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Mansour N, Heinrich K, Zhang D, Winkelmann M, Ingenerf M, Gold L, Klambauer K, Rudelius M, Klauschen F, von Bergwelt-Baildon M, Ricke J, Heinemann V, Westphalen CB, Kunz WG. Patient eligibility for trials with imaging response assessment at the time of molecular tumor board presentation. Cancer Imaging 2024; 24:70. [PMID: 38849902 PMCID: PMC11157753 DOI: 10.1186/s40644-024-00708-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 05/11/2024] [Indexed: 06/09/2024] Open
Abstract
PURPOSE To assess the eligibility of patients with advanced or recurrent solid malignancies presented to a molecular tumor board (MTB) at a large precision oncology center for inclusion in trials with the endpoints objective response rate (ORR) or duration of response (DOR) based on Response Evaluation Criteria in Solid Tumors (RECIST version 1.1). METHODS Prospective patients with available imaging at the time of presentation in the MTB were included. Imaging data was reviewed for objectifiable measurable disease (MD) according to RECIST v1.1. Additionally, we evaluated the patients with MD for representativeness of the identified measurable lesion(s) in relation to the overall tumor burden. RESULTS 262 patients with different solid malignancies were included. 177 patients (68%) had MD and 85 (32%) had non-measurable disease (NMD) at the time point of MTB presentation in accordance with RECIST v1.1. MD was not representative of the overall tumor burden in eleven patients (6%). The main reasons for NMD were lesions with longest diameter shorter than 10 mm (22%) and non-measurable peritoneal carcinomatosis (18%). Colorectal cancer and malignant melanoma displayed the highest rates of MD (> 75%). In contrast, gastric cancer, head and neck malignancies, and ovarian carcinoma had the lowest rates of MD (< 55%). In case of MD, the measurable lesions were representative of the overall tumor burden in the vast majority of cases (94%). CONCLUSION Approximately one third of cancer patients with advanced solid malignancies are not eligible for treatment response assessment in trials with endpoints ORR or DOR at the time of MTB presentation. The rate of patients eligible for trials with imaging endpoints differs significantly based on the underlying malignancy and should be taken under consideration during the planning of new precision oncology trials.
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Affiliation(s)
- Nabeel Mansour
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Kathrin Heinrich
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Cancer Center München-LMU (CCCM LMU), LMU Munich, Munich, Germany
| | - Danmei Zhang
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Cancer Center München-LMU (CCCM LMU), LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK partner site Munich), Heidelberg, Germany
| | - Michael Winkelmann
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Maria Ingenerf
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Lukas Gold
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Konstantin Klambauer
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Martina Rudelius
- Institute of Pathology, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Frederick Klauschen
- Institute of Pathology, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Michael von Bergwelt-Baildon
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Cancer Center München-LMU (CCCM LMU), LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK partner site Munich), Heidelberg, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Volker Heinemann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Cancer Center München-LMU (CCCM LMU), LMU Munich, Munich, Germany
| | - C Benedikt Westphalen
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Cancer Center München-LMU (CCCM LMU), LMU Munich, Munich, Germany
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
- Comprehensive Cancer Center München-LMU (CCCM LMU), LMU Munich, Munich, Germany.
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Furqan M, Karanth S, Goyal RK, Cai B, Rombi J, Davis KL, Caro N, Saliba T. Effectiveness of standard treatments in non-small-cell lung cancer with METexon14 skipping mutation: a real-world study. Future Oncol 2024; 20:1553-1563. [PMID: 38629593 DOI: 10.2217/fon-2023-1064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/06/2024] [Indexed: 06/12/2024] Open
Abstract
Aim: To assess real-world clinical outcomes with standard therapies for advanced non-small-cell lung cancer (aNSCLC) with METexon14 skipping mutation (METex14).Methods: In an oncologists-led retrospective review of medical records, data were abstracted and analyzed for patients initiating first-line (1L) systemic therapy after 1 January 2017.Results: In total 287 aNSCLC patients with METex14, the real-world best overall response rate was 73.4% for capmatinib (n = 146), 68.8% for immunotherapy (IO) monotherapy (n = 48), 52.0% for chemotherapy (CT, n = 30), and 54.8% for IO + CT (n = 63). As compared with capmatinib, patients receiving IO (hazard ratio [HR]: 1.57; 95% CI: 0.77-3.20; p = 0.220), CT (HR: 2.41; 95% CI: 1.19-4.85; p = 0.014) and IO + CT (HR: 2.33; 95% CI: 1.35-4.04; p = 0.003) had higher rates of progression. Further, patients receiving CT (HR: 4.43; 95% CI: 1.54-12.75; p = 0.006) and IO + CT (HR: 3.53, 95% CI: 1.41-8.85; p = 0.007) had higher rates of mortality than patients receiving capmatinib.Conclusion: The study showed better clinical outcomes with capmatinib than other standard therapies in 1L setting for aNSCLC harboring METex14.
