Population-based impact on overall survival (OS) after the introduction of docetaxel as standard therapy for metastatic castration resistant prostate cancer (CRPC).

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 77-77 ◽  
Author(s):  
Robert Richard Zielinski ◽  
Scott Tyldesley ◽  
Kim N. Chi
Keyword(s):  
Standard Therapy ◽  
Palliative Radiotherapy ◽  
Population Level ◽  
Standard Of Care ◽  
Population Based ◽  
Rank Test ◽  
Severe Toxicity ◽  
Castration Resistant Prostate Cancer ◽  
Kaplan Meier ◽  
Study Results

77 Background: Docetaxel (DOC) was the first systemic therapy to improve OS (Hazard Ratio (HR) = 0.79) for patients (pts) with CRPC and a standard therapy since 2004. Because of the potential for severe toxicity with DOC, its use has been subject to pt selection. Even with this selective use, we sought to determine whether the introduction of docetaxel has improved OS at a population level. Methods: We performed aretrospective review of all CRPC pts treated with palliative radiotherapy (PRT) to bone metastases in the province of British Columbia, Canada. The pre-docetaxel cohort (pre-D) received PRT from 1998-2001. The docetaxel-era cohort (post-D)received PRT from 2006-2009. Time of first PRT to bone was used to select pts at a similar point in their disease state (i.e., onset of bone pain). Mortality and cause of death was attained from public registries. OS was calculated from time of first PRT using the Kaplan-Meier method and compared using the log-rank test. Results: Comparative baseline characteristics for the 1876 patients split into the pre-D (n=919) and post-D (n=957) eras were: metastatic at diagnosis 30% vs. 33% (p = 0.09), median age at PRT 75.5 vs. 76.7 years (p=0.04), time from diagnosis to PRT 3.9 vs. 3.1 years (p = 0.31), received DOC 7% vs. 37% (p < 0.0001). Median OS from time of first PRT was 7.5 months (m) vs. 10.3 m (HR: 0.79, 95% Confidence Interval 0.70 – 0.89, p < 0.0001) in the pre-D and post-D cohorts respectively. Within the post-D cohort, the median OS from time of RT was longer in pts receiving DOC at 13.9 m vs. 7.4 m for pts not receiving DOC (p=0.004). Conclusions: In this population based analysis, the introduction of DOC as a standard of care was associated with a significant improvement in OS even though DOC penetrance was <50%. This demonstrates for the first time the generalizability of the TAX-327 study results to the population at large. Even as the therapeutic landscape for CRPC evolves with the introduction of new agents that improve OS with favourable toxicity profiles, these data support the continued use of DOC in appropriately selected patients.

scholarly journals Population-based impact on overall survival after the introduction of docetaxel as standard therapy for metastatic castration resistant prostate cancer

2014 ◽  
Vol 8 (7-8) ◽  
pp. 520 ◽  
Author(s):  
Robert R. Zielinski ◽  
Arun A. Azad ◽  
Kim N. Chi ◽  
Scott Tyldesley
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Survival Benefit ◽  
Palliative Radiotherapy ◽  
Population Level ◽  
Population Based ◽  
Primary Objective ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Multivariable Analyses

Introduction: Utilization of docetaxel in patients with metastatic castration resistant prostate cancer (mCRPC) remains low despite its demonstrated survival benefit. In a population-based cohort, we sought to determine whether the introduction of docetaxel has improved overall survival (OS).Methods: A retrospective review was conducted of mCRPC patients treated with palliative radiotherapy to bone in British Columbia, Canada. Patients in the pre-docetaxel era (pre-DOC, prior to general availability of docetaxel for CRPC) received radiotherapy to bone (RT-B) from 1998 to 2001 and those in the docetaxel era (DOC) received radiotherapy from 2006 to 2009. Time of first radiotherapy to bone was used to select patients at a similar point in their disease state (i.e., onset of bone pain). The primary objective was to determine median OS in the two eras.Results: Of the 919 patients in the pre-DOC era and the 957 in the DOC era, 7% and 37% received docetaxel, respectively. The median OS from time of first palliative RT was 7.5 months versus 10.3 months (hazard ratio [HR]: 0.79, 95% confidence interval [CI] 0.72–0.87; p < 0.0001) in the pre-DOC and DOC cohorts, respectively. On multivariable analyses, both eras treated (HR 0.84; p = 0.001) and the receipt of docetaxel (HR 0.78; p < 0.001) were significantly associated with OS.Conclusion: Although docetaxel penetrance was <50%, median OS was significantly improved in the DOC era compared to the pre-DOC era. This is the first study to demonstrate that docetaxel improves OS in mCRPC patients at a population level.

