Less toxic chemotherapy on the uptake of all lines of chemotherapy in advanced non-small cell lung cancer: A 10-year retrospective population-based review.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19131-e19131
Author(s):  
Cheryl Ho ◽  
Katherine Ramsden ◽  
Nevin Murray ◽  
Sophie Sun ◽  
Barbara L. Melosky ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Advanced Nsclc ◽  
Geographical Area ◽  
Population Based ◽  
Second Line ◽  
First Line ◽  
Data Set ◽  
Third Line ◽  
Line Chemotherapy ◽  
Over Time

e19131 Background: The platinum doublet is standard first-line therapy in advanced NSCLC. Over the past decade, well-tolerated second-line therapies have been approved, including erlotinib and pemetrexed. We hypothesize that the introduction of less-toxic chemotherapy has increased treatment of advanced NSCLC, resulting in improved survival. Methods: The BC Cancer Agency provides cancer care to a population of 4.5 million. A retrospective review was conducted of all referred stage IIIB/IV patients in four 1-yr time cohorts; C1 baseline (1998) and 6 months after the provincial approval of C2 docetaxel (2001), C3 erlotinib (2006) and C4 pemetrexed (2007). Results: 2,623 patients were referred and 720 had systemic therapy. Characteristics: M/F 55%/45%, median age 67 (33-101), ECOG <=1/>=2/unknown 33%/56%/11%, never/former/current/unknown smoker 9%/35%/36%/20%, squam/nonsquam/NOS 18%/41%/41%. More patients received first-line chemotherapy over time; 16%, 23%, 34%, 33% C1-4 respectively. In C1 to C4 uptake of second line (21%, 27%, 38%, 55%) and third line (10%, 10% 14%, 18%) increased. In C1 the most common first-line doublet was cis/vino (70%) and in C4, cis/gem (45%). Second-line doce was frequently used in C2 (51%) but usage decreased in C4 to 7% vs. erlo 50% and pem 26%. In the >=70 group (n=1,118), first-line usage increased from C1 9% to C4 19% and second-line in the C2 (doce) 4% to C4 (erlo+pem avail) 56%. The increased use of systemic therapy was associated with improved survival in all patients: C1 4.56 m vs C4 4.98 m (p=0.004) and treated patients; C1 9.48 m vs C4 12.07 m (p=0.014) and the >= 70 group; C1 9.7 m vs C4 12.5 m (p=0.07). Conclusions: This population-based data set represents the trend of treatments over time in a large geographical area, including community and tertiary care cancer treatment sites. The introduction of less-toxic systemic therapy for advanced NSCLC resulted in an increased proportion of patients treated with first-line chemotherapy and an even greater increase in second-/third-line treatment. This trend was particularly evident in the elderly. Associated with this was a significant improvement in overall survival for all subsets.

Outcome after liver transplantation compared with chemotherapy in colorectal cancer patients with nonresectable liver-only disease.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 531-531
Author(s):  
Svein Dueland ◽  
Tormod Kyrre Guren ◽  
Morten Hagness ◽  
Bengt Glimelius ◽  
Pål-Dag Line ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Second Line ◽  
First Line ◽  
Liver Malignancies ◽  
Data Set ◽  
The Difference ◽  
Third Line ◽  
Colorectal Cancer Patients ◽  
Clinical Trial Information ◽  
Line Chemotherapy

