 patients underwent pneumonectomy and 30 lobectomy. Conclusions: In this series, bimodality therapy for patients with locally advanced NSCLC had similar treatment associated mortality and survival outcomes as reported in the literature. Trimodality therapy was associated with low treatment mortality rates and favourable survival. These two groups cannot be directly compared in this retrospective study. However, these results support a multidisciplinary approach to identify and carefully select patients with locally advanced NSCLC to undergo additional surgical resection following concurrent chemoradiation. [Table: see text]

Life-cycle health technology assessment for precision oncology

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Background: Rapid advances in precision oncology challenge timely and sustainable reimbursement decisions. Life-cycle health technology assessment (LC-HTA) can enable conditional patient access to promising precision oncology innovations alongside evidence development. Our objective was to create a life-cycle evaluative framework, called PRecision oncology Evidence Development in Cancer Treatment (PREDiCT). Methods: Through an iterative, health system and stakeholder-informed approach, we designed our LC-HTA framework. Elements supporting data and evidence generation were subsequently implemented within British Columbia, Canada’s provincial cancer control system. Our development, refinement, and pilot implementation process included a structured literature review, multi-disciplinary international expert consultation, a formal gap assessment, and a series of pan-Canadian inter-disciplinary stakeholder workshops to refine framework elements. Results: We engaged n = 15 pan-Canadian and international stakeholders to co-develop the LC-HTA framework. Defining framework components include: (a) managed access that defines the time horizon and pricing conditions of real-world healthcare system trialing; (b) collection of core data elements required to enable economic evaluation of precision oncology using real world data; (c) externally leveraged real world data and evidence generation to determine comparative effectiveness, cost-effectiveness, and the value of conducting additional research; and (d) data interpretation updating decisions, including investment, continued evaluation, or disinvestment from managed access. Key to the success of early framework implementation is the expansion of infrastructure to enable routine collection and linkage of genomic sequencing and cancer treatment data, patient quality of life and clinical outcomes, as well as health resource use spanning the diagnostic, treatment, and follow up trajectory. Conclusions: Sustainable integration of precision oncology requires the design and implementation of learning healthcare systems (LHS) that integrate genomic data with other health information. LC-HTA moves beyond static estimates of clinical and cost-effectiveness to continuously generate evidence that reduces evidentiary uncertainty and supports life-cycle decisions. We are embarking on a PREDiCT pilot to implement the framework in real-time to demonstrate the ability of real-world data to support life cycle evaluation.

Comparison of 2-Weekly Versus 4-Weekly Durvalumab Consolidation for Locally Advanced NSCLC Treated With Chemoradiotherapy: A Brief Report

Introduction

Durvalumab 10 mg/kg every 2 weeks for 1 year after chemoradiation has improved overall survival (OS) in unresectable stage III NSCLC. Subsequently, a 20 mg/kg 4-weekly regimen was approved. The study goal was to compare the efficacy and toxicity of the two regimens.

Methods

All patients with NSCLC treated with curative-intent chemoradiation followed by durvalumab from March 1, 2018 to December 31, 2020 at BC Cancer, British Columbia, Canada were included in this retrospective review. Durvalumab dosing schedule, toxicity, progression, and OS were collected. Comparisons between treatment groups were made using chi-square and independent t tests. Kaplan-Meier curves and log-rank test were used to analyze OS.

Results

A total of 152 patients were included in the 2-weekly group and 53 patients in the 4-weekly group. The median follow-up was 19.7 months and 12.0 months, respectively. The median OS was not reached, but 12-month survival rates were 88.4% versus 85.2% (p = 0.55). Toxicity profiles were similar in terms of sites and severity.

Conclusions

There was no significant difference in efficacy or toxicity between the 2-weekly and 4-weekly durvalumab in this cohort of patients with advanced NSCLC previously treated with curative-intent chemoradiation.

