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Ahmed S, Simon J, Biondo P, Slobogian V, Shirt L, King S, Paolucci A, Pabani A, Hao D, Bossio E, Cross R, Monds T, Nieuwenhuis J, Sinnarajah A. Acceptability of automatic referrals to supportive and palliative care by patients living with advanced lung cancer: qualitative interviews and a co-design process. Res Involv Engagem 2024; 10:36. [PMID: 38566198 PMCID: PMC10985851 DOI: 10.1186/s40900-024-00568-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Timely access to supportive and palliative care (PC) remains a challenge. A proposed solution is to trigger an automatic referral process to PC by pre-determined clinical criteria. This study sought to co-design with patients and providers an automatic PC referral process for patients newly diagnosed with stage IV lung cancer. METHODS In Step 1 of this work, nine one on one phone interviews were conducted with advanced lung cancer patients on their perspectives on the acceptability of phone contact by a specialist PC provider triggered by an automatic referral process. Interviews were thematically analysed. Step 2: Patient advisors, healthcare providers (oncologists, nurses from oncology and PC, clinical social worker, psychologist), and researchers were invited to join a working group to provide input on the development and implementation of the automatic referral process. The group met biweekly (virtually) over the course of six months. RESULTS From interviews, the concept of an automatic referral process was perceived to be acceptable and beneficial for patients. Participants emphasized the need for timely support, access to peer and community resources. Using these findings, the co-design working group identified eligibility criteria for identifying newly diagnosed stage IV lung cancer patients using the cancer centre electronic health record, co-developed a telephone script for specialist PC providers, handouts on supportive care, and interview and survey guides for evaluating the implemented automatic process. CONCLUSION A co-design process ensures stakeholders are involved in program development and implementation from the very beginning, to make outputs relevant and acceptable for stage IV lung cancer patients.
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Affiliation(s)
- Sadia Ahmed
- Alberta SPOR SUPPORT Unit, Patient Engagement Team, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
| | - Jessica Simon
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
- Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine University of Calgary, Calgary, AB, Canada
| | - Patricia Biondo
- Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine University of Calgary, Calgary, AB, Canada
| | - Vanessa Slobogian
- Palliative and End of Life Care, Alberta Health Services, Calgary Zone, Calgary, Canada
| | - Lisa Shirt
- Palliative and End of Life Care, Alberta Health Services, Calgary Zone, Calgary, Canada
| | - Seema King
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Alessandra Paolucci
- Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Aliyah Pabani
- Department of Oncology, Cumming School of Medicine University of Calgary, Calgary, AB, Canada
| | - Desiree Hao
- Department of Oncology, Cumming School of Medicine University of Calgary, Calgary, AB, Canada
| | - Emi Bossio
- Patient and Family Advisor, Alberta Health Services, Calgary, AB, Canada
| | - Ralph Cross
- Patient and Family Advisor, Alberta Health Services, Calgary, AB, Canada
| | - Tim Monds
- Patient and Family Advisor, Alberta Health Services, Calgary, AB, Canada
| | - Jane Nieuwenhuis
- Patient and Family Advisor, Alberta Health Services, Calgary, AB, Canada
| | - Aynharan Sinnarajah
- Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine University of Calgary, Calgary, AB, Canada
- Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
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Cook S, Samuel V, Meyers DE, Stukalin I, Litt I, Sangha R, Morris DG, Heng DYC, Pabani A, Dean M, Navani V. Immune-Related Adverse Events and Survival Among Patients With Metastatic NSCLC Treated With Immune Checkpoint Inhibitors. JAMA Netw Open 2024; 7:e2352302. [PMID: 38236598 PMCID: PMC10797458 DOI: 10.1001/jamanetworkopen.2023.52302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/28/2023] [Indexed: 01/19/2024] Open
Abstract
Importance Immune-related adverse events (irAEs) secondary to immune checkpoint inhibitor (ICI) therapy reportedly improve overall survival (OS) in patients with non-small cell lung cancer (NSCLC). However, studies have been small and the association between irAE severity and OS remains poorly defined. Objective To examine the association between irAEs and their severity with OS in patients with locally advanced or metastatic NSCLC receiving ICIs. Design, Setting, and Participants This retrospective observational cohort study included patients with NSCLC receiving ICIs between March 1, 2014, and November 30, 2021, with follow-up until March 31, 2023. Data analysis was completed April 26, 2023. The Alberta Immunotherapy Database, a provincial, multicenter cohort, was used to capture data from patients receiving ICIs in Alberta, Canada. Participants included 803 patients 18 years or older who received at least 1 cycle of ICI (alone or with chemotherapy), agnostic to treatment line. Exposure Developing an irAE mandating delay or discontinuation of ICI therapy and/or systematic corticosteroids for management of toxic effects (hereinafter referred to as clinically meaningful irAEs). Main Outcomes and Measures The primary outcome was association between irAEs and OS according to Kaplan-Meier analysis. Clinically meaningful irAEs were identified. Patients with poor prognosis (survival <3 months) who may have died prior to irAE development were excluded from OS analysis, mitigating immortal time bias. Adjusted Cox proportional hazards regression analyses ascertained variables associated with OS. Results Among the 803 patients included in the analysis, the median age of patients with irAEs was 69.7 (IQR, 63.1-75.2) years and the median age of those without irAEs was 67.5 (IQR, 60.4-73.3) years, with comparable sex distribution (139 of 295 men [47.1%] and 156 of 295 women [52.9%] with irAEs vs 254 of 505 men [50.3%] and 251 of 505 women [49.7%] without irAEs). Mitigating immortal time bias (n = 611), irAEs were associated with OS (median OS with irAEs, 23.7 [95% CI, 19.3-29.1] months; median OS without irAEs, 9.8 [95% CI, 8.7-11.4] months; P < .001). No OS difference was associated with treatment in hospital vs as outpatients for an irAE (median OS, 20.8 [95% CI, 11.7-30.6] vs 25.6 [95% CI, 20.1-29.8] months; P = .33). Developing irAEs remained associated with OS in the total cohort after Cox proportional hazards regression with known prognostic characteristics (hazard ratio, 0.53 [95% CI, 0.40-0.70]; P < .001). Conclusions and Relevance In this cohort study of 803 patients with locally advanced or metastatic NSCLC receiving ICIs, developing a clinically meaningful irAE was associated with improved OS. This association was not compromised by hospitalization for severe toxic effects. Whether and how ICI therapy resumption after an irAE is associated with OS warrants further study.
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Affiliation(s)
- Sarah Cook
- Department of Medical Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Vanessa Samuel
- Department of Medical Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Daniel E. Meyers
- Department of Medical Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Igor Stukalin
- Department of Medical Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Ishjot Litt
- Department of Medical Oncology, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Aliyah Pabani
- Department of Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Michelle Dean
- Department of Medical Oncology, University of Calgary, Calgary, Alberta, Canada
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Lim CA, Ghosh S, Morrison H, Meyers D, Stukalin I, Kerba M, Hao D, Pabani A. Durvalumab-Associated Pneumonitis in Patients with Locally Advanced Non-Small Cell Lung Cancer: A Real-World Population Study. Curr Oncol 2023; 30:10396-10407. [PMID: 38132391 PMCID: PMC10742980 DOI: 10.3390/curroncol30120757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
The PACIFIC trial led to a new standard of care for patients with locally advanced lung cancer, but real-world practice has demonstrated that immune checkpoint inhibitor (ICI) pneumonitis can lead to significant clinical complications. This study aimed to examine the clinical predictors, outcomes, and healthcare utilization data in patients who received consolidation durvalumab. Using the Alberta Immunotherapy Database, NSCLC patients who received durvalumab in Alberta, Canada, from January 2018 to December 2021 were retrospectively evaluated. We examined incidence and predictive values of severe pneumonitis, with overall survival (OS) and time-to-treatment failure (TTF) using exploratory multivariate analyses. Of 189 patients, 91% were ECOG 0-1 and 85% had a partial response from chemoradiation prior to durvalumab. Median TTF and OS were not reached; 1-year OS was 82%. An amount of 26% developed any grade of pneumonitis; 9% had ≥grade 3 pneumonitis. Male gender and a pre-existing autoimmune condition were associated with severe pneumonitis. V20 was associated with any grade of pneumonitis. Pneumonitis development was found to be an independent risk factor for worse OS (p = 0.038) and TTF (p = 0.007). Our results suggest clinical and dosimetric predictive factors of durvalumab-associated pneumonitis. These results affirm the importance of careful patient selection for safe completion of consolidation durvalumab in real-world LA-NSCLC population.
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Affiliation(s)
- Chloe Ahryung Lim
- Internal Medicine Residency Program, University of Calgary, Calgary, AB T2N 4N1, Canada; (C.A.L.); (D.M.); (I.S.)
| | - Sunita Ghosh
- Cross Cancer Institute, University of Alberta, Edmonton, AB T2S 3C3, Canada;
| | - Hali Morrison
- Tom Baker Cancer Center, University of Calgary, Calgary, AB T2N 4N2, Canada; (H.M.); (M.K.); (D.H.)
| | - Daniel Meyers
- Internal Medicine Residency Program, University of Calgary, Calgary, AB T2N 4N1, Canada; (C.A.L.); (D.M.); (I.S.)
| | - Igor Stukalin
- Internal Medicine Residency Program, University of Calgary, Calgary, AB T2N 4N1, Canada; (C.A.L.); (D.M.); (I.S.)
| | - Marc Kerba
- Tom Baker Cancer Center, University of Calgary, Calgary, AB T2N 4N2, Canada; (H.M.); (M.K.); (D.H.)
| | - Desiree Hao
- Tom Baker Cancer Center, University of Calgary, Calgary, AB T2N 4N2, Canada; (H.M.); (M.K.); (D.H.)
| | - Aliyah Pabani
- Tom Baker Cancer Center, University of Calgary, Calgary, AB T2N 4N2, Canada; (H.M.); (M.K.); (D.H.)