531 Background: Surgical treatment of colorectal liver metastases (CLM) is the only treatment option with curative potential; however, only about 10-20% of the patients are candidates for surgical resection. The majority of CLM patients has non-resectable disease, and receives palliative chemotherapy. These patients have poor prognosis with median OS of about 20-24 months after starting first-line chemotherapy and only about 10% survive five years. Methods: Individual data from patients with non-resectable liver only disease who had received liver transplantation (Ltx) (SECA-study, Hagness et al., Ann Surg. 2013) were compared to a similar group of patients with non-resectable liver only metastases included in the NORDIC VII study (first-line Flox chemotherapy ± Cetuximab, Tveit et al., J Clin Oncol. 2012). Twenty one patient included in the Ltx study were compared to 47 patients with liver only metastases included in the NORDIC VII study. All patients in the NORDIC VII study started first-line chemotherapy, whereas 57% of patients in the Ltx study had received second- or third-line chemotherapy at time of Ltx. Results: Median age of the Ltx group was 56 years (range 45-65 years) and 57 years (range 34-65 years) in the Nordic VII study. Median tumor size was 4.5cm (range 2.8-13.0cm) and 5.0cm (range 1.4-16.0cm) in the Ltx and Nordic VII groups, respectively. 5 year OS in the Ltx group was 60% compared to a 5 year OS of 9% in the NORDIC VII group. The 5 year OS of the 21 patients in the NORDIC VII data set with the longest OS was 19%. The patients in the Ltx study who had received only first-line chemotherapy at time of Ltx had a 5 year OS of 80%. Patients in the NORDIC VII study had an OS from end of second-line chemotherapy of 6-7 months. In comparison, patients with progressive disease on second-line/third-line chemotherapy at time of Ltx, had a median OS of 39 months and a 5 year OS of 30%. Conclusions: Patients with non-resectable CLMonly, has a dramatic improved OS after Ltx compared to chemotherapy. The difference could not be explained by patient selection. Selected patients with CRC obtain OS similar to Ltx patients transplanted for primary liver malignancies. Selected CRC patients should therefore be considered for Ltx. Clinical trial information: NCT01311453.

scholarly journals Second-line systemic therapies for metastatic urothelial carcinoma: a population-based cohort analysis

2019 ◽  
Vol 26 (2) ◽  
Author(s):  
E. S. Tsang ◽  
C. Forbes ◽  
K. N. Chi ◽  
B. J. Eigl ◽  
S. Parimi
Keyword(s):  
Urothelial Carcinoma ◽  
Systemic Therapy ◽  
Topoisomerase I ◽  
Cohort Analysis ◽  
Retrospective Chart Review ◽  
Population Based ◽  
Second Line ◽  
First Line ◽  
Real World Data ◽  
Line Setting

Introduction Patients with urothelial carcinoma (uc) have a poor prognosis after progression on first-line cisplatinbased chemotherapy. Real-world data about second-line cytotoxic therapies are limited. We sought to characterize patients with metastatic uc who receive more than 1 line of systemic therapy and to describe their treatments and outcomes.Methods Using BC Cancer’s pharmacy database, we identified patients with documented metastatic uc who had received more than 1 line of systemic therapy. A retrospective chart review was then performed to collect clinicopathologic, treatment, and outcomes data.Results The 51 included patients, of whom 42 were men (82%), had a median age of 65 years (range: 38–81 years). Sites of metastasis included lymph nodes (n = 30), bone (n = 7), lung (n = 9), and peritoneum (n = 2). Second-line chemotherapy regimens included gemcitabine–cisplatin [gc (n = 14)], paclitaxel (n = 24), docetaxel (n = 12), and an oral topoisomerase i inhibitor (n = 1). Median time to progression (ttp) and overall survival (os) were 2.0 and 6.83 months respectively. Compared with patients who received a different agent, patients who had experienced a prior response to first-line gc and who were re-challenged with second-line gc had a better median ttp (11.0 months vs. 6.0 months, p = 0.02) and survived longer (4.0 months vs. 1.0 months, p = 0.02). No differences in os between non-gc regimens were evident.Conclusions In patients with metastatic uc, overall outcomes remain poor, but compared with patients receiving other agents, the subgroup of patients re-challenged with second-line gc demonstrated improved ttp. Conventional chemotherapy regimens provide only modest benefits in the second-line setting and have largely been replaced with immunotherapy.

