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Ksienski D, Truong PT, Bone JN, Egli S, Clarkson M, Patterson T, Lesperance M, Lakkunarajah S. Advanced cutaneous squamous cell carcinoma: Impact of age on the safety and efficacy of cemiplimab and the prognostic significance of blood biomarkers. J Geriatr Oncol 2024; 15:101789. [PMID: 38710153 DOI: 10.1016/j.jgo.2024.101789] [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] [Received: 11/13/2023] [Revised: 03/23/2024] [Accepted: 04/26/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Age-related differences in the safety profile of cemiplimab for patients with locally advanced or metastatic cutaneous squamous cell carcinoma (cSCC) have not been well described. We investigated the association of increasing age with immune related adverse events (irAE) from cemiplimab, efficacy outcomes, and the prognostic significance of pre-treatment blood biomarkers in contemporary practice. MATERIALS AND METHODS Patients starting first-line cemiplimab for locally advanced or metastatic cSCC at British Columbia Cancer between April 2019 and January 2023 were identified. Landmark four-month logistic regression analysis compared the odds of developing irAE or sequelae amongst patients aged <75 years to those aged 75-84 or ≥ 85. Objective responses were determined using Response Evaluation Criteria in Solid Tumors version 1.1. Univariable Cox proportional hazard (PH) regression modelling of factors associated with overall survival (OS) was performed. RESULTS Of 106 patients, the proportions aged <75, 75-84, and ≥ 85 years were 34%, 45%, and 21%, respectively. Overall, the proportion of patients with irAE ≥ grade 3, cemiplimab discontinuation, and hospitalization for immune toxicity was 27.4%, 31.1%, and 11.3%, respectively. There was no clear association between age and the odds of high grade irAE. However, increased odds of cemiplimab discontinuation was observed in patients aged 75-84 years (p = 0.05). Patients ≥85 years had increased hospitalizations due to irAE (OR = 5.00, 95% CI = 0.97-37.52) with two treatment-related deaths. Objective responses were similar across age cohorts (50.0%, 60.4%, and 54.5%) but progressive disease was higher in the age ≥ 85 group (22.2%, 18.8%, and 31.8%). On Cox PH regression analysis, age ≥ 85 years (vs. <75), Eastern Cooperative Oncology Group performance status 2-3 (vs. 0-1), and neutrophil to lymphocyte ratio (NLR) ≥7.80 (vs. <7.80) were associated with shorter survival. DISCUSSION While the odds of high grade irAE were similar across age groups, significant age-related differences in treatment discontinuation and hospitalization due to immune toxicity were observed. Despite a higher incidence of primary progression and shorter OS in the oldest cohort, cemiplimab yielded robust objective responses regardless of age. Higher pre-treatment NLR was associated with shorter survival and the cut-point identified requires further study.
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Affiliation(s)
- Doran Ksienski
- BC Cancer-Victoria, British Columbia, Canada; University of British Columbia, Victoria, British Columbia, Canada.
| | - Pauline T Truong
- BC Cancer-Victoria, British Columbia, Canada; University of British Columbia, Victoria, British Columbia, Canada
| | - Jeffrey N Bone
- Biostatistics, Clinical Research Support Unit, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Sarah Egli
- BC Cancer-Victoria, British Columbia, Canada
| | | | | | - Mary Lesperance
- University of Victoria, Department of Mathematics and Statistics, Victoria, British Columbia, Canada
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Preti BTB, Sanatani MS, Breadner D, Lakkunarajah S, Scott C, Esmonde-White C, McArthur E, Rodrigues G, Chaudhary M, Mutsaers A, Sachdeva R, Vincent MD. Real-World Analysis of Durvalumab after Chemoradiation in Stage III Non-Small-Cell Lung Cancer. Curr Oncol 2023; 30:7713-7721. [PMID: 37623040 PMCID: PMC10453685 DOI: 10.3390/curroncol30080559] [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: 06/07/2023] [Revised: 07/20/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
The 2017 PACIFIC trial heralded the incorporation of routine adjuvant durvalumab following curative-intent chemoradiation for stage III non-small-cell lung cancer (NSCLC). However, carefully selected clinical trial populations can differ significantly from real-world populations, which can have implications on treatment toxicities and outcomes, making it difficult to accurately counsel patients. Consequently, we performed a real-world, retrospective analysis of outcomes and toxicities in 118 patients with stage III NSCLC treated with durvalumab after platinum-based chemoradiotherapy. The data were collected from patients who underwent treatment at a single, tertiary-level Canadian cancer centre from May 2018 to October 2020. The variables collected included patient demographics, treatment specifics, progression-free survival, overall survival, and immune-related adverse events (IRAE) from durvalumab. Descriptive statistics were used for toxicity analysis, and progression-free survival and overall survival estimates were calculated using the Kaplan-Meier method. The statistical analyses indicated a 64.4% (n = 76) toxicity rate, with a 21% (n = 25) toxicity rate of grade 3+ IRAEs. The most common documented IRAEs were pneumonitis (n = 44; 40%), followed by rash (n = 20; 18%) and thyroid dysfunction (n = 17; 15%). FEV1 and DLCO were not found to be associated predictors of pneumonitis toxicity. The median PFS and OS were estimated to be >1.7 years and >2.7 years, respectively.