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Pabani A, Gainor JF. Facts and Hopes: Immunocytokines for Cancer Immunotherapy. Clin Cancer Res 2023; 29:3841-3849. [PMID: 37227449 DOI: 10.1158/1078-0432.ccr-22-1837] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/26/2023] [Accepted: 05/11/2023] [Indexed: 05/26/2023]
Abstract
The clinical development of cytokines as cancer therapeutics has been limited due to significant toxicities generally observed with systemic administration. This narrow therapeutic window, together with relatively modest efficacy, has made natural cytokines unattractive drug candidates. Immunocytokines represent a class of next-generation cytokines designed to overcome the challenges associated with traditional cytokines. These agents seek to improve the therapeutic index of cytokines by using antibodies as vehicles for the targeted delivery of immunomodulatory agents within the local tumor microenvironment (TME). Various molecular formats and cytokine payloads have been studied. In this review, we provide an overview of the rationale, preclinical support, and current clinical development strategies for immunocytokines.
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Affiliation(s)
- Aliyah Pabani
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Justin F Gainor
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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5
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Boyne DJ, Dawe DE, Shakir H, Joe-Uzuegbu O, Farah E, Pabani A, Baratta C, Brenner DR, Cheung WY. Comparative Effectiveness of Lurbinectedin for the Treatment of Relapsed Small Cell Lung Cancer in the Post-Platinum Setting: A Real-World Canadian Synthetic Control Arm Analysis. Target Oncol 2023; 18:697-705. [PMID: 37656263 DOI: 10.1007/s11523-023-00995-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Based on findings from a single-arm, phase 2 basket trial (NCT02454972), lurbinectedin may be an effective treatment for individuals with small cell lung cancer (SCLC) who progressed on or after platinum-based chemotherapy. OBJECTIVE To estimate the comparative effectiveness of lurbinectedin versus the historical standard of care for relapsed SCLC in Canada. METHODS A synthetic control arm (SCA) analysis was conducted using real-world data. Population-level data were obtained from real-world databases in Alberta, Canada. Individuals diagnosed with SCLC who initiated post-platinum systemic therapy and met approximated eligibility criteria from the lurbinectedin trial were included in the SCA. Median overall survival (OS) in the SCA was estimated after adjusting for chemotherapy-free interval (CTFI; < 90 versus ≥ 90 days) and stage at initial diagnosis (extensive versus limited). The CTFI-adjusted hazard ratio was estimated using a Cox proportional hazards model. RESULTS One hundred seventy-four individuals were included in the SCA and 105 in the lurbinectedin trial. The adjusted median OS in the SCA was 6.1 months (95% CI 5.4-7.7 months; unadjusted: 6.7 months, 95% CI 6.0-7.7 months) versus 9.3 months (95% CI 6.3-11.8 months) in the lurbinectedin trial. The adjusted hazard ratio comparing lurbinectedin with the historical standard of care (referent group) was 0.61 (95% CI 0.45-0.82; unadjusted HR: 0.72; 95% CI 0.54-0.97). The hazard ratio was more pronounced among individuals with CTFI ≥ 90 days (HR: 0.49, 95% CI 0.33-0.73). CONCLUSION These findings suggest improved OS with lurbinectedin monotherapy versus the historical standard of care in Alberta, Canada.
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Affiliation(s)
- Devon J Boyne
- Department of Oncology, Cumming School of Medicine, Health Research Innovation Centre (HRIC), University of Calgary, 3300 Hospital Drive NW, Room 2AA18, Calgary, AB, T2N 4N1, Canada.
- Oncology Outcomes Research Initiative, University of Calgary, Calgary, AB, Canada.
| | - David E Dawe
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Hematology and Medical Oncology, CancerCare Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada
| | - Huma Shakir
- Department of Oncology, Cumming School of Medicine, Health Research Innovation Centre (HRIC), University of Calgary, 3300 Hospital Drive NW, Room 2AA18, Calgary, AB, T2N 4N1, Canada
- Oncology Outcomes Research Initiative, University of Calgary, Calgary, AB, Canada
| | - Ofodile Joe-Uzuegbu
- Department of Oncology, Cumming School of Medicine, Health Research Innovation Centre (HRIC), University of Calgary, 3300 Hospital Drive NW, Room 2AA18, Calgary, AB, T2N 4N1, Canada
- Oncology Outcomes Research Initiative, University of Calgary, Calgary, AB, Canada
| | - Eliya Farah
- Department of Oncology, Cumming School of Medicine, Health Research Innovation Centre (HRIC), University of Calgary, 3300 Hospital Drive NW, Room 2AA18, Calgary, AB, T2N 4N1, Canada
- Oncology Outcomes Research Initiative, University of Calgary, Calgary, AB, Canada
| | - Aliyah Pabani
- Oncology Outcomes Research Initiative, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cristina Baratta
- Medical Affairs, Oncology, Jazz Pharmaceuticals, Mississauga, ON, Canada
| | - Darren R Brenner
- Department of Oncology, Cumming School of Medicine, Health Research Innovation Centre (HRIC), University of Calgary, 3300 Hospital Drive NW, Room 2AA18, Calgary, AB, T2N 4N1, Canada
- Oncology Outcomes Research Initiative, University of Calgary, Calgary, AB, Canada
| | - Winson Y Cheung
- Department of Oncology, Cumming School of Medicine, Health Research Innovation Centre (HRIC), University of Calgary, 3300 Hospital Drive NW, Room 2AA18, Calgary, AB, T2N 4N1, Canada
- Oncology Outcomes Research Initiative, University of Calgary, Calgary, AB, Canada
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Meyers DE, Pasternak M, Dolter S, Grosjean HA, Lim CA, Stukalin I, Goutam S, Navani V, Heng DY, Cheung WY, Morris DG, Pabani A. Impact of Performance Status on Survival Outcomes and Health Care Utilization in Patients With Advanced NSCLC Treated With Immune Checkpoint Inhibitors. JTO Clin Res Rep 2023; 4:100482. [PMID: 37090101 PMCID: PMC10120368 DOI: 10.1016/j.jtocrr.2023.100482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/24/2023] [Accepted: 02/16/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction Landmark trials testing immune checkpoint inhibitors (ICIs) in advanced NSCLC are difficult to extrapolate to real-world practice given the exclusion of patients with poor (i.e., ≥2) Eastern Cooperative Oncology Group performance status (ECOG PS). We sought to evaluate the impact of ECOG PS on clinical outcomes and health care utilization in patients with NSCLC treated with ICIs in real-world practice. Methods Patients with advanced NSCLC who received at least one dose of pembrolizumab or nivolumab were retrospectively identified from the Alberta Immunotherapy Database. The primary outcome was median overall survival, as stratified by ECOG PS. Secondary outcomes included median time-to-treatment failure and metrics of health care utilization, including emergency department visits, hospitalizations, and death in hospital. Results A total of 790 patients were included, with 29.2% having poor ECOG PS at initiation of ICI. These patients had significantly lower median overall survival (3.3 versus 13.4 mo) and median time-to-treatment failure (1.4 versus 4.9 mo) compared with those with favorable ECOG PS (p < 0.0001 for both outcomes). Patients with poor ECOG PS were also more likely to present to the emergency department, be admitted to the hospital, and die in the hospital during their first admission (risk ratio = 1.6, 2.3-2.7, p < 0.001). Conclusions Patients with NSCLC with poor ECOG PS treated with ICI had significantly worse survival outcomes and were significantly more likely to use health care services than those with favorable ECOG PS. The large proportion of patients with poor ECOG PS further justifies the urgent need for randomized trials evaluating the efficacy of ICI in this high-risk population.
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Affiliation(s)
- Daniel E. Meyers
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Corresponding author. Address for correspondence: Daniel E. Meyers, MD, MSc, Department of Oncology, University of Calgary, 1331 29th Street Northwest, Calgary, AB T2N 4N2, Canada.
| | - Meghann Pasternak
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Samantha Dolter
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | | | - Chloe A. Lim
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Igor Stukalin
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Siddhartha Goutam
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Vishal Navani
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Y.C. Heng
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Winson Y. Cheung
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Don G. Morris
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Aliyah Pabani
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
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Gibson AJW, Pabani A, Dean ML, Martos G, Cheung WY, Navani V. Real-World Treatment Patterns and Effectiveness of Targeted and Immune Checkpoint Inhibitor-Based Systemic Therapy in BRAF Mutation-Positive NSCLC. JTO Clin Res Rep 2023; 4:100460. [PMID: 36915629 PMCID: PMC10006852 DOI: 10.1016/j.jtocrr.2022.100460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction BRAF mutations (present in 2%-3% of NSCLC) are a known oncogenic driver and emerging therapeutic target. There is a scarcity of real-world data describing the clinical characteristics, treatment patterns, and effectiveness of targeted BRAF-inhibiting and immune checkpoint inhibitor (ICI)-based systemic therapies, yet this is required for appropriate treatment decisions that optimize patient outcome. Methods Demographic, clinical, treatment, and outcome data of patients with BRAF mutation-positive NSCLC diagnosed between 2018 and 2022 were identified from the Glans-Look Lung Cancer Research database and included in this analysis. Results A total of 53 BRAF mutation-positive patients were identified (V600E, n = 35; non-V600E, n = 18). Furthermore, 46 patients (87%) were diagnosed with metastatic disease, of whom 61% were treated with systemic anticancer therapy, which significantly improved overall survival (34.1 versus 2.2 mo, p = 0.01). ICI-based regimens were found to have effectiveness in the first-line setting for both V600E and non-V600E cohorts (objective response rate: 38%-43%; real-world calculations of median progression-free survival: 10.5-10.8 mo, respectively). Dual-targeted BRAF/MEK inhibition was also found to have effectiveness in the first-line setting for V600E patients (objective response rate: 33%, real-world calculations of median progression-free survival: 15.2 mo). Conclusions This study of real-world patients with BRAF mutations confirms the importance of effective systemic therapies. Both dual-targeted BRAF/MEK inhibition and ICI-based regimens have evidence of benefit in this population revealing that real-world populations can experience similar clinical response and outcome to clinical trial cohorts on these treatment regimens. Future studies to clarify the role of co-mutations on response to both dual-targeted BRAF/MEK inhibition and ICI-based regimens may be important to treatment selection and optimization of patient outcome.
