Augustine Lau, Jessy Delaisla, Jeff Dang, Sang Chau and Andrew Hertler
Jeff Dang, Sang Chau, Jessy Delaisla, Divya Prakash and Andrew Hertler
Background: Lung cancer is the leading cause of death in the United States. We are challenged with finding the optimal treatment for patient subgroups in a real-world setting. Treatment options have expanded to include immunotherapies versus platinum-based therapies to improve the quality of cancer care. Platinum combinations are known to have overall response rates of 25%–35%, time to progression of 4–6 months, and a median survival of 8–10 months. The purpose of this study was to determine how long metastatic NSCLC patients were on first-line treatments and what characteristics potentially contribute to the duration of therapy prior to progression. Methods: All patients with a diagnosis of metastatic NSCLC that received first line treatment between January 1, 2016 and December 31, 2017 but later switched to a different treatment because of disease progression or intolerance were included in the study (n=1,222). The sample, obtained from a nationwide database of treatment requests, was stratified into 4 groups based on the type of treatment the patient received: single agent (n=66), PD-1/PDL-1 (n=157), platinum doublet (n=720), and platinum triplet (n=279). Chi-square and Kruskal-Wallis tests were performed as appropriate. Results: The findings suggested that the median duration to progression was shorter for single agents as compared to multiple agent treatments (Χ 2 =7.67, P=.05). The median treatment duration for the groups were as follows: 90 days for single agent, 90 days for PD-1/PDL-1, 93 days for platinum doublet, and 111 days for platinum triplet. Additional analyses were conducted to understand whether pathway adherence and growth factor usage impact the duration of time to discontinuation within each group. Conclusions: These data provide insight into the duration of first line treatments for advanced lung cancer. Shorter duration times were found for single agent treatments as compared to multiple agent treatments.
William J. Gradishar, Benjamin O. Anderson, Jame Abraham, Rebecca Aft, Doreen Agnese, Kimberly H. Allison, Sarah L. Blair, Harold J. Burstein, Chau Dang, Anthony D. Elias, Sharon H. Giordano, Matthew P. Goetz, Lori J. Goldstein, Steven J. Isakoff, Jairam Krishnamurthy, Janice Lyons, P. Kelly Marcom, Jennifer Matro, Ingrid A. Mayer, Meena S. Moran, Joanne Mortimer, Ruth M. O'Regan, Sameer A. Patel, Lori J. Pierce, Hope S. Rugo, Amy Sitapati, Karen Lisa Smith, Mary Lou Smith, Hatem Soliman, Erica M. Stringer-Reasor, Melinda L. Telli, John H. Ward, Jessica S. Young, Jennifer L. Burns and Rashmi Kumar
Several new systemic therapy options have become available for patients with metastatic breast cancer, which have led to improvements in survival. In addition to patient and clinical factors, the treatment selection primarily depends on the tumor biology (hormone-receptor status and HER2-status). The NCCN Guidelines specific to the workup and treatment of patients with recurrent/stage IV breast cancer are discussed in this article.
Featured Updates to the NCCN Guidelines
Matthew P. Goetz, William J. Gradishar, Benjamin O. Anderson, Jame Abraham, Rebecca Aft, Kimberly H. Allison, Sarah L. Blair, Harold J. Burstein, Chau Dang, Anthony D. Elias, William B. Farrar, Sharon H. Giordano, Lori J. Goldstein, Steven J. Isakoff, Janice Lyons, P. Kelly Marcom, Ingrid A. Mayer, Meena S. Moran, Joanne Mortimer, Ruth M. O'Regan, Sameer A. Patel, Lori J. Pierce, Elizabeth C. Reed, Hope S. Rugo, Amy Sitapati, Karen Lisa Smith, Mary Lou Smith, Hatem Soliman, Melinda L. Telli, John H. Ward, Jessica S. Young, Dorothy A. Shead and Rashmi Kumar
These NCCN Guidelines Insights highlight the updated recommendations for use of multigene assays to guide decisions on adjuvant systemic chemotherapy therapy for women with hormone receptor–positive, HER2-negative early-stage invasive breast cancer. This report summarizes these updates and discusses the rationale behind them.