Patterns and predictors of treatment in muscle-invasive bladder cancer (MIBC): A real-world study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16531-e16531
Author(s):  
Zengqi Lu ◽  
Jessica M. Clement ◽  
Qi Pan ◽  
Helen Swede ◽  
Rajni Mehta ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Real World ◽  
Alternative Treatment ◽  
Standard Care ◽  
Strong Predictor ◽  
Treatment Patterns ◽  
Cancer Center ◽  
Data Set ◽  
Adoption Rate ◽  
To Receive

e16531 Background: Among the approaches to curative-intent therapy for MIBC, neoadjuvant cisplatin-based chemotherapy (NAC) is recognized as the gold standard. The combined modality approach of concurrent chemo-radiation is also considered a standard of care. Despite guidelines recommending multidisciplinary care, studies have shown a low adoption rate of multidisciplinary approaches for MIBC. This study aimed to describe the treatment patterns for MIBC pts using real world data. Methods: Following the appropriate IRB approvals, investigators followed a common protocol under the auspices of the Rapid Case Ascertainment at the Yale Cancer Center. Manual chart review was performed on MIBC pts diagnosed in Connecticut from 2004 –2015 and treated at investigator-affiliated hospitals. Information on medical history, comorbidity, and treatment types were recorded. This data set was linked to the Surveillance, Epidemiology, and End Results (SEER) database for demographic information. The descriptive and logistic regression were used to analyze treatment patterns and predicators in each treatment lines: surgery alone, chemotherapy alone, radiation alone and standard care (NAC followed by surgery; surgery followed by adjuvant chemotherapy and concurrent chemo-radiation). Results: The number of adult MIBC pts in the cohort was 1,198. Among them, 290 (24.2%) received surgery as the only treatment; 117 (9.8%) received chemotherapy only; 100 (8.3%) received concurrent chemo-radiation; 96 (8.0%) received NAC followed by surgery. Besides age ( OR: 0.546, 95% CI: 0.289-0.986), when comparing female to male patients on the likelihood of receiving NAC to the alternative treatment types (radiation or surgery), female pts were less likely to receive NAC than males (OR: 0.421, 95% CI: 0.184-0.930). Conclusions: Regardless of demographics, the overall adoption rate of standard care was low, consisting of 236 pts (19.7%) of the population. From the logistic regression results, age was consistently shown as a predictor for receiving NAC over the alternative treatment types, and sex was identified as another strong predictor. Older and female patients were less likely to receive NAC than younger males.[Table: see text]

Racial disparities in radium-223 treatment in a large real-world population.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 268-268
Author(s):  
Hanson Hanqing Zhao ◽  
Lauren Howard ◽  
Amanda de Hoedt ◽  
Martha K Terris ◽  
Christopher L. Amling ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Black Men ◽  
Real World ◽  
Multivariable Analysis ◽  
Treatment Patterns ◽  
World Population ◽  
Castration Resistant Prostate Cancer ◽  
Cox Models ◽  
Radium 223 ◽  
To Receive

268 Background: Black men with prostate cancer are more likely to have unfavorable tumor characteristics and are at greater risk of prostate cancer mortality. Radium-223 is a FDA approved treatment for metastatic castration-resistant prostate cancer (mCRPC) that showed a survival benefit in the ALSYMPCA trial, where 94% of the participants were Caucasian. We aim to examine treatment patterns and outcomes of radium-223 in a large, heterogeneous population in the real world. Methods: We reviewed charts of all men with diagnosed with mCRPC in the entire Veterans Affairs (VA) system alive as of January 1st, 2013 who received radium-223. We compared common treatment patterns and characteristics between black and nonblack men. We analyzed predictors of time from radium-223 start to overall survival and time to skeletal related event (SRE) with Cox models. Results: 318 patients with bone mCRPC who received radium-223 were identified. 27% (87/318) were black. Black men were younger (67 vs 70 years, p = 0.001) and had higher PSA and alkaline phosphatase (ALP) levels at radium start (p = 0.014 and 0.017, respectively). There were no significant differences in biopsy Gleason, number of bone metastasis, primary localized treatment (yes/no), PSA doubling time, bone pain, or number of radium injections. Black men had lower mortality risk (HR 0.75; 95% CI 0.57 to 0.98; P = 0.038) on multivariable analysis. Comparison of common treatment patterns between black and nonblack men revealed that black men were more likely to receive other therapies prior to radium, including chemotherapy. Conclusions: Using a large, heterogeneous, real world cohort, we describe differences in treatment patterns and outcomes with radium-223 between black and nonblack men with mCRPC. While black men had a lower risk of mortality in this cohort, they had higher PSA and ALP levels when receiving radium-223. They were also more likely to receive other therapies prior to radium-223, indicating a possible delay in radium use in black men.