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Affiliation(s)
- Amanda J W Gibson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aliyah Pabani
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medical Oncology, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Michelle L Dean
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Guillermo Martos
- Department of Medical Oncology, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Winson Y Cheung
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medical Oncology, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Vishal Navani
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medical Oncology, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
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Bratti VF, Wilson BE, Fazelzad R, Pabani A, Zurn SJ, Johnson S, Sung L, Rodin D. Scoping review protocol on the impact of antimicrobial resistance on cancer management and outcomes. BMJ Open 2023; 13:e068122. [PMID: 36746540 PMCID: PMC9906175 DOI: 10.1136/bmjopen-2022-068122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a growing global public health concern and is becoming a significant challenge in the management of patients with cancer. Due to the immunosuppressive nature of cancer treatment, infection is a common complication and the necessary high usage of antibiotics increases the risk of AMR. Failure to adequately prevent and treat infection in patients with cancer as a result of AMR can increase the morbidity and mortality of the disease. The objective of this scoping review is to understand the relationship between AMR and cancer in order to develop effective antimicrobial stewardship in this patient population and minimise the detrimental effects of AMR on cancer outcomes. METHODS AND ANALYSIS This scoping review will follow the Arksey and O'Malley methodology framework. An exploratory review of the literature on antibiotic resistance in cancer care will help to define the research questions (stage 1). A broad range of electronic databases (MEDLINE ALL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Embase) and search terms will be used to retrieve relevant articles published between 2000 and 2021 (stage 2). Studies will be systematically selected based on the eligibility criteria by two independent reviewers (stage 3). The titles and abstracts will be appraised to determine whether articles meet the eligibility criteria. This will be followed by screening of the full texts and only relevant publications will be retrieved. Data will then be extracted, collated and charted (stage 4); and the summary of aggregated results will be presented (stage 5). ETHICS AND DISSEMINATION As this scoping review will collect and synthesise data from publicly available sources, no ethics review is required. When data collection and summarisation is completed, results will be disseminated through peer-reviewed publication and the key findings of the review will be presented at relevant conferences.
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Affiliation(s)
- Vanessa F Bratti
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- Global Cancer Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Brooke E Wilson
- Global Cancer Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Rouhi Fazelzad
- Library and Information Services, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Aliyah Pabani
- Department of Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Shalini J Zurn
- Union for International Cancer Control, Geneva, Switzerland
| | - Sonali Johnson
- Union for International Cancer Control, Geneva, Switzerland
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Danielle Rodin
- Global Cancer Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Radiation Medicine Program, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
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9
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Navani V, Meyers DE, Ruan Y, Boyne DJ, O'Sullivan DE, Dolter S, Grosjean HA, Stukalin I, Heng DYC, Morris DG, Brenner DR, Sangha R, Cheung WY, Pabani A. Lung Immune Therapy Evaluation (LITE) Risk, a Novel Prognostic Model for Patients With Advanced Non-Small Cell Lung Cancer Treated With Immune Checkpoint Blockade. Clin Lung Cancer 2023; 24:e152-e159. [PMID: 36774234 DOI: 10.1016/j.cllc.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/28/2022] [Accepted: 12/26/2022] [Indexed: 01/21/2023]
Abstract
INTRODUCTION/BACKGROUND Immune checkpoint inhibitors (ICI) have revolutionized non-small cell lung cancer (NSCLC). We aimed to identify baseline characteristics, that are prognostic factors for overall survival (OS) in patients with NSCLC treated with ICI monotherapy, in order to derive the Lung Immune Therapy Evaluation (LITE) risk, a prognostic model. MATERIALS AND METHODS Multi-center observational cohort study of patients with advanced NSCLC that received ≥1 dose of ICI monotherapy. The training set (n=342) consisted of patients with NSCLC who received first line ICI. The test set (n=153) used for external validation was a discrete cohort of patients who received second line ICI. 20 candidate prognostic factors were examined. Penalized Cox regression was used for variable selection. Multiple imputation was used to address missingness. RESULTS Three baseline characteristics populated the final model: ECOG (0, 1 or ≥2), lactate dehydrogenase>upper limit of normal, and derived neutrophil to lymphocyte ratio ≥3. Patients were parsed into 3 risk groups; favorable (n=146, risk score 0-1), intermediate (n=101, risk score 2) and poor (n=95, risk score ≥3). The c-statistic of the training cohort was 0.702 and 0.694 after bootstrapping. The test cohort c-statistic was 0.664. The median OS for favorable, intermediate and poor LITE risk were; 28.3 months, 9.1 months and 2.1 months respectively. Improving LITE risk group was associated with improved OS, intermediate vs favorable HR 2.08 (95%CI 1.46-2.97, P < .001); poor vs favorable HR 5.21 (95%CI 3.69-7.34, P < .001). CONCLUSION A simple prognostic model, utilizing accessible clinical data, can discriminate survival outcomes in patients with advanced NSCLC.
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Affiliation(s)
- Vishal Navani
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Daniel E Meyers
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Yibing Ruan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada; Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, Alberta, Canada
| | - Devon J Boyne
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada
| | - Dylan E O'Sullivan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada; Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, Alberta, Canada
| | - Samantha Dolter
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Heidi Ai Grosjean
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Igor Stukalin
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Daniel Y C Heng
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Don G Morris
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Darren R Brenner
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Alberta, Canada
| | - Randeep Sangha
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Winson Y Cheung
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aliyah Pabani
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Watson AS, Goutam S, Stukalin I, Ewanchuk BW, Sander M, Meyers DE, Pabani A, Cheung WY, Heng DYC, Cheng T, Monzon JG, Navani V. Association of Immune-Related Adverse Events, Hospitalization, and Therapy Resumption With Survival Among Patients With Metastatic Melanoma Receiving Single-Agent or Combination Immunotherapy. JAMA Netw Open 2022; 5:e2245596. [PMID: 36480204 PMCID: PMC9856439 DOI: 10.1001/jamanetworkopen.2022.45596] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Immune-related adverse events (irAEs) due to immune checkpoint blockade (ICB) have been shown to be positively associated with survival. Among patients with metastatic melanoma, evidence supporting this association has been conflicting, while ipilimumab-nivolumab combination ICB has been examined only in small clinical cohorts. OBJECTIVE To examine the association between irAEs and survival among patients with metastatic melanoma, in particular for those receiving combination ICB. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort of 492 consecutive patients with metastatic melanoma treated with ICB at 2 tertiary and 4 regional cancer centers in Alberta, Canada, from August 1, 2013, to May 31, 2020, was observed. Patients were aged 18 years or older with metastatic melanoma agnostic to primary site, who received 1 or more doses of an anti-programmed cell death protein 1 agent as single or combination ICB. Clinically significant irAEs requiring systemic corticosteroids and/or treatment delay were captured. To minimize immortal time bias, only patients surviving 12 weeks after ICB initiation were included in survival analyses. Statistical analysis was conducted on December 10, 2021. EXPOSURES Development of irAEs requiring systemic corticosteroids and/or treatment delay. MAIN OUTCOMES AND MEASURES The primary outcome was overall survival (OS), with the association of irAE development with OS assessed via Kaplan-Meier and Cox proportional hazards regression analyses. The association of hospitalization for irAEs and ICB resumption after irAE with OS was examined. RESULTS Among 492 patients, the median age of those with irAEs was 61.8 years (IQR, 52.9-72.1 years), and the median age of those without irAEs was 65.5 years (IQR, 56.5-76.9 years), while sex distribution was comparable (137 of 198 men [69.2%] with irAEs vs 183 of 294 men [62.2%] without irAEs). There was an association between irAEs and OS both in the overall cohort (with irAEs: median OS, 56.3 months [95% CI, 38.2 months to not evaluable] vs without irAEs: median OS, 18.5 months [95% CI, 14.4-23.2 months]; P < .001) and in the 124 patients (25.2%) receiving combination ICB (with irAEs: median OS, 56.2 months [95% CI, 52.2 months to not evaluable] vs without irAEs: median OS, 19.0 months [95% CI, 6.6 months to not evaluable]; P < .001). Hospitalization for irAE did not alter this positive association with OS compared with outpatient treatment (median OS, not evaluable [95% CI, 31.5 months to not evaluable] vs median OS, 52.2 months [95% CI, 35.2 months to not evaluable]; P = .53), while resumption of ICB was associated with longer OS than not resuming ICB (median, 56.3 months [95% CI, 40.8 months to not evaluable] vs 31.5 months [95% CI, 21.0 months to not evaluable]; P = .009). A favorable independent association of irAEs with OS was confirmed in multivariable analysis (hazard ratio for death, 0.382 [95% CI, 0.254-0.576]; P < .001). CONCLUSIONS AND RELEVANCE This study suggests an association between irAEs and OS for patients with metastatic melanoma, including those treated with combination ICB and those with severe irAEs requiring hospitalization. The potential benefit associated with ICB resumption after irAEs warrants further investigation.
