Real-world data analysis of patients with cancer of unknown primary

AbstractCancer of unknown primary (CUP) is a heterogeneous malignancy in which the primary site of the tumor cannot be identified through standard work-up. The survival outcome of CUP is generally poor, and there is no consensus for treatment. Here, we comprehensively analyzed the real-world data of 218 patients with CUP (median age, 62 years [range, 19–91]; male, 62.3%). Next-generation sequencing was conducted in 22 (10%) patients, one of whom showed level 1 genetic alteration. Most (60.3%) patients were treated with empirical cytotoxic chemotherapy, and two patients received targeted therapy based on the NGS results. The median OS was 8.3 months (95% confidence interval [CI] 6.2–11.4), and the median progression-free survival of patients treated with chemotherapy was 4.4 months (95% CI 3.4–5.3). In multivariate Cox regression analysis, Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 or 1 and localized disease were significantly associated with favorable survival outcomes. Collectively, we found that CUP patients had a poor prognosis after standard treatment, and those with localized disease who received local treatment and those with better PS treated with multiple lines of chemotherapy had better survival outcomes. Targeted therapies based on NGS results are expected to improve survival outcomes.

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Real-world data analysis of patients with cancer of unknown primary

10.21203/rs.3.rs-516390/v1 ◽

2021 ◽

Author(s):

Sora Kang ◽

Jae Ho Jeong ◽

Shinkyo Yoon ◽

Changhoon Yoo ◽

Kyu-Pyo Kim ◽

...

Keyword(s):

Real World ◽

Group Performance ◽

Local Treatment ◽

Cancer Of Unknown Primary ◽

Unknown Primary ◽

Survival Outcomes ◽

Real World Data ◽

Cox Regression Analysis ◽

World Data ◽

Localized Disease

Abstract Cancer of unknown primary (CUP) is a heterogeneous malignancy in which the primary site of the tumor cannot be identified through standard work-up. The survival outcome of CUP is generally poor, and there is no consensus for treatment. Here, we comprehensively analyzed the real-world data of 218 patients with CUP (median age, 62 years [range, 19–91]; male, 62.3%). Next-generation sequencing was conducted in 22 (10%) patients, one of whom showed level 1 genetic alteration. Most (60.3%) patients were treated with empirical cytotoxic chemotherapy, and two patients received targeted therapy based on the NGS results. The median OS was 8.3 months (95% confidence interval [CI], 6.2–11.4), and the median progression-free survival of patients treated with chemotherapy was 4.4 months (95% CI, 3.4–5.3). In multivariate Cox regression analysis, Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 or 1 and localized disease were significantly associated with favorable survival outcomes. Collectively, we found that CUP patients had a poor prognosis after standard treatment, and those with localized disease who received local treatment and those with better PS treated with multiple lines of chemotherapy had better survival outcomes. Targeted therapies based on NGS results are expected to improve survival outcomes.

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Development and validation of a nomogram for predicting overall survival of patients with cancer of unknown primary: a real-world data analysis

Annals of Translational Medicine ◽

10.21037/atm-20-4826 ◽

2021 ◽

Vol 9 (3) ◽

pp. 198-198

Author(s):

Yizi Jin ◽

Mingxi Lin ◽

Zhiguo Luo ◽

Xichun Hu ◽

Jian Zhang

Keyword(s):

Overall Survival ◽

Data Analysis ◽

Real World ◽

Cancer Of Unknown Primary ◽

Unknown Primary ◽

Real World Data ◽

World Data ◽

Patients With Cancer ◽

Development And Validation

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Trastuzumab-based palliative chemotherapy for HER2-positive gastric cancer: a single-center real-world data

BMC Cancer ◽

10.1186/s12885-021-08058-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tae-Hwan Kim ◽

Hun Do Cho ◽

Yong Won Choi ◽

Hyun Woo Lee ◽

Seok Yun Kang ◽

...