Pembrolizumab plus enzalutamide for enzalutamide-resistant metastatic castration-resistant prostate cancer (mCRPC): Updated analyses after one additional year of follow-up from cohorts 4 and 5 of the KEYNOTE-199 study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 5042-5042
Author(s):  
Julie N Graff ◽  
Scott T. Tagawa ◽  
Christopher J. Hoimes ◽  
Winald R. Gerritsen ◽  
Ulka N. Vaishampayan ◽  
...  
Keyword(s):  
Antitumor Activity ◽  
Safety Data ◽  
Standard Of Care ◽  
Castration Resistant Prostate Cancer ◽  
Fisher Syndrome ◽  
Castration Resistant ◽  
Kaplan Meier ◽  
Phase 2 Study ◽  
Grade 3

5042 Background: KEYNOTE-199 (NCT02787005) is a multicohort phase 2 study to evaluate pembrolizumab (pembro) in mCRPC. A previous analysis of patients with RECIST-measurable (cohort 4 [C4]) or bone-predominant nonmeasurable (cohort 5 [C5]) disease who were chemotherapy-naive and had progression while on enzalutamide (enza) found that pembro + enza showed antitumor activity and manageable safety. Long-term outcomes are of interest with immunotherapy; hence, updated efficacy and safety data after an additional 1 year of follow-up are presented. Methods: Pts were eligible if they had resistance to enza after prior response. Prior treatment with abiraterone was allowed. Pts received pembro 200 mg Q3W for up to 35 cycles + enza QD until progression, unacceptable toxicity, or withdrawal. Primary end point was ORR per RECIST v1.1 by blinded independent central review (BICR) in C4. Secondary end points were DOR (C4), and DCR, rPFS, OS and safety (both cohorts). Results: 126 pts (C4, 81; C5, 45) were treated. Median age was 72 years (range 43-92), 32.5% had visceral disease and 87.3% previously received ≥6 mo of enzalutamide; 121 pts (96.0%) discontinued, most because of progressive disease. Median (range) time from enrollment to data cutoff was 31.7 mo (23.1-37.1) in C4 and 35.5 mo (22.9-37.3) in C5. In C4, confirmed ORR was 12.3% (95% CI 6.1-21.5) (2 CRs, 8 PRs); median (range) DOR was 8.1 mo (2.5+ to 15.2), and 62.5% had a response ≥6 mo (Kaplan-Meier estimate). Additional efficacy analyses are outlined in the table. A total of 27.2% and 28.9% of pts in C4 and C5, respectively, experienced grade ≥3 treatment-related adverse events. Two pts in C4 died of immune-related AEs (Miller Fisher syndrome and myasthenia gravis). Incidence of any-grade (34.1%) and grade 3 or 4 (5.6%) rash, regardless of relatedness to treatment, was higher than previously reported for individual agents but manageable with standard-of-care treatments; 2 pts discontinued because of rash. Conclusions: After an additional 1 year of follow-up, pembro + enza continued to show antitumor activity and a manageable safety profile in pts with mCRPC who became resistant to enza. The treatment combination is being further evaluated in the ongoing phase 3 KEYNOTE-641 trial (NCT03834493). Clinical trial information: NCT02787005. [Table: see text]

Impact of COVID19 pandemic on treatment outcome of locally-advanced head and neck squamous cell carcinoma (LA-HNSCC): IMPACCT study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6061-6061
Author(s):  
Pau Guillen Sentis ◽  
Carmen Castillo Manzano ◽  
Beatriz Quirós ◽  
Francisca Morey Cortes ◽  
Sara Tous ◽  
...  
Keyword(s):  
Negative Impact ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Stage Iii ◽  
Rank Test ◽  
Historical Cohort ◽  
First Semester ◽  
Kaplan Meier ◽  
Chi Squared ◽  
One Year

