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Venditti A, Palmieri R, Maurillo L, Röllig C, Wierzbowska A, de Leeuw D, Efficace F, Curti A, Ngai LL, Tettero J, Adès L, Almeida A, Bullinger L, Dennis M, Esteve J, Ferrara F, Heuser M, Huls G, Lübbert M, Mehta P, Montesinos P, Pabst T, Récher C, Rossi G, Russell N, Sierra J, Stauder R, Vey N, Walter RB, Wang E, Nier S, Martins CG, Ossenkoppele G. Fitness assessment in acute myeloid leukemia: recommendations from an expert panel on behalf of the European LeukemiaNet. Blood Adv 2025; 9:2207-2220. [PMID: 39913928 PMCID: PMC12083920 DOI: 10.1182/bloodadvances.2024013744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 01/26/2025] [Indexed: 04/30/2025] Open
Abstract
ABSTRACT Fitness assessment in patients with acute myeloid leukemia (AML) is critical to deliver the right therapy to the right patient. Although several scoring systems are available to aid in determining fitness, the absence of validation studies has resulted in the lack of universally accepted assessment procedures. This limitation, combined with the increasing availability of novel agents expanding the spectrum of less-intensive options, has introduced additional complexity to the fitness assessment process. In this evolving context, fitness should reflect eligibility for a specific treatment among the several available, rather than a generic binary classification of eligibility for intensive chemotherapy. Moreover, the growing emphasis on patient-centered care, further highlights the importance of integrating quality of life, patient preferences, patient self-reported physical and social functioning status, social support, and early integration of palliative care into the assessment framework. A modern interpretation of fitness assessment should incorporate a comprehensive evaluation that extends beyond traditional clinical and biological disease characteristics. Thus, fitness assessment in patients with AML represents only 1 piece of a larger puzzle, encompassing the patient's overall capacity to sustain and benefit from a specific therapeutic program.
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Affiliation(s)
- Adriano Venditti
- Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Rome, Italy
- Department of Onco-Hematology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Raffaele Palmieri
- Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Rome, Italy
| | - Luca Maurillo
- Department of Onco-Hematology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Christoph Röllig
- Medizinische Klinik und Poliklinik 1, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Agnieszka Wierzbowska
- Department of Hematology, Medical University of Lodz, Lodz, Poland
- Department of Hematology and Transplantology, Provincial Multispecialized Oncology and Trauma Center, Lodz, Poland
| | - David de Leeuw
- Department of Hematology, Amsterdam University Medical Center, Location Vrije University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Fabio Efficace
- Data Center and Health Outcomes Research Unit, Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto, Rome, Italy
| | - Antonio Curti
- Dipartimento delle “Malattie oncologiche ed ematologiche,” Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Bologna, Italy
| | - Lok Lam Ngai
- Department of Hematology, Amsterdam University Medical Center, Location Vrije University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Jesse Tettero
- Department of Hematology, Amsterdam University Medical Center, Location Vrije University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Lionel Adès
- Service Hématologie Séniors, Hôpital Saint-Louis (Assistance Publique–Hôpitaux de Paris), Paris Cité University and INSERM U944, Paris, France
| | - Antonio Almeida
- Department of Hematology, Hospital da Luz, Lisbon, Portugal and Faculdade de Medicina, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Lars Bullinger
- Department of Hematology, Oncology and Cancer Immunology, Campus Virchow, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu, Berlin, Germany
| | - Mike Dennis
- Hematology, The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Jordi Esteve
- Servicio de Hematología, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | | | - Michael Heuser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Gerwin Huls
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michael Lübbert
- Department of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Priyanka Mehta
- Hematology, University Hospitals of Bristol and Weston National Health Service Trust, Bristol, United Kingdom
| | - Pau Montesinos
- Hematology Department, Hospital Universitario i Politècnico la Fe, Valencia, Spain
| | - Thomas Pabst
- Department of Medical Oncology, Bern University Hospital, University of Bern, Inselspital, Bern, Switzerland
| | - Christian Récher
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Giuseppe Rossi
- Divisione di Ematologia, Ematologia, Azienda Socio Sanitaria Territoriale degli Spedali Civili, Brescia, Italy
| | - Nigel Russell
- Hematology, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Reinhard Stauder
- Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology Tirol, The Tyrolean Private University, Hall in Tirol, Austria
- Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Norbert Vey
- Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Roland B. Walter
- Translational Science and Therapeutics Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Eunice Wang
- Leukemia Service, Roswell Park Comprehensive Cancer Center, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | | | | | - Gert Ossenkoppele
- Department of Hematology, Amsterdam University Medical Center, Location Vrije University Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Wang Z, Yuan J, Zhou N, Zhang J. Serum stromal cell-derived factor 1α as a prognostic indicator in elderly patients with acute myeloid leukemia receiving CAG-based chemotherapy. Front Oncol 2025; 14:1521179. [PMID: 39871937 PMCID: PMC11769979 DOI: 10.3389/fonc.2024.1521179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Accepted: 12/20/2024] [Indexed: 01/29/2025] Open
Abstract
Background Stromal-cell-derived factor 1 (SDF-1) plays a crucial role in hematopoiesis and has been implicated in acute myeloid leukemia (AML) pathogenesis. Understanding its relationship with chemotherapy outcomes could lead to improved therapeutic approaches for elderly AML patients. Methods This study retrospectively analyzed the medical records of elderly AML patients (n = 187) and compared serum SDF-1α levels with age-matched controls (n = 120). Patients received CAG (cytarabine, aclarubicin, and G-CSF)-based chemotherapy, and serum SDF-1α levels were assessed using ELISA. Results Serum SDF-1α levels were significantly elevated in elderly AML patients compared to controls (p < 0.001). Receiver operating characteristic (ROC) analysis confirmed its diagnostic relevance, revealing the area under the ROC curve (AUC) of 0.76. Factors such as age, French-American-British (FAB) classification, Eastern Cooperative Oncology Group (ECOG) performance status, primary AML status, white blood cell count, and bone marrow blast cell ratio, were confirmed to be prognostically relevant. Serum SDF-1α levels were elevated in patients who did not achieve complete remission (NCR) compared to those in complete remission (CR). ROC analysis further highlighted the predictive capability of serum SDF-1α for chemotherapy responsiveness. Independent predictors of treatment failure included age, FAB classification, ECOG status, and serum SDF-1α levels. Following chemotherapy, serum SDF-1α levels decreased in patients in CR but remained unchanged in those in NCR. Higher baseline levels of SDF-1α were associated with shorter overall survival. Conclusions Elevated serum SDF-1α levels in elderly AML patients are associated with poor chemotherapy response and shorter survival. Baseline serum SDF-1α levels could serve as a prognostic marker for CAG-based treatment outcomes.
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Affiliation(s)
- Zhenzhen Wang
- Department of Hematology, the Second Hospital of Hebei Medical University, Hebei, Shijiazhuang, China
| | - Jing Yuan
- Department of Hematology, the Second Hospital of Hebei Medical University, Hebei, Shijiazhuang, China
| | - Nan Zhou
- Department of Hematology, the Second Hospital of Hebei Medical University, Hebei, Shijiazhuang, China
| | - Jianfeng Zhang
- The Second Department of General Surgery, the Fourth Hospital of Hebei Medical University, Hebei, Shijiazhuang, China
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Ferraz-Gonçalves JA, Lima Á, Silva ÁJ, Calisto R. Factors Associated With Prolonged Survival in Colorectal Cancer Patients Admitted to Palliative Care: An Exploratory Study. Am J Hosp Palliat Care 2025:10499091241313224. [PMID: 39756808 DOI: 10.1177/10499091241313224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2025] Open
Abstract
OBJECTIVE A recently published study concerning variables associated with survival longer than one year in palliative care included several types of cancer. A secondary analysis limited to patients with colorectal cancer was performed to analyze a more homogeneous group of patients. METHODS Patients were identified through electronic records from 2012 to December 2018. All patients were over 18 years old and deceased. Cases were defined as patients who survived ≥1 year after being admitted to the palliative care service (PCS), while controls were those who had survived ≤6 months. RESULTS The study includes 33 patients as cases and 119 as controls. 82 (54%) were male, and the median age was 78.5 years (49 to 95). In the univariable analysis, the variables associated with a low probability of living ≥1 year were an ECOG performance status ≥2, liver metastases, and pain. The variables associated with a survival ≥1 year were the neutrophil count ≤5.66 x 109/L and a neutrophil/lymphocyte ratio ≤3.59. In the multivariable analysis, only pain and liver metastases were associated with a low probability, and the neutrophil/lymphocyte ratio ≤3.59 with a high likelihood of living one year or more. CONCLUSION The data of this study suggests that in colorectal cancer patients admitted to a PCS, the presence of pain, liver metastases, and a high neutrophil/lymphocyte ratio negatively impact the probability of living ≥1 year.