Doctor, What Are My Chances of Having a Positive Sentinel Node? A Validated Nomogram for Risk Estimation

2007 ◽  
Vol 25 (24) ◽  
pp. 3670-3679 ◽  
Author(s):  
José Luiz B. Bevilacqua ◽  
Michael W. Kattan ◽  
Jane V. Fey ◽  
Hiram S. Cody ◽  
Patrick I. Borgen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Logistic Regression ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Cancer Center ◽  
Tumor Type ◽  
Data Set ◽  
Specific Patient ◽  
Node Metastasis ◽  
Pathologic Features

Purpose Lymph node metastasis is a multifactorial event. Several variables have been described as predictors of lymph node metastasis in breast cancer. However, it is difficult to apply these data—usually expressed as odds ratios—to calculate the probability of sentinel lymph node (SLN) metastasis for a specific patient. We developed a user-friendly prediction model (nomogram) based on a large data set to assist in predicting the presence of SLN metastasis. Patients and Methods Clinical and pathologic features of 3,786 sequential SLN biopsy procedures were assessed with multivariable logistic regression to predict the presence of SLN metastasis in breast cancer. The model was subsequently applied to 1,545 sequential SLN biopsies. A nomogram was created from the logistic regression model. A computerized version of the nomogram was developed and is available on the Memorial Sloan-Kettering Cancer Center (New York, NY) Web site. Results Age, tumor size, tumor type, lymphovascular invasion, tumor location, multifocality, and estrogen and progesterone receptors were associated with SLN metastasis in multivariate analysis. The nomogram was accurate and discriminating, with an area under the receiver operating characteristic curve of 0.754 when applied to the validation group. Conclusion Newly diagnosed breast cancer patients are increasingly interested in information about their disease. This nomogram is a useful tool that helps physicians and patients to accurately predict the likelihood of SLN metastasis.

Real-world neo-adjuvant with or without adjuvant treatment patterns among pancreatic ductal adenocarcinoma patients in the U.S.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16217-e16217
Author(s):  
Prakash Navaratnam ◽  
Monica Chase ◽  
Howard Steven Friedman ◽  
Seongjung Joo ◽  
Michael J. Pishvaian
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Adjuvant Treatment ◽  
Real World ◽  
Unmet Need ◽  
Treatment Patterns ◽  
Ductal Adenocarcinoma ◽  
Administrative Claims ◽  
Surgery Patient ◽  
To Receive ◽  
The U.S