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Affiliation(s)
- Alexander S. Watson
- Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Siddhartha Goutam
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Igor Stukalin
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Michael Sander
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Daniel E. Meyers
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aliyah Pabani
- Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Winson Y. Cheung
- Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Y. C. Heng
- Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Tina Cheng
- Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Jose G. Monzon
- Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Vishal Navani
- Tom Baker Cancer Centre, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
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11
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O’Sullivan DE, Jarada TN, Yusuf A, Hu L(XY, Gogna P, Brenner DR, Abbie E, Rose JB, Eaton K, Elia-Pacitti J, Ewara EM, Pabani A, Cheung WY, Boyne DJ. Prevalence, Treatment Patterns, and Outcomes of Individuals with EGFR Positive Metastatic Non-Small Cell Lung Cancer in a Canadian Real-World Setting: A Comparison of Exon 19 Deletion, L858R, and Exon 20 Insertion EGFR Mutation Carriers. Curr Oncol 2022; 29:7198-7208. [PMID: 36290844 PMCID: PMC9600059 DOI: 10.3390/curroncol29100567] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Real-world evidence surrounding EGFR positive NSCLC patients in Canada is limited. Administrative databases in Alberta, Canada were used to evaluate EGFR testing and mutation prevalence in de novo metastatic NSCLC, as well as the characteristics, treatment patterns, and outcomes of individuals with Exon 19, L858R and Exon20ins mutations. Between 2013-2019, 2974 individuals underwent EGFR testing, of which 451 (15.2%) were EGFR positive. Among EGFR positive individuals, 221 (49.0%) had an Exon 19 mutation, 159 (35.3%) had an L858R mutation, and 18 (4%) had an Exon20ins mutation. The proportion of individuals who initiated 1L systemic therapy was 89.1% for Exon19, 85.5% for L858R, and 72.2% for Exon20ins carriers. The primary front-line systemic therapy was gefitinib or afatinib monotherapy for individuals with Exon 19 (93.4%) and L858R (94.1%) mutations versus platinum combination therapy for individuals with Exon20ins mutations (61.5%). The Exon20ins cohort had worse median overall survival from initiation of 1L systemic therapy (10.5 months [95% CI: 8.0-not estimable]) than the Exon19 (20.6 months [95% CI: 18.4-24.9]), and L858R cohorts (19.1 months [95% CI: 14.5-23.1]). These findings highlight that Exon20ins mutations represent a rare subset of NSCLC in which treatment options are limited and survival outcomes are worse relative to individuals with more common types of EGFR mutations.
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Affiliation(s)
- Dylan E. O’Sullivan
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada
- Oncology Outcomes Initiative, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Tamer N. Jarada
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada
- Oncology Outcomes Initiative, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Amman Yusuf
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada
- Oncology Outcomes Initiative, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Leo (Xun Yang) Hu
- Oncology Outcomes Initiative, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Priyanka Gogna
- Oncology Outcomes Initiative, University of Calgary, Calgary, AB T2N 4N2, Canada
- Public Health Sciences, Queen’s University, Kingston, Toronto, ON K7L 3N6, Canada
| | - Darren R. Brenner
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada
- Oncology Outcomes Initiative, University of Calgary, Calgary, AB T2N 4N2, Canada
| | | | | | | | | | | | - Aliyah Pabani
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Winson Y. Cheung
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada
- Oncology Outcomes Initiative, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Devon J. Boyne
- Department of Oncology, University of Calgary, Calgary, AB T2N 4N2, Canada
- Oncology Outcomes Initiative, University of Calgary, Calgary, AB T2N 4N2, Canada
- Correspondence:
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12
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Gibson A, Dean M, Elegbede A, Pabani A, Bebb G, Cheung W. EP05.02-001 Early Treatment Failure Of Consolidation Durvalumab for Unresectable Stage III NSCLC: A Real-World Canadian Cohort. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Samnani S, Alsafar N, Lupichuk S, Alimohamed N, Pabani A, Card C, Hao D. EP06.01-003 Impact of COVID-19 on Lung Cancer Patients; The Patients’ Perspective. J Thorac Oncol 2022. [PMCID: PMC9452027 DOI: 10.1016/j.jtho.2022.07.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Litt I, Gibson A, Dean M, Elegbede A, Bebb G, Cheung W, Pabani A. EP08.02-071 Brain Metastases in EGFR-mutant NSCLC: Outcome of Osimertinib +/- Radiation Therapy in a Real-World Canadian Cohort. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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15
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King S, Ahmed S, Shirt L, Slobogian V, Vig C, Barbera L, Kurien E, Santana M, Pabani A, Biondo P, Sinnarajah A, Simon J, Hao D. EP10.01-008 Examining Social Determinants of Health Among Newly Diagnosed Lung Cancer Patients Contacted for Early Specialist Palliative Care Consultation. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Gibson A, Litt I, Hao D, Dean M, Elegbede A, Bebb G, Pabani A, Cheung W. EP08.02-014 Impact of East Asian Ancestry on Response to First-Line Osimertinib: A Real-World Canadian Cohort. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Boyne D, Shakir H, Joe-Uzuegbu O, Dawe D, Pabani A, Farah E, Baratta C, Cheung W, Brenner D. 1536P Synthetic control arm (SCA) analysis of lurbinectedin compared to the standard of care (SoC) among patients with small cell lung cancer (SCLC) previously treated with platinum-based chemotherapy. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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18
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Meyers DE, Pasternak M, Dolter S, Grosjean HA, Lim C, Stukalin I, Navani V, Heng DYC, Cheung WY, Morris DG, Pabani A. Impact of performance status on survival outcomes and health care utilization in patients with advanced non–small cell lung cancer treated with immune checkpoint inhibitors. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9053 Background: Immune checkpoint inhibitors (ICIs) have revolutionized the treatment paradigm of non-small cell lung cancer (NSCLC). Despite the high prevalence of patients with poor Eastern Cooperative Oncology Group (ECOG) performance status (PS ≥2) in real-world practice, landmark studies have typically excluded this patient group from enrolment. The primary objective of this study was to evaluate the impact of ECOG PS on clinical outcomes and health care utilization in a large cohort of NSCLC patients treated with ICI in real-world practice. Methods: Using the Alberta Immunotherapy Database, we identified consecutive patients who received at least one dose of Pembrolizumab or Nivolumab for the treatment of advanced NSCLC between 1/1/2010 and 12/30/2019. The data cut-off date was 10/1/2020. Baseline clinical, pathological, and laboratory-based data were collected retrospectively. The primary outcome was median overall survival (mOS), as stratified by ECOG PS. The secondary outcomes were median time-to-treatment failure (mTTF) and metrics of health care utilization, including emergency department (ED) visits, hospitalizations, and death in hospital. Kaplan-Meier survival curves were used to determine survival outcomes, and compared with the log-rank test. The association between ECOG PS and healthcare utilization were represented with risk ratios and evaluated using chi-square tests. Results: A total of 790 patients were included. Median follow-up time was 20.6 months. 29.2% (n = 231) had PS ≥2 at the time of ICI initiation. As compared with the favorable PS group (PS < 2), patients with PS ≥2 had significantly lower mOS - 3.3 months (95% CI 2.5-4.0) versus 13.4 months (95% CI 11.7-16.0) (HR, 3.0; 95% CI 2.5-3.6, p < 0.0001), and mTTF – 1.4 months (95% CI 0.9-1.8) versus 4.9 months (95% CI 4.4-5.6) (HR, 2.2; 95% CI 1.9-2.6, p < 0.0001). 3- and 12-month survival rates were also significantly lower in the PS ≥2 group as compared with the PS < 2 group (52.8% versus 86.4% and 13.4% versus 41.0%, p < 0.0001 for both comparisons). Patients with PS ≥2 were also significantly more likely to present to the ED (RR 1.6; 95% CI, 1.3-2.0, p < 0.001) and be admitted to hospital (RR 2.3; 95% CI 1.7-3.0, p < 0.0001) within the first month after treatment initiation. These patients were also significantly more likely to die in hospital during their first admission (RR 2.7; 95% CI 1.8-4.1, p < 0.0001), as well as at any point during treatment (RR 2.2; 95% CI 1.60-3.0, p < 0.0001). Conclusions: NSCLC patients with poor ECOG PS at the time of ICI initiation had significantly worse survival outcomes and were significantly more likely to utilize health care services than those with favorable ECOG PS. The large proportion of patients with poor ECOG PS further justifies the urgent need for randomized trials evaluating the efficacy of ICI in this high-risk population.