6061 Background: Treatment (ttm) of cancer patients (pts) was compromised during the first wave of COVID19 pandemic due to collapse of healthcare systems. Standard of care (SOC) for LA-HNSCC pts had to be adapted as operating rooms were temporarily unavailable, and to reduce risk of COVID19 exposure. The IMPACCT study evaluated the outcome of LA-HNSCC pts treated at the Catalan Institute of Oncology during the first semester of 2020 and compared it to a control cohort previously treated in the same institution. Methods: Retrospective single institution analysis of two consecutively-treated cohorts of newly-diagnosed HNSCC pts: from January to June of 2020 (CT20) and same period of 2018 and 2019 (CT18-19). Pt demographics and disease characteristics were obtained from our in-site prospective database. Ttm modifications from SOC as per COVID19-contingency protocol in CT20 for LA-HNSCC were collected. Chi-squared was used to compare variables and ttm response between cohorts. One-year recurrence-free survival (1yRFS) and overall survival (1yOS) of LA-HNSCC pts were estimated by Kaplan-Meier method and compared by Log-rank test. Results: A total of 306 pts were included: CT20=99; CT18-19=207. Baseline characteristics were balanced between cohorts (Table1). In pts treated with conservative ttm (non-surgical approach), persistence disease was higher in CT20 vs CT18-19 (26 vs. 10% p=0.02). Median follow-up of CT20 and CT18-19 was 6.8 months (IQR 5.1-7.9) and 12.3 (6.7-18.4), respectively. A trend towards lower 1yRFS and 1yOS was observed in CT20 vs CT18-19 (72 vs 83% p=0.06; 80 vs 84% p=0.07), respectively. Within CT20, 37 pts (37%) had one or more ttm modifications: switch from surgery to conservative ttm (n=13); altered radiotherapy fractionation (n=14); reduced cisplatin cumulative dose to 200mg/m2 (n=19); no adjuvant ttm (n=1). Pts who received modified ttm had no differences in 1yRFS vs those who did not (80 vs 66% p=0.31), but higher 1yOS was observed (97 vs 67% p<0.01). When stratified by stage, 1yOS difference remained significant in stage III/IVA (100 vs 61% p<0.01) but not in I/II (100 vs 77% p=0.28) or IVB (67 vs 50% p=0.54). Conclusions: COVID19 pandemic had a negative impact on ttm outcomes and survival in LA-HNSCC pts when compared to our historical cohort. Ttm modifications based on COVID19-contingency protocol did not compromise ttm efficacy in terms of RFS and was associated with better OS in Stage III/IVA.[Table: see text]

scholarly journals Upfront docetaxel with androgen deprivation therapy in the elderly patient with metastatic hormone-naïve prostate cancer: Single institution experience.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 328-328 ◽  
Author(s):  
Lindsay Jennifer Andrew Rayner ◽  
Amarnath Challapalli ◽  
Eve Blackmore ◽  
Katherine Rea ◽  
Natasha Wells ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
The Elderly ◽  
Rank Test ◽  
Free Survival ◽  
Kaplan Meier ◽  
Elderly Cohort ◽  
Docetaxel Chemotherapy ◽  
Dose Reductions

