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Blanco R, Dómine M, González JL, Loutfi S, Alfaro J, Saldaña J, Rubio J, Campos B, Hidalgo J, Barba A, Márquez D, Martin M, Olaverri A, Nadal E. Pembrolizumab as first-line treatment for advanced NSCLC in older adults: A phase II clinical trial evaluating geriatric and quality-of-life outcomes. Lung Cancer 2023; 183:107318. [PMID: 37557022 DOI: 10.1016/j.lungcan.2023.107318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVES Since specific data on immunotherapy in older adults with advanced non-small cell lung cancer (aNSCLC) are scarce, we designed this study to determine the overall survival (OS) at one year of first-line pembrolizumab in patients older than 70 years with aNSCLC expressing PD-L1. Secondary objectives included progression-free survival, disease-specific survival, response rate, tolerability, quality of life (QoL) changes, and geriatric assessments. MATERIALS AND METHODS A single-arm, open-label, phase II clinical trial was carried out by the Spanish Lung Cancer Group between February 2018 and November 2019 at ten active sites in Spain. We included patients 70 years old and older with histological or cytological documented stage IIIB or IV aNSCLC and PD-L1 expression ≥ 1%. Each subject received 200 mg of intravenous pembrolizumab every three weeks for a maximum of two years. RESULTS 83 patients were recruited for the study and 74 were finally analysed. Most were male (N = 64, 86.5%) and former smokers (N = 51, 68.9%). 24 patients (32.4%) completed at least one year of treatment, 62 (83.7%) discontinued treatment, and 30 (40.5%) experienced disease progression. The median follow-up of our cohort was 18.0 months [range: 0.1-47.7] and 46 patients (62.2%) died during the period of study. The estimated OS at one year was 61.7% (95% CI: 49.6-71.8%) and the median OS of our cohort was 19.2 months (95% CI: 11.3-25.5). QoL tended to improve throughout the study, although the differences were not statistically significant. The main geriatric scores remained stable, except for a worsening in nutritional status (P = 0.004) and an improvement in frailty (P = 0.028). CONCLUSION Our results support treating older adults with aNSCLC expressing PD-L1 with pembrolizumab in monotherapy. The stability of most geriatric scores and the positive trend on the patients' QoL should be highlighted, although our results did not reach statistical significance.
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Affiliation(s)
- Remei Blanco
- Department of Medical Oncology, Consorci Sanitari de Terrassa, Terrassa, Spain.
| | - Manuel Dómine
- Department of Medical Oncology, Hospital Universitario Fundación Jiménez Díaz. IIS-FJD, Madrid, Spain
| | - José Luis González
- Department of Medical Oncology, Hospital Clínico San Carlos, Madrid, Spain
| | - Sami Loutfi
- Department of Geriatrics, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Jordi Alfaro
- Department of Medical Oncology, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Juana Saldaña
- Department of Medical Oncology, Oncobell Program, Institut Català d'Oncologia (ICO), IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Jaime Rubio
- Department of Medical Oncology, Hospital Universitario Fundación Jiménez Díaz. IIS-FJD, Madrid, Spain
| | - Begoña Campos
- Department of Medical Oncology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Julia Hidalgo
- Department of Medical Oncology, Hospital Lluis Alcanyís de Xàtiva, Valencia, Spain
| | - Andrés Barba
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Diego Márquez
- Department of Medical Oncology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Maria Martin
- Department of Medical Oncology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Amaya Olaverri
- Department of Medical Oncology, Hospital Virgen de la Luz, Cuenca, Spain
| | - Ernest Nadal
- Department of Medical Oncology, Oncobell Program, Institut Català d'Oncologia (ICO), IDIBELL, L'Hospitalet de Llobregat, Spain
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Faaij M, Schoormans D, Pearce A. Work, daily activities and leisure after cancer. Eur J Cancer Care (Engl) 2022; 31:e13596. [PMID: 35451156 PMCID: PMC9542011 DOI: 10.1111/ecc.13596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 03/29/2022] [Accepted: 04/05/2022] [Indexed: 11/27/2022]
Abstract
Objective Determine if cancer survivors have lower participation in paid work, more limitations in daily activities or more limitations in leisure compared with those without cancer, stratified by age (working age ≤65 years; retirement age >65 years). Secondary objectives are identifying sociodemographic or clinical factors associated with work, daily activities or leisure and analysis of the relationship between work, daily activities and leisure. Methods Secondary analyses, using logistic regression, were performed on three cohorts (lymphoma, prostate and thyroid cancer) from the Dutch Patient Reported Outcomes Following Initial treatment and Long‐term Evaluation of Survivorship (PROFILES) registry and a nationally representative non‐cancer sample. Results Working‐age cancer survivors (n = 926) were significantly (p < 0.001) less likely to participate in paid work and more likely to report limitations in daily activities and leisure compared to the non‐cancer cohort (n = 1279). Among retirement aged cancer survivors (n = 1046), paid work was significantly more likely (p < 0.001), as were limitations in leisure (p < 0.05), compared with the non‐cancer controls (n = 334). Conclusions Cancer impacts daily activities and leisure, as well as paid work. These roles are important for cancer survivors' quality of life, suggesting support to return to these activities may be an important component of survivorship care.
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Affiliation(s)
- Marjon Faaij
- University Utrecht, Utrecht, The Netherlands.,Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Dounya Schoormans
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Alison Pearce
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Engels C, Segaux L, Canouï-Poitrine F. Occupational disruptions during lockdown, by generation: A European descriptive cross-sectional survey. Br J Occup Ther 2021. [DOI: 10.1177/03080226211057842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The periods of lockdown during 2020 led to changes in daily occupations. As participation relies on dynamic interactions between the person, his/her occupations and his/her environment, we wondered whether people from different generations shared the same perception of occupational disruptions during the lockdown. Methods We performed an online survey based on the Canadian Occupational Performance Measure (COPM) of adults in 27 European Union countries, the United Kingdom and Switzerland. Three groups were compared: young adults (YAs, aged 18–39), middle-aged adults (MAs, aged 40–59) and older adults (OAs, aged 60 and over). Results 2865 participants (YAs: 47%; MAs: 33%; OAs: 20%) reported a total of 6549 disrupted occupations. The most frequently disrupted domain was leisure (83%), followed by productivity (16%) and self-care (2%); there were no significant intergroup differences ( p = 0.18). In a multivariate analysis, socializing disruptions were more likely to be associated with younger age (adjusted odds ratio (OR) [95% confidence interval (CI)] = 0.62 [0.50–0.76] for YAs versus MAs and 0.46 [0.30–0.71] for YAs versus OAs. Conclusion With the exception of socializing, the main disrupted occupations were similar from one generation to another. Our findings might enable the more accurate assessment of the risk of occupational disruption in a restrictive environment.
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Affiliation(s)
- Cynhia Engels
- INSERM, IMRB, CEpiA Team, Univ Paris Est Creteil, Creteil, France
- Faculty of health, Univ Paris Est Créteil, Creteil, France
| | - Lauriane Segaux
- INSERM, IMRB, CEpiA Team, Univ Paris Est Creteil, Creteil, France
- Hôpitaux Henri-Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Creteil, France
| | - Florence Canouï-Poitrine
- INSERM, IMRB, CEpiA Team, Univ Paris Est Creteil, Creteil, France
- Hôpitaux Henri-Mondor, Assistance Publique Hôpitaux de Paris (AP-HP), Creteil, France
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