Treatment of HR+/HER2− breast cancer in urban mainland China: results from the CancerMPact Survey 2019

Purpose

To report the treatment utilization patterns for hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) breast cancer in urban mainland China (CancerMPact®).

Methods

The results presented are from an online survey conducted in September 2019 with 45 physicians treating breast cancer patients from 11 cities in mainland China.

Results

Surveyed physicians reported that Stage I HR+/HER2(−) breast cancer patients are often treated with surgery alone (42%), whereas the use of surgery in combination with systemic therapy with or without radiotherapy increases in later stages (Stage II 67%, Stage III 77%). Doxorubicin–cyclophosphamide (AC)-based regimens were the most common in both the neoadjuvant and adjuvant settings in HR+/HER2(−) breast cancer patients, across all stages. In metastatic patients, use of surgery and radiotherapy decreases in favor of utilization of systemic therapy alone. Pre- and post-menopausal metastatic patients were frequently treated with hormone therapy or AC-based regimens in first line. Regardless of the first-line therapy administered, capecitabine-based regimens were commonly used in second line. In third line, chemotherapy regimens containing capecitabine or gemcitabine were given to nearly 40% of HR+/HER2(−) breast cancer patients. There were no standard of care regimens established for fourth or greater lines of treatment. In metastatic HR+/HER2(−) breast cancer, physicians reported 50% objective response rates in first-line settings with a progression-free survival of 16 months.

Conclusion

HR+/HER2(−) breast cancer patients in urban mainland China were prescribed chemotherapy regimens more frequently than CDK4/6 inhibitors. Treatment practices varied, with physicians reporting the use of multiple modalities and treatment regimens for their patients.

Patterns of Care and Outcomes for Non-Metastatic Prostate Cancer in the United States: Results of the CancerMPact® Survey 2018

Purpose

We describe patterns of care and treatment outcomes for non-metastatic PCa (nmPCA), either hormone-sensitive or castration-resistant, in the United States of America (USA) in 2018.

Methods

A survey (CancerMPact^®) recruited physicians nationwide to answer an online questionnaire about how they treated patients with nmPCA. Questions covered aspects of treatment at all disease stages. Board-certified urologists and oncologists with at least five years of clinical practice and who treated at least 30 PCa patients monthly were included.

Results

The survey included responses from ninety-four physicians with an average of 17.5 years of clinical practice, who had treated a combined average of 4415 patients with nmPCA per month in 2018. Approximately 40% of patients in stage I were managed with either active surveillance or observation/no therapy, decreasing to 20%, 8% and 6% in stages II, III and IV(M0), respectively. Intensity-modulated radiotherapy was favored over other radiotherapy modalities, with rates of use ranging between 60% and 69% depending on disease stage. Leuprolide as monotherapy or in combination with enzalutamide, abiraterone or bicalutamide were the most common systemic treatment options for non-metastatic hormone-sensitive PCa (nmHSPC) patients with the first or second recurrence. Only 16.5% of non-metastatic castration-resistant PCa (nmCRPC) patients did not relapse within five years of initial therapy for nmCRPC.

Conclusion

While PCa treatment recommendations are rapidly changing due to advances in treatment, we observed great concordance between their most current versions and real-world data treatment patterns reported by US physicians.

Treatment patterns in non-small-cell lung cancer in China: Results from the CancerMPact survey 2020

PURPOSE

To report the treatment patterns of non-small-cell lung cancer (NSCLC) patients in China based on a survey of physicians (CancerMPact).

METHODS

117 Chinese physicians from 27 cities in mainland China were recruited for an online survey in October 2020, reporting on how they treat their patients across all disease stages, including histology and relevant biomarkers in advanced or metastatic NSCLC.

RESULTS

Surveyed physicians indicated that almost half of their stage I patients were treated with surgery only. For stage II patients, it is more common to treat with surgery in combination with radiation and/or systemic therapy (44.5%), whereas the use of surgery decreases for stage III patients and the overall use of systemic therapy increases (63.4%-68.8%). Physicians are more likely to use systemic therapy alone for stage IV patients (31.4%). Chosen treatment regimens for stage IV NSCLC varied by histology and biomarkers, and several observed treatment patterns differed from the USA. In China, platinum-based chemotherapy is standard of care for treating stage IV NSCLC patients, unlike the USA, where checkpoint inhibitors are the dominant choice in first-line. Further, Chinese physicians reported prescribing biomarker-targeted agents for one-third or less of their patients with EGFR, ALK, ROS-1, or BRAF driver mutations, compared to 60-95% in the USA.