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Affiliation(s)
- Daniel E. Meyers
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | | | - Chloe Lim
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Igor Stukalin
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Vishal Navani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | | | | | | | - Aliyah Pabani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
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Henick BS, Bukhari S, Winchester R, Lin Z, Khodadad-Jamayran A, Tsirigos A, Lerrer SS, Adam K, Salvatore MM, Lagos G, Pabani A, Maniar R, Reiner SL, Dallos M, Mathew M, Rizvi NA, Mor A. Baseline peripheral T-cell composition in relation to radiographic phenotypes of immune-related pneumonitis. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2545 Background: Pneumonitis is one of the most morbid complications from immune checkpoint inhibitor (ICI) treatment, but pathogenic mechanisms are unclear and no biomarkers permit pre-treatment risk assessment. We sought to characterize peripheral T cell subsets of pneumonitis patients on the single cell level. Methods: Blood was collected before and during ICI treatment in 24 patients. Cells were processed for single cell RNA sequencing (scRNAseq) employing CITEseq methodology using multiplexed cell surface markers labelled with a cocktail of oligonucleotide-tagged Total-Seq anti-human antibodies against CD4, CD8, CD45RA and CD27 followed by Chromium 10X sequencing. Principal Component Analysis was performed with iCellR, K-nearest-neighbor-based Network graph drawing Layout, and PhenoGraph clustering to assign cell types. CT scans were performed per standard of care and were reviewed by an experienced thoracic radiologist. Results: Seven of 24 patients developed pneumonitis; 9 did not experience an immune-related adverse event, and the remainder experienced arthritis (4), thyroiditis (3), or neurotoxicity (1). Pneumonitis patients had expanded proportions of TH2 TCF7+ T cells at baseline as compared to the other patients. Radiographically, two patients’ pneumonitis manifested as Chronic Hypersensitivity Pneumonitis (CHP), and four had Organized Pneumonia (OP). At baseline, CHP patients had significantly lower levels of CD8+ TCM cells (CXCR3+), double-positive T cells, gamma-delta T cells, and higher levels of naïve-like CD4+ TN TCF7+LEF1+ and CD4+ TH1/2 CXCR3+GATA3+ cells compared to OP. Gene expression levels also distinguished between these radiographic phenotypes. Conclusions: The peripheral T cell composition of patients who developed pneumonitis was distinct from those who did not in our cohort and unique by radiographic manifestation, suggesting potential pathogenic mechanisms and a prelude to circulating predictive markers of ICI toxicity.
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Affiliation(s)
| | | | | | | | | | | | | | - Kieran Adam
- Columbia University Medical Center, New York, NY
| | - Mary M. Salvatore
- Department of Radiology, Columbia University Irving Medical Center, New York, NY
| | | | | | - Rohan Maniar
- Columbia University Medical Center, New York, NY
| | | | | | | | | | - Adam Mor
- Columbia University Medical Center, New York, NY
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Pabani A, King S, Ahmed S, Shirt L, Slobogian V, Vig C, Hao D, Barbera LC, Kurien E, Santana M, Biondo P, Sinnarajah A, Simon J. Patient and caregiver-reported acceptability of an automatic phone call offering supportive and palliative care referral for advanced non-small cell lung cancer patients. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e24097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24097 Background: Timely palliative care interventions can help to alleviate the distress people experience after a diagnosis of an incurable, life-threatening cancer. However, referrals to palliative care continue to be late due to various provider and patient barriers. The Palliative Care Early and Systematic (PaCES)-Automatic study was co-designed with patients and providers and implemented an early palliative care intervention for newly diagnosed stage IV non-small lung cancer (NSCLC). The objective of this study was to determine patient/caregiver-reported acceptability of a phone call from a supportive and palliative care (SPC) nurse offering consultation, automatically (without referral) after first oncologist appointment. Methods: Two SPC specialist nurses screened out-patient clinic lists at a tertiary cancer center weekly and called all eligible patients offering an in-home consultation. Eligibility: > 18 years, newly diagnosed/suspected Stage IV NSCLC and had first medical/radiation oncologist visit. Patients/caregivers were surveyed about the acceptability (5-point Likert scale) of the automatic phone call offering a palliative care consult, using Sekhon’s Framework of Acceptability domains. Results: Among the 113 patients screened, 81 patients/caregivers were contacted and offered SPC consultation and 72% accepted the in-home consult. Of 70 patients/caregivers that agreed to be contacted for the survey: 4 did not recall the call offering SPC, 3 declined participating in the survey, and 15 were not reached. Of 48 respondents, 93.6% rated overall acceptability of the automatic call offering SPC consultation somewhat/completely acceptable, with the other 6.4% rating it as neither acceptable nor unacceptable. Of 35 patients/caregivers that completed the full survey: 31% caregivers, 63% female, 57% ≤65 years, 29% ≤high school education, 67% (n = 27) < $60,000 household income, 80% spoke only English/French, and 71% Caucasian. Within the domains of acceptability, 94.7% were comfortable receiving the call, 91.9% understood why they received it; 86.5% thought the call was a valuable; 69.5% thought the call helped them; 65.7% learned about SPC from the call; no one expressed concern that the SPC nurse had access to their contact/health information; 97.2% thought the call didn’t take much physical/emotional effort and were confident in their ability to participate (ask questions/make decisions). Conclusions: Nearly all patients/caregivers found the automatic SPC call offering consultation to be acceptable. Most patients agreed to the consultation offer. Routine calls offering SPC consultation may be a timely alternative to awaiting conventional referral by oncologists.
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Affiliation(s)
| | - Seema King
- University of Calgary, Calgary, AB, Canada
| | | | - Lisa Shirt
- Alberta Health Services, Calgary, AB, Canada
| | | | - Chandra Vig
- Alberta Health Services, Calgary, AB, Canada
| | - Desiree Hao
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
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Watson A, Goutam S, Stukalin I, Ewanchuk B, Sander M, Meyers DE, Pabani A, Cheung WY, Heng DYC, Cheng T, Monzon JG, Navani V. The prognostic impact of immune-related adverse events in real-world patients with metastatic melanoma treated with single-agent and combination immune checkpoint blockade. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9542 Background: Immune checkpoint blockade (ICB) has revolutionized the treatment of metastatic melanoma (MM). Immune-related Adverse Events (irAEs) associated with ICB have been shown to correlate positively with survival outcomes across solid tumours. In MM, conclusions on the impact of irAE severity have been conflicting, and combination ICB therapy experience is limited to smaller cohorts. We sought to clarify these relationships using the Alberta Immunotherapy Database (AID). Methods: The AID provides a multi-centre, province-wide observational cohort comprising consecutive patients treated with ICB. We included adult patients with MM, treated with ICB (single agent nivolumab or pembrolizumab, or combination ipilimumab and nivolumab) at any line of therapy, agnostic to site of origin, from August 2013 to May 2020, with analysis in December 2021. The primary endpoint of interest was the identification of a relationship between development of irAEs and subsequent overall survival (OS, defined from time of ICB initiation). To minimize immortal time bias from poor prognosis patients who may have died prior to the development of irAEs, patients who died before 12 weeks were excluded from OS and time-to-next-treatment (TTNT) analysis. Adjusted Cox regression analyses were performed to determine the association of variables with OS. Results: Of 492 MM patients receiving ICB, 124 received combination ICB, 198 developed an irAE and 67 required hospitalization for an irAE. irAEs were more common in patients < 50 years old (p = 0.02), with ECOG 0 (p < 0.001) and normal albumin (p = 0.002). Median time to irAE development (2.6 months) and frequency of individual irAEs were consistent with the published literature. In the overall population, patients who experienced an irAE had longer median OS (56.3 vs 18.5mo, p < 0.0001), and TTNT (49.6 vs 12.9mo, p < 0.0001). This remained consistent in combination ICB-treated patients (median OS 56.3 vs 19mo, p < 0.0001). Patients hospitalized for an irAE had improved OS and TTNT over patients requiring only outpatient treatment (median OS NR vs 27.9mo, p = 0.0039), while ICB re-challenge after an irAE also improved OS (56.3 vs 31.5mo, p = 0.0093). Development of an irAE retained independent association with OS after adjusted multivariable regression (HR 0.376, p < 0.001). Conclusions: These data support the association of irAEs and improved survival outcomes in MM, including those patients treated with combination ICB. Among patients with irAE, hospitalization for irAE, and ICB re-challenge post-irAE, were further associated with improved outcomes.
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Affiliation(s)
- Alexander Watson
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | | | - Igor Stukalin
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Benjamin Ewanchuk
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael Sander
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Daniel E. Meyers
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Aliyah Pabani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Winson Y. Cheung
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | | | - Tina Cheng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | | | - Vishal Navani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
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22
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Elegbede A, Pabani A, Gibson A, Cheung W. 45P Pembrolizumab versus best supportive care survival outcomes in ECOG performance status 2 NSCLC patients. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Hussain M, Abbott M, Zargham R, Pabani A, Khan OF. Evolution of an invasive ductal carcinoma to a small cell carcinoma of the breast: A case report. Medicine (Baltimore) 2022; 101:e28433. [PMID: 35029184 PMCID: PMC8758025 DOI: 10.1097/md.0000000000028433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Small cell carcinoma (SCC) is a rare subtype of breast cancer and presents a complex diagnostic and treatment challenge, due to paucity of data. To the best of our knowledge, most cases of breast SCC reported in the literature describe a de novo breast primary. Our case is unique as it describes the evolution of an invasive ductal carcinoma after treatment into a SCC of the breast. PATIENT CONCERNS AND DIAGNOSIS We report a case of a 53-year-old female, lifelong non-smoker, who initially presented with breast mass noted on self examination. Breast and axillary lymph node biopsy demonstrated a hormone receptor positive invasive ductal carcinoma with a metastatic T3 lesion. INTERVENTION She was treated with first-line palbociclib/letrozole with initial clinical response, and at progression was switched to capecitabine with no response. Repeat biopsy of the axillary lesion showed evolution of the tumor into a triple negative breast cancer. She was then treated with third-line paclitaxel and radiation therapy with good initial response. She eventually had further disease progression and presented with a new mediastinal lymphadenopathy causing SVC syndrome. Biopsy of this showed a small cell variant of breast neuroendocrine carcinoma. Due to the evolution of histology in this case, a retrospective review of her initial breast specimen as well as the second biopsy from the axilla was conducted which confirmed that the mediastinal lymphadenopathy was metastatic from the original breast tumor. OUTCOMES AND LESSONS We speculate that the initial treatment allowed a minority of treatment-resistant neuroendocrine cells to grow and become the dominant face of the tumor. Our patient had an excellent response to carboplatin/etoposide and consolidative locoregional radiotherapy but presented with an early intracranial recurrence. This is a similar pattern of metastases as seen in lung SCC and highlights a potential role for prophylactic cranial irradiation in breast SCC. Further studies are needed to better understand the biology and treatment of breast SCC which continues to present a challenge for clinicians.