Analysis and follow-up of the patients diagnosed with metastatic gastric adenocarcinoma in the Parc Taulí Hospital, Sabadell, between 2010 and 2013.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 169-169
Author(s):  
Marta Ferrer ◽  
Carles Pericay ◽  
Ismael Macias ◽  
Emma Dotor ◽  
Aleydis Pisa ◽  
...  
Keyword(s):  
Gastric Adenocarcinoma ◽  
Clinical Information ◽  
Gastric Body ◽  
Second Line ◽  
First Line ◽  
Kaplan Meier ◽  
Secondary Endpoints ◽  
Third Line ◽  
Line Chemotherapy

169 Background: The primary endpoint of this study was to know the incidence and treatment of gastric carcinoma in our area. Other secondary endpoints were percentage of treated patients, overall survival (OS), survival in subgroups, and more frequent treatments. Methods: Since 2010 to 2013 all the patients diagnosed with metastatic gastric adenocarcinoma and treated at the hospital Parc Taulí from Sabadell were registered. The clinical information was compiled and analyzed. Survivals curves were determined with Kaplan-Meier functions Results: 168 patients were studied, with 79 metastatic (47%). 56% men and median age 67 years. Localizations were gastric body 52%, gastro-esophageal junction 20%, and antrum 25%. OS of the series was 5,05 months (95% CI, 2,99-7,10). 60% of the patients were treated with first line chemotherapy (CT). From them, 42% had a second line and 25% a third line. DFS were respectively 6,62 months (4,06-9,17), 4,29 months (2,28-6,30), and 2,88 months (1,12-4,64) for every line of treatment. OS of the patients that received chemotherapy was 9.7 months (6,40-13,00). CT more used in first line were triplets of fluropyrimidines, platinum and taxanes, in 45% (21 patients). Also just fluoropyrimidines and platinum without taxanes, in 38%. As a second line the predominant CT is also platinum and fluoropyrimidines (37%), and irinotecan (30%). In third line, 50% are combinations based on irinotecan. Conclusions: The OS of the patients who received CT is significantly prolonged respect the ones who didn’t. The data obtained matches the data already published in the literature, even the more frequent chemotherapy.

Metastatic NSCLC: Treatment patterns, outcomes, and costs of newer agents.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 7606-7606 ◽  
Author(s):  
Adrian G. Sacher ◽  
Lisa W. Le ◽  
Anthea Lau ◽  
Craig Earle ◽  
Natasha B. Leighl
Keyword(s):  
Clinical Trials ◽  
Systemic Therapy ◽  
Mortality Data ◽  
Second Line ◽  
Metastatic Nsclc ◽  
Funding Program ◽  
Nsclc Patients ◽  
To Receive ◽  
Line Chemotherapy ◽  
Over Time

7606 Background: New therapies for metastatic NSCLC have improved survival in clinical trials. The increased cost of these agents has led to variable drug funding and treatment across jurisdictions. Here we review patterns, real-world outcomes and costs of metastatic NSCLC treatment in the province of Ontario. Methods: All patients diagnosed with metastatic NSCLC from 2005-2009 were identified from the Ontario Cancer Registry with demographic, histologic and mortality data. Treatment records from the Ontario New Drug Funding Program and centralized treatment database were linked. Statistical analysis involved Wilcoxon rank sum, Kruskal-Wallis, Cochran-Armitage trend and likelihood ratio tests where appropriate. Results: 8113 metastatic NSCLC patients were identified. The median age was 68; 39% had adenocarcinoma, 14% squamous carcinoma and 43% histology not otherwise specified. Most were treated in regional cancer centers (92%). The majority (76%) did not receive systemic therapy; 23% received first-line chemotherapy, most commonly platinum doublets. More patients received systemic therapy over time (19% in 2005 v 26% in 2009, p <0.0001). Older patients (p <0.0001) and those with squamous histology (p <0.0001) were less likely to receive systemic therapy. Center of diagnosis did not affect the likelihood of treatment (p=0.46). The median time from diagnosis to death was significantly greater among patients selected to receive chemotherapy (9.3 v 3.2 months, p <0.0001), and with cisplatin/gemcitabine compared to other doublets (10.7 v 8.2 months, p=0.004). 31% of treated patients received second-line chemotherapy, predominantly with docetaxel (52%) or pemetrexed (41%). Pemetrexed use increased significantly over time (8% in 2005 v 71% in 2009, p<0.0001), as did the mean drug cost of second-line therapy ($5939/patient in 2005 v $10,057 in 2009). A longer median survival was also seen with pemetrexed in adenocarcinoma (17.9 v 15.2 months for docetaxel, p =0.02). Conclusions: Most metastatic NSCLC patients do not undergo systemic treatment. First- and second-line treatment outcomes in this population-based study were similar to clinical trials, confirming better outcomes with new agents at greater cost.

