96P US real-world immunotherapy-based treatment patterns and clinical outcomes of advanced NSCLC (aNSCLC) patients in the first-line setting

Introduction : Mechanical thrombectomy for large‐vessel acute ischemic stroke has been adopted as the standard of care treatment across the world, with dramatic improvements in long‐term functional outcomes for an otherwise debilitating disease process. Timely and complete recanalization are paramount in achieving good outcomes. Though several revascularization techniques have been described, direct contact aspiration and clot removal via stent‐retriever remain the foundation of endovascular stroke therapy. Utilizing the NeuroVascular Quality Initiative – Quality Outcomes Database (NVQI‐QOD), we present our data on real‐world, first‐line practice for treatment of large vessel occlusions (LVOs), and compare angiographic and clinical outcomes between direct contact aspiration and stent‐retriever mechanical thrombectomy techniques. Methods : Retrospective analysis of the NVQI‐QOD was performed. We included patients with LVOs that underwent mechanical thrombectomy who were older than 18 and whose baseline NIHSS ≥ 6. We compared procedural times, rate of revascularization, and outcomes, including in‐hospital mortality and discharge NIHSS. Results : We identified a total of 2381 patients who met the inclusion criteria, of which 998 (41.9%) underwent treatment with direct contact aspiration alone and 1383 (58.1%) underwent treatment utilizing a stent‐retriever (with or without local aspiration). There were no significant differences in the baseline median NIHSS scores (16 vs 17, p = 0.25) or baseline median ASPECTS scores (9 vs 9, p = 0.7). No significant difference was seen in time metrics, including last known well to puncture (282 min vs. 280 min, p = 0.22) or recanalization (323 min vs. 322 min, p = 0.39), ED to puncture (75 min vs. 71 min, p = 0.25) or recanalization (158 min vs. 160 min, p = 0.55), or median procedure times between the two groups (23 vs 23 min, p = 0.64). The median number of passes required for recanalization was lower in the direct aspiration group (1 vs 2, p = 0.01). Though there was no difference in successful recanalization (TICI 2B‐3) between the two groups (86.1% vs 88%, p = 0.71), there was a lower rate of complete recanalization (TICI 2C‐3) in the direct aspiration group (46% vs 51.7%, p = 0.007). There was also a lower rate of adjunct treatments (defined as the use of GP IIb/IIIa inhibitors, P2Y12 inhibitors, and/or salvage angioplasty and/or stenting) required in the direct contact aspiration group (36.1% vs 44.4%, p < 0.001). There were no differences noted in discharge NIHSS scores (5 vs 4, p = 0.21) or in‐hospital mortality (22.2% vs 22.5%, p = 0.92). Conclusions : In the NVQI‐QOD, stent‐retriever techniques were associated with higher rates of complete recanalization when compared to direct contact aspiration alone, although acceptable (TICI 2B‐3) recanalization rates were similar. There were no statistically significant differences in procedure times or clinical outcomes at discharge.

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SELECT-3: a phase I study of selumetinib in combination with platinum-doublet chemotherapy for advanced NSCLC in the first-line setting

British Journal of Cancer ◽

10.1038/bjc.2017.271 ◽

2017 ◽

Vol 117 (7) ◽

pp. 938-946 ◽

Cited By ~ 7

Author(s):

Alastair Greystoke ◽

Nicola Steele ◽

Hendrik-Tobias Arkenau ◽

Fiona Blackhall ◽

Noor Md Haris ◽

...

Keyword(s):

Phase I ◽

Phase I Study ◽

Advanced Nsclc ◽

First Line ◽

Line Setting ◽

Doublet Chemotherapy ◽

Platinum Doublet

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Treatment Patterns and Clinical Outcomes in Advanced Lung Neuroendocrine Tumors in Real‐World Settings: A Multicenter Retrospective Chart Review Study

The Oncologist ◽

10.1634/theoncologist.2018-0520 ◽

2019 ◽

Vol 24 (8) ◽

pp. 1066-1075

Author(s):

Arvind Dasari ◽

Emily K. Bergsland ◽

Al B. Benson ◽

Beilei Cai ◽

Lynn Huynh ◽

...

