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Imai H, Kaira K, Suzuki K, Anzai M, Tsuda T, Ishizuka T, Kuwako T, Naruse I, Nemoto K, Uchino J, Morozumi N, Ishihara S, Minato K, Hisada T. A phase II study of afatinib treatment for elderly patients with previously untreated advanced non-small-cell lung cancer harboring EGFR mutations. Lung Cancer 2018; 126:41-47. [PMID: 30527191 DOI: 10.1016/j.lungcan.2018.10.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 10/08/2018] [Accepted: 10/12/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The efficacy and safety of afatinib in elderly patients with EGFR-mutated non-small-cell lung cancer (NSCLC) have not been evaluated. This study aimed to assess the efficacy and safety of afatinib in elderly chemotherapy-naive patients with NSCLC harboring sensitive EGFR mutations. MATERIALS AND METHODS We prospectively assessed the clinical effects of afatinib as a first-line treatment for elderly (age ≥70 years) NSCLC patients with EGFR mutations (exon 19 deletion or exon 21 L858R mutation). All patients were initially administered afatinib (30 mg/day). RESULTS Between May 2014 and August 2017, 40 patients (13 men, 27 women) with adenocarcinoma were included in our analysis. The median age was 77 years (range, 70-85 years). The dose was reduced in 19 patients. The objective overall response and disease control rates were 72.5% and 100%, respectively, and the median progression-free survival and overall survival were 12.9 months and not reached, respectively. Common adverse events (AEs) included diarrhea, rash/acne, and anemia. Major grade 3 or higher toxicities included diarrhea (12.5%), mucositis (7.5%), and pneumonitis (7.5%). Afatinib treatment was discontinued in 8 patients owing to AEs of elevated amylase (n = 1), liver dysfunction (n = 1), rash/acne (n = 1), nail change (n = 1), anorexia (n = 2), pneumonitis (n = 2), and diarrhea (n = 2). Two patients died due to treatment-related pneumonitis. CONCLUSIONS This is the first study that verified the efficacy and feasibility of first-line chemotherapy with afatinib at 30 mg/day in elderly patients with advanced NSCLC harboring sensitive EGFR mutations. First-line afatinib of 30 mg/day could be a treatment option in this patient population.
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Affiliation(s)
- Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ohta, Gunma, Japan
| | - Kyoichi Kaira
- Department of Oncology Clinical Development, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
| | - Kensuke Suzuki
- Division of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Masaki Anzai
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Takeshi Tsuda
- Division of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Tamotsu Ishizuka
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Tomohito Kuwako
- Division of Respirology, National Hospital Organization Shibukawa Medical Center Hospital, Shibukawa, Gunma, Japan
| | - Ichiro Naruse
- Division of Respiratory Medicine, Hidaka Hospital, Takasaki, Gunma, Japan
| | - Kenji Nemoto
- Division of Respiratory Medicine, National Hospital Organization Ibarakihigashi National Hospital, Tokai, Ibaraki, Japan
| | - Junji Uchino
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Nobutoshi Morozumi
- Division of Respiratory Medicine, Saku Central Hospital Advanced Care Center, Saku, Nagano, Japan
| | - Shinichi Ishihara
- Division of Internal Medicine, Isesaki Municipal Hospital, Isesaki, Gunma, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ohta, Gunma, Japan
| | - Takeshi Hisada
- Department of Respiratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Doherty J, Dawe DE, Pond GR, Ellis PM. The effect of age on referral to an oncologist and receipt of chemotherapy among small cell lung cancer patients in Ontario, Canada. J Geriatr Oncol 2018; 10:449-458. [PMID: 30318328 DOI: 10.1016/j.jgo.2018.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/05/2018] [Accepted: 10/03/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Small cell lung cancer (SCLC) represents a significant health burden. There is a lack of information about patterns of referral and treatment for older patients over 70 years of age, in comparison to younger patients with SCLC. MATERIALS AND METHODS A population-based retrospective cohort study was undertaken for patients identified from the Ontario Cancer Registry, Canada. All cases of SCLC diagnosed between January 2000 and December 2010 were eligible. Data were extracted on demographic variables, treatment and outcome. Logistic regression analyses were performed as appropriate. RESULTS There were 9021 cases of SCLC, with 10% of cases ≥80 years and 32.8% of cases aged 70-79 years and 53% male. Older patients were less likely to be referred to a medical oncologist (OR 0.28 ≥ 80 years, OR 0.60 70-79 years) and less likely to receive chemotherapy (OR 0.19 ≥ 80 years, OR 0.52 70-79 years) compared to younger patients (age < 70). Age, higher comorbidity and prior receipt of home care services were all prognostic of a lower likelihood of referral to a medical oncologist and receipt of chemotherapy. Local health region was also prognostic for referral to and receipt of chemotherapy, indicative of significant regional variation in practice. CONCLUSIONS Older patients with SCLC are less likely to be referred for treatment and less likely to receive treatment than younger patients. These data represent a potential gap in knowledge translation.
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Affiliation(s)
- Jordan Doherty
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - David E Dawe
- Department of Internal Medicine, University of Manitoba, 820 Sherbrook St., Winnipeg, MB R3A 1R9, Canada; Department of Hematology and Medical Oncology, CancerCare Manitoba, 675 McDermot Ave, Winnipeg, MB R3E 0V9, Canada
| | - Gregory R Pond
- Department of Oncology, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Peter M Ellis
- Department of Oncology, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada; Division of Medical Oncology, Juravinski Cancer Centre, 699 Concession St, Hamilton, ON, Canada, L8V 5C2.
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Imai H, Yamada Y, Minemura H, Sugiyama T, Kotake M, Kaira K, Kanazawa K, Nakamura Y, Kasai T, Shibata Y, Kaburagi T, Minato K. Topotecan monotherapy for the treatment of relapsed small cell lung cancer in elderly patients: A retrospective analysis. Thorac Cancer 2018; 9:1699-1706. [PMID: 30281216 PMCID: PMC6275829 DOI: 10.1111/1759-7714.12884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 11/29/2022] Open
Abstract
Background Topotecan is one of the most active chemotherapeutic drugs for small cell lung cancer (SCLC). However, its efficacy in elderly patients with SCLC has not been validated. This study evaluated the feasibility and efficacy of topotecan monotherapy in elderly patients with relapsed SCLC. Methods Between January 2000 and March 2017, 43 patients aged ≥ 70 years received topotecan monotherapy for relapsed SCLC at four institutions. The clinical outcomes and adverse events of treatment were retrospectively analyzed. Results Twenty‐nine patients (median age 75 years; range: 70–83 years) had sensitive‐type relapse, while 14 (median age 78 years; range: 71–82 years) had refractory relapse. The median number of treatment cycles was two (range: 1–6). The response rate was 7.0% (10.3% and 0% in sensitive and refractory patients, respectively), while the disease control rate was 23.2% (20.6% and 42.8% in sensitive and refractory patients, respectively). Median progression‐free survival was 1.9 months in sensitive patients and 1.4 months in refractory patients (P = 0.87). The median survival time from the start of topotecan therapy was 5.5 months in sensitive patients and 4.0 months in refractory patients (P = 0.64). Grade ≥ 3 hematological toxicities were as follows: leukopenia, 37.2%; neutropenia, 51.1%; anemia, 0%; thrombocytopenia, 32.5%; and febrile neutropenia, 9.3%. No treatment‐related deaths occurred. Conclusion Although hematological toxicities (particularly neutropenia) were severe, topotecan showed favorable disease control in both sensitive and refractory patients. Topotecan may thus be a preferred treatment for elderly patients with relapsed SCLC.
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Affiliation(s)
- Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ohta, Japan
| | - Yutaka Yamada
- Division of Respiratory Medicine, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Hiroyuki Minemura
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tomohide Sugiyama
- Division of Thoracic Oncology, Tochigi Cancer Center, Utsunomiya, Japan
| | - Mie Kotake
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ohta, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Kenya Kanazawa
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan.,Clinical Oncology Center, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yoichi Nakamura
- Division of Thoracic Oncology, Tochigi Cancer Center, Utsunomiya, Japan
| | - Takashi Kasai
- Division of Thoracic Oncology, Tochigi Cancer Center, Utsunomiya, Japan
| | - Yoko Shibata
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takayuki Kaburagi
- Division of Respiratory Medicine, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ohta, Japan
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Kjeldsen JW, Iversen TZ, Engell-Noerregaard L, Mellemgaard A, Andersen MH, Svane IM. Durable Clinical Responses and Long-Term Follow-Up of Stage III-IV Non-Small-Cell Lung Cancer (NSCLC) Patients Treated With IDO Peptide Vaccine in a Phase I Study-A Brief Research Report. Front Immunol 2018; 9:2145. [PMID: 30283461 PMCID: PMC6157336 DOI: 10.3389/fimmu.2018.02145] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/30/2018] [Indexed: 12/26/2022] Open
Abstract
Background: Long-term follow-up on a clinical trial of 15 stage III-IV NSCLC patients treated with an Indoleamine 2,3-Dioxygenase (IDO) peptide vaccine (NCT01219348). Methods: Fifteen HLA-A2-positive patients with stable stage III-IV NSCLC after standard chemotherapy were treated with subcutaneous vaccinations (100 μg IDO5 peptide, sequence ALLEIASCL, formulated in 900 μl Montanide) biweekly for 2.5 months and thereafter monthly until progression or up to 5 years. Here we report long-term clinical follow-up, toxicity and immunity. Results: Three of 15 patients are still alive corresponding to a 6-year overall survival of 20 %. Two patients continued monthly vaccinations for 5 years (56 vaccines). One of the two patients developed a partial response (PR) of target lesions in the liver 15 months after the first vaccine and has remained in PR ever since. The other patient had a solitary distant metastasis in a lymph node in retroperitoneum at baseline which normalized during treatment. All following evaluation scans during the treatment have been tumor free. The vaccine was well tolerated for all 5 years with no long-term toxicities registered. The third long-term surviving patient discontinued vaccinations after 11 months due to disease progression. Flow cytometry analyses of PBMCs from the two long-term responders demonstrated stable CD8+ and CD4+ T-cell populations during treatment. In addition, presence of IDO-specific T-cells was detected by IFN-γ Elispot in both patients at several time points during treatment. Conclusion: IDO peptide vaccination was well tolerated for administration up to 5years. Two of 15 patients are long-term responders with ongoing clinical response 6 years after 1st vaccination.
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Affiliation(s)
- Julie Westerlin Kjeldsen
- Department of Oncology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.,Department of Hematology, Center for Cancer Immune Therapy, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | | | | | - Anders Mellemgaard
- Department of Oncology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Mads Hald Andersen
- Department of Hematology, Center for Cancer Immune Therapy, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Inge Marie Svane
- Department of Oncology, Herlev Hospital, University of Copenhagen, Herlev, Denmark.,Department of Hematology, Center for Cancer Immune Therapy, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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Sacco PC, Maione P, Palazzolo G, Gridelli C. Treatment of advanced non-small cell lung cancer in the elderly. Expert Rev Respir Med 2018; 12:783-792. [PMID: 30092728 DOI: 10.1080/17476348.2018.1510322] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Lung cancer is predominantly a disease that affects the elderly; about 30-40% of lung cancers are diagnosed in patients aged 70 or more. The increasing number of elderly patients over the next decades is generating a new social and health problem; despite that, these patients are underrepresented in clinical trials and undertreated in clinical practice. Areas covered: The main difficulty in treating elderly patients is to maximize the therapy benefits while minimizing the treatment risk. Elderly patients show a vulnerable clinical profile due to the higher prevalence of comorbid disease, higher polypharmacy interactions and aged organ dysfunction that increase the risk of mortality and toxicity with cancer treatments compared to younger patients. Expert commentary: The choice to treat or not to treat elderly patients cannot be taken only on the basis of the chronological age. Thus, the clinical approach should be to select patients who are effectively suitable for treatment having a better individual functional reserve and a better life expectancy. Elderly patients are a heterogeneous population and those who are fit to receive cancer treatment can be treated similarly to younger patients.