328 Background: Following CHAARTED & STAMPEDE, upfront Docetaxel chemotherapy became standard of care for metastatic hormone-naïve prostate cancer (mHNPC). We sought to evaluate our experience in the elderly group of patients (>70 yrs) compared with the non-elderly cohort. Methods: A retrospective analysis was undertaken of 38 patients commenced on upfront docetaxel chemotherapy, from Jan 16 - Jan 17. Patients were stratified as low (LR) and high risk (HR), as per the LATITUDE study. Progression was defined as per PCWG-3 criteria. The progression free survival (PFS) was calculated as time from start of treatment to date of progression and analysed by Kaplan-Meier estimates and log-rank test. Rates of febrile neutropenia (FN) were also evaluated. Results: The median age was 69 (range: 53-80) yrs, with 50% (19/38) HR patients. The median PFS was 11.5m for progressors (P; 42%) and not reached for non-progressors (NP; 58%), (p<0.0001). Granulocyte colony stimulating factor (G-CSF) was used in 13/38 (34%) patients; these did not experience FN. The overall rate of FN was 20% where G-CSF was not used. Overall 31/38 (81.6%) completed 6 cycles of chemotherapy, with 26% requiring dose reductions (Table). Overall, of the 9/16 (56.3%) patients who progressed within 6m of completing docetaxel, 3 had Cabazitaxel as the next treatment (P: 2/3 (66.7%), median PFS 6.2m) and 6 had novel androgen receptor targeted therapy (P: 5/6 (83.3%), median PFS 3.3m). Conclusions: Upfront docetaxel is reasonably well tolerated in the elderly with comparable median PFS to younger patients. Use of GCSF significantly minimizes the risk of FN in this group and should be considered as standard of care. In patients who progress within 6m of completing docetaxel, we feel optimal sequencing to be Cabazitaxel followed by subsequent therapies.[Table: see text]

Surgery Versus Radiation Therapy for Stage IB2 Cervical Carcinoma: A Population-Based Analysis

2012 ◽  
Vol 22 (3) ◽  
pp. 484-489 ◽  
Author(s):  
Bunja Rungruang ◽  
Madeleine Courtney-Brooks ◽  
Sushil Beriwal ◽  
Kristin K. Zorn ◽  
Scott D. Richard ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Initial Treatment ◽  
Population Based ◽  
Rank Test ◽  
Primary Surgery ◽  
Kaplan Meier ◽  
Improved Outcomes ◽  
Surgery First

ObjectiveThe objective of the study was to examine outcomes in stage IB2 cervical cancer patients undergoing primary surgery versus radiation.MethodsStage IB2 cervical cancer patients were identified from the Surveillance, Epidemiology and End Results Public-Use Database from 2000 to 2006. Patients were divided into those receiving radiation (radiation first) or surgery (surgery first) as initial treatment. Overall survival was calculated by Kaplan-Meier method and compared using log-rank test.ResultsIn total, 770 patients were identified with stage IB2 cervical cancer; 369 received radiation, and 401 received surgery initially. The radiation-first group had larger mean tumor size than the surgery-first group (6.0 vs 5.5 cm, respectively; P < 0.0001). The overall survival was longer in the surgery-first group compared with the radiation-first group (72.0 vs 61.4 months, respectively; P < 0.0001).ConclusionsPatients undergoing surgery as initial treatment for stage IB2 cervical cancer appear to have improved outcomes in the current era of chemoradiation; however, given the lack of chemotherapy information, a randomized trial will be necessary to see if these results remain valid.

scholarly journals Outcome of Adolescents and Young Adults with Acute Myeloid Leukemia (AML) As Compared to Pediatric AML Patients: Real World Data from SEER Registry

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4484-4484
Author(s):  
Smith Giri ◽  
Nunnery Sara ◽  
Syed S. Nasir ◽  
Michael G Martin
Keyword(s):  
Overall Survival ◽  
Pediatric Patients ◽  
Survival Curve ◽  
Population Based ◽  
Early Mortality ◽  
Rank Test ◽  
P Value ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Significant Difference

