scholarly journals Real-World Treatment Patterns and Survival in Stage IV Non-Small-Cell Lung Cancer in Canada

2020 ◽  
Vol 27 (4) ◽  
pp. 361-367
Author(s):  
S.J. Seung ◽  
M. Hurry ◽  
R.N. Walton ◽  
W.K. Evans
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Stage Iv ◽  
Palliative Radiotherapy ◽  
Treatment Patterns ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Stage Iv Disease ◽  
Line Chemotherapy

Background: Almost half of all patients with non-small-cell lung cancer (nsclc) present with stage iv disease. The objective of the present study was to characterize treatment patterns and survival outcomes in patients with advanced nsclc. Methods: We conducted a longitudinal population-level study in patients diagnosed with stage iv nsclc in Ontario between 1 April 2010 and 31 March 2015, with follow-up to 31 March 2017 for overall survival and treatment sequence. Patients were stratified as nonsquamous or squamous histology. A sub-analysis was conducted for patients with nonsquamous histology who received targeted therapies, on the assumption that their tumours were EGFR mutation–positive (EGFRm+). Treatment patterns were determined, and survival was calculated from date of diagnosis to death or censoring. Results: Of 24,729 nsclc cases identified, stage iv disease was diagnosed in 49.2%, histology was nonsquamous in 10,103, and EGFRm+ was assumed in 508. Median patient age ranged from 69 to 72 years for the three cohorts. For patients with nonsquamous histology, palliative radiotherapy was the most frequently used first-line treatment (44.4%), followed by no treatment (26.7%) and chemotherapy (14.9%). In the EGFRm+ cohort, 75.6% received gefitinib as first- or second-line therapy, and almost half (47.4%) the 473 patients with squamous histology treated with first-line chemotherapy received cisplatin or carboplatin with gemcitabine. Median overall survival in the nonsquamous and squamous cohorts was 4.9 and 4.6 months respectively; it was 17.6 months for patients who were EGFRm+. Conclusions: Survival of patients with stage iv nsclc remains poor, with the exception of patients who are EGFRm+. Only 14.9% of patients received first-line chemotherapy; the mainstay of treatment was palliative radiotherapy.

scholarly journals Treatment Patterns and Overall Survival Associated with First-Line Systemic Therapy for Patients with Advanced Non-Small Cell Lung Cancer

2017 ◽  
Vol 23 (2) ◽  
pp. 195-205 ◽  
Author(s):  
Michele M. Spence ◽  
Rita L. Hui ◽  
Jennifer T. Chang ◽  
Joanne E. Schottinger ◽  
Mirta Millares ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Systemic Therapy ◽  
Treatment Patterns ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line

scholarly journals First-Line Systemic Treatments for Stage IV Non-Small Cell Lung Cancer in California: Patterns of Care and Outcomes in a Real-World Setting

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Frances B Maguire ◽  
Cyllene R Morris ◽  
Arti Parikh-Patel ◽  
Rosemary D Cress ◽  
Theresa H M Keegan ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Kinase Inhibitors ◽  
Stage Iv ◽  
Population Level ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Treatment Groups ◽  
Systemic Treatments

Abstract Background Multiple systemic treatments have been developed for stage IV non-small cell lung cancer (NSCLC), but their use and effect on outcomes at the population level are unknown. This study describes the utilization of first-line systemic treatments among stage IV NSCLC patients in California and compares survival among treatment groups. Methods Data on 17 254 patients diagnosed with stage IV NSCLC from 2012 to 2014 were obtained from the California Cancer Registry. Systemic treatments were classified into six groups. The Kaplan-Meier method and multivariable Cox proportional hazards models were used to compare survival between treatment groups. Results Fifty-one percent of patients were known to have received systemic treatment. For patients with nonsquamous histology, pemetrexed regimens were the most common treatment (14.8%) followed by tyrosine kinase inhibitors (11.9%) and platinum doublets (11.5%). Few patients received pemetrexed/bevacizumab combinations (4.5%), bevacizumab combinations (3.6%), or single agents (1.7%). There was statistically significantly better overall survival for those on pemetrexed regimens (hazard ratio [HR] = 0.86, 95% confidence interval [CI] = 0.80 to 0.92), bevacizumab regimens (HR = 0.73, 95% CI = 0.65 to 0.81), pemetrexed/bevacizumab regimens (HR = 0.68, 95% CI = 0.61 to 0.76), or tyrosine kinase inhibitors (HR = 0.62, 95% CI = 0.57 to 0.67) compared with platinum doublets. The odds of receiving most systemic treatments decreased with decreasing socioeconomic status. For patients with squamous histology, platinum doublets were predominant (33.7%) and were not found to have statistically significantly different overall survival from single agents. Conclusions These population-level findings indicate low utilization of systemic treatments, survival differences between treatment groups, and evident treatment disparities by socioeconomic status.