CONCLUSION

As treatment options expand in NSCLC in China, physicians face complex decisions for the treatment of their patients. Treatment patterns often vary, including by disease histology and clinically relevant biomarkers. The standard of care for NSCLC in China also differs from the USA.

Treatment of Advanced/Metastatic Melanoma in the United States and Western Europe: Results of the CancerMPact Survey

Context

Melanoma treatment has substantially changed over the last several years, yet little information regarding physician's preferences around treatment exists.

Objective

Our aim is to describe the results of the CancerMPact (CMP) survey performed in 2019 about the treatment of advanced/metastatic melanoma.

Methods

CMP is a data source from Kantar, Health Division, containing data on cancer epidemiology and treatment. Once a year, Kantar performs a series of surveys with specialists in the field of interest in the United States of America (USA), Western Europe (WE), Japan, and China. The results of the survey reported in this work comprise the answers from 94 USA and 99 WE physicians about the treatment of melanoma.

Results

In the first-line for the BRAF wild-type population, immuno-oncology (IO) drugs including nivolumab, ipilimumab or pembrolizumab (alone or in combination) were used in 80.1% of the cases in the USA and 70.6% in WE. Conventional chemotherapy or cytokine-based treatments were used in 16.4% of the USA patients and 28.2% in WE. In the second-line in the USA, 45.8% of BRAF wild-type patients received IO drugs, while 45.0% of patients received conventional chemotherapy or cytokine-based treatments. The majority of patients with BRAF mutant advanced/metastatic melanoma were treated in the first-line with BRAF-targeted therapy (61.3% USA, 71.9% WE), and few patients received conventional chemotherapy or cytokine-based treatments (11.9% USA, 12.4% WE); the most commonly used BRAF-targeted therapy was the combination of dabrafenib plus trametinib. In the second-line, BRAF mutant patients received IO drugs (45.1% USA, 53.7% WE), targeted therapy (37.6% USA, 32% WE) or conventional chemotherapy/cytokine-based treatments (14.4% USA, 11.7% WE).

Conclusion

The use of IO or targeted therapy for patients with advanced/metastatic melanoma is the preferred treatment strategy by physicians in the USA and WE based on BRAF mutation status. Many patients still receive conventional chemotherapies or cytokines with unsubstantial benefit, especially in recurrent patients of BRAF wild type.

Treatment patterns in non-small-cell lung cancer in USA: results of the CancerMPact Survey 2018

Aim: To report the results of a survey of USA physicians (CancerMPact) that treat non-small-cell lung cancer patients. Materials & methods: 60 physicians were surveyed. Questions covered aspects of the treatment for all stages of the disease. Results: For stage I patients, over 70% of the treatments were based on surgery. For stage II/III disease, a strong preference for combined therapy (surgery/radiation/systemic therapy) was observed. For advanced/stage IV patients, physicians used systemic therapy alone, and choosed the regimen based on histology and biomarkers. Use of PD-L1 inhibitors was highly dependent on histology and biomarkers. Conclusion: The treatment choices of non-small-cell lung cancer are increasingly complex, involve different treatment modalities and are highly dependent on histology and biomarkers, besides stage.

The smell of success? You go, girl!

Feminism has been declared dead, so I'm not sure what to call the assertive culture of modern girls and women. You can find it in marketing and pop-culture phenomena-the thrust of the jaw in The Gap's model, Vivian Solari, or Shania Twain's hit single ("That Don't Impress Me Much," a wry comment on male vanities). You can listen to kids talk ("You go, girl!"). Or you can look at the serious strides women are taking: Women own 38% of all US businesses; women now outpace men in college degrees earned (56% to 44% in 1999); and they are expected to take a similar lead at the graduate level in a few years.

Supplements: modern miracles?

Our news editor, Lisa Schnirring, joked not long ago that The Physician and Sportsmedicine should run a "supplement of the month" column. If we did, filling the column wouldn't be a problem-narrowing the choices would be. You might have read this year about SAMe (S-adenosylmethionine), whey protein, glutamine, olive leaf extract, and glyconutrients, to name a few. But the story would tend to follow a standard pattern: Claims of "Great Benefit X" would usually give way to "Inconsistent Evidence of Y" or "Side Effect Z," and the various views would be supported by enthusiastic, cautious, or cautionary statements by proponents and skeptics.

PSM at 25-"Fit for the Future"

Throughout 1998 we'll be celebrating The Physician and Sportsmedicine's (PSM's) 25th anniversary. From the time of its launch in June 1973 with Allan J. Ryan, MD, at the helm as editor-in-chief, PSM has been the best and most prominent source of information on the care of active patients.