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Affiliation(s)
- Muhammad Furqan
- University of Iowa Hospitals & Clinics, Carver College of Medicine, Iowa City, IA 52242, USA
| | | | - Ravi K Goyal
- RTI Health Solutions, Research Triangle Park, NC 27709, USA
| | - Beilei Cai
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
| | - Julien Rombi
- RTI Health Solutions, Research Triangle Park, NC 27709, USA
| | - Keith L Davis
- RTI Health Solutions, Research Triangle Park, NC 27709, USA
| | - Nydia Caro
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
| | - Teddy Saliba
- Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936, USA
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Lerro CC, Bradley MC, Forshee RA, Rivera DR. The Bar Is High: Evaluating Fit-for-Use Oncology Real-World Data for Regulatory Decision Making. JCO Clin Cancer Inform 2024; 8:e2300261. [PMID: 38241598 PMCID: PMC10807892 DOI: 10.1200/cci.23.00261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/21/2024] Open
Affiliation(s)
- Catherine C. Lerro
- Oncology Center of Excellence, Office of the Commissioner, US Food and Drug Administration, Silver Spring, MD
| | - Marie C. Bradley
- Office of Medical Policy, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
| | - Richard A. Forshee
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
| | - Donna R. Rivera
- Oncology Center of Excellence, Office of the Commissioner, US Food and Drug Administration, Silver Spring, MD
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Paik PK, Goyal RK, Cai B, Price MA, Davis KL, Ansquer VD, Caro N, Saliba TR. Real-world outcomes in non-small-cell lung cancer patients with MET Exon 14 skipping mutation and brain metastases treated with capmatinib. Future Oncol 2023; 19:217-228. [PMID: 36749292 DOI: 10.2217/fon-2022-1133] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: To assess real-world clinical outcomes in patients with non-small-cell lung cancer with MET exon 14 skipping mutation and brain metastases (BM) who received capmatinib, a recently approved MET inhibitor, in routine US clinical practice. Materials & methods: Patient data were collected using a retrospective medical record review, led by participating oncologists. Eligible patients initiated treatment with capmatinib in any line, after BM diagnosis, between May 2020 and June 2021. Data on real-world overall response rate (rwORR) and real-world progression-free survival (rwPFS) were descriptively analyzed. Results: 68 eligible patients were analyzed. In patients treated with first-line (1L) capmatinib (n = 55), the rwORR was 90.9% systemically and 87.3% intracranially; median systemic rwPFS was 14.1 months. Among radiation-naive patients on 1L capmatinib (n = 20), rwORR was 85.0%, both systemically and intracranially; median systemic rwPFS was 14.1 months. Conclusion: This study showed substantial systemic and intracranial effectiveness for capmatinib in real-world setting; findings were consistent for RT-naive patients.
