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Denault MH, Feng J, Kuang S, Shokoohi A, Leung B, Liu M, Berthelet E, Laskin J, Sun S, Zhang T, Ho C, Melosky B. Beyond PACIFIC: Real-World Outcomes of Adjuvant Durvalumab According to Treatment Received and PD-L1 Expression. Curr Oncol 2023; 30:7499-7507. [PMID: 37623024 PMCID: PMC10453050 DOI: 10.3390/curroncol30080543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/20/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
Adjuvant durvalumab after chemoradiotherapy (CRT) is the standard of care for unresectable stage III non-small cell lung cancer (NSCLC). A post hoc exploratory analysis of PACIFIC revealed no OS benefit in the PD-L1 < 1% subgroup. This retrospective analysis assesses the real-world impact of durvalumab on OS according to PD-L1 tumor proportion score (TPS). Patients with stage III, unresectable NSCLC treated by CRT, with available PD-L1 TPS, from 1 March 2018 to 31 December 2020, at BC Cancer, British Columbia, Canada were included. Patients were divided into two groups, CRT + durvalumab and CRT alone. OS and PFS were analyzed in the PD-L1 ≥ 1% and <1% subgroups. A total of 134 patients were included in the CRT + durvalumab group and 117, in the CRT alone group. Median OS was 35.9 months in the CRT + durvalumab group and 27.4 months in the CRT alone group [HR 0.59 (95% CI 0.42-0.83), p = 0.003]. Durvalumab improved OS in the PD-L1 ≥ 1% [HR 0.53 (95% CI 0.34-0.81), p = 0.003, n = 175], but not in the <1% subgroup [HR 0.79 (95% CI 0.44-1.42), p = 0.4, n = 76]. This retrospective study demonstrates a statistically significant improvement in OS associated with durvalumab after CRT in PD-L1 ≥ 1%, but not PD-L1 < 1% NSCLC. Variables not accounted for may have biased the survival analysis. A prospective study would bring more insight.
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Affiliation(s)
- Marie-Hélène Denault
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada
| | - Jamie Feng
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Shelley Kuang
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Aria Shokoohi
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Bonnie Leung
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Mitchell Liu
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Eric Berthelet
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Janessa Laskin
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Sophie Sun
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Tina Zhang
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Cheryl Ho
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
| | - Barbara Melosky
- BC Cancer, Vancouver Centre, 600 West 10th Avenue, Vancouver, BC V5Z 4E6, Canada
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Vézina FA, Bouchard PA, Breton-Gagnon É, Dion G, Viglino D, Roy P, Bilodeau L, Provencher S, Denault MH, Saey D, Lellouche F, Maltais F. Automated O 2 Titration Alone or With High-Flow Nasal Cannula During Walking Exercise in Chronic Lung Diseases. Respir Care 2023; 69:respcare.10810. [PMID: 37491073 PMCID: PMC10753602 DOI: 10.4187/respcare.10810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
BACKGROUND Exercise-induced O2 desaturation contributes to dyspnea and exercise intolerance in various respiratory diseases. This study assessed whether automated O2 titration was superior to fixed-flow O2 to improve exertional dyspnea and walking exercise endurance. We also aimed at evaluating possible additive effects of high-flow nasal cannula coupled with automated O2 titration on these outcomes. METHODS Subjects with chronic respiratory diseases and exercise-induced desaturation performed a 3-min constant-speed shuttle test (CSST) and an endurance shuttle walking test (ESWT) with either (1) fixed-flow O2, (2) automated O2 titration targeting an SpO2 of 94% (± 2%), and (3) automated O2 titration + high-flow nasal cannula according to a randomized sequence. The main outcome was Borg dyspnea score at the end of the 3-min CSST. Secondary outcomes included endurance time and dyspnea during ESWT and oxygenation status during exercise. RESULTS Ten subjects with COPD, 10 with interstitial lung disease, 5 with pulmonary hypertension, and 3 with cystic fibrosis completed the study. Compared to fixed-flow O2, automated O2 titration did not reduce dyspnea at the end of the 3-min CSST. Endurance time during the ESWT was prolonged with automated O2 titration (mean difference 298 [95% CI 205-391] s, P < .001), and dyspnea at isotime was reduced. No further improvement was noted when high-flow nasal cannula was added to automated O2 titration. Compared to fixed-flow O2, O2 flows were higher with automated O2 titration, resulting in better oxygenation. CONCLUSIONS Automated O2 titration was superior to fixed-flow O2 to alleviate dyspnea and improve exercise endurance during the ESWT in subjects with a variety of chronic respiratory diseases. Adding high-flow nasal cannula to automated O2 titration provided no further benefits.