Keyword(s):

Gastric Cancer ◽

Real World ◽

Group Performance ◽

Eastern Cooperative Oncology Group ◽

Conversion Surgery ◽

Single Center ◽

Her2 Positive ◽

Real World Data ◽

World Data ◽

The Real

Abstract Background Since the results of the ToGA trial were published, trastuzumab-based chemotherapy has been used as the standard first-line treatment for HER2-positive recurrent or primary metastatic gastric cancer (RPMGC). However, the real-world data has been rarely reported. Therefore, we investigated the outcomes of trastuzumab-based chemotherapy in a single center. Methods This study analyzed the real-world data of 47 patients with HER2-positive RPMGC treated with trastuzumab-based chemotherapy in a single institution. Results With the median follow-up duration of 18.8 months in survivors, the median overall survival (OS) and progression-free survival were 12.8 and 6.9 months, respectively, and the overall response rate was 64%. Eastern Cooperative Oncology Group performance status 2 and massive amount of ascites were independent poor prognostic factors for OS, while surgical resection before or after chemotherapy was associated with favorable OS, in multivariate analysis. In addition, 5 patients who underwent conversion surgery after chemotherapy demonstrated an encouraging median OS of 30.8 months, all with R0 resection. Conclusions Trastuzumab-based chemotherapy in patients with HER2-positive RPMGC in the real world demonstrated outcomes almost comparable to those of the ToGA trial. Moreover, conversion surgery can be actively considered in fit patients with a favorable response after trastuzumab-based chemotherapy.

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Real-world outcomes of patients with BRAF-mutated mCRC treated in the United States.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.4030 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 4030-4030

Author(s):

Matthew Braithwaite ◽

Christopher Duane Nevala-Plagemann ◽

Kelsey Baron ◽

Benjamin Haaland ◽

Lisa M. Pappas ◽

...

Keyword(s):

United States ◽

Real World ◽

Braf Mutation ◽

The United States ◽

Survival Outcomes ◽

Prognostic Impact ◽

Braf Mutations ◽

Real World Data ◽

World Data ◽

Significant Difference

4030 Background: BRAF mutations portend a poor prognosis in metastatic colorectal cancer (mCRC). Recent trials have hypothesized that using more aggressive triplet-based chemotherapy regimens such as FOLFOXIRI in the frontline setting may improve outcomes in this patient population. In this study, we utilized real-world data to assess whether FOLFOXIRI is being used in the United States (US) and compared survival outcomes in BRAF mutated (BRAFmt) mCRC stratified by first line (1L) therapy. Methods: The nationwide Flatiron Health EHR-derived de-identified database was reviewed for patients diagnosed with mCRC between 2013 and 2018. Patients who had documented BRAF mutation testing and received a standard 1L therapy were included for analysis. Patients who did not have a visit or medication order within 90 days of metastatic diagnosis were excluded to ensure patients were engaged with care at the data-providing institution. Kaplan-Meier and Cox proportional hazard modeling were used to compare survival outcomes stratified by BRAF mutation status and 1L therapy received. Results: A total of 4,454 patients with documented BRAF mutational status were included, of which 3,988 (89.5%) were BRAF wild type (BRAFwt) and 466 (10.5%) were BRAFmt. Median OS was 15.4 months (mo) in the BRAFmt group compared to 28.1 mo in the BRAFwt group (HR 0.48, 95% CI 0.41- 0.56, p < 0.001). Only 3% (n = 16) of BRAFmt patients received 1L FOLFOXIRI +/- bevacizumab with a median OS of 13.8 mo compared to 15.5 mo in patients receiving a chemotherapy doublet (FOLFOX, CAPEOX, or FOLFIRI) +/- bevacizumab (95% CI 4.9 – not reached vs 14.3 – 19.0, p = 0.38). In BRAFmt patients, multivariate analysis (MVA) did not detect a significant improvement in OS with the use of FOLFIRI plus bevacizumab (HR 0.88, 95% CI 0.50-1.56, p = 0.67) or FOLFOX/CAPEOX plus bevacizumab (HR 0.89, 95% CI 0.59 – 1.34, p = 0.58) when compared to chemotherapy doublet alone. A MVA comparing 1L therapies in the BRAFwt group did not detect a significant improvement in OS with bevacizumab plus chemotherapy doublet compared to chemotherapy doublet alone. When stratified by 1L treatment regimen, similar proportions of BRAFmt patients received second line therapy. Conclusions: This analysis of real-world data confirms the negative prognostic impact of BRAF mutations in mCRC and suggests that FOLFOXIRI has not been widely adopted in the management of these patients in the US. We were unable to demonstrate any significant difference in OS of patients with BRAFmt mCRC based on type of 1L therapy received.

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