e16217 Background: The vast majority of pancreatic ductal adenocarcinoma (PDAC) patients have unresectable disease at diagnosis, with only about 20% presenting with either resectable or borderline resectable tumors and who may receive adjuvant with or without neo-adjuvant treatment with surgery. This study seeks to characterize these treatment patterns in the real-world setting. Methods: This was a retrospective observational study to evaluate adjuvant treatment of PDAC patients, with or without neo-adjuvant treatment in the U.S. Patients with at least two medical claims with a primary diagnosis for PDAC between 2016 to 2019 were identified in the Truven MarketScan administrative claims database. A surgical resection within 3 months of any primary PDAC coded medical encounter was the index event, with patients required to be continuously enrolled for at least 3 months before and 6 months after the surgery. Patient demographics and treatment patterns (chemotherapy, radiotherapy, and chemoradiation) were evaluated over the pre-index (3 months) and post-index (3 and 6 months) observation windows. Neo-adjuvant and adjuvant treatment patterns were reported for the overall population and also stratified by age and sex. Results: 737 patients met the selection criteria with a majority (n=520, 71%) being <65 years old and 53% females (n=387). 65% (n=478) of patients received adjuvant chemotherapy during the 6-month post-index compared with 28% (n=207) receiving neo-adjuvant treatment. In the neo-adjuvant setting, patients were likely to receive leucovorin+fluorouracil+irinotecan+oxaliplatin (FOLFIRINOX; 43%, n=88) followed by gemcitabine+pacitaxel (18%, n=37), across all patients, as well as stratified by age or sex. Among patients that received adjuvant but did not receive neo-adjuvant treatment, patients were likely to receive gemcitabine monotherapy (35%, n=112) followed by gemcitabine+capecitabine (GEMCAP; 23%, n=72). Among adjuvant patients that had received neo-adjuvant treatment, the most common chemotherapy regimens were gemcitabine monotherapy (22%, n=35), GEMCAP (18%, n=29) and FOLFIRINOX (16%, n=26). For patients ≥ 65 years old, the most common adjuvant regimen was gemcitabine monotherapy (n=62, 29%) whereas for patients <65, the most common regimens were GEMCAP (25%, n=90) and gemcitabine monotherapy (16%, n=85). Gemcitabine monotherapy (41%; n=118 of 453) was the main adjuvant regimen for patients with index dates of 2016-2017 but for those with index dates of 2018-2019 the most common was FOLFIRINOX (34%; n=64 of 284) followed by GEMCAP (18%; n=35 of 284). Conclusions: The majority (70%) of patients that underwent PDAC resection surgery did not receive neo-adjuvant treatment and about a third of patients did not receive any adjuvant treatment. These results suggest an unmet need in the management of PDAC.

Patterns of HPV testing and treatment decision in patients with SCCHN.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17526-e17526
Author(s):  
Giovanni Zanotti ◽  
Jean-Francois Martini ◽  
Roberto Uehara ◽  
Pamela Hallworth ◽  
Katherine Byrne
Keyword(s):  
Real World ◽  
Local Level ◽  
Treatment Decision ◽  
Treatment Patterns ◽  
Hpv Testing ◽  
Cross Sectional Survey ◽  
Real World Data ◽  
Cross Sectional ◽  
Data Set ◽  
Hpv Status

e17526 Background: Human papillomavirus (HPV) is one of the main risk factors associated with squamous cell carcinoma of the head and neck (SCCHN). Although it is a prognostic factor, SCCHN patients are not routinely tested for HPV status because it may not be informative for therapy initiation. The objective of this study was to understand the real world testing patterns, and treatment decision of SCCHN patients. Methods: Real world data was gathered using Adelphi’s Disease-Specific Programme (DSP) - a real world, cross-sectional survey conducted in the USA, France, Germany and the UK (April - September 2016). The DSP incorporated 182 physician interviews (54 US, 128 EU) covering all stages of SCCHN caseloads and treatment patterns. Physicians also provided data for 8 consecutive consulting SCCHN patients regarding treatment patterns, progression, and symptoms. Results: A total of 2193 SCCHN patient cases were captured. HPV testing was carried out in 42% of patients within the DSP data set with no particular difference across the 4 countries. Of those tested, 35% of patients were HPV positive. Testing was mainly performed at the local level (51%, onsite or local hospital) apart from Germany where central testing was higher (73%). In over half of patients cases (54%) , physicians are unaware of the type of test performed for the HPV status determination; in fact, up to 10 different types of tests were used to determine the HPV status in this real world experience. Platinum based cetuximab and fluorouracil was used in 30% of the HPV positive patients while 20% received platinum monotherapy. In 2nd line, docetaxel/paclitaxel monotherapy was used in 22% of the patients. HPV negative patients also mainly received platinum based cetuximab and fluorouracil (27%) in 1st line, while in 2ndline, docetaxel/paclitaxel monotherapy was used in 20% of the patients. Conclusions: This analysis of real world treatment patterns and outcomes among SCCHN patients shows that HPV testing is not widely carried out for either patient characterization or to guide treatment decisions within this disease. Therapy choices were generally consistent standard clinical guidelines.