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Affiliation(s)
- Paola C Sacco
- a Division of Medical Oncology , "S.G.Moscati" Hospital , Avellino , Italy
| | - Paolo Maione
- a Division of Medical Oncology , "S.G.Moscati" Hospital , Avellino , Italy
| | | | - Cesare Gridelli
- a Division of Medical Oncology , "S.G.Moscati" Hospital , Avellino , Italy
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TNFAIP8 promotes the proliferation and cisplatin chemoresistance of non-small cell lung cancer through MDM2/p53 pathway. Cell Commun Signal 2018; 16:43. [PMID: 30064446 PMCID: PMC6069800 DOI: 10.1186/s12964-018-0254-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/19/2018] [Indexed: 12/29/2022] Open
Abstract
Background The highly refractory nature of non-small cell lung cancer (NSCLC) to chemotherapeutic drugs is an important factor resulting in its poor prognosis. Recent studies have revealed that tumour necrosis factor alpha-induced protein 8 (TNFAIP8) is involved in various biological and pathological processes of cells, but their underlying mechanisms in processes ranging from cancer development to drug resistance have not been fully elucidated. Methods TNFAIP8 expression in clinical NSCLC samples was examined through immunohistochemistry (IHC). After adjusting for patients’ characteristics with propensity score matching, Kaplan-Meier analysis and Cox regression analysis were performed for comparison of patients’ survival according to the TNFAIP8 level. Lentiviral transfection with TNFAIP8-specific shRNAs was used to establish stable TNFAIP8 knockdown (TNFAIP8 KD) NCI-H460, A549 and cis-diamminedichloroplatinum II resistant A549 (A549/cDDP) cell lines. Cell proliferation and viability were assessed by CCK-8 assay. Cell cycle was examined by flow cytometry. Multiple pathways regulated by TNFAIP8 KD were revealed by microarray analysis. Results We found that high TNFAIP8 expression was associated with advanced pT stage, advanced pTNM stage, lymph node metastasis and unfavourable survival in NSCLC patients. TNFAIP8 shRNAs reduced in vitro cancer cell proliferation and in vivo tumor growth. Additionally, TNFAIP8 KD increased the sensitivity of NSCLC cells to cisplatin in vitro and in vivo. Conversely, up-regulation of TNFAIP8 promoted the proliferation and drug resistance to cisplatin of NSCLC cells. TNFAIP8 influences cancer progression pathways involving the MDM2/p53 pathway. Indeed, we observed that TNFAIP8 KD mediated the MDM2 downregulation and the p53 ubiquitination, thereby decreasing the degradation of p53 protein. shRNA p53 reversed TNFAIP8 shRNA-mediated regulation of cell proliferation, cell cycle, cisplatin sensitivity, and expression levels of RAD51, a DNA repair gene. Conclusion Our work uncovers a hitherto unappreciated role of TNFAIP8 in NSCLC proliferation and cisplatin chemoresistance that is mediated through the MDM2/p53 pathway. These findings might offer potential therapeutic targets for reversing cisplatin resistance in NSCLC patients with high TNFAIP8 expression. Electronic supplementary material The online version of this article (10.1186/s12964-018-0254-x) contains supplementary material, which is available to authorized users.
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Bunn PA, Dimou A. Systemic Therapy for Elderly Patients With Advanced Non-Small-Cell Lung Cancers. J Clin Oncol 2018; 36:2571-2574. [PMID: 30028655 DOI: 10.1200/jco.2018.79.2457] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Paul A Bunn
- Paul A. Bunn Jr and Anastasios Dimou, University of Colorado Denver and University of Colorado Cancer Center, Aurora, CO
| | - Anastasios Dimou
- Paul A. Bunn Jr and Anastasios Dimou, University of Colorado Denver and University of Colorado Cancer Center, Aurora, CO
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Boldrini L, Giordano M, Lucchi M, Melfi F, Fontanini G. Expression profiling and microRNA regulation of the LKB1 pathway in young and aged lung adenocarcinoma patients. Biomed Rep 2018; 9:198-205. [PMID: 30271594 PMCID: PMC6158392 DOI: 10.3892/br.2018.1122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/11/2018] [Indexed: 12/14/2022] Open
Abstract
Lung cancer in young patients appears to have distinct clinicopathological features. The present study focused on the role of the serine/threonine kinase liver kinase B1 (LKB1), a known tumor suppressor gene, and its miRNA regulation in lung adenocarcinoma, particularly in young versus elderly patients. A total of 88 patients with lung adenocarcinoma were retrospectively analysed. A simultaneous quantification was performed of the expression of LKB1 mRNA and 15 microRNAs (miRNA/miRs; miRs −93, −96, −34a, −34c, −214, −33a, −30b, −145, −182, −30c, −183, −29b, −29c, −153 and −138) involved in the LKB1 pathway, as well as of 5 identified target mRNAs [cyclin D1 (CCND1), catenin β-1 (CTNNB1), lysyl oxidase (LOX), yes-associated protein 1 (YAP1) and survivin], using NanoString technology. KRAS mutations were investigated by pyrosequencing analysis. Patients ≤50 years were defined as a younger group, while patients >50 years old as an older group (n=44/group). No difference between the two groups was identified in terms of survival times analysed using the Kaplan-Meier method or KRAS mutations. Subsequently, the LKB1 signalling pathway was focused on, as a target for therapy in lung adenocarcinoma, and assessed with regards to clinicopathological features; we found that LOX levels in adenocarcinoma patients were significantly associated with histological subtype (P=0.03), stage (P<0.0001) and prognosis (P=0.02 for disease-free interval and P=0.005 for overall survival), but not with age. Furthermore, the miRNA target prediction model indicated that miR-93 and miR-30b appeared to have functional binding sites and downregulate the gene expression of LKB1 and LOX, respectively. In conclusion, young patients appeared have similar survival rates to elderly patients. The assessment of LKB1, its downstream genes and its regulation by miRNAs may have an impact on future research on lung adenocarcinoma in young and elderly patients. Further investigations will be necessary to elucidate the potential of this pathway as a novel target for therapy.
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Affiliation(s)
- Laura Boldrini
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, I-56126 Pisa, Italy
| | - Mirella Giordano
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, I-56126 Pisa, Italy
| | - Marco Lucchi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, I-56126 Pisa, Italy
| | - Franca Melfi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, I-56126 Pisa, Italy
| | - Gabriella Fontanini
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, I-56126 Pisa, Italy
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Real-World Treatment Patterns, Overall Survival, and Occurrence and Costs of Adverse Events Associated With Second-Line Therapies for Medicare Patients With Advanced Non-Small-Cell Lung Cancer. Clin Lung Cancer 2018; 19:e783-e799. [PMID: 29983370 DOI: 10.1016/j.cllc.2018.05.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/19/2018] [Accepted: 05/28/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Real-world data on current treatment practices for non-small-cell lung cancer (NSCLC) are needed to understand the place in therapy and potential economic impact of newer therapies. PATIENTS AND METHODS This retrospective cohort study identified patients ≥ 65 years old in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database with first-time diagnosis of stage IIIB/IV NSCLC from 2007-2011 who received second-line therapy after first-line platinum-based chemotherapy from 2007 through mid-2013. Second-line regimens, health care resource use, adverse events (AEs), and associated costs were analyzed descriptively. Overall survival was determined by Kaplan-Meier test. Costs were adjusted to 2013 US dollars. RESULTS We identified 4033 patients with advanced NSCLC who received second-line therapy (47% of those who received first-line platinum-based chemotherapy). Mean (SD) age was 73 (5) years, 2246 (56%) were male; 1134 (28%) and 2899 (72%) had squamous and nonsquamous NSCLC, respectively. The 4 most common second-line regimens were pemetrexed (22%), docetaxel (12%), carboplatin/paclitaxel (11%), and gemcitabine (7%). Median overall survival from second-line therapy initiation was 7.3 months (95% confidence interval, 7.0-7.7). Dyspnea and anemia were the most common AEs of interest, affecting 29% and 26% of patients, respectively; atypical pneumonia was associated with the highest AE-related costs (mean, $5339). The mean total per-patient-per-month cost was $10,885; AE-related per-patient-per-month costs totaled $1036 (10%). Costs were highest for pemetrexed-treated patients. CONCLUSION These real-world data illustrate the variety of second-line regimens, poor prognosis, and high cost of second-line chemotherapy for patients with advanced NSCLC treated before the approval of immunotherapies for these patients.
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Lee YG, Lee JH, Kim SH, Kim YJ, Lee H, Ahn S, Jang JS, Lee JS, Kim JH. Comparative analysis between combination and single-agent chemotherapy for elderly patients with advanced non-small cell lung cancer: A nationwide population-based outcome study. Lung Cancer 2018; 122:88-93. [PMID: 30032852 DOI: 10.1016/j.lungcan.2018.05.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/19/2018] [Accepted: 05/31/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION To determine whether an upfront combination compared to single-agent therapy is beneficial for elderly patients with advanced non-small cell lung cancer (NSCLC) in the real world, a population-based epidemiologic study was conducted. METHODS Patients ≥70 years with advanced NSCLC from 2007 to 2012 were identified in the National Health Insurance Service Database of Korea. A Cox proportional-hazards regression model and propensity score analysis were used to examine the effect of treatment modality on survival. RESULTS Among 41,276 patients newly diagnosed with lung cancer, 8274 (20.0%) identified to be treated with upfront palliative chemotherapy were eligible for this study. After excluding 976 patients who received a first-line anti-epidermal growth factor receptor (EGFR) treatment, 7298 (88.2%) who received cytotoxic chemotherapy were included in further analyses: 5636 (77.2%) received doublet chemotherapy and 1662 (22.8%) received monotherapy. The most frequent regimen in combination group was gemcitabine and platinum doublet (44.7%), whereas that in monotherapy group was gemcitabine (46.7%). Multivariate analyses indicated lower use of combination chemotherapy with increasing age (odds ratio [OR] 0.73; 95% CI 0.67-0.79; P < 0.001) and female sex (OR 0.71; 95% CI 0.62-0.80; P < 0.001). Receipt of combination over single-agent chemotherapy was associated with a reduced risk of death (hazard ratio [HR] 0.91; 95% CI 0.86-0.96; P = 0.001) in overall population and (HR 0.89; 95% CI 0.80-0.98; P = 0.019) in the propensity-matched cohort. CONCLUSION In elderly patients with advanced NSCLC excluding those receiving frontline anti-EGFR targeted agents, receiving initial combination chemotherapy compared to single-agent was associated with improved survival.
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Affiliation(s)
- Yun-Gyoo Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ju Hyun Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Se-Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Heeyoung Lee
- Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Soyeon Ahn
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joung-Soon Jang
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang Unversity College of Medicine, Seoul, Republic of Korea
| | - Jong-Seok Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
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Imai H, Minemura H, Sugiyama T, Yamada Y, Kaira K, Kanazawa K, Kasai T, Kaburagi T, Minato K. Efficacy and safety of cytotoxic drug chemotherapy after first-line EGFR-TKI treatment in elderly patients with non-small-cell lung cancer harboring sensitive EGFR mutations. Cancer Chemother Pharmacol 2018; 82:119-127. [PMID: 29737372 DOI: 10.1007/s00280-018-3596-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 05/01/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE Epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) is effective as first-line chemotherapy for patients with advanced non-small-cell lung cancer (NSCLC) harboring sensitive EGFR mutations. However, whether the efficacy of second-line cytotoxic drug chemotherapy after first-line EGFR-TKI treatment is similar to that of first-line cytotoxic drug chemotherapy in elderly patients aged ≥ 75 years harboring sensitive EGFR mutations is unclear. Therefore, we aimed to investigate the efficacy and safety of cytotoxic drug chemotherapy after first-line EGFR-TKI treatment in elderly patients with NSCLC harboring sensitive EGFR mutations. METHODS We retrospectively evaluated the clinical effects and safety profiles of second-line cytotoxic drug chemotherapy after first-line EGFR-TKI treatment in elderly patients with NSCLC harboring sensitive EGFR mutations (exon 19 deletion/exon 21 L858R mutation). Between April 2008 and December 2015, 78 elderly patients with advanced NSCLC harboring sensitive EGFR mutations received first-line EGFR-TKI at four Japanese institutions. Baseline characteristics, regimens, responses to first- and second-line treatments, whether or not patients received subsequent treatment, and if not, the reasons for non-administration were recorded. RESULTS Overall, 20 patients with a median age of 79.5 years (range 75-85 years) were included in our analysis. The overall response, disease control, median progression-free survival, and overall survival rates were 15.0, 60.0%, 2.4, and 13.2 months, respectively. Common adverse events included leukopenia, neutropenia, anemia, thrombocytopenia, malaise, and anorexia. Major grade 3 or 4 toxicities included leukopenia (25.0%) and neutropenia (45.0%). No treatment-related deaths were noted. CONCLUSION Second-line cytotoxic drug chemotherapy after first-line EGFR-TKI treatment among elderly patients with NSCLC harboring sensitive EGFR mutations was effective and safe and showed equivalent outcomes to first-line cytotoxic drug chemotherapy.