scholarly journals Treatment beyond four cycles of first line Platinum and Etoposide chemotherapy in real-life patients with stage IV Small Cell Lung Cancer: a retrospective study of the Merseyside and Cheshire Cancer network

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Mostafa Sallam ◽  
Helen Wong ◽  
Carles Escriu
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Clinical Benefit ◽  
Real Life ◽  
Stage Iv ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Stage Iv Disease

Abstract Background Dose intensity and dose density of first line Platinum and Etoposide (PE) do not influence Overall Survival (OS) of Small Cell Lung Cancer (SCLC) patients. The effect of treatment length, however, remains unclear. Current guidelines recommend treating beyond 4 cycles -up to 6-, in patients that respond to and tolerate systemic treatment. This has led to variable practice both in clinical practice and clinical research. Here we aimed at quantifying the possible clinical benefit of the extended regimen in our real-life patients treated with PE doublet. Methods Of all patients with SCLC treated in our network with non-concurrent first line PE chemotherapy between 2008 and 2015, we identified and described patients that received 4 cycles (4c) or more (> 4c), and analysed patients with stage IV disease. Results Two hundred forty-one patients with stage IV had 4c and 69 had > 4c. The latter were more likely to have sequential thoracic radiotherapy, which suggested a lower metastatic burden. Nevertheless, there were no statistically significant differences when comparing clinical outcomes. The median Duration of Response (DoR; time from last chemotherapy cycle to progression) was 5 months in both groups (HR 1.22; 95% CI 0.93–1.61). Median Progression Free Survival (PFS; time from diagnosis to radiological progression) was 8 months (4c) versus 9 months (> 4c) (HR 0.86; 95% CI 0.66–1.13) and median OS was 11 versus 12 months (HR 0.86, 95% CI 0.66–1.14). Conclusion Our results highlight a lack of clinical benefit by extending first line PE treatment in stage IV disease, and support limiting treatment to 4 cycles until superiority of a longer regimen is identified in a randomised study.

scholarly journals Maintenance Chemotherapy for Advanced Non–Small-Cell Lung Cancer: New Life for an Old Idea

2013 ◽  
Vol 31 (8) ◽  
pp. 1009-1020 ◽  
Author(s):  
David E. Gerber ◽  
Joan H. Schiller
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Maintenance Therapy ◽  
Small Cell Lung Cancer ◽  
Small Cell ◽  
Maintenance Chemotherapy ◽  
Small Cell Lung ◽  
First Line ◽  
Continuation Maintenance ◽  
Line Chemotherapy

Although well established for the treatment of certain hematologic malignancies, maintenance therapy has only recently become a treatment paradigm for advanced non–small-cell lung cancer. Maintenance therapy, which is designed to prolong a clinically favorable state after completion of a predefined number of induction chemotherapy cycles, has two principal paradigms. Continuation maintenance therapy entails the ongoing administration of a component of the initial chemotherapy regimen, generally the nonplatinum cytotoxic drug or a molecular targeted agent. With switch maintenance (also known as sequential therapy), a new and potentially non–cross-resistant agent is introduced immediately on completion of first-line chemotherapy. Potential rationales for maintenance therapy include increased exposure to effective therapies, decreasing chemotherapy resistance, optimizing efficacy of chemotherapeutic agents, antiangiogenic effects, and altering antitumor immunity. To date, switch maintenance therapy strategies with pemetrexed and erlotinib have demonstrated improved overall survival, resulting in US Food and Drug Administration approval for this indication. Recently, continuation maintenance with pemetrexed was found to prolong overall survival as well. Factors predicting benefit from maintenance chemotherapy include the degree of response to first-line therapy, performance status, the likelihood of receiving further therapy at the time of progression, and tumor histology and molecular characteristics. Several aspects of maintenance therapy have raised considerable debate in the thoracic oncology community, including clinical trial end points, the prevalence of second-line chemotherapy administration, the role of treatment-free intervals, quality of life, economic considerations, and whether progression-free survival is a worthy therapeutic goal in this disease setting.

Association of plasma EGFR mutations with response to first-line chemotherapy and prognosis in Chinese patients with advanced non-small cell lung cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19017-e19017
Author(s):  
M. N. Wu ◽  
J. Zhao ◽  
H. Bai ◽  
M. L. Zhuo ◽  
S. H. Wang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Stage Iv ◽  
Small Cell ◽  
Chinese Patients ◽  
Egfr Mutations ◽  
Wild Type ◽  
Small Cell Lung ◽  
First Line ◽  
Nsclc Patients ◽  
Line Chemotherapy