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Affiliation(s)
| | - Áurea Lima
- Department of Medical Oncology, Portuguese Oncology Institute of Porto, Porto, Portugal
- Department of Pharmaceutical Sciences, IUCS-CESPU, Cooperativa de Ensino Superior Politécnico e Universitário, Gandra, Portugal
- Molecular Oncology & Viral Pathology Group, IPO-Porto Research Center, Portuguese Oncology Institute of Porto, Portugal
| | | | - Rita Calisto
- Department of Epidemiology, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Centre (Porto.CCC) & Health Research Network@Research Center of Portuguese Oncology Institute of Porto, Porto, Portugal
- Group of Epidemiology, Results, Economy and Management in Oncology - Research Center, Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
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Ferraz-Gonçalves JA, Alves A, Silva ÁJ, Valente AC, Pina A, Lima Á, Antunes D, Cubal F, Costa I, Rodrigues J, Costa M, Ramos M, Luis M, Soares SG, Sousa S, Moreira TD, Sá-Araújo V, Bento MJ. Factors Associated With Long Survival in Patients With Cancer Admitted to Palliative Care: An Exploratory Study. J Palliat Care 2024; 39:244-252. [PMID: 38374645 PMCID: PMC11097604 DOI: 10.1177/08258597241231005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Objective: Some patients with cancer admitted to palliative care have relatively long survivals of 1 year or more. The objective of this study was to find out factors associated with prolonged survival. Methods: Retrospective case-control study comparing the available data of patients with cancer who survived more than 1 year after admission in a palliative care service with patients with cancer who survived 6 months or less. The intended proportion was 4 controls for each case. Patients were identified through electronic records from 2012 until 2018. Results: And 1721 patients were identified. Of those patients, 111 (6.4%) survived for at least 1 year, and 363 (21.1%) were included as controls according to the established criteria. The intended proportion could not be reached; the proportion was only 3.3:1. The median survival of cases was 581 days (range: 371-2763), and the median survival of controls was 57 days (range: 1-182). In the multivariable analysis, patients with a hemoglobin ≥ 10.6 g/dL and a creatinine level >95 µmol/L had a higher probability of living more than 1 year. In contrast, patients with abnormal cognition, pain, anorexia, liver metastases, an Eastern Cooperative Oncology Group performance status >1, and a neutrophil/lymphocyte ratio ≥ 3.43 had a low probability of living more than 1 year. Conclusion: Several factors were statistically associated positively or negatively with prolonged survival. However, the data of this study should be confirmed in other studies.
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Affiliation(s)
- José António Ferraz-Gonçalves
- Faculty of Medicine, Porto University, Porto, Portugal
- Department of Palliative Care, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Adelaide Alves
- Department of Pneumology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Álvaro José Silva
- Faculty of Medicine, Porto University, Porto, Portugal
- Condestável Family Health Unit, Department of General and Family Medicine, Batalha, Portugal
| | - Ana Carmo Valente
- Department of Medical Oncology, Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Ana Pina
- Department of Medical Oncology, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Áurea Lima
- Department of Medical Oncology, Portuguese Oncology Institute of Porto, Porto, Portugal
- CESPU, Cooperativa de Ensino Superior Politécnico e Universitário, Gandra, Portugal
| | | | - Francisco Cubal
- Department of Clinical Hematology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Isabel Costa
- Department of Palliative Care, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Jorge Rodrigues
- Department of Medical Oncology, Braga Hospital, Braga, Portugal
| | - Mariana Costa
- Department of Medical Oncology, Centro Hospitalar e Universitário de S. João, Porto, Portugal
| | - Mariana Ramos
- Department of Internal Medicina, Hospital de Santarém, Santarém, Portugal
| | - Michael Luis
- Department of Palliative Care, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Sofia Garcês Soares
- Department of Internal Medicine, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Sofia Sousa
- Serviço de Pneumologia do Hospital de Braga, Braga, Portugal
| | - Teresa Dias Moreira
- Department of Palliative Care, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Vânia Sá-Araújo
- Department of Palliative Care, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Maria José Bento
- Group of Epidemiology, Results, Economy and Management in Oncology, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Portugal
- Department of Epidemiology, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
- Population Studies Department. School of Medicine and Biomedical Sciences, ICBAS, University of Porto, Porto, Portugal
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Chen E, Jiao C, Yu J, Gong Y, Jin D, Ma X, Cui J, Wu Z, Zhou J, Wang H, Su B, Ge J. Assessment of 2022 European LeukemiaNet risk classification system in real-world cohort from China. Cancer Med 2023; 12:21615-21626. [PMID: 38098254 PMCID: PMC10757130 DOI: 10.1002/cam4.6696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/09/2023] [Accepted: 10/26/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND The European LeukemiaNet (ELN) risk classification system for acute myeloid leukemia (AML) patients has been used worldwide. In 2022, the ELN risk classification system modified risk genes including CEBPA mutation status, myelodysplasia-related (MR) gene mutations and internal tandem duplications of FLT3 (FLT3-ITD). METHODS We include newly diagnosed de novo AML patients at our center from January 2017 to December 2021, regardless of the further treatment received. Clinical data and date of survival were included. Survival analysis were performed using the Kaplan-Meier method, and the log-rank test was used to compare survival between different risk groups. RESULTS We include 363 newly diagnosed de novo AML patients from 2017 to 2021 to assess the accuracy of the ELN risk classification system. Their survival results show that the ELN-2022 risk classification system is not superior to the ELN-2017 version; for patients with FLT3-ITD mutations but without FLT3 inhibitor treatment, their survival is similar to the ELN-2022 adverse risk group. The ELN-2022 risk classification system cannot accurately clarify ECOG performance status (PS) 2-4 patients, especially in the ELN-2022 favorable risk group. CONCLUSION The ELN-2022 risk stratification system may not be appropriate for patients unable to receive intensive therapy or FLT3 inhibitor; more real-world data is needed to straify patients with worse ECOG PS and inferior intensive therapy.