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Affiliation(s)
- Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, 617-1, Takahayashinishi, Ota, Gunma, 373-8550, Japan.
| | - Hiroyuki Minemura
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tomohide Sugiyama
- Division of Thoracic Oncology, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Yutaka Yamada
- Division of Respiratory Medicine, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | - Kyoichi Kaira
- Department of Oncology Clinical Development, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kenya Kanazawa
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan.,Clinical Oncology Center, Fukushima Medical University Hospital, Fukushima, Japan
| | - Takashi Kasai
- Division of Thoracic Oncology, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Takayuki Kaburagi
- Division of Respiratory Medicine, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, 617-1, Takahayashinishi, Ota, Gunma, 373-8550, Japan
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Racial disparities in guideline-concordant cancer care and mortality in the United States. Adv Radiat Oncol 2018; 3:221-229. [PMID: 30202793 PMCID: PMC6128037 DOI: 10.1016/j.adro.2018.04.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/20/2018] [Accepted: 04/29/2018] [Indexed: 01/05/2023] Open
Abstract
Purpose We identified the frequency of racial disparities in guideline-concordant cancer care for select common disease sites in the United States and the impact of guideline concordance on mortality disparities. Methods and materials Using Surveillance, Epidemiology, and End Results Medicare data, we evaluated patients age >65 years of black or non-Hispanic white race who were diagnosed with stage III breast (n = 3607), stage I (n = 14,605) or III (n = 15,609) non-small cell lung, or stage III prostate (n = 3548) cancer between 2006 and 2011. Chemotherapy, surgery, and radiation therapy (RT) treatments were identified using claims data. Pearson χ2 was used to test the associations between race and guideline concordance on the basis of National Comprehensive Cancer Network curative treatment guidelines. Mortality risks were modeled using Cox proportional hazards. Results Black patients were less likely to receive guideline-concordant curative treatment than non-Hispanic white patients for stage III breast cancer postmastectomy RT (53% black, 61% white; P = .0014), stage I non-small cell lung cancer stereotactic radiation or surgery (61% black, 75% white; P < .0001), stage III non-small cell lung cancer chemotherapy in addition to RT or surgery (36% black, 41% white; P = .0001), and stage III prostate cancer RT or prostatectomy (82% black, 95% white; P < .0001). Disparities in guideline concordance impacted racial mortality disparities. Specifically, hazard ratios that demonstrated elevated all-cause mortality risks in black patients were lowered (and more closely approached hazard ratio of 1.00) after adjusting for guideline concordance. A similar impact for cause-specific mortality was observed. Conclusions Racial disparities in the receipt of curative cancer therapy impacted racial mortality disparities across multiple cancer sites. Benchmarking adherence to guideline-concordant care could represent an opportunity to stimulate improvements in disparities in cancer treatment and survival.
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Henson KE, Fry A, Lyratzopoulos G, Peake M, Roberts KJ, McPhail S. Sociodemographic variation in the use of chemotherapy and radiotherapy in patients with stage IV lung, oesophageal, stomach and pancreatic cancer: evidence from population-based data in England during 2013-2014. Br J Cancer 2018; 118:1382-1390. [PMID: 29743552 PMCID: PMC5959922 DOI: 10.1038/s41416-018-0028-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 01/17/2018] [Accepted: 01/24/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Sociodemographic inequalities in cancer treatment have been generally described, but there is little evidence regarding patients with advanced cancer. Understanding variation in the management of these patients may provide insights into likely mechanisms leading to inequalities in survival. METHODS We identified 50,232 patients with stage IV lung, oesophageal, pancreatic and stomach cancer from the English national cancer registry. A generalised linear model with a Poisson error structure was used to explore variation in radiotherapy and chemotherapy within 6 months from diagnosis by age, sex, deprivation, ethnicity, cancer site, comorbidity and, additionally, performance status. RESULTS There was substantial variation by cancer site, large gradients by age, and non-trivial associations with comorbidity and deprivation. After full adjustment, more deprived patients were consistently least likely to be treated with chemotherapy alone or chemotherapy and radiotherapy combined compared with less deprived patients with equally advanced disease stage (treatment rate ratio: 0.82 95% CI (0.78, 0.87) for CT, 0.78 95% CI (0.71, 0.85) for CTRT p < 0.0001). CONCLUSIONS There was marked variation in the management of patients with stage IV cancer. Routinely collected data could be used for surveillance across all cancers to help reduce treatment variation and optimise outcomes among patients with advanced cancer.
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Affiliation(s)
- Katherine E Henson
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, London, SE1 6LH, UK.
| | - Anna Fry
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, London, SE1 6LH, UK
- Cancer Research UK, Angel Building, London, EC1V 4AD, UK
| | - Georgios Lyratzopoulos
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, London, SE1 6LH, UK
- ECHO (Epidemiology of Cancer Healthcare and Outcomes) Group, Department of Behavioural Science and Health, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK
| | - Michael Peake
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, London, SE1 6LH, UK
- University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
- Centre for Cancer Outcomes, University College London Hospitals (UCLH) Cancer Collaborative, UCLH Cancer Division, 47 Wimpole Street, London, W1G 8SE, UK
| | - Keith J Roberts
- Nuffield House, University Hospitals Birmingham, Edgbaston, Birmingham, B15 2TH, UK
| | - Sean McPhail
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, London, SE1 6LH, UK
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Galsky MD, Pal SK, Lin SW, Ogale S, Zivkovic M, Simpson J, Derleth C, Schiff C, Sonpavde G. Real-World Effectiveness of Chemotherapy in Elderly Patients With Metastatic Bladder Cancer in the United States. Bladder Cancer 2018; 4:227-238. [PMID: 29732393 PMCID: PMC5929305 DOI: 10.3233/blc-170149] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Outcomes for patients with metastatic bladder cancer (mBC) are generally poor and progressively worse following first-line (1L) chemotherapy. Objective To evaluate treatment patterns, survival outcomes, and characteristics of a large, real-world US population of elderly patients with advanced mBC receiving 1L and second-line (2L) treatment retrospectively. Methods We identified patients with advanced mBC (aged ≥66 years)-newly diagnosed between January 1, 2004, and December 31, 2011-in the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program-Medicare linked database and assessed their palliative systemic chemotherapy treatments and survival outcomes. Results Of 1703 eligible patients, 42% received 1L chemotherapy; 1L-treated patients tended to be younger and healthier than nontreated patients. Only 27% of 1L-treated patients received cisplatin-based chemotherapy, most commonly cisplatin-gemcitabine. Cisplatin-treated patients were younger and had fewer comorbidities than non-cisplatin-treated patients. Thirty-five percent of 1L-treated patients subsequently received 2L chemotherapy. Patients received a variety of 2L agents as combination chemotherapy (52%) or single-agent chemotherapy (39%). Median overall survival durations in 1L-treated and 2L-treated patients were 8.5 and 7.9 months, respectively. Conclusions Results from this retrospective SEER-Medicare database analysis underscore the historical inadequacies of 1L and 2L treatments in elderly patients with advanced mBC. Few patients were treated with 1L chemotherapy, a minority of whom received 1L cisplatin-based chemotherapy, and even fewer received 2L chemotherapy. These findings highlight the disconnect between 1L treatment in clinical trials and treatment in the real-world setting and the lack of standard approaches to 2L treatment in the United States.
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Affiliation(s)
- Matthew D Galsky
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sumanta Kumar Pal
- Department of Medical Oncology and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | | | | | | | | | | | | | - Guru Sonpavde
- University of Alabama Comprehensive Cancer Center, Birmingham, AL, USA
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Visser S, de Mol M, Cheung K, van Toor JJ, van Walree NC, Stricker BH, Den Oudsten BL, Aerts JGJV. Treatment Satisfaction of Patients With Advanced Non-Small-cell Lung Cancer Receiving Platinum-based Chemotherapy: Results From a Prospective Cohort Study (PERSONAL). Clin Lung Cancer 2018; 19:e503-e516. [PMID: 29705017 DOI: 10.1016/j.cllc.2018.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 02/05/2018] [Accepted: 03/10/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In patients with advanced non-small-cell lung cancer, the treatment benefits and risks need to be constantly weighed. We explored patient-reported satisfaction with therapy (SWT) and assessed its value in addition to quality of life (QoL) and adverse events (AEs). PATIENTS AND METHODS In a prospective multicenter cohort study, patients with stage IIIB/IV non-small-cell lung cancer received platinum-pemetrexed chemotherapy. They completed the World Health Organization Quality of Life-BREF (WHOQoL-BREF) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) before and during chemotherapy. After the last cycle, patients reported on SWT, expectations of therapy, and feelings about side effects (FSE) using the Cancer Therapy Satisfaction Questionnaire. The explained variance (R2) of QoL after treatment by SWT was calculated. Using multivariable linear regression, we examined the association of SWT with patient- and treatment-related variables, FSE, and AEs. RESULTS Eighty-nine patients finished 4 cycles of chemotherapy, 65 of whom completed the Cancer Therapy Satisfaction Questionnaire. Fifty-six patients (86.2%) would probably or definitely decide to undergo the same treatment again, regardless of deterioration or improvement in QoL or a high or low frequency of AEs during chemotherapy. The explained variance of QoL by SWT was greatest for the EORTC QLQ C-30 global health status/QoL scale (R2 = 0.170). Patient age (β = 0.43; 95% confidence interval [CI], 0.05-0.82), FSE (β = 0.17; 95% CI, 0.06-0.29), and tumor response (β = 7.93; 95% CI (1.64 to 14.22)) were independently associated with SWT. CONCLUSION SWT could provide important supplementary information in addition to QoL assessments and treatment toxicities. Tumor response, older age, and FSE score were associated with better SWT. These insights could affect decision-making during palliative chemotherapy.
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Affiliation(s)
- Sabine Visser
- Department of Pulmonary Medicine, Amphia Hospital Breda, Breda, The Netherlands; Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center University Medical Center, Rotterdam, The Netherlands
| | - Mark de Mol
- Department of Pulmonary Medicine, Amphia Hospital Breda, Breda, The Netherlands; Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Kiki Cheung
- Department of Epidemiology, Erasmus Medical Center University Medical Center, Rotterdam, The Netherlands; Inspectorate of Health Care, Utrecht, The Netherlands
| | - Jermo J van Toor
- Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Nico C van Walree
- Department of Pulmonary Medicine, Amphia Hospital Breda, Breda, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus Medical Center University Medical Center, Rotterdam, The Netherlands; Inspectorate of Health Care, Utrecht, The Netherlands.
| | - Brenda L Den Oudsten
- Department of Medical and Clinical Psychology, Centre of Research on Psychological and Somatic Disorders, Tilburg University, Tilburg, The Netherlands
| | - Joachim G J V Aerts
- Department of Pulmonary Medicine, Amphia Hospital Breda, Breda, The Netherlands; Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
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Sheffield KM, Bowman L, Smith DM, Li L, Hess LM, Montejano LB, Willson TM, Davidoff AJ. Development and validation of a claims-based approach to proxy ECOG performance status across ten tumor groups. J Comp Eff Res 2018. [DOI: 10.2217/cer-2017-0040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aim: To develop a claims-based prediction model of poor performance status (PS) in commercially insured and Medicare supplemental beneficiaries with cancer. Patients & methods: Retrospective analysis was conducted of electronic medical records (EMR) from community oncology practices linked to MarketScan claims. Multivariable logistic regression predicted PS scores from the EMR using claims-based diagnostic and procedure codes. Results: The study included 8442 patients diagnosed with cancer from 2007 to 2015. Overall, 8.1% of patients had poor EMR-based PS. Bootstrapping results from the final model showed sensitivity and specificity of approximately 75% with a predicted probability cutpoint = 0.078, c-statistic = 0.821 and pseudo-R2 = 0.25. Conclusion: Patients with poor PS can be identified in claims data. This prediction model enables future studies evaluating cancer treatments and outcomes to account for PS.
