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Gibson AJW, Pabani A, Dean ML, Martos G, Cheung WY, Navani V. Real-World Treatment Patterns and Effectiveness of Targeted and Immune Checkpoint Inhibitor-Based Systemic Therapy in BRAF Mutation-Positive NSCLC. JTO Clin Res Rep 2023; 4:100460. [PMID: 36915629 PMCID: PMC10006852 DOI: 10.1016/j.jtocrr.2022.100460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction BRAF mutations (present in 2%-3% of NSCLC) are a known oncogenic driver and emerging therapeutic target. There is a scarcity of real-world data describing the clinical characteristics, treatment patterns, and effectiveness of targeted BRAF-inhibiting and immune checkpoint inhibitor (ICI)-based systemic therapies, yet this is required for appropriate treatment decisions that optimize patient outcome. Methods Demographic, clinical, treatment, and outcome data of patients with BRAF mutation-positive NSCLC diagnosed between 2018 and 2022 were identified from the Glans-Look Lung Cancer Research database and included in this analysis. Results A total of 53 BRAF mutation-positive patients were identified (V600E, n = 35; non-V600E, n = 18). Furthermore, 46 patients (87%) were diagnosed with metastatic disease, of whom 61% were treated with systemic anticancer therapy, which significantly improved overall survival (34.1 versus 2.2 mo, p = 0.01). ICI-based regimens were found to have effectiveness in the first-line setting for both V600E and non-V600E cohorts (objective response rate: 38%-43%; real-world calculations of median progression-free survival: 10.5-10.8 mo, respectively). Dual-targeted BRAF/MEK inhibition was also found to have effectiveness in the first-line setting for V600E patients (objective response rate: 33%, real-world calculations of median progression-free survival: 15.2 mo). Conclusions This study of real-world patients with BRAF mutations confirms the importance of effective systemic therapies. Both dual-targeted BRAF/MEK inhibition and ICI-based regimens have evidence of benefit in this population revealing that real-world populations can experience similar clinical response and outcome to clinical trial cohorts on these treatment regimens. Future studies to clarify the role of co-mutations on response to both dual-targeted BRAF/MEK inhibition and ICI-based regimens may be important to treatment selection and optimization of patient outcome.
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Affiliation(s)
- Amanda J W Gibson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aliyah Pabani
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medical Oncology, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Michelle L Dean
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Guillermo Martos
- Department of Medical Oncology, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Winson Y Cheung
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medical Oncology, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Vishal Navani
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medical Oncology, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
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Erashdi M, Al-Ani A, Mansour A, Al-Hussaini M. Libyan cancer patients at King Hussein Cancer Center for more than a decade, the current situation, and a future vision. Front Oncol 2023; 12:1025757. [PMID: 36776359 PMCID: PMC9911041 DOI: 10.3389/fonc.2022.1025757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/15/2022] [Indexed: 01/28/2023] Open
Abstract
Background Since 2011, the Libyan civil war crisis had affected all dimensions of livelihood including cancer care. This has resulted in a steady incline in the number of Libyan patients with cancer seeking oncologic care and management in Tunisia, Egypt and Jordan, among others. King Hussein Cancer Center (KHCC) has been one of the main destinations for Libyan patients with cancer for more than a decade. Aim We are reporting on the characteristics of Libyan patients with cancer presenting to KHCC during the past fourteen years. Methods We performed a retrospective chart review of all Libyan patients with cancer presenting to KHCC between 2006 and 2019. Results A total of 3170 records were included in the final analysis. The overall sample was predominantly adults (71%) with a male-to-female ratio of 1:1.2. Overall, the most common referred cancers to KHCC were breast (21%), hematolymphoid (HL) (17%), and gastrointestinal tract (GIT) (16.2%) cancers. Breast cancer was the most common among adult females (41.7%), GIT among adult males (23.6%), and HL among pediatrics (38.5%). Around 37.8% of patients presented with distant metastasis at their first encounter at KHCC, among which 14.7% were candidates for palliative care. Conclusion The sustenance of treatment for Libyan patients with cancer requires extensive collaboration between governmental and private sectors. The Libyan oncological landscape could benefit from national screening and awareness programs, twining programs and telemedicine, introduction of multidisciplinary boards, and the formulation of a national cancer registry. Adopting the successful models at KHCC can help to augment the oncology services within the Libyan healthcare sector.