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Affiliation(s)
- Beatrice T. B. Preti
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
- Division of Medical Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Michael S. Sanatani
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
- Division of Medical Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Daniel Breadner
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
- Division of Medical Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Suganija Lakkunarajah
- Department of Medical Oncology, University of British Columbia, Victoria, ON V8R 6V5, Canada
| | - Carolyn Scott
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
| | - Caroline Esmonde-White
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
| | - Eric McArthur
- London Health Sciences Centre, London, ON M5S 1A8, Canada
| | - George Rodrigues
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
- Division of Radiation Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Mitali Chaudhary
- Temerty School of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Adam Mutsaers
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
- Division of Radiation Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Robin Sachdeva
- Department of Medical Oncology, University of British Columbia, Victoria, ON V8R 6V5, Canada
| | - Mark D. Vincent
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
- Division of Medical Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
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Lakkunarajah S, Truong PT, Bone JN, Hughesman C, Yip S, Alex D, Hart J, Pollock P, Egli S, Clarkson M, Lesperance M, Ksienski D. First-line osimertinib for patients with EGFR-mutated advanced non-small cell lung cancer: efficacy and safety during the COVID-19 pandemic. Transl Lung Cancer Res 2023; 12:1454-1465. [PMID: 37577326 PMCID: PMC10413024 DOI: 10.21037/tlcr-23-81] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/04/2023] [Indexed: 08/15/2023]
Abstract
Background The FLAURA trial demonstrated improved overall survival (OS) with first-line osimertinib for patients with epidermal growth factor receptor (EGFR)-mutated advanced non-small cell lung cancer (NSCLC). We studied the efficacy and safety of osimertinib in a cohort treated during the coronavirus disease 2019 (COVID-19) pandemic. Methods Patients diagnosed with EGFR-mutated advanced NSCLC between 11 March 2020 to 31 December 2021 who received first-line osimertinib in British Columbia, Canada were identified retrospectively. Kaplan-Meier curves of OS and progression-free survival (PFS) from the start of osimertinib were plotted. The associations of baseline characteristics with PFS, and development of pneumonitis or dose reductions due to toxicity with OS were evaluated with hazard ratios estimated using univariable and multivariable Cox models. Results The cohort comprised 231 individuals. 58.7% of patients with de novo advanced NSCLC were initially diagnosed after presentation to the Emergency Room. At osimertinib initiation, 31.6% were aged ≥75 years and 45.5% had an Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2. Median PFS and OS were 18.0 months [95% confidence interval (CI): 16.1-26.2] and 25.4 months (95% CI: 20.3-not reached), respectively. On multivariable analysis, age ≥75 years (vs. <75), ECOG PS 2/3 (vs. 0/1), ECOG PS 4 (vs. 0/1), current smokers (vs. never smokers), programmed death ligand 1 (PD-L1) expression ≥50% (vs. <1%), and L858R mutation (vs. exon 19 deletion) were associated with shorter PFS. Among 110 patients who progressed, 33.6% received subsequent therapy. A proportion of 16.5% of the cohort developed grade ≥3 adverse events. Pneumonitis from osimertinib (3.9% incidence) was weakly associated with shorter OS (hazard ratio: 2.59, 95% CI: 0.94-7.12, P=0.066); dose reductions were not associated with worse OS. 10.8% of patients developed COVID-19. Conclusions In a cohort receiving first-line osimertinib during the COVID-19 pandemic, ECOG PS ≥2 was observed in nearly half of patients at treatment initiation contributing to a median OS shorter than in FLAURA. The incidence of severe adverse events was low and dose reduction for drug toxicity did not impact OS. Identifying and reducing barriers to the diagnosis of NSCLC during the COVID-19 pandemic are required.