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Affiliation(s)
- Kristin M Sheffield
- Global Patient Outcomes & Real World Evidence, Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - Lee Bowman
- Global Patient Outcomes & Real World Evidence, Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - David M Smith
- Outcomes Research, Truven Health Analytics, an IBM Company, 100 Phoenix Drive, Ann Arbor, MI 48108, USA
| | - Li Li
- Global Patient Outcomes & Real World Evidence, Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - Lisa M Hess
- Global Patient Outcomes & Real World Evidence, Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA
| | - Leslie B Montejano
- Outcomes Research, Truven Health Analytics, an IBM Company, 100 Phoenix Drive, Ann Arbor, MI 48108, USA
| | - Tina M Willson
- Outcomes Research, Truven Health Analytics, an IBM Company, 100 Phoenix Drive, Ann Arbor, MI 48108, USA
| | - Amy J Davidoff
- Department of Health Policy and Management, Yale School of Public Health, 60 College Street, PO Box 208034, New Haven, CT 06510, USA
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Lu C, Wang H, Chen S, Yang R, Li H, Zhang G. Baicalein inhibits cell growth and increases cisplatin sensitivity of A549 and H460 cells via miR-424-3p and targeting PTEN/PI3K/Akt pathway. J Cell Mol Med 2018; 22:2478-2487. [PMID: 29392841 PMCID: PMC5867147 DOI: 10.1111/jcmm.13556] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/04/2018] [Indexed: 12/21/2022] Open
Abstract
Lung cancer is the leading cause of death in individuals with malignant disease. Non‐small‐cell lung cancer (NSCLC) is the most common type of lung cancer, and chemotherapy drugs such as cisplatin are the most widely used treatment for this disease. Baicalein is a purified flavonoid compound that has been reported to inhibit cancer cell growth and metastasis and increase sensitization to chemotherapeutic drugs via different pathways. Therefore, we assessed the effects of baicalein on the proliferation, apoptosis and cisplatin sensitivity in the NSCLC A549 and H460 cell lines and determined the pathways through which baicalein exerts its effects. Baicalein was slightly toxic to normal human bronchial NHBE cells but inhibited growth, induced apoptosis and increased cisplatin sensitivity in A549 and H460 cells. Baicalein down‐regulated miR‐424‐3p, up‐regulated PTEN expression and down‐regulated expression of PI3K and p‐Akt in A549 and H460 cells. Dual‐luciferase reporter assay demonstrated that PTEN is a target gene of miR‐424‐3p, and overexpression of miR‐424‐3p or silencing of PTEN partially attenuated the effects of baicalein on A549 and H460 cells. Taken together, we concluded that baicalein inhibits cell growth and increases cisplatin sensitivity to A549 and H460 cells via down‐regulation of miR‐424‐3p and targeting the PTEN/PI3K/Akt pathway.
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Affiliation(s)
- Chunya Lu
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Huaqi Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shanshan Chen
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Rui Yang
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hui Li
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Guojun Zhang
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Koff JL, Rai A, Flowers CR. Characterizing Autoimmune Disease-associated Diffuse Large B-cell Lymphoma in a SEER–Medicare Cohort. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e115-e121. [DOI: 10.1016/j.clml.2017.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/17/2017] [Accepted: 11/27/2017] [Indexed: 01/04/2023]
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Jiang X, Chen C, Gu S, Zhang Z. Regulation of ABCG2 by nuclear factor kappa B affects the sensitivity of human lung adenocarcinoma A549 cells to arsenic trioxide. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2018; 57:141-150. [PMID: 29274627 DOI: 10.1016/j.etap.2017.12.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 11/18/2017] [Accepted: 12/16/2017] [Indexed: 06/07/2023]
Abstract
Arsenic trioxide (As2O3) is successfully used as an anticancer agent against acute promyelocytic leukemia and some solid tumors. However, the application of As2O3 is largely limited by its drug resistance in the treatment of non-small cell lung carcinoma (NSCLC). Therefore, it is an urgent task to enhance the sensitivity of lung cancer cells to As2O3. In this study, using human lung adenocarcinoma A549 cells as a cell culture model, we demonstrated that an adenosine triphosphate binding cassette (ABC) transporter, ABCG2, was significantly increased by As2O3 treatment, while other ABC transporters, ABCB1 and ABCC1 showed no remarkable change in the response to As2O3. After inhibition of ABCG2 by its specific inhibitor, the drug sensitivity of As2O3 to A549 cells was significantly enhanced, manifested by decreased cell viability and colony formation as well as the increased ROS production and cell apoptosis. To further understand the molecular mechanism underlying the elevation of ABCG2 expression in As2O3-treated cells, we detected the activation state of nuclear factor kappa B (NF-κB) pathway and its relationship with ABCG2 expression. Our results revealed that the increased expression of ABCG2 was regulated by NF-κB, and thus affecting the cell death of As2O3-treated A549 cells. These findings indicate that inhibition of NF-κB/ABCG2 pathway by specific inhibitors may be a new strategy for the improvement of As2O3 sensitivity in NSCLC treatment.
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Affiliation(s)
- Xuejun Jiang
- Department of Occupational and Environmental Health, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China; Center of Experimental Teaching for Public Health, Experimental Teaching and Management Center, Chongqing Medical University, Chongqing, People's Republic of China
| | - Chengzhi Chen
- Department of Occupational and Environmental Health, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China; Department of Occupational and Environmental Health, School of Public Health and Management, Chongqing Medical University, Chongqing, People's Republic of China
| | - Shiyan Gu
- Department of Occupational and Environmental Health, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Zunzhen Zhang
- Department of Occupational and Environmental Health, West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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Hingmire SS, Sambhus MB, Kelkar DS, Joshi SW, Narsinghpura KS. First-line therapy outcomes in patients with advanced stage nonsmall cell lung cancer treated at nongovernment tertiary care centrer in India: Experience from a real world practice. Indian J Cancer 2017; 54:182-186. [PMID: 29199686 DOI: 10.4103/0019-509x.219594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Reports on first line or subsequent treatment and their outcomes for patients with advanced nonsmall cell lung cancer (NSCLC) in India are scarce. The present study is an attempt to understand real world practice scenario of first-line therapy and outcome in advanced stage NSCLC patients. METHODS Observational study was conducted at a nongovernment tertiary cancer care center. Totally 83 patients with newly diagnosed advanced NSCLC who were evaluated for further treatment from 2008 onward were included in the study. RESULTS Best supportive care was the only treatment received in 11/83 patients. Sixty-three patients received platinum-based doublet chemotherapy and nine received epidermal growth factor receptor tyrosine kinase inhibitor (TKI) as first-line therapy. Pemetrexed and platinum was the most common first-line chemotherapy (56%) regimen used. First-line chemotherapy had to be discontinued in these eight patients due to Grade III/IV toxicity. Disease control rate with the first-line chemotherapy was 70% (partial response 38%, stable disease 32%). Median overall survival (OS) was 17 months with OS at 1 and 2 years was 52% and 29.5%, respectively. CONCLUSION First-line platinum-based chemotherapy is feasible and does achieve disease control in the majority of patients with advanced NSCLC. Strategies of selection of therapy based on histology and the presence of driver mutations, use of small molecule TKI, maintenance therapy and multiple lines of therapies are being increasingly implemented in clinical practice and thus improving survival of Indian patients of NSCLC.
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Affiliation(s)
- S S Hingmire
- Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - M B Sambhus
- Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - D S Kelkar
- Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - S W Joshi
- Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - K S Narsinghpura
- Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
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Presley CJ, Reynolds CH, Langer CJ. Caring for the Older Population With Advanced Lung Cancer. Am Soc Clin Oncol Educ Book 2017; 37:587-596. [PMID: 28561726 DOI: 10.1200/edbk_179850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The management of advanced lung cancer is changing rapidly, with new drug approvals occurring almost monthly. The average age of a newly diagnosed patient with advanced lung cancer remains around age 70. Caring for the older adult with advanced cancer differs from the care of younger adults. Chronologic age often does not accurately reflect the physiologic and functional status of older adults. Selecting treatment based on age alone results in undertreatment and overtreatment of many older adults. Addressing issues such as multiple chronic conditions, polypharmacy, geriatric syndromes, and heterogeneity in functional status among an expanding menu of treatment options for advanced disease is increasingly difficult, particularly among older adults historically underrepresented in clinical trials. In this article, we highlight key issues in caring for the older adult with advanced non-small cell lung cancer and the continued need for data supporting current and emerging treatment options. Key issues include the unique challenges of managing advanced lung cancer and a summary of the current treatment evidence as they apply to the elderly lung cancer population including supportive care strategies, risk stratification, and patient-reported outcomes.
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Affiliation(s)
- Carolyn J Presley
- From the VA Connecticut Cancer Center and Yale Cancer Center, West Haven and New Haven, CT; Florida Cancer Specialists and Research Institute, Ocala, FL; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | - Craig H Reynolds
- From the VA Connecticut Cancer Center and Yale Cancer Center, West Haven and New Haven, CT; Florida Cancer Specialists and Research Institute, Ocala, FL; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
| | - Corey J Langer
- From the VA Connecticut Cancer Center and Yale Cancer Center, West Haven and New Haven, CT; Florida Cancer Specialists and Research Institute, Ocala, FL; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA
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Ziogas DC, Liontos M, Kyriazoglou A, Tsironis G, Bamias A, Dimopoulos MA. Gefitinib: an “orphan” drug for non-small cell lung cancer. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1392852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Dimitrios C. Ziogas
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Michalis Liontos
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Anastasios Kyriazoglou
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Georgios Tsironis
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Aristotelis Bamias
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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El Zoghbi M, Salameh P, Stücker I, Paris C, Pairon JC, Gislard A, Siemiatycki J, Bonneterre V, Clin B, Brochard P, Delva F, Lacourt A. Phenotypes of lung cancer and statistical interactions between tobacco smoking and occupational exposure to asbestos and crystalline silica from a large case-only study: The CaProMat study. Lung Cancer 2017; 112:140-155. [DOI: 10.1016/j.lungcan.2017.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 07/28/2017] [Accepted: 08/06/2017] [Indexed: 12/23/2022]
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Choi J, Kong K, Chang Y, Jho H, Ahn E, Choi S, Park S, Lee M. Effect of the duration of hospice and palliative care on the quality of dying and death in patients with terminal cancer: A nationwide multicentre study. Eur J Cancer Care (Engl) 2017; 27:e12771. [DOI: 10.1111/ecc.12771] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2017] [Indexed: 01/27/2023]
Affiliation(s)
- J.Y. Choi
- Hospice & Palliative Care Branch; National Cancer Control Institute; National Cancer Center; Goyang South Korea
| | - K.A. Kong
- Department of Preventive Medicine; College of Medicine; Ewha Womans University; Seoul South Korea
| | - Y.J. Chang
- Hospice & Palliative Care Branch; National Cancer Control Institute; National Cancer Center; Goyang South Korea
| | - H.J. Jho
- Hospice & Palliative Care Branch; National Cancer Control Institute; National Cancer Center; Goyang South Korea
| | - E.M. Ahn
- Hospice & Palliative Care Branch; National Cancer Control Institute; National Cancer Center; Goyang South Korea
| | - S.K. Choi
- Hospice & Palliative Care Branch; National Cancer Control Institute; National Cancer Center; Goyang South Korea
| | - S. Park
- Hospice & Palliative Care Branch; National Cancer Control Institute; National Cancer Center; Goyang South Korea
| | - M.K. Lee
- College of Nursing; Research Institute of Nursing Science; Kyungpook National University; Daegu South Korea
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Hari P, Romanus D, Henk HJ, Becker LK, Noga SJ, Morrison VA. Factors associated with second-line triplet therapy in routine care in relapsed/refractory multiple myeloma. J Clin Pharm Ther 2017; 43:45-51. [PMID: 28833305 DOI: 10.1111/jcpt.12606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/09/2017] [Indexed: 12/12/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Second-line therapy (SLT) trials in relapsed/refractory multiple myeloma (RRMM) report superior outcomes with triplet combinations. We sought to determine factors associated with triplet SLT in routine practice. METHODS A retrospective cohort with claims for MM between 01/01/2008 and 03/31/2015 was grouped by 1-2 ("doublet") or 3+ ("triplet") agent therapy. Charlson comorbidity index (CCI) and disability status; CRAB symptoms (hypercalcaemia, renal/bone disease, anaemia); and relapse risk were determined. RESULTS Among 623 patients, the triplet group (n=146 [23%]) was younger (65.2 vs 69.8 years) and more likely to have high-risk relapse (67% vs 50%), CRAB symptoms (94.5% vs 81.1%), triplet first-line treatment (75% vs 51%) and frontline stem cell transplant (38% vs 20%) (P<0.001 for all). In multivariate analyses, CRAB symptoms (OR: 3.22, 95% CI: 1.47, 7.10), high-risk relapse (OR: 1.71, 95% CI: 1.12, 2.62) and prior triplet therapy (OR: 2.16, 95% CI: 1.38, 3.40), but neither CCI nor disability, were associated with triplet SLT. A trend towards triplets among younger patients (<65 vs >75 years, OR: 1.73, 95% CI: 0.99, 3.04) was observed. WHAT IS NEW AND CONCLUSION The majority of patients did not receive triplet regimens. Treatment selection with triplet therapy for RRMM should carefully consider comorbidities and patient-specific characteristics.
