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Calvo V, Camps C, Carcereny E, Cobo M, Dómine M, García Campelo MR, González Larriba JL, Guirado M, Hernando-Trancho F, Massutí B, Nadal E, Rodríguez-Abreu D, Sánchez A, Sullivan IG, Provencio M. Difficulties on the access to innovative targeted therapies for lung cancer in Spain. Clin Transl Oncol 2024; 26:597-612. [PMID: 37651020 PMCID: PMC10869378 DOI: 10.1007/s12094-023-03303-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Spanish Lung Cancer Group (SLCG) conducted a review to analyze the barriers to access to innovative targeted therapies for non-small cell lung cancer (NSCLC) in clinical practice in Spain. METHODS Review all relevant content published on websites of European Commission, European Medicines Agency, and Spanish Agency of Medicines and Medical Products regarding the authorization and access to oncology treatments. RESULTS More than 20 targeted therapies are available to treat different molecular alterations in patients with NSCLC. European Commission has approved treatments for genomic alterations involving the following genes: ALK, RET, ROS1, EGFR, BRAF, NTRK, KRAS, MET. However, the availability of these therapies in Spain is not complete, as innovative treatments are not reimbursed or funded late, with only five of these alterations currently covered by National Health System. CONCLUSION SLCG considers imperative to improve the access in Spain to innovative treatments for NSCLC to reduce inequity across European countries.
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Affiliation(s)
- Virginia Calvo
- Oncology Department, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla 1, Majadahonda, 28222, Madrid, Spain.
| | | | | | - Manuel Cobo
- Hospital Regional Universitario, Málaga, Spain
| | - Manuel Dómine
- Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
| | | | | | | | | | | | - Ernest Nadal
- Institut Català d'Oncologia, l'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | - Mariano Provencio
- Oncology Department, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla 1, Majadahonda, 28222, Madrid, Spain
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Odeny TA, Lurain K, Strauss J, Fling SP, Sharon E, Wright A, Martinez-Picado J, Moran T, Gulley JL, Gonzalez-Cao M, Uldrick TS, Yarchoan R, Ramaswami R. Effect of CD4+ T cell count on treatment-emergent adverse events among patients with and without HIV receiving immunotherapy for advanced cancer. J Immunother Cancer 2022; 10:e005128. [PMID: 37935055 PMCID: PMC9442492 DOI: 10.1136/jitc-2022-005128] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The Food and Drug Administration recommends that people living with HIV (PWH) with a CD4+ T cell count (CD4) ≥350 cells/µL may be eligible for any cancer clinical trial, but there is reluctance to enter patients with lower CD4 counts into cancer studies, including immune checkpoint inhibitor (ICI) studies. Patients with relapsed or refractory cancers may have low CD4 due to prior cancer therapies, irrespective of HIV status. It is unclear how baseline CD4 prior to ICI impacts the proportion of treatment-emergent adverse events (TEAE) and whether it differs by HIV status in ICI treated patients. METHODS We conducted a pilot retrospective cohort study of participants eligible for ICI for advanced cancers from three phase 1/2 trials in the USA and Spain. We determined whether baseline CD4 counts differed by HIV status and whether the effect of CD4 counts on incidence of TEAE was modified by HIV status using a multivariable logistic regression model. RESULTS Of 122 participants, 66 (54%) were PWH who received either pembrolizumab or durvalumab and 56 (46%) were HIV-negative who received bintrafusp alfa. Median CD4 at baseline was 320 cells/µL (IQR 210-495) among PWH and 356 cells/µL (IQR 260-470) among HIV-negative participants (p=0.5). Grade 3 or worse TEAE were recorded among 7/66 (11%) PWH compared with 7/56 (13%) among HIV-negative participants. When adjusted for prior therapies, age, sex, and race, the effect of baseline CD4 on incidence of TEAE was not modified by HIV status for any TEAE (interaction term p=0.7), or any grade ≥3 TEAE (interaction term p=0.1). CONCLUSIONS There was no significant difference in baseline CD4 or the proportions of any TEAE and grade ≥3 TEAE by HIV status. CD4 count thresholds for cancer clinical trials should be carefully reviewed to avoid unnecessarily excluding patients with HIV and cancer.
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Affiliation(s)
- Thomas A Odeny
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Kathryn Lurain
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Julius Strauss
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Steven P Fling
- Cancer Immunotherapy Trials Network, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Elad Sharon
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Anna Wright
- Cancer Immunotherapy Trials Network, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Javier Martinez-Picado
- IrsiCaixa AIDS Research Institute, Research Institute Germans Trias i Pujol, University of Vic-Central University of Catalonia, CIBERINFECT, ICREA, Barcelona, Spain
| | - Teresa Moran
- Medical Oncology Department, Catalan Institute of Oncology (ICO), Germans Trias i Pujol Hospital, Badalona-Applied Research Group in Oncology, Badalona, Spain
| | - James L Gulley
- Center for Immuno-Oncology, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Maria Gonzalez-Cao
- Translational Cancer Research Unit, Instituto Oncológico Dr Rosell, Dexeus University Hospital, Barcelona, Spain
| | - Thomas S Uldrick
- Cancer Immunotherapy Trials Network, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Robert Yarchoan
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Ramya Ramaswami
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland, USA
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