Survival post-progression (SPP) in phase III trials of chemotherapy in advanced NSCLC: Its potentially different impact on OS in the first-line and salvage settings.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e18027-e18027
Author(s):  
Katsuyuki Hotta ◽  
Nagio Takigawa ◽  
Yoshiro Fujiwara ◽  
Akiko Hisamoto ◽  
Eiki Ichihara ◽  
...  
Keyword(s):  
Advanced Nsclc ◽  
Phase Iii ◽  
Coefficient Of Determination ◽  
Steady Increase ◽  
First Line ◽  
Phase Iii Trials ◽  
Third Line ◽  
Line Setting ◽  
The Relationship ◽  
Line Chemotherapy

e18027 Background: We previously demonstrated that in advanced NSCLC, survival after progression to first-line chemotherapy (SPP-1) has significantly improved and has become more closely associated with OS after the initiation of first-line chemotherapy (OS-1), potentially because of the recent development of active agents even in salvage settings (Plos One 2011). We conducted a literature survey to examine time trend in survival after progression to second- or third-line chemotherapy (SPP-2/3) and its potential correlation with OS after the initiation of second- or third-line chemotherapy (OS-2/3). Methods: SPP-2/3 was pragmatically defined in each second- or third-line chemotherapy trial as the interval of MST (OS-2/3) minus median PFS time (PFS-2/3) (OS-2/3 = PFS-2/3 + SPP-2/3). The relationship between PFS-2/3 and OS-2/3 or SPP-2/3 and OS-2/3 was assessed in the regression analysis using the coefficient of determination (r2); higher r2 means a higher correlation. Results: Twenty trials of the second- or third-line chemotherapy initiated between 2001 and 2009, were defined (14,951 patients, 37 chemotherapy arms). Contrary to our previous findings regarding SPP-1, SPP-2/3 has not been significantly prolonged over the years (8.0-day increase per year; p = 0.161) despite a steady increase in OS-2/3 (17.2-dayincrease per year; p = 0.003) and PFS-2/3 (9.8-day increase per year; p = 0.005). Overall, a moderate association was observed between OS-2/3 and SPP-2/3 (r2 = 0.6755), suggesting SPP-2/3 could predict 68% of the variation in OS-2/3. Interestingly, the association between OS-2/3 and SPP-2/3 became less close over the years (r2 = 0.9849, 0.8280, and 0.5667 in 2001–2003, 2004–2006, and 2007–2009, respectively). Conclusions: During the period SPP-2/3 seemed stable, and the association between SPP-2/3 and OS-2/3 has become unclear probably because of recent survival improvement in PFS-2/3 rather than SPP-2/3. This seems in contrast with our previous report that SPP-1 has become more tightly associated with OS-1 over the year, potentially due to the establishment of active post-study treatments just in second- or third-line setting.

scholarly journals A randomized placebo-controlled clinical study of nab-paclitaxel as second-line chemotherapy for patients with advanced non-small cell lung cancer in China