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Affiliation(s)
- Paul K Paik
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Manhattan, NY 10065, USA.,Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
| | - Ravi K Goyal
- RTI Health Solutions, 3040 E Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Beilei Cai
- Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hanover, NJ 07936, USA
| | - Mark A Price
- RTI Health Solutions, 3040 E Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Keith L Davis
- RTI Health Solutions, 3040 E Cornwallis Road, Research Triangle Park, NC 27709, USA
| | | | - Nydia Caro
- Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hanover, NJ 07936, USA
| | - Teddy R Saliba
- Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hanover, NJ 07936, USA
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Ton TG, Pal N, Trinh H, Mahrus S, Bretscher MT, Machado RJ, Sadetsky N, Chaudhary N, Lu MW, Riely GJ. Replication of Overall Survival, Progression-Free Survival, and Overall Response in Chemotherapy Arms of Non-Small Cell Lung Cancer Trials Using Real-World Data. Clin Cancer Res 2022; 28:2844-2853. [PMID: 35511917 PMCID: PMC9355621 DOI: 10.1158/1078-0432.ccr-22-0471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE The utility of real-world data (RWD) for use as external controls in drug development is informed by studies that replicate trial control arms for different endpoints. The purpose of this study was to replicate control arms from four non-small cell lung cancer (NSCLC) randomized controlled trials (RCT) to analyze overall survival (OS), progression-free survival (PFS), and overall response rate (ORR) using RWD. PATIENTS AND METHODS This study used RWD from a nationwide de-identified database and a clinico-genomic database to replicate OS, PFS, and ORR endpoints in the chemotherapy control arms of four first-line NSCLC RCTs evaluating atezolizumab [IMpower150-wild-type (WT), IMpower130-WT, IMpower131, and IMpower132]. Additional objectives were to develop a definition of real-world PFS (rwPFS) and to evaluate the real-world response rate (rwRR) endpoint. RESULTS Baseline demographic and clinical characteristics were balanced after application of propensity score weighting methods. For rwPFS and OS, RWD external controls were generally similar to their RCT control counterparts. Across all four trials, the hazard ratio (HR) point estimates comparing trial controls with external controls were closer to 1.0 for the PFS endpoint than for the OS endpoint. An exploratory assessment of rwRR in RWD revealed a slight but nonsignificant overestimation of RCT ORR, which was unconfounded by baseline characteristics. CONCLUSIONS RWD can be used to reasonably replicate the OS and PFS of chemotherapy control arms of first-line NSCLC RCTs. Additional studies can provide greater insight into the utility of RWD in drug development.
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Affiliation(s)
- Thanh G.N. Ton
- Genentech, Inc., South San Francisco, California
- Corresponding Author: Thanh G.N. Ton, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080. Phone: 206-375-9710; E-mail:
| | - Navdeep Pal
- Genentech, Inc., South San Francisco, California
| | - Huong Trinh
- Genentech, Inc., South San Francisco, California
| | - Sami Mahrus
- Genentech, Inc., South San Francisco, California
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A Retrospective Cohort Study of Treatment Outcomes of Adult Patients With Relapsed or Refractory Follicular Lymphoma (ReCORD-FL). Hemasphere 2022; 6:e745. [PMID: 35813099 PMCID: PMC9263496 DOI: 10.1097/hs9.0000000000000745] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/20/2022] [Indexed: 11/04/2022] Open
Abstract
This study (ReCORD-FL) sought to construct a historical control cohort to augment single-arm trials in relapsed/refractory follicular lymphoma (r/r FL). A retrospective study in 10 centers across North America and Europe was conducted. Adults with grade 1–3A FL were required to be r/r after ≥2 therapy lines including an anti-CD20 and an alkylator. After first becoming r/r, patients were required to initiate ≥1 additional therapy line, which defined the study index date. Endpoints were observed from start of each therapy line (including index line) until death, last follow-up, or December 31, 2020. Endpoints were complete response (CR) rate, overall response rate (ORR), time to next treatment or death (TNT-D), event-free survival (EFS), and overall survival (OS). One hundred eighty-seven patients were identified. Most patients’ (80.2%) index therapy occurred in third line (3L) (range, 3L–6L). Median follow-up from FL diagnosis was 9 years (range, 1–21 years). CR and ORR to the index therapy were 39.0% and 70.6%, respectively. Median (95% confidence interval) EFS from index was 14.6 (11.0-18.0) months; median OS from index was 10.6 years. Outcomes worsened across successive treatment lines and for patients who were double refractory (r/r to both an anti-CD20 monoclonal antibody and an alkylator) or POD24 (progressed ≤24 months after front-line anti-CD20) at index. Findings demonstrate the unmet need of FL patients with multiply relapsed, double refractory, or POD24 disease. Based on robustness of the historical data collected and comparability with a previous study (SCHOLAR-5), ReCORD-FL presents a valuable source of control data for comparative studies in r/r FL.