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Affiliation(s)
- Marya Hussain
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Marcia Abbott
- Department of Pathology and Laboratory Medicine, Cummings Medical School, University of Calgary, Calgary, Alberta
| | - Ramin Zargham
- Department of Pathology and Laboratory Medicine, Cummings Medical School, University of Calgary, Calgary, Alberta
| | - Aliyah Pabani
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Omar F. Khan
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
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Elegbede AA, Gibson AJ, Fung AS, Cheung WY, Dean ML, Bebb DG, Pabani A. A Real-World Evaluation of Atezolizumab Plus Platinum-Etoposide Chemotherapy in Patients With Extensive-Stage SCLC in Canada. JTO Clin Res Rep 2021; 2:100249. [PMID: 34877555 PMCID: PMC8628038 DOI: 10.1016/j.jtocrr.2021.100249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/25/2021] [Accepted: 10/19/2021] [Indexed: 01/20/2023] Open
Abstract
Introduction The real-world data evaluating treatment outcomes of atezolizumab plus carboplatin-etoposide chemotherapy (atezolizumab) for extensive-stage SCLC (ESCLC) are lacking. Our objective was to evaluate real-world outcomes of ESCLC treated with atezolizumab. Methods A retrospective analysis of provincial patients with ESCLC who started first-line (1L) systemic treatment was conducted. We primarily evaluated the progression-free survival (PFS) and overall survival (OS) outcomes in association with atezolizumab compared with platinum-etoposide chemotherapy (chemotherapy) while adjusting for relevant demographic and clinical factors. Adverse events (AEs) during 1L were evaluated. Results A total of 67 patients were identified. Of the 34 patients who received atezolizumab, 24% had Eastern Cooperative Oncology Group performance status greater than or equal to 2, approximately 50% were more than or equal to 65 years, 21% received cisplatin-etoposide chemotherapy before atezolizumab, and 12% had thoracic radiation (tRT). Within the atezolizumab versus chemotherapy group, the median PFS equals to 6.0 versus 4.3 months (p = 0.03) whereas OS = 12.8 versus 7.1 months (p = 0.01). Relative to chemotherapy, the hazard ratio (95% confidence interval) for PFS was 0.53 (0.28–1.02) and OS was 0.42 (0.20–0.88) with atezolizumab. tRT compared with no tRT receipt correlated with reduced death risk (hazard ratio [95% confidence interval] = 0.33 [0.13–0.88]). AE-related treatment withdrawal with atezolizumab was 32% and 15% with chemotherapy (p = 0.02). Within the tRT subgroup, 25% versus 20% in atezolizumab versus chemotherapy group, respectively, discontinued 1L owing to AE. Conclusions This is the first real-world study revealing comparable survival with that in the IMpower133 trial. Treatment discontinuation from AEs was higher with atezolizumab among Canadian patients with ESCLC. Our data suggest safe use of tRT and chemoimmunotherapy, but its efficacy for ESCLC warrants further study.
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Affiliation(s)
- Anifat A Elegbede
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Amanda J Gibson
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Andrea S Fung
- Cancer Centre of Southeastern Ontario, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Winson Y Cheung
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada.,Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Michelle L Dean
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - D Gwyn Bebb
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada.,Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Aliyah Pabani
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada.,Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
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Grosjean HAI, Dolter S, Meyers DE, Ding PQ, Stukalin I, Goutam S, Kong S, Chu Q, Heng DYC, Bebb DG, Morris DG, Cheung WY, Pabani A. Effectiveness and Safety of First-Line Pembrolizumab in Older Adults with PD-L1 Positive Non-Small Cell Lung Cancer: A Retrospective Cohort Study of the Alberta Immunotherapy Database. Curr Oncol 2021; 28:4213-4222. [PMID: 34677275 PMCID: PMC8534423 DOI: 10.3390/curroncol28050357] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022] Open
Abstract
The emergence of immunotherapy revolutionized the treatment of non-small-cell-lung cancer (NSCLC), with multiple landmark clinical trials establishing the efficacy of these agents. However, many patients who receive immunotherapy in clinical practice would be considered clinical trial ineligible. One such population that is often under-represented in clinical trials is older adults. In the current study, we evaluated clinical and safety outcomes in this population. Overall, older adults (>70 years of age) and younger adults had comparable clinical outcomes with an equivalent objective response rate (ORR), time to treatment failure (TTF), and median overall survival (p = 0.67, p = 0.98, and p = 0.91, respectively). Furthermore, the safety outcomes were equivalent between the cohorts with similar rates of immune-related adverse events (irAEs), irAE-related hospitalizations, and all-cause hospitalization (p = 0.99, p = 0.63, and p = 0.74, respectively). While older age was not found to impact overall survival, multivariant analysis revealed that a poor Eastern Cooperative Oncology Group (ECOG) status, low body-mass-index (BMI), and poor/intermediate lung immune prognostic index (LIPI) were all associated with worse survival. In conclusion, age does not impact the efficacy or safety of pembrolizumab in NSCLC, and therefore advanced age should not be a deterrent for treating these patients with pembrolizumab. Physicians and care providers can thus focus on other factors that may influence therapeutic outcomes.
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Affiliation(s)
- Heidi A. I. Grosjean
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
| | - Samantha Dolter
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
| | - Daniel E. Meyers
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
| | - Philip Q. Ding
- Oncology Outcomes, Calgary, AB T2N4N2, Canada;
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G2R3, Canada;
| | - Igor Stukalin
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
| | - Siddhartha Goutam
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G2R3, Canada;
- Cross Cancer Institute, Edmonton, AB T6G1Z2, Canada;
| | - Shiying Kong
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
| | - Quincy Chu
- Cross Cancer Institute, Edmonton, AB T6G1Z2, Canada;
| | - Daniel Y. C. Heng
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
| | - D. Gwyn Bebb
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
| | - Don G. Morris
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
| | - Winson Y. Cheung
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
| | - Aliyah Pabani
- Department of Oncology, University of Calgary, Calgary, AB T2N4N2, Canada; (H.A.I.G.); (S.D.); (D.E.M.); (I.S.); (S.K.); (D.Y.C.H.); (D.G.B.); (D.G.M.); (W.Y.C.)
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Elegbede A, Gibson A, Pabani A, Dean M, Bebb G. P63.13 Long Term Survival Characteristics in SCLC Patients Receiving Atezolizumab and Chemotherapy. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Martos G, Bebb G, Pabani A, Gibson A, Dean M, Petersen L. P59.29 Frequency of PIK3CA Mutations and Therapeutic Outcomes in NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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28
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Sander M, Stukalin I, Vallerand IA, Goutam S, Ewanchuk BW, Meyers DE, Pabani A, Morris D, Heng DY, Cheng T. 27995 Evaluation of the modified immune prognostic index to prognosticate outcomes in metastatic uveal melanoma patients treated with immune checkpoint inhibitors. J Am Acad Dermatol 2021. [DOI: 10.1016/j.jaad.2021.06.695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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29
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Martos G, Pabani A, Bebb DG, Gibson AW, Dean ML, Petersen L. Molecular characteristics of BRAF mutated non-small cell lung cancer and therapeutic outcomes: Multi-institution study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e21029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21029 Background: BRAF-mutations are uncommon, present in only 2-4% of all new non-small cell lung cancer (NSCLC) diagnoses. BRAF-mutation type has treatment implications, where the most common BRAFV600E shows sensitivity to tyrosine kinase inhibitors (Dabrafenib or Vemurafenib) with additional benefit seen in duel therapy adding MEK-inhibitors (Trametinib or Cobimetinib). Clinical responses have also been observed with immune checkpoint inhibitors in both V600E and non-V600E mutant patients. The optimal management strategy in this patient population is still unknown. Methods: Patients from the province of Alberta, Canada, with a BRAF-mutation and initiating systemic therapy between 2018 and 2020 were identified. Demographic, clinical, treatment and outcome data were extracted from the institutional Glans-Look Lung Cancer Database. Results: 31 patients with a BRAF-mutation were identified: 52% alive, 58% female, 87% ‘ever’ smokers (average: 40 pack-years). 70% ECOG > 2, 58% Stage IV at diagnosis, with the M1b (one extrathoracic metastatic site) being the most common. 87% had an adenocarcinoma histology and 64.5% carried the BRAFV600E mutation. 19% had other concurrent mutations (KRAS, PIK3CA or EGFR-L858R), 52% showed high PD-L1 expression ( > 50%). In addition, concurrent mutations also were associated with high PD-L1 positivity. 55% of the cohort received systemic treatment, with 71% still on treatment at the time of analysis. Conclusions: BRAF mutant NSCLC is associated with high PD-L1 expression and responses to both checkpoint inhibitors and BRAF inhibitor combinations. Treatment with immunotherapy appears to have a superior toxicity profile and prolonged disease control in both BRAF V600E and non-V600E mutant NSCLC and is an effective first-line strategy. Higher overall response rates are observed with BRAF inhibitor combinations in BRAF V600E patients. Further investigation is warranted to further elucidate sequencing strategies among specific subgroups.[Table: see text]
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Affiliation(s)
| | | | - D. Gwyn Bebb
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
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30
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Gan CL, Stukalin I, Meyers DE, Dudani S, Grosjean HAI, Dolter S, Ewanchuk BW, Goutam S, Sander M, Wells C, Pabani A, Cheng T, Monzon J, Morris D, Basappa NS, Pal SK, Wood LA, Donskov F, Choueiri TK, Heng DYC. Outcomes of patients with solid tumour malignancies treated with first-line immuno-oncology agents who do not meet eligibility criteria for clinical trials. Eur J Cancer 2021; 151:115-125. [PMID: 33975059 DOI: 10.1016/j.ejca.2021.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/03/2021] [Accepted: 04/05/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Immuno-oncology (IO)-based therapies have been approved based on randomised clinical trials, yet a significant proportion of real-world patients are not represented in these trials. We sought to compare the outcomes of trial-ineligible vs. -eligible patients with advanced solid tumours treated with first-line (1L) IO therapy. PATIENTS AND METHODS Using the International Metastatic Renal Cell Carcinoma (RCC) Database Consortium and the Alberta Immunotherapy Database, patients with advanced RCC, non-small-cell lung cancer (NSCLC) or melanoma treated with 1L PD-(L)1 inhibition-based therapy were included. Trial eligibility was retrospectively determined as per commonly used exclusion criteria. The outcomes of interest were overall survival (OS), overall response rate (ORR), treatment duration (TD) and time to next treatment (TTNT). RESULTS A total of 395 of 1241 (32%) patients were deemed trial-ineligible. The main reasons for ineligibility based on preselected exclusion criteria were Karnofsky performance status <70%/Eastern Cooperative Oncology Group performance status >1 (40%, 158 of 395), brain metastases (32%, 126 of 395), haemoglobin < 9 g/dL (16%, 63 of 395) and estimated glomerular filtration rate <40 mL/min (15%, 61 of 395). Between the ineligible vs. eligible groups, the median OS, ORR, median TD and median TTNT were 10.2 vs. 39.7 months (p < 0.01), 36% vs. 47% (p < 0.01), 2.7 vs. 6.9 months (p < 0.01) and 6.0 vs. 16.8 months (p < 0.01), respectively. Subgroup analyses showed statistically significant inferior OS, TD and TTNT for trial-ineligible vs. -eligible patients across all tumour types. Adjusted hazard ratios for death in RCC, NSCLC and melanoma were 1.84 (95% confidence interval [CI] 1.22-2.77), 2.21 (95% CI 1.58-3.11) and 1.82 (95% CI 1.21-2.74), respectively.. CONCLUSIONS Thirty-two percent of real-world patients treated with contemporary 1L IO-based therapies were ineligible for clinical trials. Although one-third of the trial-ineligible patients responded to treatment, the overall trial-ineligible population had inferior outcomes than trial-eligible patients. These data may guide patient counselling and temper expectations of benefit.