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Affiliation(s)
- P Hari
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - D Romanus
- Takeda Pharmaceuticals International Co., Cambridge, MA, USA
| | | | | | - S J Noga
- Takeda Pharmaceuticals International Co., Cambridge, MA, USA
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76
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MacEwan JP, Batt K, Yin W, Peneva D, Sison S, Vine S, Chen C. Economic burden of multiple myeloma among patients in successive lines of therapy in the United States. Leuk Lymphoma 2017; 59:941-949. [PMID: 28805105 DOI: 10.1080/10428194.2017.1361035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study characterized the costs of multiple myeloma (MM) during first-line (1L), second-line (2L) and third-line (3L) treatment from the US payer perspective. Patients with ≥2 outpatient or ≥1 inpatient claims with a primary MM diagnosis and 12 months continuous enrollment post index were identified in a retrospective claims database between 1 July 2006 and 30 June 2013. A cost per-patient per-month (PPPM) metric was used to calculate total all-cause and anti-MM pharmacy costs in 1L, 2L, and 3L treatment. Of 5704 patients included, 3626 initiated 1L treatment, 1797 initiated 2L and 817 initiated 3L. Average total all-cause PPPM costs were $22,527 in 1L, $35,266 in 2L and $47,417 in 3L. Anti-MM pharmacy costs represented 22%, 29% and 29% of total all-cause costs PPPM in 1L, 2L and 3L, respectively. Study results suggest that delaying 2L and/or 3L treatment initiation may result in lower treatment costs for patients with MM.
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Affiliation(s)
| | - Katharine Batt
- b Wake Forest Baptist Medical Center , Winston-Salem , NC , USA
| | - Wes Yin
- c University of California, Los Angeles , Los Angeles , CA , USA
| | - Desi Peneva
- a Precision Health Economics , Los Angeles , CA , USA
| | - Steve Sison
- a Precision Health Economics , Los Angeles , CA , USA
| | - Seanna Vine
- a Precision Health Economics , Los Angeles , CA , USA
| | - Clara Chen
- d Bristol-Myers Squibb , Princeton , NJ , USA
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Imai H, Sugiyama T, Tamura T, Minemura H, Kaira K, Kanazawa K, Yokouchi H, Kasai T, Kaburagi T, Minato K. A retrospective study of amrubicin monotherapy for the treatment of relapsed small cell lung cancer in elderly patients. Cancer Chemother Pharmacol 2017; 80:615-622. [PMID: 28761968 PMCID: PMC5573757 DOI: 10.1007/s00280-017-3403-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 07/21/2017] [Indexed: 11/06/2022]
Abstract
Purpose Amrubicin is one of the most active chemotherapeutic drugs for small cell lung cancer (SCLC). Previous studies reported its effectiveness and severe hematological toxicity. However, the efficacy of amrubicin monotherapy in elderly patients with SCLC has not been described. The objective of this study was to investigate the feasibility of amrubicin monotherapy in elderly patients and its efficacy for relapsed SCLC. Methods A retrospective cohort study design was used. We retrospectively evaluated the clinical effects and adverse events of amrubicin treatment in elderly (≥70 years) SCLC patients with relapsed SCLC. Results Between November 2003 and September 2015, 86 patients (aged ≥70 years) received amrubicin monotherapy for relapsed SCLC at four institutions. There were 42 cases of sensitive relapse (S) and 44 of refractory relapse (R). S cases with median age of 75 years (range 70–85 years) and R cases with median age of 74 years (range 70–84 years) were included in our analysis. The median number of treatment cycles was three (range 1–9), and the response rate was 33.7% (40.5% in the S and 27.2% in the R cases). Median progression-free survival time was 4.0 months in the S and 2.7 months in the R patients (p = 0.013). Median survival time from the start of amrubicin therapy was 7.6 months in the S and 5.5 months in the R cases (p = 0.26). The frequencies of grade ≥3 hematological toxicities were as follows: leukopenia, 60.4%; neutropenia, 74.4%; anemia, 11.6%; thrombocytopenia, 16.2%; and febrile neutropenia, 17.4%. Treatment-related death was observed in one patient. Conclusion Although hematological toxicities, particularly neutropenia, were severe, amrubicin showed favorable efficacy, not only in the S but also in the R cases, as shown in previous studies. Amrubicin could be a preferable standard treatment in elderly patients with relapsed SCLC. These results warrant further evaluation of amrubicin in elderly patients with relapsed SCLC by a prospective trial. Electronic supplementary material The online version of this article (doi:10.1007/s00280-017-3403-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, 617-1, Takahayashinishi, Ohta, Gunma, 373-8550, Japan.
| | - Tomohide Sugiyama
- Division of Thoracic Oncology, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Tomohiro Tamura
- Division of Respiratory Medicine, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | - Hiroyuki Minemura
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kyoichi Kaira
- Department of Oncology Clinical Development, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kenya Kanazawa
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan.,Clinical Oncology Center, Fukushima Medical University Hospital, Fukushima, Japan
| | - Hiroshi Yokouchi
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takashi Kasai
- Division of Thoracic Oncology, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | - Takayuki Kaburagi
- Division of Respiratory Medicine, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, 617-1, Takahayashinishi, Ohta, Gunma, 373-8550, Japan
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Shiroyama T, Tamiya M, Minami S, Takata S, Masuhiro K, Futami-Nishijima Y, Uenami T, Mori M, Koba T, Matsuki T, Takimoto T, Suzuki H, Okamoto N, Komuta K, Hirashima T, Kumanogoh A, Kijima T. Carboplatin plus weekly nanoparticle albumin-bound paclitaxel in elderly patients with previously untreated advanced squamous non-small-cell lung cancer selected based on Mini Nutritional Assessment short-form scores: a multicenter phase 2 study. Cancer Chemother Pharmacol 2017; 80:461-467. [PMID: 28688052 DOI: 10.1007/s00280-017-3385-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/03/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE This multicenter, single-arm, open-label, phase 2 study assessed the efficacy and safety of carboplatin plus weekly nanoparticle albumin-bound paclitaxel in elderly patients with previously untreated advanced squamous non-small-cell lung cancer, selected based on the Mini Nutritional Assessment short-form scores (MNA-SF). METHODS Patients received carboplatin (area under the curve: 6) on Day 1, and nanoparticle albumin-bound paclitaxel (100 mg/m2) on Days 1, 8, and 15, every 28 days for ≤4 cycles. Eligibility criteria included an MNA-SF score of ≥8 points. The primary endpoint was the objective response rate. RESULTS Thirty patients with a median age of 76 (range 70-83) years were enrolled. The objective response rate was 50.0% (95% confidence interval: 31.3-68.7%), which met the primary objective of this study. The disease control rate was 73.3% (95% CI: 54.1-87.7%). At a median follow-up of 15.0 months, the median progression-free and overall survival was 7.1 and 19.1 months, respectively. The most common treatment-related adverse event of Grade ≥3 was neutropenia (66.7%). Non-hematological adverse events of Grade ≥3 were minor. Well-nourished patients, based on the MNA-SF, experienced fewer adverse events of Grade ≥3 compared to patients at risk of malnutrition. All treatment-related adverse events were tolerable and reversible. There were no treatment-related deaths. CONCLUSIONS Carboplatin plus weekly nanoparticle albumin-bound paclitaxel is effective and well tolerated as a first-line treatment for elderly patients with advanced squamous non-small-cell lung cancer. Eligibility based on MNA-SF screening may be useful in determining acceptable toxicity.
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Affiliation(s)
- Takayuki Shiroyama
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1 Habikino, Habikino, Osaka, 583-8588, Japan.
| | - Motohiro Tamiya
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1 Habikino, Habikino, Osaka, 583-8588, Japan
| | - Seigo Minami
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | - So Takata
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | - Kentaro Masuhiro
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | | | - Takeshi Uenami
- Department of Thoracic Oncology, National Hospital Organization Toneyama National Hospital, Osaka, Japan
| | - Masahide Mori
- Department of Thoracic Oncology, National Hospital Organization Toneyama National Hospital, Osaka, Japan
| | - Taro Koba
- Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takanori Matsuki
- Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takayuki Takimoto
- Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1 Habikino, Habikino, Osaka, 583-8588, Japan
| | - Norio Okamoto
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1 Habikino, Habikino, Osaka, 583-8588, Japan
| | - Kiyoshi Komuta
- Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
| | - Tomonori Hirashima
- Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, 3-7-1 Habikino, Habikino, Osaka, 583-8588, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Kijima
- Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Osaka, Japan
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Rai A, Nastoupil LJ, Williams JN, Lipscomb J, Ward KC, Howard DH, Lee D, Flowers CR. Patterns of use and survival outcomes of positron emission tomography for initial staging in elderly follicular lymphoma patients. Leuk Lymphoma 2017; 58:1570-1580. [PMID: 27830968 PMCID: PMC5726977 DOI: 10.1080/10428194.2016.1253836] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The role of positron emission tomography (PET) in the initial assessment of follicular lymphoma (FL) has been a topic of debate. We examined the patterns of utilization of PET staging in FL and assessed the association of PET with survival. Using the SEER-Medicare database, we identified 5712 patients diagnosed with first primary FL between 2000 and 2009. Older age, African-American race, poor performance status, B-symptoms and history of anemia were negatively associated with PET staging. Receipt of PET staging was positively associated with treatment at institutions affiliated with research networks and with residence in areas with higher concentrations of nuclear medicine specialists. PET was associated with improved lymphoma-related (HR 0.69, 95% CI: 0.58-0.82) and overall (HR 0.75, 95% CI: 0.68-0.83) survival. Our findings substantiate the use of PET as the standard of care for imaging in FL patients. Further investigation is warranted to identify mechanisms underlying the apparent survival advantage associated with PET staging in FL.
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Affiliation(s)
- Ashish Rai
- Surveillance & Health Services Research Program, American Cancer Society, Atlanta, GA, USA
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kevin C. Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - David H. Howard
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Daniel Lee
- Emory University School of Medicine, Atlanta, GA, USA
| | - Christopher R. Flowers
- Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
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Lakdawalla DN, Shafrin J, Hou N, Peneva D, Vine S, Park J, Zhang J, Brookmeyer R, Figlin RA. Predicting Real-World Effectiveness of Cancer Therapies Using Overall Survival and Progression-Free Survival from Clinical Trials: Empirical Evidence for the ASCO Value Framework. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:866-875. [PMID: 28712615 DOI: 10.1016/j.jval.2017.04.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 03/23/2017] [Accepted: 04/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To measure the relationship between randomized controlled trial (RCT) efficacy and real-world effectiveness for oncology treatments as well as how this relationship varies depending on an RCT's use of surrogate versus overall survival (OS) endpoints. METHODS We abstracted treatment efficacy measures from 21 phase III RCTs reporting OS and either progression-free survival or time to progression endpoints in breast, colorectal, lung, ovarian, and pancreatic cancers. For these treatments, we estimated real-world OS as the mortality hazard ratio (RW MHR) among patients meeting RCT inclusion criteria in Surveillance and Epidemiology End Results-Medicare data. The primary outcome variable was real-world OS observed in the Surveillance and Epidemiology End Results-Medicare data. We used a Cox proportional hazard regression model to calibrate the differences between RW MHR and the hazard ratios on the basis of RCTs using either OS (RCT MHR) or progression-free survival/time to progression surrogate (RCT surrogate hazard ratio [SHR]) endpoints. RESULTS Treatment arm therapies reduced mortality in RCTs relative to controls (average RCT MHR = 0.85; range 0.56-1.10) and lowered progression (average RCT SHR = 0.73; range 0.43-1.03). Among real-world patients who used either the treatment or the control arm regimens evaluated in the relevant RCT, RW MHRs were 0.6% (95% confidence interval -3.5% to 4.8%) higher than RCT MHRs, and RW MHRs were 15.7% (95% confidence interval 11.0% to 20.5%) higher than RCT SHRs. CONCLUSIONS Real-world OS treatment benefits were similar to those observed in RCTs based on OS endpoints, but were 16% less than RCT efficacy estimates based on surrogate endpoints. These results, however, varied by tumor and line of therapy.