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Ma X, Bellomo L, Hooley I, Williams T, Samant M, Tan K, Segal B, Bourla AB. Concordance of Clinician-Documented and Imaging Response in Patients With Stage IV Non-Small Cell Lung Cancer Treated With First-Line Therapy. JAMA Netw Open 2022; 5:e229655. [PMID: 35552726 PMCID: PMC9099424 DOI: 10.1001/jamanetworkopen.2022.9655] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE In observational oncology studies of solid tumors, response to treatment can be evaluated based on electronic health record (EHR) documentation (clinician-assessed response [CAR]), an approach different from standardized radiologist-measured response (Response Evaluation Criteria in Solid Tumours [RECIST] 1.1). OBJECTIVE To evaluate the feasibility of an imaging response based on RECIST (IRb-RECIST) and the concordance between CAR and imaging response based on RECIST assessments, and investigate discordance causes. DESIGN, SETTING, AND PARTICIPANTS This cohort study used an EHR-derived, deidentified database that included patients with stage IV non-small cell lung cancer (NSCLC) diagnosed between January 1, 2011, to June 30, 2019, selected from 3 study sites. Data analysis was conducted in August, 2020. EXPOSURES Undergoing first-line therapy and imaging assessments of response to treatment. MAIN OUTCOMES AND MEASURES In this study, CAR assessments (referred to in prior publications as "real-world response" [rwR]) were defined as clinician-documented changes in disease burden at radiologic evaluation time points; they were abstracted manually and assigned to response categories. The RECIST-based assessments accommodated routine practice patterns by using a modified version of RECIST 1.1 (IRb-RECIST), with independent radiology reads. Concordance was calculated as the percent agreement across all response categories and across a dichotomous stratification (response [complete or partial] vs no response), unconfirmed or confirmed. RESULTS This study found that, in 100 patients evaluated for concordance, agreement between CAR and IRb-RECIST was 71% (95% CI, 61%-80%), and 74% (95% CI, 64%-82%) for confirmed and unconfirmed response, respectively. There were more responders using CAR than IRb-RECIST (40 vs 29 with confirmation; 64 vs 43 without confirmation). The main sources of discordance were the different use of thresholds for tumor size changes by RECIST vs routine care, and unavailable baseline or follow-up scans resulting in inconsistent anatomic coverage over time. CONCLUSIONS AND RELEVANCE In this cohort study of patients with stage IV NSCLC, we collected routine-care imaging, showing the feasibility of response evaluation using IRb-RECIST criteria with independent centralized review. Concordance between CAR and centralized IRb-RECIST was moderate. Future work is needed to evaluate the generalizability of these results to broader populations, and investigate concordance in other clinical settings.
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Affiliation(s)
- Xinran Ma
- Flatiron Health, Inc, New York, New York
| | | | - Ian Hooley
- Flatiron Health, Inc, New York, New York
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Vo TT, Espirito JL, Boyd M, Gumuscu B, Chirovsky D, Robert NJ, Swaby RF, Zhou W, Cowey CL. Real-world outcomes of systemic therapy in locally advanced, recurrent or metastatic cutaneous squamous cell carcinoma. Future Oncol 2022; 18:2087-2099. [PMID: 35240857 DOI: 10.2217/fon-2021-1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Real-world treatment patterns and clinical outcomes in advanced cutaneous squamous cell carcinoma were evaluated. Methods: Adults receiving their first systemic therapy for unresectable, locally advanced or recurrent/metastatic cutaneous squamous cell carcinoma from 4 September 2014, to 30 June 2017, were evaluated. The primary end point was real-world overall response rate per Response Evaluation Criteria in Solid Tumors or physician assessment. Time-to-event outcomes were assessed using the Kaplan-Meier method. Results: Of 51 eligible patients, the median age was 76 years, 80% were male and 65% had an Eastern Cooperative Oncology Group score of 0-1. The most common regimens were cetuximab (51%) and carboplatin + paclitaxel (22%). Median real-world overall response rate ranged from 9.8% per Response Evaluation Criteria in Solid Tumors to 43.1% when supplemented by physician assessment. Median overall survival was 10.7 months, and median time to next treatment was 7.5 months. Conclusion: Survival in advanced cutaneous squamous cell carcinoma was short. Real-world overall response rate was lower with Response Evaluation Criteria in Solid Tumors than physician assessment.