Abstract Background: Limited data exists regarding the characteristics and outcomes of adolescents and young adults (AYAs) with acute myeloid leukemia (AML) which are largely under-represented in both pediatric and adult trials. We sought to compare the characteristics and outcomes of AYAs with AML using a large population based registry in the United States. Methods: We utilized Surveillance Epidemiology and End Results (SEER)-18 registry to identify all pediatric (0-18 years) and AYA (age 19-30 years) patients diagnosed with AML using appropriate histology codes based on the International Classification of Diseases for Oncology, 3rd version. Patients with acute promyelocytic leukemia (APL) were excluded from all analysis. Survival statistics were computed for each group using actuarial (Kaplan-Meier method) and compared using Z test for comparison of population proportions. Early mortality, defined as mortality within 1 month of diagnosis, was used as a surrogate for treatment related mortality. Kaplan Meier survival curves were plotted and compared using log-rank test. Multivariate analysis was done using logistic regression and Cox proportional hazard regression model. All p values were two sided and the level of significance was chosen at 0.05. Results: A total of 6343 eligible patients were identified, which comprised 2836 (44.7%) AYAs. A total of 52% (n=3346) were males, whereas 76%(n=4825) were whites. Histologically, majority of patients (56%; n=3545) were categorized as AML, not otherwise specified, followed by acute monocytic leukemia (9.9%, n=630). Majority (55%; n-3509) of the patients were diagnosed between 2001-2012. The early mortality rate was lower in the pediatric AML patients (pAML) as compared to AYAs (6.2% vs 9.2%; p<0.01). Similarly the 1 year (70.3% versus 62.1%; p <0.01) and 5 year (48.2% vs 36.4%; p<0.01) was higher in pediatric patients as compared to AYAs. Kaplan Meier plot showed worse overall survival of AYAs compared to pAMLs (Figure 1; p value of log rank <0.01). Multivariate logistic regression showed higher early mortality among AYAs as compared to pAML patients (OR 1.48; 95% CI 1.23-1.79; p<0.01). Similarly Cox regression showed worse overall survival among AYAs as compared to pAML (HR 1.34; 95% CI 1.26-1.44; p <0.01) Conclusions: Our population based analysis shows worse overall survival among AYAs as compared to pAML patients. Future clinical trials specifically focused on this age group are warranted to establish appropriate treatment regimens in this population. Figure 1. Kaplan Meier Survival curve showing cumulative survival among pediatric patients with AML as compared to AYAs. Log rank test showed statistically significant difference between the two curves (p value <0.01) Figure 1. Kaplan Meier Survival curve showing cumulative survival among pediatric patients with AML as compared to AYAs. Log rank test showed statistically significant difference between the two curves (p value <0.01) Disclosures No relevant conflicts of interest to declare.

scholarly journals Glioblastoma and increased survival with longer chemotherapy duration.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e13006-e13006
Author(s):  
Dory Abou-Jaoude ◽  
Joseph A Moore ◽  
Matthew B Moore ◽  
Philip Twumasi-Ankrah ◽  
Elizabeth Ablah ◽  
...  
Keyword(s):  
Sample Size ◽  
Retrospective Chart Review ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
Rank Test ◽  
Science Data ◽  
Chi Square ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Regional Referral Center

e13006 Background: The 5-year survival for patients (pts) with glioblastoma (GBM) is low at approximately 3%. Radiotherapy plus concomitant and adjuvant temozolomide (TMZ) remain the standard of care. The optimal duration of therapy with TMZ is unknown, though treatment periods of 6 months (mo), 12 mo and longer have been utilized. Whether or not there is a benefit with longer treatment duration is controversial. Methods: A retrospective chart review of all pts diagnosed with GBM who were treated at a regional referral center was conducted with data obtained from their electronic medical records. These pts were treated with TMZ for up to 2 years between January 1, 2002 and December 31, 2011. Survival was calculated as the time from initial surgical diagnosis until death. The Kaplan-Meier method with log-rank test was used to estimate the progression-free survival (PFS) as well as the overall survival (OS) distribution of pts after treatment. The results were compared to historical controls and data from previous clinical trials of pts treated up to 1 year. Results: Data from 56 pts were evaluated, the majority of whom had gross total resection and had external pathology review confirming the diagnosis of GBM. The OS probability was 55.4% (SE = 0.068) at 1 year, 26.9% (SE = 0.067) at 2 years and 20.1% (SE = 0.065) at 3 years. The median PFS time in this study group was 8 mo (95% CI = 4.0 – 9.0 mo). The probability of no progression at 2 years was 8.6% (SE = 0.05). Seven pts (12.5%) were treated with TMZ for 2 years. The probability of disease progression at 2 years among these pts was 33.3% with a median time-to-progression of 20 mo (95% CI = 5.0-28.0). These patients showed an increased survival probability at 3 years compared to pts who did not receive the 2 year treatment of TMZ (log-rank test Chi-square = 12.4, p = 0.0004). Conclusions: This analysis suggests that there may be an advantage for a longer duration of TMZ therapy in pts with GBM. In this review, treatment with TMZ for 2 years was associated with an increased survival benefit. While we consider the sample size to be too small for generalization, a prospective/multicenter study with a larger sample size might better evaluate the question of duration of TMZ therapy, particularly if both clinical and basic science data are paired.