2017 ◽  
Vol 37 (4) ◽  
Author(s):  
Yueming Wu ◽  
Jiang Feng ◽  
Weiwei Hu ◽  
Qingquan Luo
Keyword(s):  
Lung Cancer ◽  
Clinical Study ◽  
Small Cell Lung Cancer ◽  
Advanced Nsclc ◽  
Small Cell ◽  
Second Line ◽  
Small Cell Lung ◽  
First Line ◽  
Controlled Clinical Study ◽  
Line Chemotherapy

We performed a randomized and placebo-controlled clinical study to investigate whether nab-paclitaxel can improve survival in patients with advanced non-small cell lung cancer (NSCLC) after unsuccessful first-line chemotherapy. Patients with stages III to IV advanced NSCLC after first-line platinum-based chemotherapy failure were randomly assigned in a 1:1 ratio to receive second-line treatment of nab-paclitaxel or placebo. Ninety two eligible patients were enrolled in the study. The median progression-free survival (PFS) was 4.6 months (95% confidence interval (CI): 3.4–6.7 months) for nab-paclitaxel, compared with 2.0 months (95% CI: 0.9–4.3 months) for placebo, representing a 56% reduction in disease progression (hazard ratio: 0.62; 95% CI: 0.33–0.81; P<0.001). The median overall survival (OS) was 6.3 months (95% CI: 3.9–8.2 months) for nab-paclitaxel, compared with 4.9 months (95% CI: 2.1–5.9 months) for placebo, representing a 22% reduction in disease progression (hazard ratio: 0.71; 95% CI: 0.33–0.85; P<0.001). Adverse events (AEs) were also observed for nab-paclitaxel. Nab-paclitaxel can improve survival in patients with advanced NSCLC after unsuccessful first-line chemotherapy.

scholarly journals Contemporary Treatment Patterns and Response in Relapsed/Refractory Cutaneous T-Cell Lymphoma (CTCL) across Five European Countries

Cancers ◽  
2021 ◽  
Vol 14 (1) ◽  
pp. 145
Author(s):  
Chalid Assaf ◽  
Nathalie Waser ◽  
Martine Bagot ◽  
Mary He ◽  
Tina Li ◽  
...  
Keyword(s):  
T Cell ◽  
Systemic Therapy ◽  
Cell Lymphoma ◽  
Treatment Patterns ◽  
Second Line ◽  
Cutaneous T Cell Lymphoma ◽  
First Line ◽  
Line Therapy ◽  
Third Line Therapy ◽  
Third Line

The treatment pattern of cutaneous T-cell lymphoma (CTCL) remains diverse and patient-tailored. The objective of this study was to describe the treatment patterns and outcomes in CTCL patients who were refractory or had relapsed (R/R) after a systemic therapy. A retrospective chart review study was conducted at 27 sites in France, Germany, Italy, Spain and the United Kingdom (UK) of patients who received a first course of systemic therapy and relapsed or were refractory. Data were collected longitudinally from diagnosis to first-, second- and third-line therapy. The study included 157 patients, with a median follow-up of 3.2 years. In total, 151 proceeded to second-line and 90 to third-line therapy. In the first line (n = 147), patients were treated with diverse therapies, including single- and multi-agent chemotherapy in 67 (46%), retinoids in 39 (27%), interferon in 31 (21%), ECP in 4 (3%), corticosteroids in 3 (2%) and new biological agents in 3 (2%). In the second line, the use of chemotherapy and retinoids remained similar to the first line, while the use of new biologics increased slightly. In sharp contrast to the first line, combination chemotherapy was extremely diverse. In the third line, the use of chemotherapy remained high and diverse as in the second line. From the time of first R/R, the median PFS was 1.2 years and the median OS was 11.5 years. The presented real-world data on the current treatments used in the management of R/R CTCL in Europe demonstrate the significant heterogeneity of systemic therapies and combination therapies, as expected from the European guidelines.

scholarly journals Lapatinib as second-line treatment after the double block pertuzumab-trastuzumab: a case report