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Affiliation(s)
- Chun L Gan
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Igor Stukalin
- University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Daniel E Meyers
- University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Shaan Dudani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | | | - Samantha Dolter
- University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | | | | | - Michael Sander
- University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Connor Wells
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Aliyah Pabani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Tina Cheng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Jose Monzon
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Don Morris
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Naveen S Basappa
- Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Sumanta K Pal
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Lori A Wood
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | - Toni K Choueiri
- Dana-Farber Cancer Institute/Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.
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Sander MS, Stukalin I, Vallerand IA, Goutam S, Ewanchuk BW, Meyers DE, Pabani A, Morris DG, Heng DYC, Cheng T. Evaluation of the modified immune prognostic index to prognosticate outcomes in metastatic uveal melanoma patients treated with immune checkpoint inhibitors. Cancer Med 2021; 10:2618-2626. [PMID: 33724676 PMCID: PMC8026925 DOI: 10.1002/cam4.3784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/04/2021] [Accepted: 01/16/2021] [Indexed: 12/14/2022] Open
Abstract
Background Metastatic uveal melanoma (MUM) is associated with poor survival and inferior response to immune checkpoint inhibitor (ICI) therapy when compared with metastatic cutaneous melanoma. Currently, prognostic biomarkers are lacking to guide treatment decisions. Patients and Methods We conducted a multicenter, retrospective cohort study using a centralized, province‐wide cancer database in Alberta, Canada. We identified 37 patients with histologically confirmed MUM who received at least one dose of single‐agent pembrolizumab or nivolumab, or combination therapy nivolumab and ipilimumab. A modified immune prognostic index (IPI), based on the previously reported lung immune prognostic index, was used to stratify patients into favorable and poor IPI groups. Survival analyses were conducted using the Kaplan–Meier method and Cox proportional hazards models, adjusting for baseline age (≥60) and ECOG performance status, to assess the associations between IPI and overall survival (OS). Time to treatment failure (TTF) was also assessed using the Kaplan–Meier method. The association between IPI and objective response rate was examined using chi‐squared tests. Logistic regression was used to determine the association between IPI and immune‐related adverse events (irAEs). Results Median OS was 15.6 (range 0.6–57.6) months with 45.9% 1‐year survival rate at a median follow‐up of 11.8 months. We found that a favorable IPI was significantly associated with OS [median 30.5 (12.0‐not reached) months in the favorable IPI group compared with 4.6 (2.1–16.0) months in the poor IPI group (p = 0.001)] (HR=4.81, 95% CI; 1.64–14.10, p = 0.004), TTF [median 5.1 (95% CI; 2.1–10.4) months in the favorable IPI group compared with 3.7 (95% CI; 1.4–6.4) months in the poor IPI group (p = 0.0191)], and irAE (HR=6.67, 95% CI; 1.32–33.69, p = 0.0220). Conclusions The modified IPI may be a useful tool in clinical practice for identifying MUM patients who are more likely to experience irAEs and realize a survival benefit from ICI treatment.
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Affiliation(s)
- Michael S Sander
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Igor Stukalin
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Isabelle A Vallerand
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Section of Dermatology, University of Calgary, Calgary, AB, Canada
| | - Siddhartha Goutam
- Faculty of Medicine and Dentistry, University of Alberta, Calgary, AB, Canada
| | | | - Daniel E Meyers
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Aliyah Pabani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Don G Morris
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Tina Cheng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
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Dolter S, Grosjean H, Meyers D, Javizian O, Stukalin I, Goutam S, Morris D, Bebb D, Pabani A. P09.08 Age-Related Outcomes of First-Line Pembrolizumab in a Real-World Non-Small-Cell Lung Cancer (NSCLC) Cohort. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gan C, Meyers D, Stukalin I, Dudani S, Dolter S, Grosjean H, Ewanchuk B, Goutam S, Sander M, Wells J, Pabani A, Cheng T, Yuasa T, Morris D, Kanesvaran R, Pal S, Wood L, Donskov F, Choueiri T, Heng D. 425P The impact of obesity on treatment outcomes in patients with solid tumour malignancies treated with first-line (1L) immuno-oncology (IO) agents. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Gan C, Stukalin I, Meyers D, Dudani S, Grosjean H, Dolter S, Ewanchuk B, Goutam S, Sander M, Wells J, Pabani A, Cheng T, Monzon J, Morris D, Basappa N, Pal S, Wood L, Donskov F, Choueiri T, Heng D. 1046P Outcomes of patients with solid tumour malignancies treated with first-line (1L) immuno-oncology (IO) agents who do not meet eligibility criteria for clinical trials. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Meyers DE, Stukalin I, Vallerand IA, Lewinson RT, Suo A, Dean M, North S, Pabani A, Cheng T, Heng DYC, Bebb DG, Morris DG. The Lung Immune Prognostic Index Discriminates Survival Outcomes in Patients with Solid Tumors Treated with Immune Checkpoint Inhibitors. Cancers (Basel) 2019; 11:cancers11111713. [PMID: 31684111 PMCID: PMC6896022 DOI: 10.3390/cancers11111713] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 01/01/2023] Open
Abstract
Immune checkpoint inhibitors (ICI) have revolutionized the treatment landscape of several solid tumor types. However, as patient outcomes are heterogeneous, clinical tools to aid in prognostication are needed. The Lung Immune Prognostic Index (LIPI) correlates with outcomes in patients with non-small cell lung cancer (NSCLC) treated with ICI, but its applicability beyond NSCLC is poorly defined. We sought to determine whether LIPI is associated with overall survival (OS), progression-free survival (PFS) and objective response rate (ORR) in a pooled, real-world, retrospective cohort of patients with solid tumors treated with ICI. Of the total pooled cohort (N = 578), 47.2%, 38.2% and 14.5% of patients were stratified into good, intermediate and poor LIPI group, respectively. Median OS were 22.8 (95% CI 17.4–29.5), 7.8 (95% CI 6.6–9.6), and 2.5 months (95% CI 1.4–3.4) (p < 0.0001). Median PFS were 9.9 (95% CI 7.2–11.5), 3.6 (95% CI 2.7–4.3), and 1.4 months (95% CI 1.2–2.2) (p < 0.0001). ORR was also associated with LIPI group (p < 0.001). Intermediate and poor LIPI were independently prognostic of OS compared to good LIPI, with hazard ratios (HR) of 1.8 (95% CI 1.4–2.3, p < 0.001) and 3.6 (95% CI 2.5–5.1, p < 0.001), respectively. These data are the first to suggest that in a real-world setting, the prognostic value of LIPI may be tumor agnostic.
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Affiliation(s)
- Daniel E Meyers
- Department of Oncology, University of Calgary, Calgary, Alta T2N 4N2, Canada.
| | - Igor Stukalin
- Department of Oncology, University of Calgary, Calgary, Alta T2N 4N2, Canada.
| | - Isabelle A Vallerand
- Department of Oncology, University of Calgary, Calgary, Alta T2N 4N2, Canada.