Treating anaplastic lymphoma kinase (ALK) fusion-driven metastatic non-small cell lung cancer (NSCLC) with alectinib through pregnancy

Management of cancer during pregnancy requires careful consideration of risks and benefits from maternal and fetal perspectives. For advanced lung adenocarcinomas, with no targetable driver mutations, there is evidence-based guidance on the use of carboplatin-paclitaxel chemotherapy after first trimester. In contrast, for epidermal growth factor receptor (EGFR)-mutated or anaplastic lymphoma kinase (ALK)-rearranged metastatic lung adenocarcinomas, there is a paucity of clinical data on the safety of EGFR and ALK tyrosine kinase inhibitors to mother and fetus for official guidelines to recommend the use of these otherwise-first-line therapies in pregnancy. Considering this knowledge gap, we present a case of a young gravida 1 para 0 (G1P0) woman who continued alectinib 300 mg oral two times per day for ALK-rearranged metastatic lung adenocarcinoma throughout all 36 weeks of her pregnancy and delivered a healthy baby at term via caesarean section (C-section).

Patterns of Radiotherapy Utilization for Lung Cancer Patients with Brain Metastases: A Population-based Analysis

INTRODUCTION

Brain metastases occur in 15%-20% of lung cancer patients. Recently, studies have suggested that whole-brain radiotherapy (WBRT) may not prolong survival for a subset of patients, and is associated with significant side-effects. Furthermore, it is hypothesized that radiotherapy is often given near the end-of-life when the potential for benefit is minimal. Therefore, this study investigates how frequently radiotherapy for brain metastases is given near the end-of-life in a population-based cohort.

MATERIALS AND METHODS

All lung cancer patients who received radiotherapy in British Columbia for brain metastases in 2014-2015 were identified. Patient and treatment characteristics were collected and analyzed to assess associations with death within 90 days of first radiation treatment.

RESULTS

In total, 740 patients were identified, with a total of 826 courses of brain radiation. The 90-day mortality rate was 40% (n=330). Multivariable analysis demonstrated higher odds for age (odds ratio (OR) = 1.04, 95% confidence interval (CI) 1.02-1.05), Eastern Cooperative Oncology Group (ECOG) performance score of 2 or higher (OR = 1.59, 95% CI 1.09-2.31) and squamous cell carcinoma (OR = 2.10, 95% CI 1.13-3.90) and lower odds for initial systemic therapy (OR = 0.48, 95% CI 0.34-0.68), more than five fractions of radiotherapy (OR = 0.25, 95% CI 0.16-0.39) and stereotactic radiation (OR = 0.29, 95% CI 0.13-0.65).

CONCLUSION

In our population-based study, WBRT is given in 86% of radiotherapy courses for brain metastases from lung cancer. Of these patients, 40% received treatment near the end-of-life. We identified several factors associated with shortened survival. Using these factors and already established prognostic tools, WBRT utilization should be decreased in the future, improving individualized treatment for patients with brain metastases from lung cancer.

Consensus Statement: Recommendations on Actionable Biomarker Testing for Thyroid Cancer Management

Thyroid cancer management is rapidly changing. The identification of actionable biomarkers through both germline and somatic testing are now an integral part of directing patient management. However, deficiencies and disparities within existing thyroid cancer biomarker test approaches are resulting in inconsistent application for patient care. An expert panel was convened to create consensus biomarker testing algorithms and recommendations on actionable biomarker testing for patients diagnosed with medullary thyroid cancer, non-anaplastic follicular cell-derived thyroid cancer, or anaplastic follicular cell-derived thyroid cancer who may benefit from targeted therapies. A review of international guidelines was performed to determine the current state, and a literature review was carried out to further evaluate the evidence supporting the use of actionable biomarkers in patients diagnosed with thyroid cancer. Thyroid biomarker-related gaps impacting patient care were also discussed, with an emphasis on the importance of a multidisciplinary team approach for optimal patient care. The recommendations are presented with the aim to help physicians navigate the current thyroid cancer biomarker testing landscape with its many challenges, balancing aspirational care with what is practical and feasible in terms of economic realities and jurisdictional constraints. By remaining therapy-agnostic, these algorithms and recommendations are broadly applicable.

Diagnostic imaging of trauma to the ankle and foot: I. Fractures about the ankle

Drs. Mitchell et al. provide a valuable radiologic perspective of trauma to the ankle. The review is divided into six parts. The initial presentation deals with ankle fractures. Subsequent dialogues will consist of ligamentous injuries, trauma to the talus, calcaneal fractures, midfoot, and forefoot injuries. Plain x-ray film, as well as sophisticated studies, will assist in recognizing these conditions.