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Affiliation(s)
- Madiha Erashdi
- Department of Pathology, James Cook University Hospital, South Tees National Health Service (NHS) Foundation Trust, Middlesbrough, United Kingdom
| | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Asem Mansour
- Human Research Participants Protection Office, King Hussein Cancer Center, Amman, Jordan
| | - Maysa Al-Hussaini
- Human Research Participants Protection Office, King Hussein Cancer Center, Amman, Jordan,*Correspondence: Maysa Al-Hussaini,
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3
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Gibson AJ, Box A, Dean ML, Elegbede AA, Hao D, Sangha R, Bebb DG. Retrospective Real-World Outcomes for Patients With ALK-Rearranged Lung Cancer Receiving ALK Receptor Tyrosine Kinase Inhibitors. JTO Clin Res Rep 2021; 2:100157. [PMID: 34590010 PMCID: PMC8474209 DOI: 10.1016/j.jtocrr.2021.100157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction This study explored the use, safety, and efficacy of initial use of an ALK-inhibiting targeted therapy (ALK tyrosine kinase inhibitor [TKI]) in patients with ALK-rearranged NSCLC in a population-based, real-world clinical population within the province of Alberta, Canada. Methods Demographic, clinical, treatment, and outcome data of the patients with advanced or metastatic ALK-rearranged NSCLC receiving their first ALK TKI between 2014 and 2019 were included in the analysis. Results A total of 92 patients with ALK-rearranged NSCLC treated with ALK TKI (78% crizotinib, 22% alectinib) were identified. In the ALK-rearranged cohort, 1-year survival rate was 73% and median overall survival (OS) and progression-free survival (PFS) were 48.5 months and 17.0 months, respectively. An objective response rate of 49% was observed, and adverse events were reported in 70% of the patients, primarily of low grade (84%). Case-matched comparison to patients with ALK-wildtype disease treated with cytotoxic chemotherapy revealed the benefit of ALK TKI in the context of an ALK rearrangement (ALK-rearranged versus ALK-wildtype) (median post-treatment initiation OS: 46.8 versus 14.2 mo, p < 0.001). Outcomes, measured from the time of ALK TKI initiation, differed by Eastern Cooperative Oncology Group (ECOG) (ECOG < 2 versus ECOG ≥ 2) (median OS: not reached versus 6.8 mo, p < 0.001; median PFS 17.6 versus 7.4 mo, p = 0.02), disease presentation (relapsed versus de novo) (median PFS: 30.8 versus 15.0 mo, p = 0.04), and brain metastasis onset (brain metastases development during ALK TKI versus baseline brain metastases) (not reached versus 12.8 mo, p = 0.04). Conclusions Clinical trials have firmly established that ALK TKIs are safe, well tolerated, and effective; these findings reveal that their impact in a real-world setting is just as profound. The availability and use of ALK TKI therapies contribute to the impressive gains in survival experienced by contemporary patients with ALK-rearranged disease, rendering patients with this oncodriven form of NSCLC among the longest surviving patients with lung cancer.
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Affiliation(s)
- Amanda J.W. Gibson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adrian Box
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Molecular Pathology Lab, Alberta Precision Laboratories, Calgary, Alberta, Canada
| | - Michelle L. Dean
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anifat A. Elegbede
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Desiree Hao
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Randeep Sangha
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Cross Cancer Institute, Alberta Health Services, Edmonton, Alberta, Canada
| | - D. Gwyn Bebb
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
- Corresponding author. Address for correspondence: D. Gwyn Bebb, MD, PhD, Professor of Medicine, University of Calgary Tom Baker Cancer Centre, 1331, 29th St NW, Calgary, T2N 4N2 Alberta, Canada.