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Affiliation(s)
- Thao T Vo
- Merck and Co., Inc., Kenilworth, NJ 07033, USA
| | | | | | | | | | | | | | - Wei Zhou
- Merck and Co., Inc., Kenilworth, NJ 07033, USA
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The use of topical ALA-photodynamic therapy combined with induction chemotherapy for locally advanced oral squamous cell carcinoma. Am J Otolaryngol 2021; 42:103112. [PMID: 34214712 DOI: 10.1016/j.amjoto.2021.103112] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/10/2021] [Accepted: 06/13/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUNDS Platinum-based induction chemotherapy (ICT) confers benefits in suitable patients with locally advanced head and neck squamous cell carcinoma (HNSCC). Additionally, the application of a proper local approach can not only promote the survival quality and alleviate the suffering, but also improve the resectability in patients with advanced malignant tumor. 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is a promising minimally invasive therapy and has shown good efficacy in the treatment of patients bearing precancerous lesions and oral squamous cell carcinoma (OSCC). The aim of the study was to evaluate the application of topical ALA-PDT synchronized with ICT in locally advanced OSCC. PATIENTS AND METHODS This study described the application of topical ALA-PDT combined with TPF (docetaxel, cisplatin, and 5-fluorouracil) ICT in eleven patients treated due to locally advanced in the oral cavity. Patients qualified for this type of local treatment had cancerous lesions located on the surface of the gum or oral mucosa. The efficacy was evaluated based on the clinical response and complications of the patients. RESULTS All patients were treated with four courses (bi-weekly) of ALA-PDT with three courses of TPF containing ICT. After treatment, the overall response rate was 90.9%. Then ten patients with surgery experienced radical surgery alone or combined with radiotherapy except a patient with serious heart condition. In the follow-up period of 26-43 months (median duration of 34.1 months), no local recurrence was observed in cases. Only one patient (9.1%) died of unrelated myocardial infarction. CONCLUSION Topical ALA-PDT proved to be a safe treatment in OSCC patients with locally advanced sites, which could be an appropriate addition to ICT. Despite the short observation period and small sample size, it seems justified to conduct prospective studies for the evaluation of the efficacy and safety of topical ALA-PDT synchronized with ICT followed by surgery.
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Hepp Z, Shah SN, Liang SY, Tan K, Balakrishna S. Real-world outcomes in locally advanced or metastatic urothelial carcinoma following platinum and PD-1/L1 inhibitor therapy. Future Oncol 2021; 17:4343-4353. [PMID: 34350778 DOI: 10.2217/fon-2021-0573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To investigate real-world overall survival (rwOS) and real-world progression-free survival (rwPFS) in locally advanced/metastatic urothelial carcinoma postplatinum and postprogrammed death receptor-1/death ligand 1 inhibitors. Patients & methods: Adult patients diagnosed with locally advanced/metastatic urothelial carcinoma from 1 January 2011 to 31 December 2018 and treated with taxane monotherapy or any therapy postplatinum and post-PD-1/L1 inhibitors were included from a nationwide electronic health record-derived oncology database. Results: Median rwOS among 72 patients treated with taxane monotherapy was 7.6 months (95% CI: 5.2-14.4) and rwPFS was 2.9 months (95% CI: 2.4-4.0). Among 208 patients treated with any therapy, median rwOS was 8.9 months (95% CI: 7.3-10.6) and rwPFS was 3.6 months (95% CI: 2.7-4.7). Conclusion: Short duration of rwOS and rwPFS were observed, highlighting the need for effective and safe treatments in this patient population.