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Affiliation(s)
| | - Pauline T. Truong
- BC Cancer-Victoria, British Columbia, Canada
- University of British Columbia, Victoria, British Columbia, Canada
| | - Jeffrey N. Bone
- Biostatistics, Clinical Research Support Unit, BC Children’s Hospital Research Institute, Vancouver, British Columbia, Canada
| | | | - Stephen Yip
- BC Cancer-Vancouver, British Columbia, Canada
| | - Deepu Alex
- BC Cancer-Vancouver, British Columbia, Canada
| | - Jason Hart
- BC Cancer-Victoria, British Columbia, Canada
- University of British Columbia, Victoria, British Columbia, Canada
| | | | - Sarah Egli
- BC Cancer-Victoria, British Columbia, Canada
| | | | - Mary Lesperance
- University of Victoria, Department of Mathematics and Statistics, Victoria, British Columbia, Canada
| | - Doran Ksienski
- BC Cancer-Victoria, British Columbia, Canada
- University of British Columbia, Victoria, British Columbia, Canada
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Breadner D, Loree JM, Cheung WY, Gipson M, Lakkunarajah S, Mulder KE, Spartlin JL, Kong S, Ding PQ, Gill S, Welch SA. The influence of adjuvant chemotherapy dose intensity on overall survival in resected colon cancer: a multicentered retrospective analysis. BMC Cancer 2022; 22:1119. [PMID: 36319973 PMCID: PMC9628061 DOI: 10.1186/s12885-022-10198-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Colorectal cancer remains the second leading cause of cancer death in North America. Fluorouracil and oxaliplatin based adjuvant chemotherapy for resected colon cancer (CC) reduces cancer recurrence, but also causes significant toxicity requiring dose reductions. The effect of dose intensity on survival outcomes is not fully understood and strengthening the evidence supports informed decision making between patients and oncologists. METHODS Patients treated with adjuvant chemotherapy, between 2006 and 2011, for resected colon cancer at four Canadian academic cancer centers were retrospectively analyzed. All patients must have received oxaliplatin with either capecitabine (CAPOX) or 5-FU (FOLFOX). Dose intensity (DI) was calculated as total delivered dose of an individual chemotherapy agent divided by the cumulative intended dose of that agent. The influence of DI on overall survival was examined. RESULTS Five hundred thirty-one patients with high-risk stage II or stage III resected CC were eligible and included in the analysis. FOLFOX was the most common regimen (69.6%) with 29.7% of patients receiving CAPOX and 0.7% receiving both therapies. Median follow-up was 36.7 months. The median DI for 5-FU and capecitabine was 100% and 100% with 13.6% and 9.8% of patients receiving ≤ 80% DI, respectively. The median DI of oxaliplatin was 70% with 56.8% of patients receiving ≤ 80% DI. A DI of > 80% for each chemotherapy component was associated with a significant improvement in overall survival compared to those with a DI of ≤ 80% (5-FU HR = 0.23, 95% CI = 0.08-0.65, p = 0.006; capecitabine HR = 0.56, 95% CI = 0.33-0.94, p = 0.026; oxaliplatin HR = 0.52, 95% CI = 0.33-0.82, p = 0.005). Patients with T2 and/or N2 disease with an oxaliplatin DI > 80% had a trend towards improved survival (HR = 0.62, 95% CI = 0.38-1.02, p = 0.06). CONCLUSIONS In resected CC an adjuvant chemotherapy DI of > 80%, of each chemotherapy agent, is associated with improved overall survival.