e19017 Background: To investigate associations of plasma EGFR mutations of advanced non-small cell lung cancer (NSCLC) patients with response to the first-line chemotherapy and prognosis. Methods: Plasma EGFR mutations from 145 chemotherapy-naive patients with advanced or metastatic NSCLC were examined by using denaturing high- performance liquid chromatography (DHPLC), and associations of EGFR mutations with tumor response to chemotherapy and clinical outcomes were evaluated. Results: 37.2% (54/145) of the patients was detected to have EGFR mutations in their plasma DNA. The response rate of mutated EGFR carriers to the chemotherapy was 37% (20/54), similar to that of 31.9% (29/91) of wild-type EGFR carriers to the chemotherapy (P= 0.323). Stage IV NSCLC patients with mutated EGFR had a longer PFS than those with wild-type EGFR (4 vs 3 months, P=0.043) after the first-line chemotherapy. The median survival time and 1-, 2- year survival rate for the patients with EGFR mutations (24 months and 85.7%,43.7%) were increased than those with wild-type EGFR (18 months and 65.7%,25.9%) (p=0.0468). Cox multivariate regression analysis showed that clinical stage (IV vs IIIb), response to the first-line chemotherapy (PR vs PD), and EGFR mutations were independent prognostic factors (P=0.008, 0.000 and 0.000 respectively). Conclusions: We conclude that plasma EGFR mutations in the Chinese patients with advanced NSCLC were not associated with response to the first-line chemotherapy, but Stage IV NSCLC patients with mutated EGFR had a longer PFS after the chemotherapy. No significant financial relationships to disclose.

A clinical prognostic model to predict survival and efficacy in advanced or metastatic non-small cell lung cancer patients who received first-line chemotherapy: A retrospective analysis of 236 patients in northeast China.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19004-e19004
Author(s):  
Xiujuan Qu ◽  
Jing Gong ◽  
Xuejun Hu ◽  
Bo Jin ◽  
Mingfang Zhao ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Prognostic Model ◽  
Risk Group ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Nsclc Patients ◽  
Adverse Factor ◽  
Line Chemotherapy

e19004 Background: This study was aimed to build a prognostic model for survival and predict efficacy in patients undergoing first-line chemotherapy in advanced or metastatic non-small cell lung cancer. Methods: Sixteen pretreatment clinical and biological variables were analyzed in 236 NSCLC patients who received first-line chemotherapy in our hospital. The prognostic model was calculated according to the results of multivariate Cox model, and the survival in different score groups were estimated by the Kaplan-Meier method and Long-rank tests. Results: Sixteen factors (smoking history, performance status, gender, disease stage, histological type, LDH, fibrinogen, WBC count, granulocyte count, lymphocyte count, hemoglobin, albumin, FBG, PLT, TP, β2-MG) were analyzed in univariate model for overall survival. The result showed PS=1 (HR=1.85, p<0.001), elevated fibrinogen (HR=1.63, p=0.008), elevated LDH (HR=1.78, p=0.002), granulocyte count >4.85×109/L (median) (HR=1.65, p=0.004) and increased PLT (HR=1.78, p=0.004) were poor prognostic factors. Then these five factors were enrolled in multivariate analysis. The result showed that PS=1 (HR=1.93, p<0.001), elevated LDH (HR=2.22, p<0.001) and increased PLT (HR=1.71, p=0.04) were independent prognostic factors. The patients were separated to low risk group (no adverse factor), intermediate risk group (1 adverse factor) and high risk group (2-3 adverse factors) according to the number of adverse factors. Median overall survival for these groups were 22.7, 14.5, and 7.5 months at a p value of <0.001. Kruskal-Wallis analysis revealed that the differences of efficacy in these three groups were statistically significant different (p=0.016). Conclusions: Prognostic model using PS=1, elevated LDH and increased PLT might be applied to predict survival and efficacy in advanced or metastatic NSCLC patients undergoing first-line chemotherapy. The model constituted by these three economic and easily acquired parameters may provide a tool in clinical decision making and therapy selection.

scholarly journals Treatment patterns in patients with metastatic non-small-cell lung cancer in the era of immunotherapy

2021 ◽  
Author(s):  
David Stenehjem ◽  
Solomon Lubinga ◽  
Keith A Betts ◽  
Wenxi Tang ◽  
Mads Jenkins ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Stage Iv ◽  
Treatment Patterns ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Programmed Death ◽  
Baseline Characteristics

Background: Chemotherapy (CT) alone was previously standard first-line (1L) therapy for metastatic non-small-cell lung cancer (NSCLC) but alternative treatments, including immunotherapy (I-O), are now available. Patients & methods: In this retrospective study, adults with stage IV NSCLC who initiated 1L treatment between 1 August 2018 and 31 December 2019 and had ≥2 visits were identified in the Flatiron database. Patients were followed up until 30 June 2020. Baseline characteristics and treatment patterns were described by treatment group: CT, I-O + CT, I-O monotherapy and other. Results: Approximately 20% of patients received 1L CT in the 2018–2019 timeframe studied; these patients tended to have squamous histology and low (≤49%) programmed death ligand-1 expression. Conclusion: A proportion of patients with metastatic NSCLC still receive 1L CT despite the availability and widespread use of I-O therapies.

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