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Affiliation(s)
- Zsolt Hepp
- Health Economics and Outcomes Research, Seagen Inc., 21823 30th Drive SE, Bothell, WA 98021, USA
| | - Sonali N Shah
- Health Economics and Outcomes Research, Astellas Pharma Inc., One Astellas Way, Northbrook, IL 60062, USA
| | - Shang-Ying Liang
- Health Economics and Outcomes Research, Seagen Inc., 21823 30th Drive SE, Bothell, WA 98021, USA
| | - Katherine Tan
- Flatiron Health, 233 Spring Street, New York, NY 10013, USA
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Cuyun Carter G, Sheffield KM, Gossai A, Huang YJ, Zhu YE, Bowman L, Nash Smyth E, Mathur R, Cohen AB, Rasmussen E, Balakrishna S, Morato Guimaraes C, Rybowski S, Seidman AD. Real-world treatment patterns and outcomes of abemaciclib for the treatment of HR+, HER2- metastatic breast cancer. Curr Med Res Opin 2021; 37:1179-1187. [PMID: 33970738 DOI: 10.1080/03007995.2021.1923468] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This retrospective observational study described baseline characteristics, real-world treatment patterns, and outcomes among patients with metastatic breast cancer treated with abemaciclib in the United States. METHODS De-identified electronic health record-derived data were used to describe patients who began abemaciclib treatment on or after 30 June 2016 and ≥4 months before data cutoff (31 December 2018). Real-world response (rwR) and real-world progression assessments were abstracted from clinical documentation. Descriptive statistics were used to calculate the real-world best response. The Kaplan-Meier method estimated real-world time to first response (rwTTFR) and real-world progression-free survival (rwPFS). RESULTS The median age of 118 female patients at abemaciclib initiation was 66.5 years (interquartile range, 57.0, 73.0). The breakdown of patients who received abemaciclib in first, second, third, or later lines was 28.8%, 21.2%, 20.3%, and 29.7%, respectively. Patients received abemaciclib as monotherapy (12.7%) or in combination with endocrine therapy: fulvestrant (59.3%); aromatase inhibitor (22.9%); aromatase inhibitor and fulvestrant (5.1%). There were 68 patients (57.6%) with ≥1 rwR assessment: 41.2% with a real-world complete response or real-world partial response. Median rwTTFR was 3.6 months (95% confidence interval, 3.5, 5.2). Twelve-month rwPFS probability was 61.7%. CONCLUSIONS This study represents utilization and outcomes associated with abemaciclib approximately 1 year following FDA approval. Treatment patterns demonstrated heterogeneity and, as in clinical trials, patients appeared to benefit from abemaciclib treatment in the real world. More research investigating outcomes associated with abemaciclib treatment is needed, with larger samples and longer follow-up to enable closer evaluation by subgroup, regimen, and line of therapy.
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Affiliation(s)
| | | | | | | | | | - Lee Bowman
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Aaron B Cohen
- Flatiron Health, Inc., New York, NY, USA
- School of Medicine, New York University, New York, NY, USA
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12
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Ma X, Bellomo L, Magee K, Bennette CS, Tymejczyk O, Samant M, Tucker M, Nussbaum N, Bowser BE, Kraut JS, Bourla AB. Characterization of a Real-World Response Variable and Comparison with RECIST-Based Response Rates from Clinical Trials in Advanced NSCLC. Adv Ther 2021; 38:1843-1859. [PMID: 33674928 PMCID: PMC8004504 DOI: 10.1007/s12325-021-01659-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/08/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Effectiveness metrics for real-word research, analogous to clinical trial ones, are needed. This study aimed to develop a real-world response (rwR) variable applicable to solid tumors and to evaluate its clinical relevance and meaningfulness. METHODS This retrospective study used patient cohorts with advanced non-small cell lung cancer from a nationwide, de-identified electronic health record (EHR)-derived database. Disease burden information abstracted manually was classified into response categories anchored to discrete therapy lines (per patient-line). In part 1, we quantified the feasibility and reliability of data capture, and estimated the association between rwR status and real-world progression-free survival (rwPFS) and real-world overall survival (rwOS). In part 2, we investigated the correlation between published clinical trial overall response rates (ORRs) and real-world response rates (rwRRs) from corresponding real-world patient cohorts. RESULTS In part 1, 85.4% of patients (N = 3248) had at least one radiographic assessment documented. Median abstraction time per patient-line was 15.0 min (IQR 7.8-28.1). Inter-abstractor agreement on presence/absence of at least one assessment was 0.94 (95% CI 0.92-0.96; n = 503 patient-lines abstracted in duplicate); inter-abstractor agreement on best confirmed response category was 0.82 (95% CI 0.78-0.86; n = 384 with at least one captured assessment). Confirmed responders at a 3-month landmark showed significantly lower risk of death and progression in rwOS and rwPFS analyses across all line settings. In part 2, rwRRs (from 12 rw cohorts) showed a high correlation with trial ORRs (Spearman's ρ = 0.99). CONCLUSIONS We developed a rwR variable generated from clinician assessments documented in EHRs following radiographic evaluations. This variable provides clinically meaningful information and may provide a real-world measure of treatment effectiveness.