Real-world treatment patterns and characteristics in patients with chronic lymphocytic leukemia.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 65-65 ◽  
Author(s):  
Brad Schenkel ◽  
Alex Rider ◽  
Brian Macomson ◽  
Pam Hallworth
Keyword(s):  
Real World ◽  
Hospital Setting ◽  
Treatment Decision ◽  
Treatment Patterns ◽  
Lymphocytic Leukemia ◽  
Academic Hospital ◽  
Treatment Decision Making ◽  
Antineoplastic Treatment ◽  
Adult Leukemia ◽  
To Receive

65 Background: CLL is the most prevalent form of adult leukemia. In recent years, there have been a number of newly approved therapies for the management of patients with CLL in both the 1st line (1L) and relapsed/refractory settings, including ibrutinib (approved for 1L CLL, March 2016). Methods: USphysicians involved in CLL treatment decision-making were recruited into the Adelphi CLL Disease Specific Programme (February-May 2016). Physicians completed record forms on consecutively presenting patients > 18 years currently on active CLL treatment. Descriptive statistics analyzed demographics, clinical characteristics, and antineoplastic treatment patterns. Results: 700 patients diagnosed with CLL for an average of 3.0 years were captured. Patients’ mean age was 68.3 years, 53% were male, 75% were Caucasian, 25% had 17p deletion, and 55% were Medicare insured. Of the 81 physicians, 35% were based in an academic hospital setting, 51% in a non-academic hospital setting, 4% in both, and 9% were office-based. Within the overall cohort, BR was the most common 1L regimen (25%), while ibrutinib was the most common 2nd line (2L) regimen (42%). Among patients with 17p deletion, BR was the most common 1L regimen (25%) and ibrutinib was the most common 2L regimen (50%). Older patients ( ≥ 65) were most likely to receive BR at 1L (28%), while 1L younger patients ( < 65) received FCR (24%). Conclusions: This analysis of real world treatment patterns identified BR, FCR, and ibrutinib as the most common 1L regimens in US CLL patients. Ibrutinib, BR, and idelalisib + rituximab were the most common 2L regimens. Choice of therapy varied depending on age and 17p deletion status. For example, FCR was more frequently used as 1L therapy in patients < 65 years, and the proportion of ibrutinib use as 1L therapy was higher in those with 17p deletion. [Table: see text]

scholarly journals Does Provider Experience Treating Patients (pts) with Myelodysplastic Syndromes (MDS) Explain Duration of Hypomethylating Agent (HMA) Therapy and Overall Survival (OS)? A Large Population-Based Analysis

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 370-370 ◽  
Author(s):  
Amer M. Zeidan ◽  
Xin Hu ◽  
Weiwei Zhu ◽  
Maximilian Stahl ◽  
Smith Giri ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Research Funding ◽  
Prior Experience ◽  
Large Population ◽  
Skewed Distribution ◽  
Cancer Center ◽  
The Past ◽  
Provider Experience ◽  
To Receive ◽  
Different Levels