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Affiliation(s)
- Daniel Breadner
- grid.412745.10000 0000 9132 1600Department of Oncology, A3-924 LRCP Medical Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, ON N6A5W9 Canada ,grid.39381.300000 0004 1936 8884Schulich School of Medicine and Dentistry at, Western University, London, ON Canada
| | | | - Winson Y. Cheung
- grid.22072.350000 0004 1936 7697Department of Oncology, Arnie Charbonneau Cancer Institute, Calgary, AB Canada
| | - Meghan Gipson
- grid.4912.e0000 0004 0488 7120Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Suganija Lakkunarajah
- grid.39381.300000 0004 1936 8884Schulich School of Medicine and Dentistry at, Western University, London, ON Canada
| | - Karen E. Mulder
- grid.17089.370000 0001 2190 316XDepartment of Oncology, Cross Cancer Institute, Edmonton, AB Canada
| | - Jennifer L. Spartlin
- grid.17089.370000 0001 2190 316XDepartment of Oncology, Cross Cancer Institute, Edmonton, AB Canada
| | - Shiying Kong
- grid.22072.350000 0004 1936 7697Department of Oncology, Arnie Charbonneau Cancer Institute, Calgary, AB Canada
| | - Philip Q. Ding
- Oncology Outcomes, Calgary, AB Canada ,grid.17089.370000 0001 2190 316XFaculty of Medicine & Dentistry, University of Alberta, Edmonton, AB Canada
| | | | - Stephen A. Welch
- grid.412745.10000 0000 9132 1600Department of Oncology, A3-924 LRCP Medical Oncology, London Regional Cancer Program, 800 Commissioners Road East, London, ON N6A5W9 Canada ,grid.39381.300000 0004 1936 8884Schulich School of Medicine and Dentistry at, Western University, London, ON Canada
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Lakkunarajah S, Breadner DA, Zhang H, Yamanaka E, Warner A, Welch S. The Influence of Adjuvant Chemotherapy Dose Intensity on Five-Year Outcomes in Resected Colon Cancer: A Single Centre Retrospective Analysis. Curr Oncol 2021; 28:4031-4041. [PMID: 34677260 PMCID: PMC8535138 DOI: 10.3390/curroncol28050342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/04/2021] [Accepted: 09/28/2021] [Indexed: 01/22/2023] Open
Abstract
There is evidence that achieving a dose intensity > 80% in adjuvant colon cancer treatment improves survival. In total, 192 consecutive patients with resected stage III and high-risk stage II colon cancer that received adjuvant chemotherapy were retrospectively analyzed. Patients who received at least 6 weeks of adjuvant therapy were included. The primary objective was to assess the influence of dose index (DI) and relative dose intensity (RDI) on DFS and OS at 3 and 5 years in patients receiving fluorouracil-based doublet therapy with oxaliplatin (FOLFOX) (5-FU and oxaliplatin assessed separately), or capecitabine monotherapy. In the capecitabine group, DFS rates for 3 and 5 years were 66.7% and 57.6%, respectively, while OS rates were 80.3% and 66.7%, respectively. Those who received FOLFOX had DFS rates of 76.9% and 71.2% at 3 and 5 years, respectively. OS rates were 86.4% and 76.7% at 3 and 5 years, respectively. Median RDI was 73.8% for capecitabine and 76.3% and 85.6% for the oxaliplatin and 5-FU components respectively. Based on a multivariate analysis in patients receiving FOLFOX, those with an oxaliplatin DI > 80% had improvements in DFS and OS compared to those with an oxaliplatin DI of ≤80%. Otherwise, there was no significant difference in DFS or OS when comparing patients who achieved an RDI or a DI of above versus below 80% in the patients receiving adjuvant chemotherapy for resected colon cancer.
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Affiliation(s)
- Suganija Lakkunarajah
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5A5, Canada;
| | - Daniel A. Breadner
- Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5W9, Canada;
- London Regional Cancer Program, London Health Sciences Centre, Victoria Hospital, London, ON N6A 5W9, Canada; (E.Y.); (A.W.)
- Correspondence:
| | - Hanbo Zhang
- Department of Internal Medicine, Section of Hematology and Oncology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada;
| | - Ellen Yamanaka
- London Regional Cancer Program, London Health Sciences Centre, Victoria Hospital, London, ON N6A 5W9, Canada; (E.Y.); (A.W.)
| | - Andrew Warner
- London Regional Cancer Program, London Health Sciences Centre, Victoria Hospital, London, ON N6A 5W9, Canada; (E.Y.); (A.W.)
| | - Stephen Welch
- Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 5W9, Canada;
- London Regional Cancer Program, London Health Sciences Centre, Victoria Hospital, London, ON N6A 5W9, Canada; (E.Y.); (A.W.)