scholarly journals First- and Second-Line Palliative Systemic Treatment Outcomes in a Real-World Metastatic Pancreatic Cancer Cohort

2021 ◽  
pp. 1-8
Author(s):  
Esther N. Pijnappel ◽  
Willemieke P.M. Dijksterhuis ◽  
Lydia G. van der Geest ◽  
Judith de Vos-Geelen ◽  
Jan Willem B. de Groot ◽  
...  
Keyword(s):  
Real World ◽  
Systemic Treatment ◽  
Population Based ◽  
Ductal Adenocarcinoma ◽  
Rank Test ◽  
Time To Failure ◽  
Second Line ◽  
First Line ◽  
Kaplan Meier ◽  
Netherlands Cancer Registry

Background: Metastatic pancreatic ductal adenocarcinoma (PDAC) is characterized by a poor survival rate, which can be improved by systemic treatment. Consensus on the most optimal first- and second-line palliative systemic treatment is lacking. The aim of this study was to describe the use of first- and second-line systemic treatment, overall survival (OS), and time to failure (TTF) of first- and second-line treatment in metastatic PDAC in a real-world setting. Patients and Methods: Patients with synchronous metastatic PDAC diagnosed between 2015 and 2018 who received systemic treatment were selected from the nationwide Netherlands Cancer Registry. OS and TTF were evaluated using Kaplan-Meier curves with log-rank test and multivariable Cox proportional hazard analyses. Results: The majority of 1,586 included patients received FOLFIRINOX (65%), followed by gemcitabine (18%), and gemcitabine + nab-paclitaxel (13%) in the first line. Median OS for first-line FOLFIRINOX, gemcitabine + nab-paclitaxel, and gemcitabine monotherapy was 6.6, 4.7, and 2.9 months, respectively. Compared to FOLFIRINOX, gemcitabine + nab-paclitaxel showed significantly inferior OS after adjustment for confounders (hazard ratio [HR], 1.20; 95% CI, 1.02–1.41), and gemcitabine monotherapy was independently associated with a shorter OS and TTF (HR, 1.98; 95% CI, 1.71–2.30 and HR, 2.31; 95% CI, 1.88–2.83, respectively). Of the 121 patients who received second-line systemic treatment, 33% received gemcitabine + nab-paclitaxel, followed by gemcitabine (31%) and FOLFIRINOX (10%). Conclusions: Based on population-based data in patients with metastatic PDAC, treatment predominantly consists of FOLFIRINOX in the first line and gemcitabine with or without nab-paclitaxel in the second line. FOLFIRINOX in the first line shows superior OS compared with gemcitabine with or without nab-paclitaxel.

Survival in men diagnosed with castration resistant prostate cancer: A population-based observational study in Sweden.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16555-e16555
Author(s):  
Markus Aly ◽  
Frida Schain ◽  
Amy Leval ◽  
Johan Liwing ◽  
Joe Lawson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cox Regression ◽  
Specific Antigen ◽  
Population Level ◽  
Population Based ◽  
Calendar Period ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistance ◽  
Prostate Biopsies ◽  
Castration Resistant