Abstract Introduction: Real-world survival for pts with MDS treated with HMAs is substantially inferior than the landmark AZA-001 trial (median OS, 11-16 and 24.5 months, respectively). The reasons behind this gap remain unclear. Clinical use of HMAs differs from traditional chemotherapy in that multiple HMA cycles are generally required before responses are observed, therapy is continued even in the presence of significant cytopenias, and therapy must be continued to sustain response. We hypothesized that practice at academic hospital setting or prior experience of providers in treating MDS pts (more specifically the number of pts initiated on HMAs) are positively associated with persistence in HMA therapy and improved OS. Methods: Using SEER-Medicare linked data, we identified MDS pts diagnosed in 2004-13. Inclusion criteria included being ≥66 years at diagnosis, continuous Medicare Parts A&B coverage, and ≥ 1 full HMA cycle (defined by 3-10 days of HMA use within 28 days). Pts were followed until death or December 31, 2014. We identified the physician associated with HMA initiation, and assessed that provider's prior experience in caring for MDS pts or in initiating HMAs in a 2-year lookback period. Only pts diagnosed with MDS and initiated HMA in 2006-2013 were included for analysis to allow 2-year lookback for volume calculation. MDS volume and HMA volume were categorized into dichotomous variables given their skewed distribution (0-14 vs. 15 or more for MDS volume, 0 vs. 1 or more for HMA volume). Provider type was defined based on claim type (hospital outpatient [HOPD] or community provider) and linked information on hospital characteristics as 1) HOPD, teaching or cancer center (academic) or 2) HOPD, neither teaching hospital nor cancer center (HOPD-nonacademic) and 3) community-based practice. We assessed HMA duration as number of cycles of HMA therapy, with cycles separated by a gap of >= 2 weeks without therapy. We calculated OS from the first day of HMA. Chi-squared tests were used to assess differences in proportion of pts receiving ≥4 HMA cycles, and proportion with 2-year survival across different levels of HMA volume, MDS volume, and provider types. Wilcoxon rank sum test and Kaplan-Meier (KM) log-rank test was used to examine distribution of HMA cycles and OS across different levels of volume and provider types. Finally, we used multivariate Cox proportional hazards model to analyze OS, and similarly multivariate logistic regression for duration of HMA treatment, both of which were adjusted for relevant covariates (see footnote of Figure 1 for covariates). Two-sided statistical tests were used with alpha=0.05. Results: We identified 2,128 eligible pts under the care of 1,157 providers with 2-year lookback period. Median age at diagnosis was 77 (interquartile range 72-82) years, and 90.2% of patients were white. Median number of HMA cycles was 4, and median OS was 10 months (95% CI: 10-11). Median MDS volume was 8 and 32.2% of pts' providers had at least 1 HMA initiation in the past 2 years. Pts treated by provider with MDS volume ≥15 or with HMA initiation volume ≥1 are more likely to receive ≥4 HMA cycles in unadjusted analyses (P=.03 and P=.002 respectively). Community providers had significantly higher percentage of ≥ 1 HMA initiation than either group of HOPD hospital providers (P<.001). However, no differences were found between HOPD academic vs. HOPD non-academic (P=.17). In adjusted logistic regression analysis, we found that pts whose provider had ≥ 1 HMA initiation in the past year are more likely to receive persistent HMA (OR=1.29, 95% CI=1.06-1.57, P=.01, [Figure 1]). No significant association was found between MDS volume and persistent HMA therapy. KM analyses indicated no significant differences in OS across different levels of MDS volume or HMA initiation volume [Figure 2]. Conclusions: MDS pts whose providers were more experienced with HMA had higher odds of receiving persistent HMA than pts with less experienced providers. However, there was no difference in the OS based on provider experience. These findings suggest specialized care of MDS pts can decrease inappropriate early discontinuation of HMA therapy, but does not seem to improve OS. Further research into the underlying reasons for the gap in OS between HMA-treated pts observed in clinical trials compared to real-life setting is warranted to help develop interventions to improve outcomes at the population setting. Disclosures Zeidan: Celgene: Consultancy; Pfizer: Consultancy; Novartis: Consultancy; Incyte: Employment; Gilead: Consultancy; Abbvie: Consultancy; Agios: Consultancy; Ariad: Consultancy, Speakers Bureau. Huntington:Bayer: Consultancy; Celgene: Consultancy; Janssen: Consultancy. Podoltsev:Celator: Research Funding; Astellas Pharma: Research Funding; Boehringer Ingelheim: Research Funding; Daiichi Snakyo: Research Funding; Pfizer: Membership on an entity's Board of Directors or advisory committees; Genentech: Research Funding; Astex Pharmaceuticals: Research Funding; Celgene: Research Funding; Sunesis Pharmaceuticals: Research Funding; Pfizer: Research Funding; LAM Therapeutics: Research Funding. Gore:Celgene: Consultancy, Research Funding. Ma:Incyte: Consultancy; Celgene: Consultancy. Davidoff:Celgene: Research Funding.

scholarly journals Treatment Patterns and Intensity Differ between Pediatric and Adult Centers in AYA with Hodgkin's Lymphoma but Result in Equivalent Outcomes: A Population-Based Study Using the IMPACT Cohort