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Panuganty VDS, Lakkunarajah S, Shanmuganathan S, Black M, Nasreen S, Karp I, Vandenberg TA, Raphael J, Fernandes R, Blanchette PS. Usage and factors associated with adjuvant bisphosphonate therapy among postmenopausal women diagnosed with early-stage breast cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e12532] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12532 Background: Early Breast Cancer Trialist Collaborative Group meta-analysis suggested significant reduction in bone metastasis and breast cancer mortality among post-menopausal women diagnosed with early breast cancer when treated with an adjuvant bisphosphonate. Cancer Care Ontario and American Society of Clinical Oncology clinical practice guideline published in 2017, recommends the use of an adjuvant bisphosphonate in postmenopausal women who are candidates for adjuvant systemic therapy. Our goal was to evaluate trends and factors associated with adjuvant bisphosphonate usage since the guideline’s publication. Methods: This study is a retrospective review of postmenopausal women treated for early breast at the London Regional Cancer Program from 2017-2018. Univariate and a multivariable logistic regression models were used to investigate factors potentially associated with adjuvant bisphosphonate use including age, stage, grade, estrogen receptor, progesterone receptor, HER2 receptor status and previous use of adjuvant chemotherapy. The percentage of patients offered, receiving and declining therapy was also recorded and the time interval from surgery to start of bisphosphonate therapy (< 6 months, 6-12 months or >12 months). Results: We identified 286 postmenopausal breast cancer patients, of whom 75 (28%) received adjuvant bisphosphonate therapy. In our multivariable model, cancer stage [odds ratio (OR) stage II vs. I=2.26, 95% confidence interval (CI) 1.08-4.74) and OR Stage III vs. I=4.94, 95% CI 1.84-13.17] and previous use of adjuvant chemotherapy (OR=2.76, 95%CI 1.37-5.55) were significantly associated with adjuvant bisphosphonate use. Among 133 patients who received adjuvant systemic chemotherapy, 51% were offered adjuvant bisphosphonate and of these 81% patients accepted therapy. Among a total of 75 patients receiving adjuvant bisphosphonate therapy 19% initiated therapy within 6 months of surgery, 48% within 6-12 months of surgery, and 33% after 12 months following surgery. Conclusions: Stage and previous use of chemotherapy were significantly associated with adjuvant bisphosphonate therapy. Our study observes the potential underutilization of adjuvant bisphosphonate therapy and possible need to start treatment earlier in some patients. Further education and awareness of the clinical practice guidelines regarding adjuvant bisphosphonate therapy may be warranted and additional population-based study investigating treatment patterns and real-world effectiveness.
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Affiliation(s)
- Veera Durga Sravanthi Panuganty
- Department of Oncology, Division of Medical Oncology, Schulich School of Medicine & Dentistry, Western University and London Regional Cancer Program, London, ON, Canada
| | - Suganija Lakkunarajah
- Department of Internal Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Sumugan Shanmuganathan
- Department of Internal Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Morgan Black
- Department of Oncology, Division of Medical Oncology, Schulich School of Medicine & Dentistry, Western University and London Regional Cancer Program, London, ON, Canada
| | - Sharifa Nasreen
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Igor Karp
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | | | - Jacques Raphael
- London Regional Cancer Program, Western University, London, ON, Canada
| | - Ricardo Fernandes
- London Regional Cancer Program, Western University, London, ON, Canada
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Lakkunarajah S, Breadner DA, Zhang H, Spratlin JL, Mulder KE, Gill S, Sha A, Abadi S, Kong S, Cheung WY, Loree JM, Welch S. The influence of adjuvant chemotherapy dose intensity on overall survival in resected colon cancer: A multicenter retrospective analysis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.248] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
248 Background: Colorectal cancer remains the second leading cause of cancer death in developed countries. The benefit of using fluorouracil-based chemotherapy with oxaliplatin, such as FOLFOX (fluorouracil (5-FU), leucovorin, oxaliplatin) and CAPOX (capecitabine and oxaliplatin) is well established. The optimal dose intensity (DI) under which overall survival (OS) is inferior is not established. Methods: Patients (pts) treated with adjuvant chemotherapy between 2006 and 2011 for resected stage III colon cancer (CC) from four academic cancer centres in Canada were retrospectively analysed. Patients that received CAPOX and FOLFOX were examined for the relationship between DI and OS. Results: A total of 625 pts with resected high risk stage II or stage III CC that received adjuvant chemotherapy were analysed. The median age was 63. Pts with T4 and N2 disease comprised 35.4% and 29.9% of pts, respectively. Median follow-up was 3.2 years. There was available survival data for 319 pts. The median oxaliplatin DI was 70%. The frequency of pts reaching an oxaliplatin DI of > 80% was 43%, while 76.6% of pts had a dose intensity of > 80% for their FU component. An oxaliplatin DI of > 80% was associated with a significant improvement in survival, HR = 0.42 (95%CI 0.21 – 0.81, p < 0.01). Achieving a DI of > 80% for capecitabine or 5-FU did not improve OS. Other factors associated with inferior OS included T4 (HR = 3.5, p = 0.03) and N2 (HR = 5.27, p = 0.0005) subgroups. The improvement in OS was not significant when restricting the analysis to pts with non-T4 and non-N2 disease (n = 144), HR = 0.16 (0.02 – 1.26; p = 0.08). Conclusions: Oxaliplatin DI of > 80% is associated with improved OS in patients receiving chemotherapy for high risk stage II and stage III CC.
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Affiliation(s)
| | | | - Hanbo Zhang
- University of Manitoba, Winnipeg, MB, Canada
| | | | | | | | - Aaron Sha
- BC Cancer Agency, Vancouver, BC, Canada
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