Abstract 2631: Restrictions on access to systemic therapy limit the application of whole genome sequencing in clinical care

Background: Whole genome analyses have the potential to identify the full landscape of activating and inactivating genomic abnormalities at work within cancers, and can thus be used to provide rationales for selection of treatment agents or clinical trials in a broad range of patients.

Patients & Methods: Eligible patients (pts) with metastatic cancers were recruited within a general oncology practice across the province of B.C., Canada. Each pt underwent a fresh tumor biopsy and a blood sample and had comprehensive DNA (80X) and RNA sequencing. In-depth bioinformatic analyses were preformed to identify genomic changes that may be cancer “drivers” or therapeutically actionable targets. Aberrant pathways were matched to drug databases and manual literature reviews undertaken to identify drugs or clinical trials of potential utility for the individual pt.

Results: Between July 2012 - Oct 2015: 380 pts (358 adult + 22 peds) consented; 227 have completed whole DNA and RNA sequencing and analysis to date (remainder ongoing). For this analysis, data is available on 160 pts. Genome bioinformaticians assessed the genomic data to be potentially druggable in all cases. Medical Oncologists assessed this data to be directly clinically actionable in 135 (84%); the difference being that clinicians did not agree that some putative “druggable” drivers (such as p53) or pathways with no current drugs available (MMP, AURA, WNT) were “actionable”.

Of the 135 cases, 58 (43%) pts received therapy based directly on this genomic information; 6 on a phase 1 clinical trial. The most common reasons for 77 pts defined as actionable but who have not received genomically-informed therapy were: drug only available on a clinical trial but trial not available to pt - 22 (26%); drug approved but not available off label - 18 (23%); pt presently on first-line therapy that is working - 14 (18%); or death/too unwell 13 (17%). The limited availability of clinical trials was primarily because of highly restrictive trials entry criteria, primarily limiting patients to one primary tumour type or narrowly defined biomarker entry criteria.

The most commonly mutated cancer genes identified by the genome analysts were: p53 as the predominant driver in 42%; APC in 16%; KRAS and PI3KCA mutations in 14%. Going forward it is essential to distinguish what driver mutations might be clinically actionable from those that are still only theoretically druggable; and similarly learn to distinguish which targets are actionable but not truly drivers.

Conclusions: Genomic DNA and RNA sequencing data were found to be clinically actionable in 84% of pts with advanced cancers in a population cancer care setting. However, the ability to act on this information is limited by the restrictive nature of clinical trials and the lack of accessibility of off-label drugs despite an identified biomarker. As genome sequencing becomes integrated into cancer management these drug access issues need to be addressed.

Citation Format: Janessa J. Laskin, Yaoqing Shen, Daniel Renouf, Martin Jones, Howard Lim, Alexandra Fok, Cheryl Ho, Balvir Deol, Karen A. Gelmon, Stephen Chia, Richard Moore, Andrew Mungall, Stephen Yip, Steven Jones, Marco Marra. Restrictions on access to systemic therapy limit the application of whole genome sequencing in clinical care. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2631.

Less toxic chemotherapy on the uptake of all lines of chemotherapy in advanced non-small cell lung cancer: A 10-year retrospective population-based review