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 831-831 ◽  
Author(s):  
Sumit Gupta ◽  
Nancy Baxter ◽  
Jason Pole ◽  
Chenthila Nagamuthu ◽  
Cindy Lau ◽  
...  
Keyword(s):  
Community Hospital ◽  
Population Based ◽  
Treatment Patterns ◽  
Cancer Center ◽  
Treatment Intensity ◽  
Community Hospitals ◽  
Cancer Centers ◽  
Multivariable Analyses ◽  
The Impact ◽  
To Receive

Abstract Background: Hodgkin's lymphoma (HL) is one of the most common cancers in adolescents and young adults (AYA). Unlike acute lymphoblastic leukemia, few studies have compared AYA HL outcomes between pediatric and adult centers, or pediatric and adult protocols. Recently, a comparison of AYA (17-21 years) treated on a pediatric COG trial vs. an adult ECOG trial demonstrated superior survival in AYA treated on the pediatric trial, but other studies have not demonstrated a treatment center disparity. None of these studies were population-based. We therefore compared treatment patterns, intensity, and outcomes between AYA HL treated at pediatric vs. adult centers using a population-based clinical database. Methods: The IMPACT Cohort comprises all Ontario, Canada AYA aged 15-21 years diagnosed with one of six common cancers (including HL) between 1992-2012. Detailed demographic, disease, treatment, and outcome data were collected through chart abstraction and validated by content experts. Locus of cancer care (pediatric vs. adult cancer center vs. adult community hospital) was based on where the majority of therapy was delivered in the first three months after diagnosis. Linkage to population-based health administrative data identified additional cancer events (second cancers, relapse, death). The treatment modalities received [radiation vs. chemotherapy vs. combined modality treatment (CMT)] were compared by locus of care, as were cumulative doses of doxorubicin, bleomycin, and radiation. Predictors of CMT (vs. chemotherapy only) were examined using logistic regression. Event-free (EFS) and overall survival (OS) were determined using Kaplan-Meier methods. The impact of locus of care on EFS and OS was determined using multivariable Cox proportional hazard models, adjusting for demographic, disease, and treatment variables. Events included disease progression, relapse, death, and second malignancies. Results: Among 954 AYA with HL, 711 (74.5%) received therapy at an adult center (adult regional cancer center or community hospital). The proportion of AYA with limited stage disease did not vary between pediatric centers [90/221 (40.7%)] and adult centers [172/456 (37.7%); p=0.45]. While AYA treated at pediatric centers were more likely to receive radiation, radiation doses were higher at both adult cancer centers and adult community hospitals, as were cumulative doses of doxorubicin and bleomycin (Table 1). When adjusted for age, stage, and histology, AYA treated at pediatric centers were significantly more likely to receive CMT rather than chemotherapy alone as compared to AYA at adult cancer centers [odds ratio (OR) 5.0; 95% confidence interval (CI) 3.0-8.4; p<0.0001] or adult community hospitals (OR 3.9, CI 2.2-7.0; p<0.0001). 5-year EFS and OS for the cohort were 83.0%±1.2% and 94.9%±0.7%. 10-year EFS and OS were 81.1%±1.3% and 92.6%±7.4%. In multivariable analyses, CMT was associated with superior EFS as compared to chemotherapy alone [hazard ratio (HR) 0.68; CI 0.50-0.93; p=0.02] but was not significantly associated with OS. Despite the significant differences in treatment modality and treatment intensity between pediatric and adult centers, locus of care was not significantly associated with either EFS or OS in either univariate or multivariable analyses (Table 2). Conclusions: In this large, population-based cohort, survival outcomes did not differ between AYA treated at pediatric vs. adult centers. However, treatment intensity patterns varied, with AYA treated at a pediatric center more likely to receive radiation (though at lower doses) but exposed to lower cumulative chemotherapy doses. These results imply that acute toxicities and the types and cumulative burden of late effects may differ by locus of care. Given equivalent outcomes, these results also suggest that a proportion of AYA are being over-treated. Future analyses will study these hypotheses. Disclosures No relevant conflicts of interest to declare.