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Snee M, Cheeseman S, Thompson M, Riaz M, Sopwith W, Lacoin L, Chaib C, Manley Daumont M, Penrod JR, O'Donnell JC, Hall G. Trends in the prescription of systemic anticancer therapy and mortality among patients with advanced non-small cell lung cancer: a real-world retrospective observational cohort study from the I-O optimise initiative. BMJ Open 2021; 11:e043442. [PMID: 33941627 PMCID: PMC8098989 DOI: 10.1136/bmjopen-2020-043442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To assess how a decade of developments in systematic anticancer therapy (SACT) for advanced non-small cell lung cancer (NSCLC) affected overall survival (OS) in a large UK University Hospital. DESIGN Real-world retrospective observational cohort study using existing data recorded in electronic medical records. SETTING A large National Health Service (NHS) university teaching hospital serving 800 000 people living in a diverse metropolitan area of the UK. PARTICIPANTS 2119 adults diagnosed with advanced NSCLC (tumour, node, metastasis stage IIIB or IV) between 2007 and 2017 at Leeds Teaching Hospitals NHS Trust. MAIN OUTCOMES AND MEASURES OS following diagnosis and the analysis of factors associated with receiving SACT. RESULTS Median OS for all participants was 2.9 months, increasing for the SACT-treated subcohort from 8.4 months (2007-2012) to 9.1 months (2013-2017) (p=0.02); 1-year OS increased from 33% to 39% over the same period for the SACT-treated group. Median OS for the untreated subcohort was 1.6 months in both time periods. Overall, 30.6% (648/2119) patients received SACT; treatment rates increased from 28.6% (338/1181) in 2007-2012 to 33.0% (310/938) in 2013-2017 (p=0.03). Age and performance status were independent predictors for SACT treatment; advanced age and higher performance status were associated with lower SACT treatment rates. CONCLUSION Although developments in SACT during 2007-2017 correspond to some changes in survival for treated patients with advanced NSCLC, treatment rates remain low and the prognosis for all patients remains poor.
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Affiliation(s)
| | | | - Matthew Thompson
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Real-World Insights, IQVIA, London, UK
| | - Majid Riaz
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Real-World Insights, IQVIA, London, UK
| | - Will Sopwith
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Real-World Insights, IQVIA, London, UK
| | | | - Carlos Chaib
- R&D Medical Affairs, Bristol Myers Squibb, Madrid, Spain
| | - Melinda Manley Daumont
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Braine-l'Alleud, Belgium
| | - John R Penrod
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - John C O'Donnell
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Geoff Hall
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
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5
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Wah W, Stirling RG, Ahern S, Earnest A. Association between Receipt of Guideline-Concordant Lung Cancer Treatment and Individual- and Area-Level Factors: A Spatio-Temporal Analysis. Cancer Epidemiol Biomarkers Prev 2020; 29:2669-2679. [PMID: 32948632 DOI: 10.1158/1055-9965.epi-20-0709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/03/2020] [Accepted: 09/11/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Guideline-concordant treatment (GCT) of lung cancer has been observed to vary across geographic regions over the years. However, there is little evidence as to what extent this variation is explained by differences in patients' clinical characteristics versus contextual factors, including socioeconomic inequalities. METHODS This study evaluated the independent effects of individual- and area-level risk factors on geographic and temporal variation in receipt of GCT among patients with lung cancer. Receipt of GCT was defined on the basis of the National Comprehensive Cancer Network guidelines. We used Bayesian spatial-temporal multilevel models to combine individual and areal predictors and outcomes while accounting for geographically structured and unstructured correlation and linear and nonlinear trends. RESULTS Our study included 4,854 non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) cases, reported to the Victorian Lung Cancer Registry between 2011 and 2018. Area-level data comprised socioeconomic disadvantage and remoteness data at the local government area level in Victoria, Australia. Around 60.36% of patients received GCT, and the rates varied across geographic areas over time. This variation was mainly associated with poor performance status, advanced clinical stages, NSCLC types, public hospital insurance, area-level deprivation, and comorbidities. CONCLUSIONS This study highlights the need to address disparities in receipt of GCT among patients with lung cancer with poor performance status, NSCLC, advanced clinical stage, stage I-III SCLC, stage III NSCLC, public hospital insurance, and comorbidities, and living in socioeconomically disadvantaged areas. IMPACT Two-year mortality outcomes significantly improved with GCT. Interventions aimed at reducing these inequalities could help to improve lung cancer outcomes.
