Estimation of US patients with cancer who may respond to cytotoxic chemotherapy.

AIMS PATIENTS & METHODS: In this retrospective review, we sought to estimate the proportion of patients in the USA with advanced or metastatic cancer who are eligible for and may respond to recommended first-line cytotoxic chemotherapy based on National Comprehensive Cancer Network treatment guidelines. RESULTS: Among 609,640 patients, we estimate 479,823 (78.7%, 95% CI: 78.6-78.8%) may be eligible for cytotoxic chemotherapy while 189,159 out of 609,640 patients (31.0%, 95% CI: 30.9-31.1%) may have achieved treatment response. The average objective response rate from these regimens was 48.6% (range 9.2 to 90.6%). CONCLUSION: Given the large role of cytotoxic agents in cancer, drug development in this space may remain of interest in specific cancer types, and regulatory approval of novel oncology drugs may justify head-to-head comparisons against cytotoxic regimens.

Comparison of Drugs Used for Adjuvant and Metastatic Therapy of Colon, Breast, and Non-Small Cell Lung Cancers.

Importance: Drugs are used in the adjuvant, metastatic, or both settings in cancer, but the rate, direction, and speed with which drugs are tested and indicated in each setting are unknown. Objective: To identify the number of unique agents that are currently category 1 or 2A per National Comprehensive Cancer Network (NCCN) guidelines in metastatic and adjuvant settings of non-small cell lung cancer (NSCLC), breast cancer, and colon cancer, as well as the mean delay between use in these 2 settings and the quality of supporting evidence. Design, Setting, and Participants: This cross-sectional study used NCCN treatment guidelines current as of May 15, 2019, and the clinical trials cited either by these guidelines or within corresponding drug labels. Trials published between 1970 and 2019 were evaluated. The analysis included published clinical trials of systemic therapy options deemed by the NCCN as category 1 or 2A. Participants included patients with early or metastatic NSCLC, breast cancer, or colon cancer who were included in clinical trials evaluating current NCCN-recommended systemic therapy options. Data analysis was performed from March 2019 to May 2019. Exposures: Systemic therapy regimens used as either adjuvant treatment or as therapy for metastatic disease in the 3 cancer types. Main Outcomes and Measures: Number of agents recommended for use in adjuvant and metastatic settings of NSCLC, colon cancer, and breast cancer, the mean delay between use in these 2 settings, and the percentage of agents supported by trials with substantial improvement in either progression-free survival (disease-free survival for adjuvant agents) or overall survival. Results: This study identified 69 agents recommended for use in metastatic disease compared with 25 agents recommended for adjuvant use. For agents used in both settings, the mean (SD) delay between use in metastatic disease and as adjuvant therapy was 10.0 (7.5) years. On the basis of trials with positive outcomes, 39 of 69 agents (56.5%) were approved or recommended in the metastatic setting, compared with 23 of 25 agents (92.0%) approved for use as adjuvant therapy. Conclusions and Relevance: There is a substantial difference in the number of agents available for use, as well as the timing of supporting evidence, in the metastatic and adjuvant settings for NSCLC, breast cancer, and colon cancer. Given the potential benefit of adjuvant therapy in these cancer types, further investigation into additional adjuvant systemic therapy options is warranted.

Treatment Patterns and Outcomes in Early-stage Hodgkin Lymphoma in the Elderly: A National Cancer Database Analysis.

BACKGROUND: The outcome for early-stage (I/II) Hodgkin lymphoma (HL) has improved significantly during the past few decades. However, older age (≥ 60 years) has continued to be associated with poor outcomes, and a paucity of data is available defining the optimal treatment regimens. In the present study, we sought to identify the practice patterns and outcomes in elderly patients with early-stage HL using the National Cancer Database. MATERIALS AND METHODS: We performed a retrospective study of patients aged 60 years with early-stage classic HL diagnosed from 2004 to 2012. The overall survival (OS) of patients undergoing chemotherapy (CT), radiation therapy (RT), or CT plus RT were compared. Kaplan-Meier curves of OS for individual therapy were constructed and compared using the log-rank test. Multivariate analysis for predictors of mortality was conducted using the Cox proportional hazard method. RESULTS: A total of 3795 patients were included in the analysis. At baseline, 41% patients had stage I disease. Of the 3795 patients, 51% underwent CT, 16% underwent RT, and 33% underwent CT plus RT. With a median follow-up duration of 40.4 months, the unadjusted OS rates for patients receiving CT, RT, or CT plus RT were 58.1%, 54%, and 77.7%, respectively (P < .0001). On multivariate analysis, CT plus RT improved OS compared with monotherapy. CONCLUSION: In older patients (age ≥ 60 years) with stage I/II HL, the combination of CT plus consolidative RT resulted in improved OS compared with monotherapy. However, the use of combination therapy in this age group seems suboptimal. This could be, in part, secondary to comorbidities limiting the use of CT plus RT in the elderly.