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Affiliation(s)
- Felix-Antoine Vézina
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada; and Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec City, Québec, Canada
| | - Pierre-Alexandre Bouchard
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Émilie Breton-Gagnon
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Geneviève Dion
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Damien Viglino
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada; and Université Grenoble Alpes, Laboratoire Hypoxie-Physiopathologie HP2 INSERM U1300, Grenoble, France
| | - Pascalin Roy
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Lara Bilodeau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Steeve Provencher
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Marie-Hélène Denault
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Didier Saey
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - François Lellouche
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada.
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Denault MH, Labbé C, St-Pierre C, Fournier B, Gagné A, Morillon C, Joubert P, Simard S, Martel S. Wait Times and Survival in Lung Cancer Patients across the Province of Quebec, Canada. Curr Oncol 2022; 29:3187-3199. [PMID: 35621649 PMCID: PMC9140092 DOI: 10.3390/curroncol29050259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/23/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
Lung cancer is the leading cause of cancer death worldwide, with a five-year survival of 22% in Canada. Guidelines recommend rapid evaluation of patients with suspected lung cancer, but the impact on survival remains unclear. We reviewed medical records of all patients with newly diagnosed lung cancer in four hospital networks across the province of Quebec, Canada, between 1 February and 30 April 2017. Patients were followed for 3 years. Wait times for diagnosis and treatment were collected, and survival analysis using a Cox regression model was conducted. We included 1309 patients, of whom 39% had stage IV non-small cell lung cancer (NSCLC). Median wait times were, in general, significantly shorter in patients with stage III–IV NSCLC or SCLC. Surgery was associated with delays compared to other types of treatments. Median survival was 12.9 (11.1–15.7) months. The multivariate survival model included age, female sex, performance status, histology and stage, treatment, and the time interval between diagnosis and treatment. Longer wait times had a slightly protective to neutral effect on survival, but this was not significant in the stage I–II NSCLC subgroup. Wait times for the diagnosis and treatment of lung cancer were generally within targets. The shorter wait times observed for advanced NSCLC and SCLC might indicate a tendency for clinicians to act quicker on sicker patients. This study did not demonstrate the detrimental effect of longer wait times on survival.
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Affiliation(s)
- Marie-Hélène Denault
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch. Ste-Foy, Québec, QC G1V 4G5, Canada; (C.L.); (C.S.-P.); (B.F.); (A.G.); (C.M.); (P.J.); (S.S.); (S.M.)
- BC Cancer Agency-Vancouver Center, 600 W 10th Avenue, Vancouver, BC V5Z 4E6, Canada
- Correspondence:
| | - Catherine Labbé
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch. Ste-Foy, Québec, QC G1V 4G5, Canada; (C.L.); (C.S.-P.); (B.F.); (A.G.); (C.M.); (P.J.); (S.S.); (S.M.)
| | - Carolle St-Pierre
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch. Ste-Foy, Québec, QC G1V 4G5, Canada; (C.L.); (C.S.-P.); (B.F.); (A.G.); (C.M.); (P.J.); (S.S.); (S.M.)