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Affiliation(s)
- Win Wah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Rob G Stirling
- Department of Allergy, Immunology & Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Arul Earnest
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Yusuf D, Walton RN, Hurry M, Farrer C, Bebb DG, Cheung WY. Population-based Treatment Patterns and Outcomes for Stage III Non-Small Cell Lung Cancer Patients: A Real-world Evidence Study. Am J Clin Oncol 2020; 43:615-620. [PMID: 32889830 DOI: 10.1097/coc.0000000000000716] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Most patients with stage III non-small cell lung cancer (NSCLC) develop metastases and succumb to their cancer. Approaches to the treatment of stage III disease can be highly variable. Understanding current treatment patterns can inform the optimal integration of emerging therapies. In this study, we describe contemporary treatment patterns and outcomes for a population-based cohort of stage III NSCLC patients from a large Canadian province. METHODS On the basis of the provincial cancer registry, all adult patients diagnosed with stage III NSCLC from April 1, 2010 to March 31, 2015 were identified. Analyses of these patients' existing electronic medical records and administrative claims data were conducted to describe patient characteristics, treatment patterns, and survival outcomes. RESULTS In total, we screened 6438 patients diagnosed with NSCLC, of whom 1151 (17.9%) had stage III disease. Among them, 61.2% were stage IIIA, 36.4% were stage IIIB, and 2.4% were unspecified. Median age at diagnosis was 70 (22 to 94) years and 50.2% were men. In this cohort, a significant proportion of patients received only palliative radiotherapy (35.6%), palliative chemotherapy (8.8%), or best supportive care (24.8%) as initial treatment. Conversely, relatively few underwent concurrent chemoradiotherapy (11.7%) or trimodality therapy (1.7%). Surgery±adjuvant treatments were performed in 14.8% of stage III patients. Median overall survival was 13.2 months (95% confidence interval [CI], 12.2-14.0) among stage III patients. Patients who received initial curative treatment had statistically significant better survival compared with those who received noncurative treatment (P<0.001); median overall survival 29.8 months (95% CI, 22.3-34.6) and 8.9 months (95% CI, 7.6-11.6), respectively. CONCLUSIONS In a population-based setting that includes community, regional, and tertiary cancer centers, use of concurrent chemoradiotherapy and trimodality therapy in stage III NSCLC was low despite evidence supporting the potential benefits of these strategies.
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Affiliation(s)
| | - Ryan N Walton
- AstraZeneca Canada Inc., Missiissauga, ON and BC Cancer, Vancouver, BC, Canada
| | - Manjusha Hurry
- AstraZeneca Canada Inc., Missiissauga, ON and BC Cancer, Vancouver, BC, Canada
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Blom EF, ten Haaf K, Arenberg DA, de Koning HJ. Disparities in Receiving Guideline-Concordant Treatment for Lung Cancer in the United States. Ann Am Thorac Soc 2020; 17:186-194. [PMID: 31672025 PMCID: PMC6993802 DOI: 10.1513/annalsats.201901-094oc] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 10/16/2019] [Indexed: 12/15/2022] Open
Abstract
Rationale: The level of adherence to lung cancer treatment guidelines in the United States is unclear. In addition, it is unclear whether previously identified disparities by racial or ethnic group and by age persist across all clinical subgroups.Objectives: To assess the level of adherence to the minimal lung cancer treatment recommended by the National Comprehensive Cancer Network guidelines (guideline-concordant treatment) in the United States, and to assess the persistence of disparities by racial or ethnic group and by age across all clinical subgroups.Methods: We evaluated whether 441,812 lung cancer cases in the National Cancer Database diagnosed between 2010 and 2014 received guideline-concordant treatment. Logistic regression models were used to assess possible disparities in receiving guideline-concordant treatment by racial or ethnic group and by age across all clinical subgroups, and whether these persist after adjusting for patient, tumor, and health care provider characteristics.Results: Overall, 62.1% of subjects received guideline-concordant treatment (range across clinical subgroups = 50.4-76.3%). However, 21.6% received no treatment (range = 10.3-31.4%) and 16.3% received less intensive treatment than recommended (range = 6.4-21.6%). Among the most common less intensive treatments for all subgroups was "conventionally fractionated radiotherapy only" (range = 2.5-16.0%), as was "chemotherapy only" for nonmetastatic subgroups (range = 1.2-13.7%), and "conventionally fractionated radiotherapy and chemotherapy" for localized non-small-cell lung cancer (5.9%). Guideline-concordant treatment was less likely with increasing age, despite adjusting for relevant covariates (age ≥ 80 yr compared with <50 yr: adjusted odds ratio = 0.12, 95% confidence interval = 0.12-0.13). This disparity was present in all clinical subgroups. In addition, non-Hispanic black patients were less likely to receive guideline-concordant treatment than non-Hispanic white patients (adjusted odds ratio = 0.78, 95% confidence interval = 0.76-0.80). This disparity was present in all clinical subgroups, although statistically nonsignificant for extensive disease small-cell lung cancer.Conclusions: Between 2010 and 2014, many patients with lung cancer in the United States received no treatment or less intensive treatment than recommended. Particularly, elderly patients with lung cancer and non-Hispanic black patients are less likely to receive guideline-concordant treatment. Patterns of care among those receiving less intensive treatment than recommended suggest room for improved uptake of treatments such as stereotactic body radiation therapy for subjects with localized non-small-cell lung cancer.