Keyword(s):

Clinical Outcomes ◽

Neuroendocrine Tumors ◽

Real World ◽

Chart Review ◽

Retrospective Chart Review ◽

Treatment Patterns ◽

Review Study

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Real World Treatment Patterns and Toxicity Among Elderly Patients with Multiple Myeloma

Blood ◽

10.1182/blood-2019-131114 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5571-5571

Author(s):

Jesus D Gonzalez-Lugo ◽

Ana Acuna-Villaorduna ◽

Joshua Heisler ◽

Niyati Goradia ◽

Daniel Cole ◽

...

Keyword(s):

Side Effects ◽

Real World ◽

Research Funding ◽

Treatment Patterns ◽

Line Treatment ◽

Event Free Survival ◽

First Line ◽

Treatment Change ◽

Free Survival ◽

First Line Treatment

Introduction: Multiple Myeloma (MM) is a disease of the elderly; with approximately two-thirds of cases diagnosed at ages older than 65 years. However, this population has been underrepresented in clinical trials. Hence, there are no evidence-based guidelines to select the most appropriate treatment that would balance effectiveness against risk for side effects in the real world. Currently, guidelines advise that doublet regimens should be considered for frail, elderly patients; but more detailed recommendations are lacking. This study aims to describe treatment patterns in older patients with MM and compare treatment response and side effects between doublet and triplet regimens. Methods: Patients diagnosed with MM at 70 years or older and treated at Montefiore Medical Center between 2000 and 2017 were identified using Clinical Looking Glass, an institutional software tool. Recipients of autologous stem cell transplant were excluded. We collected demographic data and calculated comorbidity burden based on the age-adjusted Charlson Comorbidity Index (CCI). Laboratory parameters included cell blood counts, renal function, serum-protein electrophoresis and free kappa/lambda ratio pre and post first-line treatment. Treatment was categorized into doublet [bortezomib/dexamethasone (VD) and lenalidomide/dexamethasone (RD)] or triplet regimens [lenalidomide/bortezomib/dexamethasone (RVD) and cyclophosphamide/bortezomib/dexamethasone (CyborD)]. Disease response was reported as VGPR, PR, SD or PD using pre-established criteria. Side effects included cytopenias, diarrhea, thrombosis and peripheral neuropathy. Clinical and laboratory data were obtained by manual chart review. Event-free survival was defined as time to treatment change, death or disease progression. Data were analyzed by treatment group using Stata 14.1 Results: A total of 97 patients were included, of whom 46 (47.4%) were males, 47 (48.5%) were Non-Hispanic Black and 23 (23.7%) were Hispanic. Median age at diagnosis was 77 years (range: 70-90). Median baseline hemoglobin was 9.4 (8.5-10.5) and 14 (16.1%) had grade 3/4 anemia. Baseline thrombocytopenia and neutropenia of any grade were less common (18.4% and 17.7%, respectively) and 11 patients (20%) had GFR ≤30. Treatment regimens included VD (51, 52.6%), CyborD (18, 18.6%), RD (15, 15.5%) and RVD (13, 13.4%). Overall, doublets were more commonly used than triplets (66, 68% vs 31, 32%). Baseline characteristics were similar among treatment regimen groups. There was no difference in treatment selection among patients with baseline anemia or baseline neutropenia; however, doublets were preferred for those with underlying thrombocytopenia compared to triplets (93.8% vs 6.2%, p<0.01). Median first-line treatment duration was 4.1 months and did not differ among treatment groups (3.9 vs. 4.3 months; p=0.88 for doublets and triplets, respectively). At least a partial response was achieved in 47 cases (63.5%) and it did not differ between doublets and triplets (61.7% vs 66.7%). In general, first line treatment was changed in 50 (51.5%) patients and the change frequency was higher for triplets than doublets (71% vs 42.4%, p<0.01). Among patients that changed treatment, 17(34.7%) switched from a doublet to a triplet; 15 (30.6%) from a triplet to a doublet and 17 (34.7%) changed the regimen remaining as doublet or triplet, respectively. There was no difference in frequency of cytopenias, diarrhea, thrombosis or peripheral neuropathy among groups. Median event-free survival was longer in patients receiving doublet vs. triplet therapy, although the difference was not statistically significant (7.3 vs 4.3 months; p=0.06). Conclusions: We show a real-world experience of an inner city, elderly MM cohort, ineligible for autologous transplantation. A doublet combination and specifically the VD regimen was the treatment of choice in the majority of cases. In this cohort, triplet regimens did not show better response rates and led to treatment change more often than doublets. Among patients requiring treatment, approximately a third switched from doublet to triplet or viceversa which suggest that current evaluation of patient frailty at diagnosis is suboptimal. Despite similar frequency of side effects among groups, there was a trend towards longer event-free survival in patients receiving doublets. Larger retrospective studies are needed to confirm these results. Disclosures Verma: Janssen: Research Funding; BMS: Research Funding; Stelexis: Equity Ownership, Honoraria; Acceleron: Honoraria; Celgene: Honoraria.