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Affiliation(s)
- Xinran Ma
- Flatiron Health, Inc, New York, NY, USA.
| | | | | | | | | | | | | | - Nathan Nussbaum
- Flatiron Health, Inc, New York, NY, USA
- New York University School of Medicine, New York, NY, USA
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Feinberg BA, Zettler ME, Klink AJ, Lee CH, Gajra A, Kish JK. Comparison of Solid Tumor Treatment Response Observed in Clinical Practice With Response Reported in Clinical Trials. JAMA Netw Open 2021; 4:e2036741. [PMID: 33630085 PMCID: PMC7907955 DOI: 10.1001/jamanetworkopen.2020.36741] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
IMPORTANCE In clinical trials supporting the regulatory approval of oncology drugs, solid tumor response is assessed using Response Evaluation Criteria in Solid Tumors (RECIST). Calculation of RECIST-based responses requires sequential, timed imaging data, which presents challenges to the method's application in real-world evidence research. OBJECTIVE To evaluate the feasibility and validity of a novel real-world RECIST method in assessing tumor burden associated with therapy for a large heterogeneous patient population undergoing treatment in routine clinical practice. DESIGN, SETTING, AND PARTICIPANTS This cohort study used physician-abstracted data pooled from retrospective, multisite electronic health record (EHR) review studies of patients treated with anticancer drugs at US oncology practices from 2014 through 2017. Included patients were receiving first-line treatment for thyroid cancer, breast cancer, or metastatic melanoma. Data were analyzed from March through August 2020. EXPOSURES Undergoing treatment with immunotherapy or targeted therapy. MAIN OUTCOMES AND MEASURES Tumor response was classified according to RECIST guidelines (ie, change in sum diameter of target lesions) post hoc with measurements derived from imaging scans and reports. RESULTS Among 1308 completed electronic case report forms, 956 forms (73.1%) had adequate data to classify real-world RECIST response. The greatest difference between physician-recorded responses and real-world RECIST-based responses was found in the proportion of complete responses: 118 responses (12.3%) vs 46 responses (4.8%) (P < .001). Among 609 patients in the metastatic melanoma population, complete responses were reported in 112 physician-recorded responses (18.4%) vs 44 real-world RECIST-based responses (7.2%) (P < .001), compared with 11 of 247 responses (4.5%) to 31 of 192 responses (16.1%) across pivotal trials of the same melanoma therapies. CONCLUSIONS AND RELEVANCE These findings suggest that comparing tumor lesion sizes and categorizing treatment response according to RECIST guidelines may be feasible using real-world data. This study found that physician-recorded assessments were associated with overestimation of treatment response, with the largest overestimation among complete responses. Real-world RECIST-based assessments were associated with better approximations of tumor response reported in clinical trials compared with those reported in EHRs.