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Affiliation(s)
- Erik F. Blom
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; and
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kevin ten Haaf
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; and
| | - Douglas A. Arenberg
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Harry J. de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; and
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Real-World Adherence to Guideline-Recommended Treatment for Small Cell Lung Cancer. Am J Clin Oncol 2019; 43:236-242. [DOI: 10.1097/coc.0000000000000657] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Comparison of Clinical Characteristics and Outcomes in Relapsed Versus De Novo Metastatic Non-Small Cell Lung Cancer. Am J Clin Oncol 2019; 42:75-81. [PMID: 30211724 DOI: 10.1097/coc.0000000000000483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To compare the clinical characteristics and outcomes between relapsed and de novo metastatic non-small cell lung cancer (NSCLC). MATERIALS AND METHODS We reviewed all NSCLC diagnoses between January 1999 and December 2013 in the institutional Glans-Look Lung Cancer Database, which contains demographic, clinical, pathologic, treatment, and outcome information. Patients with distant metastasis at diagnosis (American Joint Committee on Cancer [AJCC] eighth edition, stage IV), the "de novo" cohort, were compared with the "relapsed" cohort, consisting of patients diagnosed with early stage disease (stage I/II) undergoing curative intent treatment and subsequently experiencing metastatic relapse. Survival analysis, along with univariate and multivariable analysis was performed. RESULTS A total of 185 relapsed and 3039 de novo patients were identified. Significantly different patterns of smoking history, histology, systemic therapy use, and disease extent were observed between the relapsed and de novo cohorts. Median overall survival from time of metastasis was significantly longer in relapsed than in de novo disease (8.9 vs. 3.7 mo, P<0.001). Relapsed patients demonstrated significant improvements in outcomes over time. In multivariate analysis, de novo metastatic disease continued to bode a worse prognosis (adjusted hazard ratio [HR], 1.4) as did male sex (HR, 1.2), never-smoking history (HR, 1.2), and presence of extrapulmonary metastases (HR, 1.3). Systemic therapy receipt conferred better outcome (HR, 0.4), although the impact of relapsed versus de novo disease on outcomes persisted regardless of systemic therapy receipt. CONCLUSIONS Relapsed and de novo patients represent significantly different subpopulations within metastatic NSCLC with the latter exhibiting poorer survival. This information facilitates discussions about prognosis with patients and supports screening initiatives aimed at reducing de novo disease.
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Gotfrit J, Jonker C, Zhang T, Goss G, Nicholas G, Laurie S, Wheatley-Price P. Inpatients versus outpatients with advanced non-small cell lung cancer: Characteristics and outcomes. Cancer Treat Res Commun 2019; 19:100130. [PMID: 30927666 DOI: 10.1016/j.ctarc.2019.100130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 03/08/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Most newly diagnosed advanced NSCLC patients have an initial medical oncology consult as an outpatient. Sometimes, the initial consult occurs as an inpatient. We explored differences among NSCLC patients presenting to medical oncology while hospitalized versus as outpatients. METHODS With ethics approval, we performed a retrospective analysis of all stage IIIB and IV NSCLC patients at our institution consulted by medical oncology between 2009 and 2012. The primary analysis is descriptive, exploring differences in baseline characteristics, treatment choices, and overall survival (OS). RESULTS In total, 637 patients were included: 123 inpatients and 514 outpatients. Among outpatients, 55% received systemic therapy compared to 21% of inpatients. Among treated patients, inpatients were likely to be younger (81% vs 70% <70 years, p = 0.04), have PS 3-4 (38% vs 5%, p<0.001), have ≥5% weight loss (54% vs 42%, p = 0.01), anemia (19% vs 4%, p = 0.001), leukocytosis (38% vs 32%, p = 0.001), thrombocytosis (27 vs 23%, p = 0.001), renal dysfunction (12% vs 5%, p = 0.01) and more rapid onset of symptoms (27% vs 6% for <2 weeks, 35% vs 11% for 2-6 weeks; p<0.001). Inpatients who received systemic therapy were more likely to have a complete or partial response (42% vs 26%, p = 0.007), however had a shorter median OS than treated outpatients (8.4 vs 10.5 months, p = 0.003). CONCLUSIONS Patients initially consulted by medical oncologists while hospitalized were more unwell and fewer received systemic therapy. However, if treated, they had higher response rates than outpatients and reasonable OS. Systemic therapy can be considered in hospitalized advanced NSCLC patients. MICROABSTRACT A minority of patients with lung cancer have an initial oncology consultation as an inpatient. We compared the characteristics and outcomes of inpatients with their outpatient counterparts. Inpatients were more unwell at diagnosis and fewer received systemic therapy, but among those who did, they were more likely to respond and their overall survival approached that of the outpatient cohort.