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562 Real-world assessment of current treatment patterns and clinical outcomes among patients with EGFR and ALK wild type non-small cell lung cancer (NSCLC) in the US

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2021-sitc2021.562 ◽

2021 ◽

Vol 9 (Suppl 3) ◽

pp. A591-A591

Author(s):

Lyudmila Bazhenova ◽

Jonathan Kish ◽

Beilei Cai ◽

Nydia Caro ◽

Bruce Feinberg

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Clinical Outcomes ◽

Treatment Patterns ◽

Small Cell ◽

Wild Type ◽

Small Cell Lung ◽

First Line ◽

The Us ◽

Nsclc Patients

BackgroundTreatment for advanced non-small cell lung cancer (NSCLC) has dramatically advanced in the past 5 years with the advent of immunotherapy (IO). This study sought to describe treatment patterns and clinical outcomes in a representative sample of NSCLC patients.MethodsPatients were identified by physicians from a voluntary sample of community practices across the US. Stage IIIB/IV NSCLC patients with EGFR/ALK wild-type initiating any first-line (1L) systemic therapy between 01/01/2016 and 12/31/2019 with at least 2 months of follow-up (unless deceased) were included, and were followed until November 2020. Sampling quotas included 250 patients who initiated 1L in 2016/2017 and 250 patients who did so in 2018/2019. Best tumor response was collected from patient charts during each line of therapy (LOT). Progression-free survival (PFS) and overall survival (OS) were calculated from initiation of 1L by Kaplan-Meier method. Baseline characteristics and clinical outcomes are described and presented by treatment regimen received.ResultsOf 500 submitted patients, 497 were included post QA/QC. Across all patients, mean age at 1L initiation was 65 years, 57.3% were male, 92.9% had stage IV disease, and 68.6% were ECOG-OS 0/1 (Table 1). Overall, 60.2% (n=299), 33.2% (n=165), and 6.6% (n=33) received 1, 2, or =3 LOTs during the study period. Most common 1L regimens (%) were platinum-doublet chemotherapy plus IO (PDC+IO) (40.6%), PDC (29.4%), IO monotherapy (20.7%), PDC+bevacizumab (6.2%); while most common 2L regimens were IO monotherapy (42.4%), single-agent chemotherapy (SAC) (18.2%), SAC+VEGF inhibitor (15.7%), PDC (8.1%), and PDC+bevacizumab (5.6%). Over 90% of pts who received IO monotherapy had PD-L1 >50%. Moving from 2016/2017 to 2018/2019, utilization of 1L PDC declined from 45.0% to 13.7% while utilization of 1L PDC+IO increased from 27.3% to 54.0%. Among those who received only one LOT (n=299), 44.5% were still on 1L, 14.0% stopped receiving 1L, and 41.5% were deceased. Overall response rates were 67.3%, 35.6%, 60.2%, and 61.3% for 1L PDC+IO, PDC, IO monotherapy, and PDC+bevacizumab, respectively (Table 1). First-line median PFS/OS (months) was 15.6/26.5, 5.3/13.7, 17.8/NR, and 10.8/18.6, respectively for PDC+IO, PDC, IO monotherapy, and PDC+bevacizumab (table 1).Abstract 562 Table 1ConclusionsData from 2016 to 2020 was used provide a contemporary assessment of treatment patterns among EGFR/ALK wild-type NSCLC patients. Although 1L treatment utilization shifted to IO-based regimens in recent years, 41.5% of patients did not survive to receive second-line therapy, 1L PFS did not exceed 1.5 years, and median OS remained limited across all 1L treatment groups.Ethics ApprovalOn August 20, 2020, Western Institutional Review Board (WIRB) approved a request for a waiver of authorization for use and disclosure of protected health information (PHI) for this research. The study is exempt under 45 CFR § 46.104(d)(4).

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