- Division of Dermatology, University of Calgary, Calgary, Alta T2N 2T9, Canada.
| | - Ryan T Lewinson
- Department of Oncology, University of Calgary, Calgary, Alta T2N 4N2, Canada.
- Division of Dermatology, University of Calgary, Calgary, Alta T2N 2T9, Canada.
- Faculty of Kinesiology, University of Calgary, Calgary, Alta T2N 1N4, Canada.
| | - Aleksi Suo
- Department of Oncology, University of Calgary, Calgary, Alta T2N 4N2, Canada.
| | - Michelle Dean
- Department of Oncology, University of Calgary, Calgary, Alta T2N 4N2, Canada.
| | - Scott North
- Cross Cancer Institute, Edmonton, Alta T6G 1Z2, Canada.
| | - Aliyah Pabani
- Department of Oncology, University of Calgary, Calgary, Alta T2N 4N2, Canada.
| | - Tina Cheng
- Department of Oncology, University of Calgary, Calgary, Alta T2N 4N2, Canada.
| | - Daniel Y C Heng
- Department of Oncology, University of Calgary, Calgary, Alta T2N 4N2, Canada.
| | - D Gwyn Bebb
- Department of Oncology, University of Calgary, Calgary, Alta T2N 4N2, Canada.
| | - Don G Morris
- Department of Oncology, University of Calgary, Calgary, Alta T2N 4N2, Canada.
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Phillips GS, Wu J, Hellmann MD, Postow MA, Rizvi NA, Freites-Martinez A, Chan D, Dusza S, Motzer RJ, Rosenberg JE, Callahan MK, Chapman PB, Geskin L, Lopez AT, Reed VA, Fabbrocini G, Annunziata MC, Kukoyi O, Pabani A, Yang CH, Chung WH, Markova A, Lacouture ME. Treatment Outcomes of Immune-Related Cutaneous Adverse Events. J Clin Oncol 2019; 37:2746-2758. [PMID: 31216228 PMCID: PMC7001790 DOI: 10.1200/jco.18.02141] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The aim of the current study was to report the efficacy of topical and systemic treatments for immune-related cutaneous adverse events (ircAEs) attributed to checkpoint inhibitors in an uncontrolled cohort of patients referred to oncodermatology clinics. METHODS A retrospective analysis of patients with ircAEs evaluated by dermatologists from January 1, 2014, to December 31, 2017, at three tertiary care hospitals and cancer centers were identified through electronic medical records. Clinicopathologic characteristics, dermatologic therapy outcome, and laboratory data were analyzed. RESULTS A total of 285 patients (median age, 65 years [range, 17 to 89 years]) with 427 ircAEs were included: pruritus (n = 138; 32%), maculopapular rash (n = 120; 28%), psoriasiform rash (n = 22; 5%), and others (n = 147; 34%). Immune checkpoint inhibitor class was associated with ircAE phenotype (P = .007), where maculopapular rash was predominant in patients who received combination therapy. Severity of ircAEs was significantly reduced (mean Common Terminology Criteria for Adverse Events grade: 1.74 v 0.71; P < .001) with dermatologic interventions, including topical corticosteroids, oral antipruritics, and systemic immunomodulators. A total of 88 ircAEs (20%) were managed with systemic immunomodulators. Of these, 22 (25%) of 88 persisted or worsened. In seven patients with corticosteroid-refractory ircAEs, improvement resulted from targeted biologic immunomodulatory therapies that included rituximab and dupilumab. Serum interleukin-6 (IL-6) was elevated in 34 (52%) of 65 patients; grade 3 or greater ircAEs were associated with increased absolute eosinophils (odds ratio, 4.1; 95% CI, 1.3 to 13.4) and IL-10 (odds ratio, 23.8; 95% CI, 2.1 to 262.5); mean immunoglobulin E serum levels were greater in higher-grade ircAEs: 1,093 kU/L (grade 3), 245 kU/L (grade 2), and 112 kU/L (grade 1; P = .043). CONCLUSION Most ircAEs responded to symptom- and phenotype-directed dermatologic therapies, whereas biologic therapies were effective in patients with corticosteroid-refractory disease. Increased eosinophils, IL-6, IL-10, and immunoglobulin E were associated with ircAEs, and they may represent actionable therapeutic targets for immune-related skin toxicities.
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Affiliation(s)
| | - Jennifer Wu
- Memorial Sloan Kettering Cancer Center, New York, NY
- Chang Gung Memorial Hospital, Taipei, Republic of China
- Chang Gung University, Taoyuan, Republic of China
| | - Matthew D. Hellmann
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Michael A. Postow
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | - Donald Chan
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephen Dusza
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert J. Motzer
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Jonathan E. Rosenberg
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Margaret K. Callahan
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Paul B. Chapman
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | | | | | | | | | | | | | | | - Chih-Hsun Yang
- Memorial Sloan Kettering Cancer Center, New York, NY
- Chang Gung Memorial Hospital, Taipei, Republic of China
- Chang Gung University, Taoyuan, Republic of China
| | - Wen-Hung Chung
- Memorial Sloan Kettering Cancer Center, New York, NY
- Chang Gung Memorial Hospital, Taipei, Republic of China
- Chang Gung University, Taoyuan, Republic of China
| | - Alina Markova
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Mario E. Lacouture
- Memorial Sloan Kettering Cancer Center, New York, NY
- Weill Cornell Medical College, New York, NY
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Abstract
For patients with advanced non-small-cell lung cancer (nsclc) lacking a targetable molecular driver, the mainstay of treatment has been cytotoxic chemotherapy. The survival benefit of chemotherapy in this setting is modest and comes with the potential for significant toxicity. The introduction of immunotherapeutic agents targeting the programmed cell death 1 protein (PD-1) and the programmed cell death ligand 1 (PD-L1) has drastically changed the treatment paradigms for these patients. Three agents-atezolizumab, nivolumab, and pembrolizumab-have been shown to be superior to chemotherapy in the second-line setting. For patients with tumours strongly expressing PD-L1, pembrolizumab has been associated with improved outcomes in the first-line setting. Demonstration of the significant benefits of immunotherapy in nsclc has focused attention on new questions. Combination checkpoint regimens, with acceptable toxicity and potentially enhanced efficacy, have been developed, as have combinations of immunotherapy with chemotherapy. In this review, we focus on the published trials that have changed the treatment landscape in advanced nsclc and on the ongoing clinical trials that offer hope to further improve outcomes for patients with advanced nsclc.
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Affiliation(s)
- A Pabani
- Division of Medical Oncology, Cross Cancer Institute, Edmonton, AB
| | - C A Butts
- Division of Medical Oncology, Cross Cancer Institute, Edmonton, AB
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Pabani A, Mazurek M, Cheung WY, Spratlin JL, Price Hiller JA, Standeven LJ, Mulder KE, Ghosh S, Ho MY. Comparison of adverse events during capecitabine versus 5-fluorouracil/oxaliplatin adjuvantchemotherapy for stage II/III colon cancer: A population based analysis. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e14663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Sunita Ghosh
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
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Pabani A, Cheung WY, Mazurek M, Spratlin JL, Price Hiller JA, Standeven LJ, Mulder KE, Ghosh S, Ho MY. Improving the prediction of colon cancer survival after curative resection. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e14587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Sunita Ghosh
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
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Pabani A, Cheung WY, Mazurek M, Spratlin JL, Mulder KE, Ghosh S, Price Hiller JA, Standeven LJ, Ho MY. Improving the prediction of colon cancer survival after curative resection. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
552 Background: Cancer staging systems convey valuable prognostic information to both clinicians and patients. Currently, colon cancer is staged according to the American Joint Committee on Cancer (AJCC) TNM classification system. However, survival estimates for patients with the same stage of colon cancer may vary considerably due to other factors including age, sex, grade, and number of lymph nodes sampled. The objectives of this study are to 1) assess the accuracy of the seventh edition of the TNM classification system in predicting survival of patients with primary colon cancer after curative-intent surgery, and 2) evaluate the utility of incorporating additional demographic and tumor variables beyond TNM staging in improving prognostic accuracy. Methods: Patients with curative-intent resection of a first primary adenocarcinoma of the colon at the time of referral to the Cross Cancer Institute between 2004 and 2007 were identified from the Alberta Cancer Registry. We constructed three multivariate Cox’s proportional hazard models to explore the effect of supplementing TNM staging with additional demographic and tumor variables in predicting overall survival (OS). Results: 559 consecutive patients with complete chart records were identified. 52 % (n=290) were male; median age was 74. In the first model based only on T and N elements, N2 disease was correlated with increased mortality (hazard ratio [HR], 2.546; p<0.0001). When the number of lymph nodes examined (HR, 0.980; p=0.034) and number of metastatic lymph nodes detected (HR, 1.094; p<0.0001) were substituted for the N-staging element, both variables correlated positively and negatively with outcome, respectively. Finally, when tumor grade, sex and age were incorporated into the model, number of examined lymph nodes (HR, 0.980; p=0.029) and those containing tumor (HR, 1.093; p<0.0001) remained independent predictors of OS. Conclusions: Incorporating readily available demographic and tumor variables, such as age, sex and number of lymph nodes examined, can enhance the current TNM staging system and improve prognostication in early stage colon cancer.
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Affiliation(s)
| | | | | | | | | | - Sunita Ghosh
- Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | | | | | - Maria Yi Ho
- Cross Cancer Institute, Edmonton, AB, Canada
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