Disparity in utilization of multiagent therapy for acute promyelocytic leukemia (APL): A large National Cancer Database (NCDB) analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6587-6587
Author(s):  
Prajwal Dhakal ◽  
Elizabeth Lyden ◽  
Krishna Gundabolu ◽  
Amer Methqal Zeidan ◽  
Kah Poh Loh ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Real World ◽  
Private Insurance ◽  
Multiple Logistic Regression Analysis ◽  
Single Agent ◽  
High Rate ◽  
Cancer Center ◽  
Uninsured Patients ◽  
Single Agent Therapy ◽  
To Receive

6587 Background: Clinical trials have demonstrated a high rate of cure in APL with the use of multiagent therapy; however, overall survival in real world practice is significantly lower than that in the trials (Blood 2020; 136 (s 1): 13-14). We performed a large NCDB analysis to determine the appropriateness of treatment as a possible explanation for worse survival outside of the clinical trials. Methods: We included a total of 7190 APL cases reported to NCDB between 2004-2015. Multiple logistic regression analysis was used to evaluate the effect of covariates on probability of multiagent therapy use. Results: Only 64% of total patients received multiagent therapy; 29% received singe agent therapy and 4% received unknown therapy. 3% (n = 207) did not receive any treatment for reasons including early death (n = 8), patient refusal (n = 15), perceived contraindication (n = 12) and unknown reasons (n = 182). Compared to patients > 60 years, younger patients aged 0-18 years (hazard ratio [HR] 3.2, 95% confidence interval [CI] 1.8-5.5, p < 0.001), 19-40 years (HR 1.6, 95% CI 1.03-2.54, p = 0.03) and 41-60 years (HR 1.6, 95% CI 1.3-1.9, p < 0.001) were more likely to receive multiagent chemotherapy. Patients with Medicaid were more likely to receive multiagent therapy compared to those with private insurance (HR 1.2, 95% CI 1.01-1.42, p = 0.04), possibly because patients with Medicaid are younger. The likelihood of receiving multiagent therapy decreased in uninsured patients (HR 0.6, 95% CI 0.5-0.8, p < 0.001). Compared to academic cancer centers, patients treated at community cancer center (HR 0.5, 95% CI 0.3-0.7, p = 0.001), comprehensive community cancer center (HR 0.7, 95% CI 0.6-0.8, p < 0.001)) and integrated network cancer center (HR 0.8, 95% CI 0.6-0-0.9, p = 0.01) were less likely to be treated with multiagent therapy. Lower comorbidity index increased the likelihood of receiving multiagent therapy. The likelihood of receiving multiagent therapy was not influenced by sex, race, annual income, distance traveled to treatment facility and high school education. Conclusions: To our knowledge, this is the first large scale analysis of utilization of multiagent therapy in APL in real world practice. In our study, 3% of patients did not receive treatment, a much smaller proportion of patients compared to acute myeloid leukemia, where a quarter to a third of patients do not receive any chemotherapy (Blood Adv; 2018 (2): 1277–1282). However, 29% of APL patients received suboptimal treatment with single agent therapy. The use of single agent therapy was higher in older adults and those with greater comorbidity. About half of the patients were treated outside of academic centers, which was associated with a higher probability of receiving single agent therapy. Uninsured patients were more likely to receive single agent therapy. Our findings highlight disparity based on insurance and health system factors.

scholarly journals Real-World Multiple Myeloma Treatment Patterns By Patient Characteristics and Outcomes in the United States

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4114-4114
Author(s):  
Joshua Richter ◽  
Erin Singh ◽  
Megan S. Rice
Keyword(s):  
Real World ◽  
Patient Characteristics ◽  
The United States ◽  
Treatment Patterns ◽  
First Line ◽  
Treatment Regimens ◽  
First Line Therapy ◽  
Line Therapy ◽  
Line Of Therapy ◽  
To Receive