ABOUTOPEN ◽  
2018 ◽  
Vol 4 (1) ◽  
pp. 185-190
Author(s):  
Valentina Magri ◽  
Simone Scagnoli ◽  
Gabriele Piesco ◽  
Giulia Pomati
Keyword(s):  
Whole Brain Radiotherapy ◽  
Trastuzumab Emtansine ◽  
Second Line ◽  
First Line ◽  
Her2 Positive ◽  
Early Recovery ◽  
Brain Radiotherapy ◽  
Free Interval ◽  
Third Line ◽  
Line Chemotherapy

We report the case of a young, 36-year-old patient diagnosed with multifocal breast carcinoma, undergoing neoadjuvant chemotherapy, surgery and adjuvant treatment. The patient presented an early recovery of liver disease after only 7 months of free interval. Histological reevaluation after liver biopsy revealed a HER2-positive disease, for which it was treated with first line chemotherapy including double anti-HER2 block. After 3 cycles the disease progressed at liver and encephalic level. It was therefore decided to treat brain localizations with whole-brain radiotherapy and to start a second line with capecitabine associated with lapatinib. This chemo-radiotherapy approach allowed to control the disease for 8 months. Following further progression (lymph node and bone), a third line was chosen with trastuzumab emtansine (TDM1). The encephalic disease remained stable for another 8 months, when due to visceral progression and worsening of clinical picture, TDM1 was interrupted and supportive therapies were started (Oncology). .

Elderly and younger patients with non-small cell lung cancer (NSCLC) derive similar benefit from second-line chemotherapy: A retrospective subset analysis of second-line chemotherapy trials conducted from the Hellenic Cooperative Research Group (HORG).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 7564-7564
Author(s):  
Sofia Agelaki ◽  
Dora Hatzidaki ◽  
Lampros Vamvakas ◽  
Athanasios G. Pallis ◽  
Athanasios Karampeazis ◽  
...  
Keyword(s):  
Advanced Nsclc ◽  
Second Line ◽  
Cooperative Research ◽  
First Line ◽  
Second Line Therapy ◽  
Younger Patients ◽  
Second Line Chemotherapy ◽  
Line Therapy ◽  
Significant Difference ◽  
Line Chemotherapy

7564 Background: Elderly patients (pts) achieve a similar survival benefit, with acceptable toxicity, from first-line chemotherapy for the treatment of advanced NSCLC compared with their younger counterparts. There have been no second-line trials specifically designed for elderly pts and few data exist on the efficacy and tolerability of second-line therapy in this population. Moreover, little if any information exists on the frequency of administration of second-line chemotherapy in these pts. Methods: The files of 2004 pts with advanced NSCLC enrolled into first-line chemotherapy trials performed by HORG from 1995 to 2007 were reviewed. A total of 600 pts who received second-line chemotherapy within the context of clinical trials were identified. Patients’ data were analysed for efficacy and toxicity according to age. Results: Second-line chemotherapy was administered in 24% and 34% of pts ≥65 and <65 years old after failure of prior therapy (p=0.0001). A total of 219 (24.8%) of 600 pts who received second-line treatment were ≥65 years old (median age 70 yrs, range 65-82). Response rates to second-line therapy were 11.9% for older pts compared to 12.3% for younger pts (p=ns). TTP was 2.8 and 3.1 months for older and younger pts, respectively (p=ns). Elderly pts receiving second-line chemotherapy had a median survival of 7.7 months compared with 8.2 months for younger pts (p=ns). Similar rates of haematological and non-haematological toxicities were encountered between the two groups. Conclusions: The participation of elderly pts to second-line chemotherapy trials was lower compared to younger patients. There was no significant difference in outcome or toxicity between elderly and younger pts. For elderly pts with advanced NSCLC and good performance status, second-line chemotherapy is appropriate. However, specific second-line trials in older pts are required since those included in the current analysis were probably highly selected to fit the inclusion criteria.

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