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Affiliation(s)
- Darius N Lakdawalla
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
| | | | - Ningqi Hou
- Precision Health Economics, Los Angeles, CA, USA
| | - Desi Peneva
- Precision Health Economics, Los Angeles, CA, USA
| | - Seanna Vine
- Precision Health Economics, Los Angeles, CA, USA
| | - Jinhee Park
- Novartis Pharmaceuticals, East Hanover, NJ, USA
| | - Jie Zhang
- Novartis Pharmaceuticals, East Hanover, NJ, USA
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81
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Bullard JT, Eberth JM, Arrington AK, Adams SA, Cheng X, Salloum RG. Timeliness of Treatment Initiation and Associated Survival Following Diagnosis of Non-Small-Cell Lung Cancer in South Carolina. South Med J 2017; 110:107-113. [PMID: 28158880 DOI: 10.14423/smj.0000000000000601] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Non-small-cell lung cancer (NSCLC) patient survival depends on a number of factors, including early diagnosis and initiation of treatment. Standard treatment options for patients with NSCLC include surgery, radiation therapy, and chemotherapy. The objective of this study was to evaluate the impact that the initiation of timely treatment has on patient survival among a cohort of privately insured patients with NSCLC in South Carolina. METHODS Data for the study were retrospectively obtained from the South Carolina Central Cancer Registry and the state health plan Blue Cross and Blue Shield claims. Patients were diagnosed as having NSCLC between January 1, 2005 and December 31, 2010, were aged 18 years or older, and were covered under the state health plan for at least 1 year before diagnosis. The final study sample included 746 patients. Kaplan-Meier curves and Cox proportional hazard modeling were conducted to examine factors associated with survival, stratified by stage at diagnosis. RESULTS The majority in the study cohort (80%) received timely (≤6 weeks) rather than untimely (>6 weeks) care (20%). The mean survival time for patients receiving timely treatment by stage was 36.9, 27.1, and 12.4 months for localized, regional, and distant metastasis, respectively. The mean survival time for patients receiving untimely care by stage was 39.4, 33.8, and 25.2 months for localized, regional, and distant metastasis, respectively. Among patients with NSCLC in the distant metastasis stage, those receiving timely treatment experienced significantly decreased survival (hazard ratio 2.2) in comparison to those receiving untimely care. CONCLUSIONS Initiation of treatment within 6 weeks is not associated with greater survival time across all stages of cancer (localized, regional, and distant metastasis). Additional research is needed to examine the impact of other treatment quality metrics on the survival of patients with NSCLC, different time thresholds for treatment initiation that may be more meaningful to survival among patients with NSCLC, and timely care among patients with NSCLC in other geographic areas and populations.
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Affiliation(s)
- Jarrod T Bullard
- From the Departments of Health Services Policy and Management and Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, the Joan C. Edwards School of Medicine and the Edwards Comprehensive Cancer Center, Marshall University, Huntington, West Virginia, and the Department of Health Outcomes and Policy, University of Florida College of Medicine, Gainesville
| | - Jan M Eberth
- From the Departments of Health Services Policy and Management and Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, the Joan C. Edwards School of Medicine and the Edwards Comprehensive Cancer Center, Marshall University, Huntington, West Virginia, and the Department of Health Outcomes and Policy, University of Florida College of Medicine, Gainesville
| | - Amanda K Arrington
- From the Departments of Health Services Policy and Management and Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, the Joan C. Edwards School of Medicine and the Edwards Comprehensive Cancer Center, Marshall University, Huntington, West Virginia, and the Department of Health Outcomes and Policy, University of Florida College of Medicine, Gainesville
| | - Swann A Adams
- From the Departments of Health Services Policy and Management and Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, the Joan C. Edwards School of Medicine and the Edwards Comprehensive Cancer Center, Marshall University, Huntington, West Virginia, and the Department of Health Outcomes and Policy, University of Florida College of Medicine, Gainesville
| | - Xi Cheng
- From the Departments of Health Services Policy and Management and Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, the Joan C. Edwards School of Medicine and the Edwards Comprehensive Cancer Center, Marshall University, Huntington, West Virginia, and the Department of Health Outcomes and Policy, University of Florida College of Medicine, Gainesville
| | - Ramzi G Salloum
- From the Departments of Health Services Policy and Management and Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, the Joan C. Edwards School of Medicine and the Edwards Comprehensive Cancer Center, Marshall University, Huntington, West Virginia, and the Department of Health Outcomes and Policy, University of Florida College of Medicine, Gainesville
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Li TT, Shore ND, Mehra M, Todd MB, Saadi R, Leblay G, Aggarwal J, Griffiths RI. Impact of subsequent metastases on costs and medical resource use for prostate cancer patients initially diagnosed with localized disease. Cancer 2017; 123:3591-3601. [DOI: 10.1002/cncr.30784] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 01/20/2017] [Accepted: 02/01/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Tracy T. Li
- Oncology Janssen Global Services; Raritan New Jersey
| | - Neal D. Shore
- Carolina Urologic Research Center; Myrtle Beach South Carolina
| | | | - Mary B. Todd
- Oncology Janssen Global Services; Raritan New Jersey
| | - Ryan Saadi
- Oncology Janssen Global Services; Raritan New Jersey
| | - Gaetan Leblay
- Oncology Janssen Global Services; Raritan New Jersey
| | | | - Robert I. Griffiths
- Boston Health Economics; Waltham Massachusetts
- Nuffield Department of Primary Care Health Sciences; University of Oxford; Oxford United Kingdom
- Department of General Internal Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland
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Swanick CW, Eifel PJ, Huo J, Meyer LA, Smith GL. Challenges to delivery and effectiveness of adjuvant radiation therapy in elderly patients with node-positive vulvar cancer. Gynecol Oncol 2017; 146:87-93. [PMID: 28506563 DOI: 10.1016/j.ygyno.2017.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/04/2017] [Accepted: 05/05/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine adjuvant radiation therapy (RT) use, patterns of RT delivery, and clinical outcomes in older patients with node-positive vulvar cancer. METHODS Using SEER-Medicare linked data, we identified 444 patients (age≥66years) with node-positive squamous cell vulvar carcinoma, without distant metastases, and treated with primary surgery between 1991 and 2009. We used claims to examine RT use and the following delivery metrics: 1) completion of ≥20 fractions, 2) treatment duration <8weeks, 3) <1week of intra-treatment break, and 4) treatment interval from surgery to start of RT <8weeks. We tested associations between RT use and metrics with overall (OS) and cause-specific survival (CSS) using multivariate proportional hazards regression. RESULTS Median age was 78years (interquartile range [IQR]=74-83). Median follow-up was 17months (IQR=9-40). Three hundred six patients (69%) received RT. Three delivery metrics were associated with improved outcomes: completion of ≥20 fractions, treatment duration <8weeks, and <1week of intra-treatment break. Patients who achieved these 3 metrics demonstrated better disease outcomes compared with surgery alone (OS hazard ratio [HR] for death=0.62, 95% confidence interval [CI]=0.46-0.82, P=0.001; CSS HR=0.58, 95% CI=0.40-0.85,P=0.005). Patients not achieving RT metrics demonstrated marginal improvements in disease outcomes over surgery alone (OS HR=0.73, 95% CI=0.55-0.99,P=0.04; CSS HR=0.76, 95% CI=0.52-1.11, P=0.16). Notably, only 51% of patients who received RT achieved all benchmarks. CONCLUSIONS In this cohort of older women with node-positive vulvar cancer, achieving metrics for RT delivery was an important factor for optimizing disease benefits from treatment.
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Affiliation(s)
- Cameron W Swanick
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Patricia J Eifel
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jinhai Huo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Larissa A Meyer
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Grace L Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
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Undertreatment trend in elderly lung cancer patients in Brazil. J Cancer Res Clin Oncol 2017; 143:1469-1475. [PMID: 28389722 DOI: 10.1007/s00432-017-2412-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 03/29/2017] [Indexed: 01/19/2023]
Abstract
PURPOSE Elderly patients with lung cancer tend to be undertreated in comparison to younger patients. The objective of this study is to compare treatment modalities offered to lung cancer patients from 70 years of age or more with patients under 70. METHODS For this study, an analytical cross-sectional epidemiological study conducted with data from the Brazilian hospital-based cancer registries between the years 2000 and 2011. In addition, odds ratios (OR) were calculated, with a 95% confidence intervals (95% CI), in conjunction with the construction of a logistic regression model. RESULTS By analyzing the records of 40,403 patients with lung cancer, we found that overall, patients from 70 years of age or more corresponded to 28.6% of the study population. Squamous cell carcinoma was the most common histological type among patients ≥70 years of age, whereas adenocarcinoma was the more prevalent type among younger patients. In comparison to younger patients, the older ones were treated less often (OR = 0.57; 95% CI: 0.52-0.62). Moreover, older patients were less likely to undergo surgery (OR = 0.69; 95% CI: 0.64-0.75), radiotherapy (OR = 0.86; 95% CI: 0.81-0.92), chemotherapy (OR = 0.61; 95% CI: 0.57-0.64), or an association of two or more treatment modalities (OR = 0.58; 95% CI: 0.54-0.62). CONCLUSION The study finds that Brazilian lung cancer patients ≥70 years of age are often undertreated and higher percentage of early death rates as compared to patients under 70. In regard to treatment, age alone should not determine whether patients with lung cancer are treated or not.
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Leduc C, Antoni D, Charloux A, Falcoz PE, Quoix E. Comorbidities in the management of patients with lung cancer. Eur Respir J 2017; 49:49/3/1601721. [PMID: 28356370 DOI: 10.1183/13993003.01721-2016] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/25/2016] [Indexed: 12/13/2022]
Abstract
Lung cancer represents a major public health issue worldwide. Unfortunately, more than half of them are diagnosed at an advanced stage. Moreover, even if diagnosed early, diagnosis procedures and treatment can be difficult due to the frequent comorbidities observed in these patients. Some of these comorbidities have a common major risk factor, i.e. smoking, whereas others are unrelated to smoking but frequently observed in the general population. These comorbidities must be carefully assessed before any diagnostic and/or therapeutic decisions are made regarding the lung cancer. For example, in a patient with severe emphysema or with diffuse lung fibrosis, transthoracic needle biopsy can be contraindicated, meaning that in some instances a precise diagnosis cannot be obtained; in a patient with chronic obstructive pulmonary disease, surgery may be impossible or should be preceded by intensive rehabilitation; patients with interstitial lung disease are at risk of radiation pneumonitis and should not receive drugs which can worsen the respiratory insufficiency. Patients who belong to what are called "special populations", e.g. elderly or HIV infected, should be treated specifically, especially regarding systemic treatment. Last but not least, psychosocial factors are of great importance and can vary from one country to another according to health insurance coverage.
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Affiliation(s)
- Charlotte Leduc
- Pneumology Dept, Nouvel Hôpital Civil, Strasbourg Cedex, France
| | - Delphine Antoni
- Radiotherapy Dept, Centre Paul Strauss, Strasbourg Cedex, France
| | - Anne Charloux
- Physiology and Functional Explorations Dept, Strasbourg Cedex, France
| | | | - Elisabeth Quoix
- Pneumology Dept, Nouvel Hôpital Civil, Strasbourg Cedex, France
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86
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Harris JP, Patel MI, Loo BW, Wakelee HA, Diehn M. A population-based comparative effectiveness study of chemoradiation regimens and sequences in stage III non-small cell lung cancer. Lung Cancer 2017. [PMID: 28625632 DOI: 10.1016/j.lungcan.2017.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES In patients receiving concurrent chemoradiation for locally advanced non-small cell lung cancer (NSCLC), consolidation chemotherapy is frequently given even though several randomized trials have failed to show a benefit. We explored the potential benefits of consolidation chemotherapy using a population-based comparative effectiveness approach. MATERIALS AND METHODS Surveillance, Epidemiology, and End Results-Medicare was used to identify patients with Stage III NSCLC aged ≥65 and diagnosed 2002-2009. We selected patients who received concurrent chemoradiotherapy and determined whether they were (concurrent-consolidation) or were not (concurrent-alone) treated with consolidation chemotherapy. Outcomes were overall and cancer specific survival using a conditional landmark analysis approach. RESULTS 1688 patients treated with concurrent-alone or concurrent-consolidation were identified with a median follow up of 29 months. Choice of chemotherapy agents did not correlate with outcome. For concurrent-consolidation versus concurrent-alone, the median overall survival was 21 months versus 18 months, respectively (log-rank p=0.008) and the median cancer specific survival was 23 months versus 19 months, respectively (log-rank p=0.03). On multivariate analysis, concurrent-consolidation remained associated with improved overall survival (HR 0.85, p=0.04), and there was a trend for improved cancer specific survival (HR 0.87, p=0.12). Inverse probability of treatment weighting using propensity scores demonstrated similar findings. Importantly, the benefit of concurrent-consolidation held only for patients treated with carboplatin-taxane but not with cisplatin-etoposide. CONCLUSION Survival outcomes were similar among the five most commonly employed platinum-based doublets. We found that patients receiving cisplatin during radiation do not appear to benefit from additional chemotherapy. However, for patients receiving carboplatin, consolidation chemotherapy was associated with improved overall and cancer specific survival.