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Background: The platinum doublet is standard first-line therapy in advanced NSCLC. Over the past decade, well-tolerated second-line therapies have been approved, including erlotinib and pemetrexed. We hypothesize that the introduction of less-toxic chemotherapy has increased treatment of advanced NSCLC, resulting in improved survival. Methods: The BC Cancer Agency provides cancer care to a population of 4.5 million. A retrospective review was conducted of all referred stage IIIB/IV patients in four 1-yr time cohorts; C1 baseline (1998) and 6 months after the provincial approval of C2 docetaxel (2001), C3 erlotinib (2006) and C4 pemetrexed (2007). Results: 2,623 patients were referred and 720 had systemic therapy. Characteristics: M/F 55%/45%, median age 67 (33-101), ECOG <=1/>=2/unknown 33%/56%/11%, never/former/current/unknown smoker 9%/35%/36%/20%, squam/nonsquam/NOS 18%/41%/41%. More patients received first-line chemotherapy over time; 16%, 23%, 34%, 33% C1-4 respectively. In C1 to C4 uptake of second line (21%, 27%, 38%, 55%) and third line (10%, 10% 14%, 18%) increased. In C1 the most common first-line doublet was cis/vino (70%) and in C4, cis/gem (45%). Second-line doce was frequently used in C2 (51%) but usage decreased in C4 to 7% vs. erlo 50% and pem 26%. In the >=70 group (n=1,118), first-line usage increased from C1 9% to C4 19% and second-line in the C2 (doce) 4% to C4 (erlo+pem avail) 56%. The increased use of systemic therapy was associated with improved survival in all patients: C1 4.56 m vs C4 4.98 m (p=0.004) and treated patients; C1 9.48 m vs C4 12.07 m (p=0.014) and the >= 70 group; C1 9.7 m vs C4 12.5 m (p=0.07). Conclusions: This population-based data set represents the trend of treatments over time in a large geographical area, including community and tertiary care cancer treatment sites. The introduction of less-toxic systemic therapy for advanced NSCLC resulted in an increased proportion of patients treated with first-line chemotherapy and an even greater increase in second-/third-line treatment. This trend was particularly evident in the elderly. Associated with this was a significant improvement in overall survival for all subsets.

Intracoronary imaging reduces target vessel failure in primary percutaneous coronary intervention

Background

Intracoronary imaging during percutaneous coronary intervention (PCI) allows better delineation of lesion characteristics and more accurate vessel sizing compared with angiogram alone. However, the benefit and safety of its use in primary percutaneous coronary intervention (PPCI) is uncertain.

Purpose

To determine whether the use of intracoronary imaging with intravascular ultrasound (IVUS) or optical coherence tomography (OCT)/ optical frequency domain imaging (OFDI) in PPCI is associated with better outcome.

Method

From Jan 2014 to Dec 2018, all patients with PPCI performed in our hospital were retrospectively studied. Baseline and procedural characteristics of angiographic-guided versus imaging-guided PCI were analyzed. Primary endpoint was target vessel failure, and procedural outcomes were contrast volume, number of stents implanted, mean stent length and diameter and use of post-dilatation. Safety outcomes were post-operative acute kidney injury (AKI), need for renal replacement therapy (RRT) and occurrence of no/slow reflow.

Results

A total of 408 patients were included, of which 223 (54.7%) used IVUS (n=176 80.3%) or OCT/OFDI (n=44 19.7%) during the procedure. Baseline and procedural characteristics were similar between both groups except more patients had history of PCI (12.6% vs 4.3% p=0.004) and left-main/ bifurcation lesions (12.6% vs 2.7% p&lt;0.001). Intra-coronary imaging was associated with less target vessel failure during a median follow up of 22 months (Hazard ratio (HR): 0.59; 95% Confidence interval (CI): 0.36–0.97; p=0.036). Patients who had intra-coronary imaging during PPCI received more post-dilatation (77.1% vs 55.1% p&lt;0.001), had longer (53mm vs 42mm p&lt;0.001) and more stents (2 vs 1.67 p=0.003) implanted but had more contrast injected (151.2ml vs 130.6ml p=0.002). There was no statistically significant difference in mean stent diameter (3.07mm vs 3.02mm p=0.53), occurrence of slow/now reflow (15.3% vs 18.4% p=0.409), incidence of AKI (7.2% vs 10.8% p=0.197) or need for RRT (3.1% vs 5.4% p=0.254) between both groups.

Conclusion

Use of intra-vascular imaging during PPCI was associated with less target vessel failure, longer and more stents implanted and more frequent use of post-dilatation. Further prospective randomized controlled trial is suggested to confirm this benefit.

Funding Acknowledgement

Type of funding source: None

Overall survival benefits of advances in NSCLC systemic treatments: Younger versus older adults

