Impact of clinical pathways on treatment patterns and outcomes for patients with non-small-cell lung cancer: real-world evidence from a community oncology practice

Introduction: The evolving treatment landscape for non-small-cell lung cancer (NSCLC) and complexities of regulations and reimbursement present challenges to community oncologists. Clinical pathways are tools to optimize care, but information on their value in the real world is limited. This retrospective study assessed treatment patterns and clinical outcomes in patients with Stage I-III NSCLC pre- and post-pathways implementation at Tennessee Oncology, a large, community-based oncology practice in the USA. Methods & Materials: Chart data were abstracted for adults diagnosed with Stage I-III NSCLC who received systemic treatment. Patients were divided into pre-pathways (treatment initiation 2014-2015) and post-pathways (treatment initiation 2016-2018) cohorts. Patient characteristics, treatment patterns and outcomes were summarized descriptively. Kaplan-Meier curves were used to assess time-dependent outcomes, and log-rank test was used to compare the cohorts. Results: 291 patients were included (Stage I-II: 38 pre-pathways, 55 post-pathways; Stage III: 105 pre-pathways, 93 post-pathways). Duration on first-line (1L) therapy was similar for Stage I-II patients pre- and post-pathways (median 1.9 months vs 2.1 months; p = 0.75), but increased for Stage III patients post-pathways (2.1 months vs 1.4 months pre-pathways; p < 0.01). Achievement of a complete or partial response with 1L therapy was similar post-pathways among Stage I-Stage -IIII patients (60.0% vs 55.2% pre-pathways), but increased for Stage III patients (56.0% vs 35.2% pre-pathways). Conclusion: Given that improvements in rates of treatment response post-pathways occurred only for patients diagnosed with Stage III NSCLC, among whom immunotherapy uptake increased post-pathways, such improvements may be attributable to evolving practices in cancer care, including advances in treatment and care delivery, rather than clinical pathways implementation. Further research is warranted to assess the impact of clinical pathways in the current treatment era, given that immunotherapy has now become the standard of care in NSCLC.

Abstract 4714: Phase I/II trial of ixabepilone (Ixa) and dasatinib (D) for treatment of metastatic breast cancer (MBC)

Background: Ixa is a novel microtubule blocking epothilone with activity in taxane and anthracycline-resistant MBC. D is a potent small molecule tyrosine kinase inhibitor with substantial activity against SRC family non-receptor kinases, known to play multiple roles in promoting tumor growth and metastases. D inhibits cellular SRC autophosphorylation in cell lines that highly express SRC and inhibits in vivo activation in a broad array of tumors in nude mice. D was safe as a single agent in MBC with modest single agent activity. Ixa and D have synergistic effects in preclinical models suggesting this strategy would be of clinical benefit as combination therapy. Methods: Open label multicenter dose escalation trial determining the maximally tolerated dose (MTD) and the dose-limiting toxicity (DLT) of the combination of Ixa + D followed by a phase II component evaluating efficacy. In phase I, up to four dose range cohorts were planned. In each dose level (DL), three patients (pts) initially enrolled and escalated until &gt; 1/3 pts on a DL exhibited DLT. The MTD was defined at the DL at which &lt; 1/6 pts experienced DLT. Eligibility included MBC previously treated with 1-2 prior lines of therapy, Grade &lt; 1 peripheral neuropathy, ability to take oral medications, HER2- or HER2-directed therapy resistant, ECOG PS 0-2, no pleural/pericardial effusions, QTc interval &lt;450 msec. DL 0 was Ixa 16 mg/m2 IV day 1, 8, 15 of a 28-day cycle with D100 mg QD PO daily. DL 1: Ixa 20 mg/m2; D100 mg QD; DL2: Ixa 20 mg/m2; D140 mg QD. Adverse event grading by CTCAE 3.0. Results: Twelve pts were treated during the phase I portion, 3 at DL 0, 6 at DL 1 and 3 at DL 2. Median age was 52.3, 25% African-American, ECOG 0 three pts, ECOG 1, 9 pts. Prior chemotherapy: 10 received two lines, 2 one line. The MTD was established at DL 1, Ixa 20 mg/m2 day 1, 8, 15, and D 100 mg QD daily Q 28 days. At DL 2, DLT of leucopenia and thrombocytopenia occurred in 2 patients. Grade 3 non-hematologic adverse events occurring in &gt;1 pt included diarrhea in 2 and fatigue in 2. No grade 4 non-hematologic toxicity was seen. One pt developed grade1 pleural effusion and 2 had grade 1/2 peripheral neuropathy. Other grade 1/2 AEs included rash, cough, dyspnea, muscle pain, pyrexia and anorexia. 2/12 pts achieved a partial response (25%) and 4 (33%) achieved stable disease. Two pts remain on study at cycle 10+ and at cycle 7+. Dose delays /reductions were not required during DL 0 until cycle 4 but dose delays occurred from cycle 1 onward in DL 1 and 2. Conclusions: Ixa + D can be safely delivered at clinically relevant doses to pts with MBC. A MTD of Ixa at 20 mg/m2 weekly 3/4 wks and D at 100 mg QD was established with clinical activity seen at this dose level. The phase II portion is actively accruing pts.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4714. doi:10.1158/1538-7445.AM2011-4714