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Affiliation(s)
- Jeremy P Harris
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Dr, MC 5847, Stanford, CA 94305, United States
| | - Manali I Patel
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, 269 Campus Dr, Stanford, CA 94305, United States
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Dr, MC 5847, Stanford, CA 94305, United States; Stanford Cancer Institute, 265 Campus Drive, Ste G2103, Stanford, CA 94305, United States
| | - Heather A Wakelee
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, 269 Campus Dr, Stanford, CA 94305, United States; Stanford Cancer Institute, 265 Campus Drive, Ste G2103, Stanford, CA 94305, United States
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Dr, MC 5847, Stanford, CA 94305, United States; Stanford Cancer Institute, 265 Campus Drive, Ste G2103, Stanford, CA 94305, United States; Institute for Stem Cell Biology and Regenerative Medicine, 265 Campus Drive, 3rd Floor Stanford, CA 94305, United States.
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87
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Lowe KA, Danese MD, Gleeson ML, Langeberg WJ, Ke J, Kelsh MA. Racial and Ethnic Variability in the Prevalence and Incidence of Comorbidities Associated with Gastric Cancer in the United States. J Gastrointest Cancer 2017; 47:168-81. [PMID: 26961791 DOI: 10.1007/s12029-016-9809-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Comorbidities are known to impact quality of life, treatment choices, and survival. Our objectives were to characterize comorbid conditions in a cohort of elderly gastric cancer patients and to determine if there is variability in the prevalence or incidence of the comorbid conditions across racial/ethnic groups. METHODS A total of 12,612 individuals, ≥66 years of age, diagnosed with gastric cancer between 2000 and 2007, and an equal number of gender- and region-matched cancer-free individuals, were identified using the National Cancer Institute's Surveillance, Epidemiology, and End Results registry linked to Medicare claims in the United States. The prevalence (%) in the year before diagnosis and the 12-month incidence rates after diagnosis were estimated for 32 chronic and ten acute comorbid conditions for the entire cohort and by race/ethnicity (Asian, Black, Hispanic, White, and other) and Asian subgroups (e.g., Chinese, Filipino, Japanese, Pacific Islander). RESULTS White and Black cases exhibited the highest prevalence of most comorbid conditions. Asian and Pacific Islander cases exhibited the lowest. There was substantial variability in the 12-month incidence of the comorbidities across the racial/ethnic groups. Electrolyte disorder was the most common incident condition among Whites and Blacks. With the exception of Whites, anemia was the most common incident condition in all racial and ethnic groups 180 days following chemotherapy. CONCLUSIONS There is variability in the prevalence and incidence in comorbidities across racial/ethnic groups.
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Affiliation(s)
| | | | | | | | - Juan Ke
- Amgen, Inc, Thousand Oaks, CA, USA
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88
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Jang J, Kim HK, Cho BC, Lee KH, Yun HJ, Woo IS, Song HS, Ryoo HM, Kim CH, Sun DS, Shin JW. Randomized phase II study comparing weekly docetaxel-cisplatin vs. gemcitabine-cisplatin in elderly or poor performance status patients with advanced non-small cell lung cancer. Cancer Chemother Pharmacol 2017; 79:873-880. [PMID: 28341958 DOI: 10.1007/s00280-017-3289-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/01/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Docetaxel/cisplatin (DP) and gemcitabine/cisplatin (GP) are standard treatment regimens for advanced non-small cell lung cancer (NSCLC). In spite of potent efficacy, the conventional 1-day DP is regarded as having more toxicity as compared with GP. There is increasing interest in a biweekly split administration of DP to reduce its toxicity. Hypothesis was that first-line biweekly DP is as safe as GP in the elderly or poor performance status (PS) patients. METHODS Chemotherapy-naïve patients with advanced NSCLC (IIIB/IV) who were elderly (65<) or PS (ECOG 2) were randomized to DP or GP arm by balancing for ECOG (0-1 vs. 2) and stage (IIIB vs. IV). DP comprised docetaxel (35 mg/m2)/cisplatin (30 mg/m2) iv on days 1 and 8, every 3 weeks. GP comprised gemcitabine (1000 mg/m2)/cisplatin (30 mg/m2) iv on days 1 and 8, every 3 weeks. Chemotherapy lasted up to 4-6 cycles or until progression. Primary endpoint was safety (proportion of grade 3/4 toxicities). Planned sample size was 49 patients in each arm. RESULTS From November 2009 to August 2012, a total of 99 patients were randomized (DP 50/GP 49) from nine institutions. Adenocarcinoma and squamous cell carcinoma were observed in 62% and 33% of patients, respectively. Toxicity profiles were comparable for both arms and the differences were not statistically significant except for anemia and leucocytopenia. Any grade of anemia (86 vs. 98%) and of leucocytopenia (18 vs. 43%) was more common in the GP arm with statistical significance. Oral mucositis tended to be predominant in the DP arm. Patients in the DP arm (51%) suffered grade 3 or higher toxicities as did 47% in the GP arm (47%). The most common grade 3 or higher toxicities were as follows: In the DP arm, neutropenia (8%), leucopenia (8%), anemia (4%), pneumonia with normal ANC (4%) and febrile neutropenia (2%) were observed. In the GP arm, anemia (15%), neutropenia (15%), pneumonia with normal ANC (4%), thrombocytopenia (4%) and leucopenia (2%) were observed. The best overall response rates (CR + PR) for the DP and GP arms were 20.0 and 21% with no CR, respectively, and disease control rates (CR + PR + SD) were 70.0 and 76%, respectively. Median progression-free survival and median overall survival were 3.7 and 14.9 months in the DP arm and 5.6 and 20.8 months in the GP arm, respectively. CONCLUSION This study showed that DP is similar to GP in terms of efficacy and toxicity in treatment of elderly or poor performance patients. Both regimens showed similar grade 3/4 toxicities with different profiles.
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Affiliation(s)
- JoungSoon Jang
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hoon-Kyo Kim
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea.
| | - Byoung Chul Cho
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hee Lee
- Department of Internal Medicine, College of Medicine Yeungnam University, Daegu, Republic of Korea
| | - Hwan-Jung Yun
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - In Sook Woo
- Department of Internal Medicine, Catholic University Yeouido St. Mary Hospital, Seoul, Republic of Korea
| | - Hong Suk Song
- Department of Internal Medicine, Dongsan Medical center, Keimyung University, Daegu, Republic of Korea
| | - Hun-Mo Ryoo
- Department of Internal Medicine, Daegu Catholic University Medical Centre, Daegu, Republic of Korea
| | - Chi-Hong Kim
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Republic of Korea
| | - Der-Sheng Sun
- Department of Internal Medicine, Uijungbu St. Mary's Hospital, The Catholic Unviersity of Korea, Uijungbu, Republic of Korea
| | - Jong Wook Shin
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Cheng R, Lu C, Zhang G, Zhang G, Zhao G. Overexpression of miR-203 increases the sensitivity of NSCLC A549/H460 cell lines to cisplatin by targeting Dickkopf-1. Oncol Rep 2017; 37:2129-2136. [DOI: 10.3892/or.2017.5505] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 12/14/2016] [Indexed: 11/05/2022] Open
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Roth JA, Goulart BHL, Ravelo A, Kolkey H, Ramsey SD. Survival Gains from First-Line Systemic Therapy in Metastatic Non-Small Cell Lung Cancer in the U.S., 1990-2015: Progress and Opportunities. Oncologist 2017; 22:304-310. [PMID: 28242792 DOI: 10.1634/theoncologist.2016-0253] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/07/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Approximately 190,000 Americans are diagnosed with non-small cell lung cancer (NSCLC) annually, and about half have metastatic (Stage IV) disease. These patients have historically had poor survival prognosis, but several new therapies introduced since 2000 provide options for improved outcomes. The objectives of this study were to quantify survival gains from 1990, when best supportive care (BSC) only was standard, to 2015 and to estimate the impact of expanded use of systemic therapies in clinically appropriate patients. MATERIALS AND METHODS We developed a simulation model to estimate survival gains for patients with metastatic NSCLC from 1990-2015. Survival estimates were derived from major clinical trials and extrapolated to a lifetime horizon. Proportions of patients receiving available therapies were derived from the Surveillance, Epidemiology, and End Results database and a commercial treatment registry. We also estimated gains in overall survival (OS) in scenarios in which systemic therapy use increased by 10% and 30% relative to current use. RESULTS From 1990-2015, one-year survival proportion increased by 14.1% and mean per-patient survival improved by 4.2 months (32,700 population life years). Increasing treated patients by 10% or 30% increased OS by 5.1 months (39,700 population life years) and 6.9 months (53,800 population life years), respectively. CONCLUSION Although survival remains poor in metastatic NSCLC relative to other common cancers, meaningful progress in per-patient and population-level outcomes has been realized over the past 25 years. These advances can be improved even further by increasing use of systemic therapies in the substantial proportion of patients who are suitable for treatment yet who currently receive BSC only. The Oncologist 2017;22:304-310 IMPLICATIONS FOR PRACTICE: Approximately 93,500 Americans are diagnosed with metastatic non-small cell lung cancer (NSCLC) annually. Historically, these patients have had poor survival prognosis, but newer therapies provide options for improved outcomes. This simulation modeling study quantified metastatic NSCLC survival gains from 1990-2015. Over this period, the one-year survival proportion and mean per-patient survival increased by 14.1% and 4.2 months, respectively. Though metastatic NSCLC survival remains poor, the past 25 years have brought meaningful gains. Additional gains could be realized by increasing systemic therapy use in the substantial proportion of patients who are suitable for treatment, yet currently receive only supportive care.
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Affiliation(s)
- Joshua A Roth
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Bernardo H L Goulart
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Holli Kolkey
- Genentech, Inc., South San Francisco, California, USA
| | - Scott D Ramsey
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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91
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Jacobson MG, Chang TY, Earle CC, Newhouse JP. Physician Agency and Patient Survival. JOURNAL OF ECONOMIC BEHAVIOR & ORGANIZATION 2017; 134:27-47. [PMID: 28133401 PMCID: PMC5260815 DOI: 10.1016/j.jebo.2016.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We investigate the role of physician agency in determining health care supply and patient outcomes. We show that an increase in health care supply due to a change in private physician incentives has a theoretically ambiguous impact on patient welfare. The increase can reflect either induced demand for ineffective care or a reduction in prior rationing of effective care. Furthermore, physician market structure matters in determining the welfare effects of changes in private physician incentives. We then analyze a change to Medicare fees that caused physicians to increase their provision of chemotherapy. We find that this increase in treatment improved patient survival, extending median life expectancy for lung cancer patients by about 18%. Consistent with the model, we find that while the treatment response was larger in less concentrated markets, survival improvements were larger in more concentrated markets.