e16555 Background: Data focusing on the castration resistant phase of prostate cancer (PC) outside clinical trial settings are scarce. This study aims to investigate PC-specific and overall survival (OS) in men with castration resistant prostate cancer (CRPC) on a population level. Methods: The STHLM-0 cohort (n = 400 000) with data on all prostate specific antigen (PSA) values and prostate biopsies taken in Stockholm, Sweden, from 2003 to 2015 were linked to other population registries. All men with a PC diagnosis and rising PSA after three months consecutive use of gonadotropin-releasing hormone or surgical castration were defined as CRPC (n = 1712). Kaplan-Meier was used to estimate median time-to-event and 95% confidence intervals (CI). Patients were stratified by metastasis status at PC diagnosis and multivariable Cox regression was used to adjust for clinical subgroups, including Gleason, age, T stage and calendar period (2006-2011 vs 2012-2015). Results: Metastasis at PC diagnosis was associated with shorter OS from castration resistance. From CRPC onset the median OS was 22.8 months (95% CI 21.2-25.5) and 13.1 (95% CI 11.5-14.2) months for patients without and with metastasis at PC diagnosis, respectively. The median PC-specific survival from CRPC was 30.7 (95% CI 27.9-34.7) months and 13.5 (95% CI 12.3-16.1) months for patients without and with metastasis at PC diagnosis, respectively. For patients with metastasis at PC diagnosis, factors influencing OS from CRPC were; entering CRPC stage in the later vs earlier calendar period (HR 0.61 95% CI 0.48-0.78, p < 0.001), age > 80 vs < 70 (HR 1.46, 95% CI 1.05-2.02, p < 0.02), T4 vs T1 stage (HR 1.56, 95% CI:1.02-2.37, p < 004). For patients without metastasis at PC diagnosis, developing CRPC in the later vs the earlier calendar period was associated with superior survival from CRPC (HR 0.78 95% CI 0.65-0.92, p < 0.004). Conclusions: Metastasis at PC diagnosis was associated with worse survival outcomes in CRPC patients. Individuals who became castration resistant in the later calendar period survived longer compared to those in the same stage in the earlier calendar period, most likely due to the introduction of novel agents for CRPC patients and more accurate staging methods.

Real-world outcomes among patients (pts) treated with gemcitabine (GEM)-based therapy post-FOLFIRINOX (FFOX) failure in advanced pancreatic cancer (APC).

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 303-303
Author(s):  
Erica S Tsang ◽  
Jennifer L. Spratlin ◽  
Winson Y. Cheung ◽  
Christina Kim ◽  
Shiying Kong ◽  
...  
Keyword(s):  
Cox Regression ◽  
Advanced Pancreatic Cancer ◽  
Population Based ◽  
Rank Test ◽  
Survival Outcomes ◽  
Test Results ◽  
Publicly Funded ◽  
Cox Regression Analysis ◽  
Treatment Regimens ◽  
Kaplan Meier

303 Background: Limited evidence exists for the selection of chemotherapy in APC after first-line (1stL) FFOX. Gemcitabine/nab-paclitaxel (GEMNAB) is publicly funded for second-line (2ndL) use in the provinces of Alberta (AB) and Manitoba (MB), but is not covered in British Columbia (BC). We compared population-based outcomes by region to examine the utility of 2ndL GEMNAB versus GEM alone. Methods: We identified pts treated with 1stL FFOX between 2013-2015 across BC, AB, and MB. Baseline characteristics and treatment regimens were compared between AB/MB and BC. Survival outcomes were assessed by the Kaplan-Meier, and compared with log-rank test. Results: 370 pts treated with 1stL FFOX were identified (145 AB/MB, 225 BC), with a median age of 61y, 42% female, and 68% with metastatic disease (similar in both groups). Receipt of 2ndL therapy was 49% AB/MB vs 44% BC ( p = 0.35), and time from diagnosis to 2ndL therapy measured 7.6 mos AB/MB versus 9.4 mos BC ( p = 0.1). The distribution of 2ndL gemcitabine use was: 72% GEMNAB, 23% GEM in AB/MB versus 27% GEMNAB, 66% GEM in BC ( p < 0.001). Median overall survival (OS) from diagnosis was similar: 12.4 mos in AB/MB versus 10.9 mos in BC ( p = 0.75). On Cox regression analysis, region was not significant. A secondary survival analysis by 2ndL regimen demonstrated a median OS of 18.0 mos with GEMNAB versus 14.3 mos GEM ( p < 0.01). Conclusions: In our population-based comparison of APC pts treated with 1stL FFOX, survival outcomes were comparable regardless of publicly funded access to 2ndL GEMNAB versus GEM. OS by regimen favored 2ndL GEMNAB, but patient selection may be largely responsible for this difference. Randomized trials are needed to demonstrate the benefit of GEMNAB post-FFOX in APC.

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