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Affiliation(s)
- Joanna Gotfrit
- Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Cancer Centre, Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| | - Caleb Jonker
- Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y4E9, Canada
| | - Tinghua Zhang
- Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y4E9, Canada
| | - Glenwood Goss
- Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Cancer Centre, Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y4E9, Canada
| | - Garth Nicholas
- Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Cancer Centre, Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y4E9, Canada
| | - Scott Laurie
- Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Cancer Centre, Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y4E9, Canada
| | - Paul Wheatley-Price
- Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Cancer Centre, Ottawa, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y4E9, Canada.
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11
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Maguire FB, Morris CR, Parikh-Patel A, Cress RD, Keegan THM, Li CS, Lin PS, Kizer KW. Disparities in Systemic Treatment Use in Advanced-stage Non-Small Cell Lung Cancer by Source of Health Insurance. Cancer Epidemiol Biomarkers Prev 2019; 28:1059-1066. [PMID: 30842132 DOI: 10.1158/1055-9965.epi-18-0823] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/26/2018] [Accepted: 03/01/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Management of advanced-stage non-small cell lung cancer (NSCLC) has changed significantly over the past two decades with the development of numerous systemic treatments, including targeted therapies. However, a high proportion of advanced-stage patients are untreated. The role that health insurance plays in receipt of systemic treatments is unclear. METHODS Using California Cancer Registry data (2012-2014), we developed multivariable Poisson regression models to assess the independent effect of health insurance type on systemic treatment utilization among patients with stage IV NSCLC. Systemic treatment information was manually abstracted from treatment text fields. RESULTS A total of 17,310 patients were evaluated. Patients with Medicaid/other public insurance were significantly less likely to receive any systemic treatments [risk ratio (RR), 0.78; 95% confidence interval (CI), 0.75-0.82], bevacizumab combinations (RR, 0.57; 95% CI, 0.45-0.71), or tyrosine kinase inhibitors (RR, 0.70; 95% CI, 0.60-0.82) compared with the privately insured. Patients with Medicare or dual Medicare-Medicaid insurance were not significantly different from the privately insured in their likelihood of receiving systemic treatments. CONCLUSIONS Substantial disparities in the use of systemic treatments for stage IV NSCLC exist by source of health insurance in California. Patients with Medicaid/other public insurance were significantly less likely to receive systemic treatments compared with their privately insured counterparts. IMPACT Source of health insurance influences care received. Further research is warranted to better understand barriers to treatment that patients with Medicaid face.