| | - Brigitte Fournier
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch. Ste-Foy, Québec, QC G1V 4G5, Canada; (C.L.); (C.S.-P.); (B.F.); (A.G.); (C.M.); (P.J.); (S.S.); (S.M.)
| | - Andréanne Gagné
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch. Ste-Foy, Québec, QC G1V 4G5, Canada; (C.L.); (C.S.-P.); (B.F.); (A.G.); (C.M.); (P.J.); (S.S.); (S.M.)
| | - Claudia Morillon
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch. Ste-Foy, Québec, QC G1V 4G5, Canada; (C.L.); (C.S.-P.); (B.F.); (A.G.); (C.M.); (P.J.); (S.S.); (S.M.)
| | - Philippe Joubert
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch. Ste-Foy, Québec, QC G1V 4G5, Canada; (C.L.); (C.S.-P.); (B.F.); (A.G.); (C.M.); (P.J.); (S.S.); (S.M.)
| | - Serge Simard
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch. Ste-Foy, Québec, QC G1V 4G5, Canada; (C.L.); (C.S.-P.); (B.F.); (A.G.); (C.M.); (P.J.); (S.S.); (S.M.)
| | - Simon Martel
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Ch. Ste-Foy, Québec, QC G1V 4G5, Canada; (C.L.); (C.S.-P.); (B.F.); (A.G.); (C.M.); (P.J.); (S.S.); (S.M.)
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Denault MH, Kuang S, Shokoohi A, Leung B, Liu M, Berthelet E, Laskin J, Sun S, Zhang T, Melosky B, Ho C. Comparison of two-weekly versus four-weekly durvalumab consolidation for advanced NSCLC treated with chemoradiotherapy: a brief report. JTO Clin Res Rep 2022; 3:100316. [PMID: 35498385 PMCID: PMC9046443 DOI: 10.1016/j.jtocrr.2022.100316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Durvalumab 10 mg/kg every 2 weeks for 1 year after chemoradiation has improved overall survival (OS) in unresectable stage III NSCLC. Subsequently, a 20 mg/kg 4-weekly regimen was approved. The study goal was to compare the efficacy and toxicity of the two regimens. Methods All patients with NSCLC treated with curative-intent chemoradiation followed by durvalumab from March 1, 2018 to December 31, 2020 at BC Cancer, British Columbia, Canada were included in this retrospective review. Durvalumab dosing schedule, toxicity, progression, and OS were collected. Comparisons between treatment groups were made using chi-square and independent t tests. Kaplan-Meier curves and log-rank test were used to analyze OS. Results A total of 152 patients were included in the 2-weekly group and 53 patients in the 4-weekly group. The median follow-up was 19.7 months and 12.0 months, respectively. The median OS was not reached, but 12-month survival rates were 88.4% versus 85.2% (p = 0.55). Toxicity profiles were similar in terms of sites and severity. Conclusions There was no significant difference in efficacy or toxicity between the 2-weekly and 4-weekly durvalumab in this cohort of patients with advanced NSCLC previously treated with curative-intent chemoradiation.
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Affiliation(s)
- Marie-Hélène Denault
- Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
- Quebec Heart and Lung Institute, Québec City, Québec, Canada
| | - Shelley Kuang
- Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Aria Shokoohi
- Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Bonnie Leung
- Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Mitchell Liu
- Radiation Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Eric Berthelet
- Radiation Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Janessa Laskin
- Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Sophie Sun
- Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Tina Zhang
- Radiation Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Barbara Melosky
- Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Cheryl Ho
- Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada
- Corresponding author. Address for correspondence: Cheryl Ho, MD, FRCPC, BC Cancer, Vancouver Center, 600 West 10th Avenue, Vancouver, BC V5Z 4E6 Canada.