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Affiliation(s)
| | | | | | - Choo H Lee
- Cardinal Health Specialty Solutions, Dublin, Ohio
| | - Ajeet Gajra
- Cardinal Health Specialty Solutions, Dublin, Ohio
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Synchronous tumours detected during cancer patient staging: prevalence and patterns of occurrence in multidetector computed tomography. Pol J Radiol 2020; 85:e261-e270. [PMID: 32612725 PMCID: PMC7315052 DOI: 10.5114/pjr.2020.95781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/01/2020] [Indexed: 01/17/2023] Open
Abstract
Purpose The incidental detection of one or more additional primary tumours during computed tomography (CT) staging of a patient with known malignancy is rare but possible. This occurrence should be considered by the radiologist when a new lesion is detected, especially if the lesion location is atypical for metastases. The purpose of this report was to document the usefulness of total body CT scan to detect synchronous primary malignancies in cancer patients undergoing a staging workup. Material and methods This was done by reviewing the staging CT studies of the adult patients with a newly diagnosed cancer evaluated during a five-year period in a single cancer institute in order to identify any possible correlation, establishing which tumours are more frequently combined with a second tumour and which second tumours are more commonly present. Results Among the patients with a second tumour, the most frequent first primary tumours were melanoma (eight patients, 17.8%), lymphoma (seven patients, 15.6%), and prostate carcinoma (seven patients, 15.6%). The most frequent incidentally detected second tumours were hepatocellular carcinoma (nine patients, 20% of 45 incidental tumours), renal carcinoma (eight patients, 17.8%), lung carcinoma (seven patients, 15.6%), and bladder carcinoma (four patients, 8.9%). One patient had three primary tumours synchronously. Conclusions We believe that the radiologist’s knowledge of the prevalence and pattern of occurrence of these multiple primary malignancies represents added diagnostic value.
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Griffith SD, Tucker M, Bowser B, Calkins G, Chang CH(J, Guardino E, Khozin S, Kraut J, You P, Schrag D, Miksad RA. Author's Response to "A Letter in Support of Real-World RECIST". Adv Ther 2020; 37:1691-1693. [PMID: 32056085 PMCID: PMC7140733 DOI: 10.1007/s12325-020-01246-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Indexed: 11/18/2022]
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Mougalian SS, Feinberg BA, Wang E, Alexis K, Chatterjee D, Knoth RL, Nero D, Miller T, Liassou D, Kish JK. Observational study of clinical outcomes of eribulin mesylate in metastatic breast cancer after cyclin-dependent kinase 4/6 inhibitor therapy. Future Oncol 2019; 15:3935-3944. [PMID: 31660764 DOI: 10.2217/fon-2019-0537] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim: To examine the effectiveness of eribulin mesylate for metastatic breast cancer post cyclin-dependent kinase inhibitor (CDKi) 4/6 therapy. Materials & methods: US community oncologists reviewed charts of patients who had received eribulin from 3 February 2015 to 31 December 2017 after prior CDKi 4/6 therapy and detailed their clinical/treatment history, clinical outcomes (lesion measurements, progression, death) and toxicity. Results: Four patient cohorts were created according to eribulin line of therapy: second line, third line, per US label and fourth line with objective response rates/clinical benefit rates of 42.2%/58.7%, 26.1%/42.3%, 26.7%/54.1% and 17.9%/46.4%, respectively. Median progression-free survival/6-month progression-free survival (79.5% of all patients censored) by cohort was: 9.7 months/77.3%, 10.3 months/71.3%, not reached/70.4% and 4.0 months/0.0%, respectively. Overall occurrence of neutropenia = 23.5%, febrile neutropenia = 1.3%, peripheral neuropathy = 10.1% and diarrhea = 11.1%. Conclusion: Clinical outcome and adverse event rates were similar to those in clinical trials and other observational studies. Longer follow-up is required to confirm these findings.
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Affiliation(s)
| | | | - Edward Wang
- Formerly with Eisai, Inc., US Health Economics and Outcomes Research and Real World Evidence, Woodcliff Lake, NJ 07677, USA
| | - Karenza Alexis
- Formerly with Eisai, Inc., Medical Affairs, Woodcliff Lake, NJ 07677, USA
| | - Debanjana Chatterjee
- Eisai, Inc., US Health Economics and Outcomes Research and Real World Evidence, Woodcliff Lake, NJ 07677, USA
| | - Russell L Knoth
- Formerly with Eisai, Inc., US Health Economics and Outcomes Research and Real World Evidence, Woodcliff Lake, NJ 07677, USA
| | - Damion Nero
- Cardinal Health Specialty Solutions, Dublin, OH 43017, USA
| | - Talia Miller
- Cardinal Health Specialty Solutions, Dublin, OH 43017, USA
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