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Affiliation(s)
- Enbo Chen
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Changqing Jiao
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Jian Yu
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Yu Gong
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
- Department of HematologyChaoyang HospitalHuainanAnhuiChina
| | - Duo Jin
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
- Department of HematologyTaihe County People's HospitalFuyangAnhuiChina
| | - Xiaoyu Ma
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Jianling Cui
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Zhonghui Wu
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Junjie Zhou
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Haixia Wang
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Bobing Su
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
| | - Jian Ge
- Department of HematologyThe First Affiliated Hospital of Anhui Medical UniversityHefeiAnhuiChina
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Black CM, Hanna GJ, Wang L, Ramakrishnan K, Goto D, Turzhitsky V, Hair GM. Real-world treatment patterns and outcomes among individuals receiving first-line pembrolizumab therapy for recurrent/metastatic head and neck squamous cell carcinoma. Front Oncol 2023; 13:1160144. [PMID: 37284189 PMCID: PMC10241070 DOI: 10.3389/fonc.2023.1160144] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/29/2023] [Indexed: 06/08/2023] Open
Abstract
Background Pembrolizumab, a PD-1 immune checkpoint inhibitor, is approved as first-line (1L) treatment for recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) as monotherapy or in combination with platinum and 5-fluorouracil chemotherapy. Limited data exist on the use of these regimens in real-world settings. Objective Our primary objectives were to describe baseline characteristics and real-world overall survival (rwOS), time on treatment (rwToT), and time to next treatment (rwTTNT) among individuals with R/M HNSCC receiving approved 1L pembrolizumab therapies. We also aimed to identify baseline factors associated with choice of 1L pembrolizumab therapy and with rwOS. Methods This was a retrospective cohort study of adults with R/M HNSCC receiving 1L pembrolizumab monotherapy or pembrolizumab plus chemotherapy. We used Kaplan-Meier analyses to assess real-world outcomes, logistic regression modeling to identify factors associated with choice of 1L pembrolizumab therapy, and Cox proportional hazards models to identify factors associated with rwOS. Results The study population included 431 individuals receiving 1L pembrolizumab monotherapy and 215 receiving 1L pembrolizumab plus chemotherapy. The use of 1L pembrolizumab monotherapy was associated with higher baseline combined positive score for PD-L1 expression, older age, higher Eastern Cooperative Oncology Group performance status (ECOG PS), laryngeal tumor site, and human papillomavirus (HPV)-positive tumor status. The pembrolizumab monotherapy group had a median (95% CI) rwOS of 12.1 (9.2-15.1) months, rwToT of 4.2 (3.5-4.6) months, and rwTTNT of 6.5 (5.4-7.4) months. Among this group, HPV-positive tumor status and lower ECOG PS were associated with longer rwOS, and oral cavity tumor site with shorter rwOS. The pembrolizumab plus chemotherapy cohort had a median (95% CI) rwOS of 11.9 (9.0-16.0) months, rwToT of 4.9 (3.8-5.6) months, and rwTTNT of 6.6 (5.8-8.3) months. In this group, HPV-positive tumor status was associated with longer rwOS. Conclusions This study adds to clinical trial data by summarizing real-world treatment outcomes with 1L pembrolizumab-containing therapies in a more heterogeneous population. Overall survival outcomes in both treatment groups were similar to those observed in the registration clinical trial. These findings support the use of pembrolizumab as standard of care for R/M HNSCC.
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Affiliation(s)
- Christopher M. Black
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, United States
| | - Glenn J. Hanna
- Center for Head & Neck Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Liya Wang
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, United States
| | - Karthik Ramakrishnan
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, United States
| | - Daisuke Goto
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, United States
| | - Vladimir Turzhitsky
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, United States
| | - Gleicy M. Hair
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, United States
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