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Denault MH, Morin-Thibault LV, Kermelly SB, Labbé C. Prevention and Treatment of Thromboembolic Events in Patients with Cancer: Advances and Challenges. Am J Respir Crit Care Med 2020; 202:124-127. [DOI: 10.1164/rccm.201909-1782rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Marie-Hélène Denault
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Quebec, Canada
| | | | - Sophie B. Kermelly
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Quebec, Canada
| | - Catherine Labbé
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Quebec, Canada
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Denault MH, Ruel C, Simon M, Bouchard PA, Simard S, Lellouche F. Evaluation of hyperoxia-induced hypercapnia in obese patients after cardiac surgery: a randomized crossover comparison of conservative and liberal oxygen administration. Can J Anaesth 2020; 67:194-202. [PMID: 31650500 DOI: 10.1007/s12630-019-01500-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/26/2019] [Accepted: 08/04/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Recent studies on patients with stable obesity-hypoventilation syndrome have raised concerns about hyperoxia-induced hypercapnia in this population. This study aimed to evaluate whether a higher oxygen saturation target would increase arterial partial pressure of carbon dioxide (PaCO2) in obese patients after coronary artery bypass grafting surgery (CABG). METHODS Obese patients having CABG were recruited. With a randomized crossover design, we compared two oxygenation strategies for 30 min each, immediately after extubation: a peripheral oxygen saturation (SpO2) target of ≥ 95% achieved with manual oxygen titration (liberal) and a SpO2 target of 90% achieved with FreeO2, an automated oxygen titration device (conservative). The main outcome was end-of-period arterial PaCO2. RESULTS Thirty patients were included. Mean (standard deviation [SD]) body mass index (BMI) was 34 (3) kg·m-2 and mean (SD) baseline partial pressure of carbon dioxide (PCO2) was 40.7 (3.1) mmHg. Mean (SD) end-of-period PaCO2 was 42.0 (5.4) mmHg in the conservative period, compared with 42.6 (4.6) mmHg in the liberal period [mean difference - 0.6 (95% confidence interval - 2.2 to 0.9) mmHg; P = 0.4]. Adjusted analysis for age, BMI, narcotics, and preoperative PaCO2 did not substantively change the results. Fourteen patients were retainers, showing an elevation in mean (SD) PaCO2 in the liberal period of 3.3 (4.1) mmHg. Eleven patients had the opposite response, with a mean (SD) end-of-period PaCO2 decrease of 1.8 (2.2) mmHg in the liberal period. Five patients had a neutral response. CONCLUSION This study did not show a clinically important increase in PaCO2 associated with higher SpO2 values in this specific population of obese patients after CABG. Partial pressure of carbon dioxide increased with liberal oxygen administration in almost half of the patients, but no predictive factor was identified. TRIAL REGISTRATION www.clinicaltrials.gov (NCT02917668); registered 25 September, 2016.
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Affiliation(s)
- Marie-Hélène Denault
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval Research Center, 2725 Chemin Ste-Foy, Quebec, QC, G1V 4G5, Canada.
| | - Carolanne Ruel
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval Research Center, 2725 Chemin Ste-Foy, Quebec, QC, G1V 4G5, Canada
| | - Mathieu Simon
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval Research Center, 2725 Chemin Ste-Foy, Quebec, QC, G1V 4G5, Canada
| | - Pierre-Alexandre Bouchard
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval Research Center, 2725 Chemin Ste-Foy, Quebec, QC, G1V 4G5, Canada
| | - Serge Simard
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval Research Center, 2725 Chemin Ste-Foy, Quebec, QC, G1V 4G5, Canada
| | - François Lellouche
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval Research Center, 2725 Chemin Ste-Foy, Quebec, QC, G1V 4G5, Canada
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Denault MH, Péloquin F, Lajoie AC, Lacasse Y. Automatic versus Manual Oxygen Titration in Patients Requiring Supplemental Oxygen in the Hospital: A Systematic Review and Meta-Analysis. Respiration 2019; 98:178-188. [DOI: 10.1159/000499119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/25/2019] [Indexed: 11/19/2022] Open
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