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Affiliation(s)
- Frances B Maguire
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis Health, Sacramento, California. .,Graduate Group in Epidemiology, University of California, Davis, Davis, California
| | - Cyllene R Morris
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis Health, Sacramento, California
| | - Arti Parikh-Patel
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis Health, Sacramento, California
| | - Rosemary D Cress
- Public Health Sciences, University of California, Davis, Davis, California
| | - Theresa H M Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, California
| | - Chin-Shang Li
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, New York
| | - Patrick S Lin
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, California
| | - Kenneth W Kizer
- California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California Davis Health, Sacramento, California.,Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, California.,Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, California
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12
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Gibson AJW, Li H, D'Silva A, Tudor RA, Elegbede AA, Otsuka SM, Bebb DG, Cheung WY. Impact of number versus location of metastases on survival in stage IV M1b non-small cell lung cancer. Med Oncol 2018; 35:117. [PMID: 30073425 DOI: 10.1007/s12032-018-1182-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 07/31/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND To assess the impact of location versus number of extra-pulmonary metastatic sites (EPMS) on survival in stage IV non-small cell lung cancer (NSCLC). METHODS AND MATERIALS Retrospective analysis was conducted on patients diagnosed during 1999-2013 with stage IV, M1b (AJCC 7th edition) NSCLC using the large, institutional Glans-Look Database, which contains patient demographic, clinical, pathological, treatment, and outcome information. We assessed the impact of location and number of EPMS and identified correlates of overall survival using the Kaplan-Meier method and Cox regression. RESULTS We identified a total of 2065 NSCLC patients with EPMS. Median age was 67 (IQR 58-75) years, 52% were men, and 78% were current or former smokers. 60% had one EPMS, and 40% had two or more EPMS. Among those with only one EPMS, most frequent organ involvement included bone (40%), brain (32%), and liver (13%). Median overall survival (mOS) was worst in those with liver metastasis and best in those with adrenal metastasis (2.0 vs. 5.2 months, p = 0.015). However, outcomes based on site of organ involvement were not significantly different in multivariable analysis. Compared to patients with one EPMS, individuals with two or more EPMS experienced worse outcomes (mOS ≤ 2.9 vs. 3.9 months, p < 0.001), and were associated with worse prognosis in Cox regression analysis (HR 1.5, 95% CI 1.3-1.7, p < 0.001). CONCLUSIONS Number rather than location of EPMS is a prognostic factor in patients with stage IV M1b NSCLC. This information is relevant for accurate prognostication, stratification of participants in future clinical trials, and timely and appropriate advanced care planning.
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Affiliation(s)
- Amanda Jane Williams Gibson
- Department of Oncology, Cumming School of Medicine, University of Calgary, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada
| | - Haocheng Li
- Department of Oncology, Cumming School of Medicine, University of Calgary, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada
| | - Adrijana D'Silva
- Department of Oncology, Cumming School of Medicine, University of Calgary, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada
| | - Roxana A Tudor
- Department of Oncology, Cumming School of Medicine, University of Calgary, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada
| | - Anifat A Elegbede
- Department of Oncology, Cumming School of Medicine, University of Calgary, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada
| | - Shannon Mary Otsuka
- Department of Oncology, Cumming School of Medicine, University of Calgary, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada
| | - D Gwyn Bebb
- Department of Oncology, Cumming School of Medicine, University of Calgary, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada
- Tom Baker Cancer Centre, Alberta Health Services, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada
| | - Winson Y Cheung
- Department of Oncology, Cumming School of Medicine, University of Calgary, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada.
- Tom Baker Cancer Centre, Alberta Health Services, 1331 29th St NW, Calgary, AB, T2N 4N2, Canada.
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Papa L, Manfredi G, Germain D. SOD1, an unexpected novel target for cancer therapy. Genes Cancer 2014; 5:15-21. [PMID: 24955214 PMCID: PMC4063254 DOI: 10.18632/genesandcancer.4] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/22/2014] [Indexed: 11/25/2022] Open
Abstract
Cancer cells have elevated levels of reactive oxygen species (ROS), which are generated in majority by the mitochondria. In the mitochondrial matrix, the manganese dismutase SOD2 acts as a major anti-oxidant enzyme. The deacetylase SIRT3 regulates the activity of SOD2. Recently, SIRT3 was reported to be decreased in 87% of breast cancers, resulting therefore in a decrease in the activity of SOD2 and an elevation in ROS. In addition to SIRT3, we recently reported that SOD2 itself is down-regulated in breast cancer cell lines upon activation of oncogenes, such as Ras. Since in absence of SOD2, superoxide levels are elevated and may cause irreversible damage, mechanisms must exist to retain superoxide below a critical threshold and maintain viability of cancer cells. The copper/zinc dismutase SOD1 localizes in the cytoplasm, the inter-membrane space of the mitochondria and the nucleus. Emerging evidences from several groups now indicate that SOD1 is overexpressed in cancers and that the activity of SOD1 may be essential to maintain cellular ROS under this critical threshold. This review summarizes the studies reporting important roles of SOD1 in cancer and addresses the potential cross-talk between the overexpression of SOD1 and the regulation of the mitochondrial unfolded protein response (UPR(mt)). While mutations in SOD1 is the cause of 20% of cases of familial amyotrophic lateral sclerosis (fALS), a devastating neurodegenerative disease, these new studies expand the role of SOD1 to cancer.
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Affiliation(s)
- Luena Papa
- From the Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY
| | - Giovanni Manfredi
- The Weill Cornell Medical College, Department of Neurology and Neuroscience, New York, New York
| | - Doris Germain
- From the Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY
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