Abstract Introduction: Despite numerous therapies approved for multiple myeloma (MM) in the past decade, the disease remains largely incurable. As a result, patients (pts) typically require successive lines of therapy, comprised of various combinations of drugs, to treat relapsed disease. As the treatment landscape evolves, continued real-world (RW) studies provide additional understanding of the treatment patterns of MM pts outside of clinical trials, particularly for those with unmet medical need and/or high-risk disease. In this retrospective, observational cohort study, we examined RW treatment patterns among MM pts overall and within patient subgroups classified by age, race/ethnicity, renal impairment (RI), cytogenetic risk, and 1q21 amplification, as well as patient outcomes. Methods: This study used the nationwide Flatiron Health electronic health record-derived de-identified database of MM pts treated in the United States. During the study period, January 1, 2016 to April 30, 2021, pts who had ≥1 line of therapy or whose first-line treatment was initiated after the study start were included. Treatment class regimens (lines 1-4) were classified as: proteasome inhibitor (PI)-based, immunomodulatory drug (IMiD)-based, PI + IMiD-based, chemotherapy-based, antibody-based, or other treatments. We examined patient characteristics as well as treatment patterns overall and in patient subgroups. We also assessed real-world progression-free survival (rwPFS), defined as the time from start of line therapy to the date of progression or death, by treatment regimen received. Results: At the time of data cutoff, 5465 pts received ≥1 line of therapy; 45.3% of pts were female, 57.4% were white, median age at the start of first-line therapy was 70 years (interquartile range 62-77), and 88.7% received care at community practices. A total of 14.6% had high-risk cytogenetic abnormalities, 21.0% had 1q21 amplification, 20.7% had International Staging System stage III at diagnosis and 33.2% had RI (eGFR &lt;60 mL/min/1.73 m 2) at the start of first-line therapy. The most common first-line regimens were PI + IMiD-based (53.4%), whereas 12.8% received PI-based, 11.5% IMiD-based, 13.4% chemotherapy-based, 2.8% antibody-based, and 6.1% had other treatments (Figure 1). Although uncommon in first-line therapy, antibody-based treatments were more commonly used in later lines of therapy (second-line: 21.0%; third-line: 33.7%; fourth-line: 40.0%). In first-line, pts aged ≥75 years were less likely to receive PI + IMiD-based regimens than those aged &lt;75 years (40.4% vs 60.1%) (Figure 2). Similarly, RI pts received PI + IMiD-based regimens less frequently in first-line than those without impairment (47.8% vs 65.0%). In first-line, 18.9% of pts had evidence of undergoing a transplant. Both older pts and those with RI were also less likely to receive a transplant as part of their first-line treatment (1.7% vs 27.7% and 13.9% vs 24.2% respectively). Treatment differences were less pronounced in later lines as well as by race/ethnicity, cytogenetic risk, and 1q21 amplification. In first-line therapy, rwPFS was longer for pts treated with PI + IMiD-based regimens (median [95% confidence interval], 29.5 months [27.3-31.9]). In later lines of therapy, pts treated with IMiD-based regimens had longer median rwPFS (second-line: 22.7 months [18.5-30.4]; third-line: 19.7 months [14.2-37.0]; fourth-line: 16.1 months [6.4-26.7]). Additional analyses examining newer treatment regimens will be presented. Conclusions: PI + IMiD combination therapy was the most common first-line therapy. Although not commonly used in first-line therapy, antibody-based regimens are increasingly used in later lines of therapy. Older pts as well as pts with RI were less likely to receive PI + IMiD regimens or transplant in first-line therapy. Pts receiving PI + IMiD regimens in first-line therapy had longer rwPFS. Pts receiving IMiD-based regimens had longer rwPFS in later lines. Analyses of newer treatment regimens to be presented within this dataset will provide additional insight into changes in RW treatment patterns in the era of novel agents. Figure 1 Figure 1. Disclosures Richter: BMS, Karyopharm, Antengene: Membership on an entity's Board of Directors or advisory committees; Adaptive biotechnologies: Speakers Bureau; Janssen, Celgene: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Tisch Cancer Institute: Icahn School of Medicine at Mount Sinai: Current Employment. Singh: Sanofi: Current Employment. Rice: Sanofi: Current Employment, Current holder of individual stocks in a privately-held company.

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