93

Background: Historically, there has been limited systemic therapy options for older adults with cancer attributed to underlying frailty, co-morbidities, poor functional status, and limited social supports. In the past decade, treatment for advanced NSCLC has changed with increasing availability of novel therapeutics associated with improved tolerability and efficacy, such as targeted therapy and immunotherapy. The study goal is to compare the difference in overall survival (OS) between younger adults and older adults with the introduction of novel therapeutic options. Methods: All patients with stage IV NSCLC referred to BC Cancer in 2009, 2011, 2015 and 2017 were included in the study. One-year time points were chosen based on molecular testing implementation and provincial formulary listing: baseline (2009), EGFR testing (2011), ALK testing (2015) and immunotherapy listing (2017). Age was categorized as younger (< 70 years) and older (≥70 years) adults. Baseline demographics, simplified comorbidity score (SCS ≥9 associated with poor prognosis), disease characteristics, and systemic therapy details (agent, duration, line of therapy) were collected retrospectively. Univariate analysis using X2 and Fisher’s exact tests were used to compare age groups. OS was calculated using the Kaplan-Meier method and compared using the log-rank test. Results: 3325 patients with stage IV NSCLC were identified. Baseline characteristics for patients < 70 y; female 51%, non-squamous 62%, ECOG ≥2 50%, SCS ≥9 29% vs patients ≥70 y; female 49%, non-squamous 57%, ECOG ≥2 61%, SCS ≥9 58%. In the four time cohorts 2009/2011/2015/2017, systemic treatment was delivered to < 70 y 44/53/51/52 % vs ≥70 y 23/25/28/30 %. Median OS with BSC for < 70 y 3.1/2.8/2.8/2.5 m vs ≥70 y 3.8/3.3/3.4/3.1 m (p = 0.10). Median OS with systemic treatment for < 70 y 9.0/10.9/13.9/15.5 m (p < 0.001) vs ≥70 y 11.4/11.7/13.9/14.9 m (p < 0.001). Median OS by type of treatment BSC/chemotherapy only/targeted therapy/immunotherapy; < 70 y 2.8/8.9/21.4/20.2 m vs ≥70 y 3.1/10.1/21.5/20.1 m (p < 0.001). Conclusions: In this real-world retrospective review of patients with advanced NSCLC, there was an increased uptake of systemic therapy for both age groups with the introduction of novel therapeutics. Although there was a smaller proportion of older adults who received systemic therapy, those who received treatment had comparable OS to their young counterpart. The benefit of systemic therapy in both age groups was seen across the different types of treatments. This suggests with careful assessment and selection of appropriate candidates, older adults with advanced NSCLC should receive equitable access to systemic therapy.

[[Reexamining the model of population density function: a study of Kaohsiung metropolis]]

"This paper [tests] both Clark's negative exponential model and Newling's quadratic exponential model [using data for] population densities in districts of Kaohsiung Metropolis [Taiwan]. It proposes four theoretical amendments and supplements to the population density function and the related theories." (SUMMARY IN ENG)

Readiness of Healthcare Systems to Generate Real-World Evidence: Reliability of CT Radiographic End Points for Evaluation of First-Line Systemic Treatment

PURPOSE

Regulatory agencies such as the US Food and Drug Administration and health technology assessment bodies are increasingly using real-world evidence (RWE). The ability of healthcare systems to reliably generate response rate and progression-free survival from real-world data is unknown. We examined the capacity of a single-payer system to provide RWE by evaluating the frequency of computed tomography (CT) imaging during standard first-line metastatic systemic treatment of breast, colorectal, and lung cancer.

METHODS

A 1-year cohort of patients with metastatic-at-diagnosis breast, colorectal, and lung cancer treated with first-line systemic therapy (excluding hormone therapy) referred to BC Cancer in 2016 was retrospectively reviewed for first-line treatment and CT imaging. Duration of first-line treatment was calculated from the first to the last dose of therapy. CT imaging was counted from the start of therapy to 8 weeks after the last therapy dose.

RESULTS

A cohort of 664 patients was identified from the BC Cancer Registry. Distribution of metastatic disease at diagnosis was breast (n = 82), colorectal (n = 214), and lung (n = 368) cancer. For breast, colorectal, and lung cancer, there was a baseline CT within 4 weeks of treatment initiation in 59%, 51%, and 48% of patients, with median duration of first-line treatment of 14.6, 25.3, and 11.9 weeks and median CT imaging interval of 9.1, 9.0, and 6.1 weeks.

CONCLUSION

In our publicly funded healthcare system, availability of baseline CT imaging was 48% to 59% and the frequency of assessment ranged from 6.1 to 9.1 weeks, subject to patterns of practice and resource availability. Our system was not capable of providing RWE for image-based end points. Alternative end points should be considered to capitalize on the wealth of real-world data.