Phase II, Open-Label Study of Encorafenib Plus Binimetinib in Patients With BRAFV600-Mutant Metastatic Non–Small-Cell Lung Cancer
Targeted therapy in NSCLC, FCS was part of this trial.
Rates of Guideline-Concordant Surgery and Adjuvant Chemotherapy Among Patients With Early-Stage Lung Cancer in the US ALCHEMIST Study (Alliance A151216)
Author(s): Kenneth L. Kehl, MD, MPH1; David Zahrieh, PhD2; Ping Yang, MD, PhD2; Shauna L. Hillman, MS2; Angelina D. Tan, BS, BA2; Jacob M. Sands, MD1; Geoffrey R. Oxnard, MD1; Erin A. Gillaspie, MD, MPH3; Dennis Wigle, MD, PhD2; Shakun Malik, MD4; Thomas E. Stinchcombe, MD5; Suresh S. Ramalingam, MD6; Karen Kelly, MD7; Ramaswamy Govindan, MD8; Sumithra J. Mandrekar, PhD2; Raymond U. Osarogiagbon, MD9; David Kozono, MD1
Source: JAMA Oncol. 2022;8(5):717-728. doi:10.1001/jamaoncol.2022.0039
Dr. Lucio Gordan's Thoughts
Lots of progress to be accomplished here. Increased standardization of care, quality metrics based on guideline-adherence and best practices remain critical to progress.
IMPORTANCE
Standard treatment for resectable non–small cell lung cancer (NSCLC) includes anatomic resection with adequate lymph node dissection and adjuvant chemotherapy for appropriate patients. Historically, many patients with early-stage NSCLC have not received such treatment, which may affect the interpretation of the results of adjuvant therapy trials.
OBJECTIVE
To ascertain patterns of guideline-concordant treatment among patients enrolled in a US-wide screening protocol for adjuvant treatment trials for resected NSCLC.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study included 2833 patients with stage IB to IIIA NSCLC (per American Joint Committee on Cancer 7th edition criteria) who enrolled in the Adjuvant Lung Cancer Enrichment Marker Identification and Sequencing Trial (ALCHEMIST) screening study (Alliance for Clinical Trials in Oncology A151216) from August 18, 2014, to April 1, 2019, and who did not enroll in a therapeutic adjuvant clinical trial; patients had tumors of at least 4 cm and/or with positive lymph nodes. Statistical analysis was conducted from June 1, 2020, through October 1, 2021.
EXPOSURES
Care patterns were ascertained overall and by sociodemographic and clinical factors, including age, sex, race and ethnicity, educational level, marital status, geography, histologic characteristics, stage, genomic variant status, smoking history, and comorbidities.
MAIN OUTCOMES AND MEASURES
Five outcomes are reported: whether patients (1) had anatomic surgical resection, (2) had adequate lymph node dissection (≥1 N1 nodal station plus ≥3 N2 nodal stations), (3) received any adjuvant chemotherapy, (4) received any cisplatin-based adjuvant chemotherapy, and (5) received at least 4 cycles of adjuvant chemotherapy.
RESULTS
Of the 2833 patients (1505 women [53%]; mean [SD] age, 66.5 [9.2] years) included in this analysis, 2697 (95%) had anatomic surgical resection, 1513 (53%) had adequate lymph node dissection, 1617 (57%) received any adjuvant chemotherapy, 1237 (44%) received at least 4 cycles of adjuvant platinum-based chemotherapy, and 965 (34%) received any cisplatin-based adjuvant chemotherapy. Rates were similar across race and ethnicity.
CONCLUSIONS AND RELEVANCE
This cohort study found that among participants in a screening protocol for adjuvant clinical trials for resected early-stage NSCLC, just 53% underwent adequate lymph node dissection, and 57% received adjuvant chemotherapy, despite indications for such treatment. These results may affect the interpretation of adjuvant trials. Efforts are needed to optimize the use of proven therapies for early-stage NSCLC.
Author Affiliations
1Dana-Farber/Partners CancerCare, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts 2Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota 3Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 4National Cancer Institute Cancer Therapy Evaluation Program, Bethesda, Maryland 5Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina 6The Winship Cancer Institute of Emory University, Atlanta, Georgia 7University of California at Davis Comprehensive Cancer Center, Sacramento 8Alvin J Siteman Cancer Center and Washington University School of Medicine, St Louis, Missouri 9Baptist Cancer Center, Memphis, TennesseeRelated Articles
Burden of chemotherapy-induced myelosuppression among patients with extensive-stage small cell lung cancer: A retrospective study from community oncology practices
FCS medical oncologist and hematologist Lowell L. Hart, MD, FACP was first-author a study with FCS co-authors President and Managing Physician Lucio N. Gordan, MD, Director of Pharmacy Operations Kristen Boykin, Senior Vice President & Data Officer Trevor Heritage, PhD, and (Retired) Vice President of Pharmacy Services Ray Bailey BPharm, RPh, that evaluated ES-SCLC patients with chemotherapy-induced myelosuppression over a seven-year period, from January 2013 through December 2020. Within this cohort, 98% of the patients experienced at least one myelosuppressive episode following chemotherapy treatment, leading to the need for supportive care, creating additional costs in health care management and time lost in treatment for ES-SCLC.
Durvalumab With or Without Tremelimumab in Combination With Chemotherapy as First-Line Therapy for Metastatic Non–Small-Cell Lung Cancer: The Phase III POSEIDON Study
Suddenly met-NSCLC is a crowded space. This study did not conclude that T+D+CT was better than D+CT, the findings showed that D+CT was better than CT alone. The addition of T to D+CT improved the PFS and OS trend but I don’t think this was a homerun result. There was not a significant OS benefit and further follow-up will declare these results. Also an improved outcomes were not seen in the non-squamous population. The pembrolizumab studies have 5+ years of follow-up and an improvement in PFS and OS across NSCLC subtypes.
Lung Cancer Diagnosed Through Screening, Lung Nodule, and Neither Program: A Prospective Observational Study of the Detecting Early Lung Cancer (DELUGE) in the Mississippi Delta Cohort
Interesting study which the demonstrates the importance of prescriptive approach to detect NSCLC. Hopefully, in the future ctDNA may enhance or replace LDCT ability to detect patients with stage I/II disease.
Neoadjuvant Nivolumab plus Chemotherapy in Resectable Lung Cancer
This is a potential practice-changing study. Future data on overall-survival (OS) will be important to confirm results. Patient selection will also evolve over time especially in real-world practice. I presume more patients with stage II/III will get neoadjuvant therapy as opposed to a patient with a small lung nodule (stage I) taken to surgery, unless if there is significant OS for early stage patients as well.