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Affiliation(s)
| | - Tom Y Chang
- USC Marshall School of Business, Department of Finance and Business Economics
| | - Craig C Earle
- The Ontario Institute for Cancer Research, Toronto, Canada
| | - Joseph P Newhouse
- Department of Health Care Policy, Harvard Medical School, Department of Health Policy and Management, Harvard School of Public Health, Harvard Kennedy School and NBER
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92
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Influence of Age on Guideline-Concordant Cancer Care for Elderly Patients in the United States. Int J Radiat Oncol Biol Phys 2017; 98:748-757. [PMID: 28366580 DOI: 10.1016/j.ijrobp.2017.01.228] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/17/2017] [Accepted: 01/25/2017] [Indexed: 01/31/2023]
Abstract
PURPOSE To examine the frequency of guideline-concordant cancer care in elderly patients, including "older" elderly (age ≥80 years). METHODS AND MATERIALS Using the Surveillance, Epidemiology and End Results-Medicare dataset in patients aged ≥66 years diagnosed with nonmetastatic breast cancer (n=55,094), non-small cell lung (NSCLC) (n=36,203), or prostate cancer (n=86,544) from 2006 to 2011, chemotherapy, surgery, and radiation (RT) treatments were identified using claims. Pearson χ2 tested associations between age and guideline concordance. RESULTS Older patients were less likely to receive guideline-concordant curative treatment: in stage III breast cancer, receipt of postmastectomy RT (70%, 46%, and 21% in patients aged 66-79, 80-89, and ≥90 years, respectively; P<.0001); in stage I NSCLC, RT or surgery (89%, 80%, and 64% in age 66-79, 80-89, and ≥90 years; P<.0001); in stage III NSCLC, RT or surgery plus chemotherapy (79%, 58%, and 27% in age 66-79, 80-89, and ≥90 years; P<.0001); and in intermediate/high-risk prostate cancer, RT or prostatectomy (projected life expectancy >10 years: 85% and 82% in age 66-69 and 70-75 years; and ≤10 years: 70%, 42%, and 9% in age 76-79, 80-89, and ≥90 years; P<.0001). However, older patients were more likely to receive guideline-concordant de-intensified treatment: in stage I to II node-negative breast cancer, hypofractionated postlumpectomy RT (9%, 16%, and 23% in age 66-79, 80-89, and ≥90 years; P<.0001); in stage I estrogen receptor-positive breast cancer, observation after lumpectomy (12%, 42%, and 84% in age 66-79, 80-89, and ≥90 years; P<.0001); in stage I NSCLC, stereotactic body RT instead of surgery (7%, 16%, and 25% in age 66-79, 80-89, and ≥90 years; P<.0001); and in lower-risk prostate cancer, no active treatment (25%, 54%, and 68% in age 66-79, 80-89, and ≥90 years; P<.0001). CONCLUSION Actual treatment of older elderly cancer patients frequently diverged from guidelines, especially in curative treatment of advanced disease. Results suggest a need for better metrics than existing guidelines alone to evaluate quality and appropriateness of care in this population.
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93
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Juan O, Popat S. Treatment choice in epidermal growth factor receptor mutation-positive non-small cell lung carcinoma: latest evidence and clinical implications. Ther Adv Med Oncol 2017; 9:201-216. [PMID: 28344665 DOI: 10.1177/1758834016687262] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/09/2016] [Indexed: 12/21/2022] Open
Abstract
Discovery of sensitizing mutations in epidermal growth factor receptor (EGFR) and the subsequent development of EGFR tyrosine kinase inhibitors (TKIs) have substantially changed the treatment of lung cancer. First-line treatment with EGFR TKIs (gefitinib, erlotinib and afatinib) has demonstrated a superior response rate and progression-free survival (PFS) compared with chemotherapy in EGFR-mutation positive patients. However, a number of open questions remain, such as choice between the three EGFR TKIs licensed, treatment of patients unsuitable for chemotherapy due to morbidity or advanced age, management of acquired resistance and optimal biological sample to determine EGFR status. Recently the first head-to-head trial comparing gefitinib and afatinib (LUX-Lung 7) has been reported. Moreover, third-generation EGFR TKIs such as osimertinib, rociletinib, olmutinib and ASP8273, with preferential activity against T790M mutant tumours, the commonest resistance mechanism to EGFR TKIs, have shown promising results in early clinical trials, with osimertinib now licensed. In this review, we summarize latest advances in the treatment of EGFR-mutation positive patients focusing on controversial areas and emerging challenges to optimally treat these patients in the future.
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Affiliation(s)
- Oscar Juan
- Department of Medical Oncology, University Hospital La Fe, Valencia, Spain
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94
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Huerter MM, Meza JL, Copur MS, Tolentino A, Marr AS, Ketcham M, DeSpiegelaere H, Kruse S, Kos ME, Swenson K, Radniecki SE, Kessinger A, Ganti AK. Weekly vinorelbine and paclitaxel in older patients with advanced non-small cell lung cancer: A phase II Fred and Pamela Buffet Cancer Center Clinical Trials Network study. J Geriatr Oncol 2017; 8:18-22. [DOI: 10.1016/j.jgo.2016.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/02/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
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95
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Gajra A. Designing geriatric-specific trials in advanced lung cancer: What, who and how to study? J Geriatr Oncol 2016; 8:16-17. [PMID: 27993461 DOI: 10.1016/j.jgo.2016.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ajeet Gajra
- Upstate Medical University, 750 E Adams Street, Syracuse, NY 13210, United States.
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96
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Ip E, Pokorny AMJ, Della-Fiorentina S, Beale P, Bray V, Kiely BE, Blinman P. Use of palliative chemotherapy in patients aged 80 years and over with incurable cancer: experience at three Sydney cancer centres. Intern Med J 2016; 47:75-81. [PMID: 27749003 DOI: 10.1111/imj.13296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/23/2016] [Accepted: 10/11/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Octogenarians represent a growing population reviewed in medical oncology clinics, yet there is a paucity of data on how chemotherapy is tolerated in this age group. AIM To describe the use of palliative first-line chemotherapy in patients 80 years and over and factors associated with its use. METHODS We identified all new patients aged 80 years or older diagnosed with incurable advanced solid organ cancer and seen in one of three Sydney medical oncology outpatient clinics between January 2009 and December 2013. Patient, disease and treatment details were summarised and factors associated with chemotherapy use explored. RESULTS Of 420 eligible patients, 100 (24%) started first-line chemotherapy. Younger age at diagnosis was the only factor associated with receiving chemotherapy (median 82.9 vs 84.1 years, P = 0.002). A total of 78% of patients had single-agent chemotherapy, and 41% received a full dose for the first cycle. During treatment, 54% experienced toxicity, necessitating dose reduction, delay or omission, and 32% were hospitalised. These events were associated with receipt of combination chemotherapy (OR 5.1; P = 0.04) and full-dose chemotherapy for cycle 1 (OR 3.5; P = 0.02). Radiological disease control was achieved in 60%. Chemotherapy was stopped because of progressive disease (48%), toxicity (37%) or completion of planned course (17%). CONCLUSION A quarter of patients 80 years and older received first-line palliative chemotherapy. Despite most receiving a modified dose, one third were hospitalised during treatment. These findings highlight the need for careful clinical assessment and selection of older cancer patients for chemotherapy.
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Affiliation(s)
- E Ip
- Department of Medical Oncology, Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, New South Wales, Australia
| | - A M J Pokorny
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - S Della-Fiorentina
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - P Beale
- Department of Medical Oncology, Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - V Bray
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, New South Wales, Australia
| | - B E Kiely
- Department of Medical Oncology, Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - P Blinman
- Department of Medical Oncology, Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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97
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Mansson JV, Alves FD, Biolo A, Souza GC. Use of ghrelin in cachexia syndrome: a systematic review of clinical trials. Nutr Rev 2016; 74:659-669. [DOI: 10.1093/nutrit/nuw029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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98
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Danese MD, Griffiths RI, Gleeson ML, Dalvi T, Li J, Mikhael JR, Deeter R, Dreyling M. Second-line therapy in diffuse large B-cell lymphoma (DLBCL): treatment patterns and outcomes in older patients receiving outpatient chemotherapy. Leuk Lymphoma 2016; 58:1094-1104. [PMID: 27659997 DOI: 10.1080/10428194.2016.1228924] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Using SEER-Medicare linked data we identified elderly patients diagnosed with diffuse large B-cell lymphoma (DLBCL) between January 2000 and December 2007 who received second-line outpatient chemotherapy for relapsed or refractory disease. Second-line regimens were classified into three mutually exclusive groups: aggressive, conventional, and palliative. Of the 632 (426 relapsed, 206 refractory) patients in the cohort, 27.8% received aggressive second-line therapy, 39.1% received conventional therapy, and 33.1% received palliative therapy. There were no differences in survival by type of therapy received, either for relapsed or refractory patients, although the patient risk profile differed significantly. However, duration of remission, male gender, and anemia at diagnosis were important predictors in relapsed patients, and male gender, B-symptoms, comorbidity burden, and poverty status were important predictors in refractory patients. Survival in elderly patients receiving second-line therapy remains poor, and the 24-month cost of all care exceeds $97,000. Patients would benefit from improved treatment options.
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Affiliation(s)
- Mark D Danese
- a Outcomes Insights, Inc , Westlake Village , CA , USA
| | - Robert I Griffiths
- a Outcomes Insights, Inc , Westlake Village , CA , USA.,b University of Oxford , Oxford , UK.,c Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | | | | | - Jingyi Li
- d AstraZeneca , Gaithersburg , MD , USA
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Tan HJ, Chamie K, Daskivich TJ, Litwin MS, Hu JC. Patient function, long-term survival, and use of surgery in patients with kidney cancer. Cancer 2016; 122:3776-3784. [PMID: 27518165 DOI: 10.1002/cncr.30275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 07/25/2016] [Accepted: 07/29/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Beyond age and comorbidity, functionality can shape the long-term survival potential of patients with cancer. Accordingly, herein the authors compared mortality and receipt of cancer-directed surgery according to patient function among older adults with kidney cancer. METHODS Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2000 through 2009, the authors studied 28,326 elderly subjects with primary kidney cancer. Patient function was quantified using function-related indicators, claims indicative of dysfunction and disability. Adjusting for patient and cancer characteristics, competing risk regression was used to assess the relationship between function-related indicator count and cause-specific mortality and then generalized estimating equations were used to quantify the probability of surgery. RESULTS A total of 13,619 adult patients (48.1%) with at least 1 function-related indicator were identified. A higher indicator category was associated with older age, greater comorbidity, female sex, unmarried status, lower socioeconomic status, and higher stage of disease (P<.001). Compared with patients with an indicator count of 0, those with an indicator count of 1 (hazard ratio, 1.10; 95% confidence interval [95% CI], 1.04-1.16) and ≥2 (hazard ratio, 1.46; 95% CI, 1.39-1.53) were found to have higher other-cause mortality. Conversely, kidney cancer mortality varied minimally with patient function. Patients with ≥ 2 indicators received cancer-directed surgery less often than those without disability (odds ratio, 0.61; 95% CI, 0.56-0.66), although treatment probabilities remained high for patients with locoregional disease and low for those with metastatic cancer. CONCLUSIONS Among older adults with kidney cancer, functional health stands as a significant predictor of long-term survival. However, receipt of cancer-directed surgery appears largely determined by cancer stage. Patient function should be considered more heavily when determining treatment for older adults with kidney cancer. Cancer 2016;122:3776-3784. © 2016 American Cancer Society.
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Affiliation(s)
- Hung-Jui Tan
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Karim Chamie
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | | | - Mark S Litwin
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.,Department of Health Policy and Management, University of California at Los Angeles Fielding School of Public Health, Los Angeles, California.,University of California at Los Angeles School of Nursing, Los Angeles, California
| | - Jim C Hu
- Department of Urology, Weill Cornell School of Medicine, New York, New York
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Assessment of Referral and Chemotherapy Treatment Patterns for Elderly Patients With Non-small-Cell Lung Cancer. Clin Lung Cancer 2016; 17:563-572.e2. [PMID: 27374398 DOI: 10.1016/j.cllc.2016.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 05/31/2016] [Accepted: 05/31/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Physiologic changes of aging in combination with greater comorbidity could lead to treatment nihilism for elderly patients (≥ 70 years old) with non-small-cell lung cancer (NSCLC). Randomized trials have shown improved survival with chemotherapy since 1999, but it remains unclear whether these data have translated into practice. PATIENTS AND METHODS We conducted a retrospective, population-based cohort study of NSCLC cases diagnosed in Ontario, Canada from 2000 to 2010. We compared referral and treatment patterns among patients aged < 70 versus ≥ 70 years. Multivariable analyses evaluated predictors of referral to medical oncology or treatment with chemotherapy. RESULTS Of 61,646 patients with NSCLC, 32,131 (52.1%) were ≥ 70 years. Fewer adenocarcinomas were diagnosed in the elderly (29.8% vs. 44%), and more elderly patients lacked microscopic confirmation of malignancy (20.1% vs. 6.2%). Charlson co-morbidity scores ≥ 2 (14.0% vs. 7.4%) were higher in the elderly. Only 59.5% of elderly patients with NSCLC were referred to a medical oncologist, versus 78.5% of younger patients. Elderly patients were less likely to receive chemotherapy (18.3% vs. 46.7%), even among those referred to a medical oncologist (30.1% vs. 58.6%). Neither referral nor treatment changed substantially over time. The elderly also had a shorter median survival (5.8 vs. 9.6 months); however, there was less difference in median survival (13.6 vs. 14.9 months) among patients receiving chemotherapy. CONCLUSION Elderly patients are less likely to be considered for systemic therapy for NSCLC, and evidence of benefit has had minimal impact on practice. We believe this disparity could be improved through systematically using tools to comprehensively assess elderly patients.
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