Variations in Patterns of Prescribing Durvalumab in Stage III Lung Cancer: A Survey of Australian Medical Oncologists.

IF 2.5 3区医学 Q3 ONCOLOGY Oncology Pub Date : 2024-01-01 Epub Date: 2024-01-17 DOI:10.1159/000535855

Udit Nindra, Victoria Bray, Deme Karikios, Mohsen Shafiei, Shalini Subramaniam, Pei Ding, Steven Kao, Abhijit Pal

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Abstract

Introduction: Local Australian guidelines for the optimal management of stage III unresectable non-small cell lung cancer (NSCLC) are lacking. The American Society of Clinical Oncology (ASCO) guidelines recommend consolidation durvalumab for all patients with unresectable stage III NSCLC, irrespective of their PD-L1 expression or driver mutation status. The European Society of Medical Oncology (ESMO) differs, with consolidation durvalumab only recommended in those patients whose tumours express PD-L1.

Methods: Due to differing global guidelines, we conducted an Australia and New Zealand wide survey of medical oncologists specialising in thoracic cancer to determine the variations in patterns of prescribing durvalumab in stage III unresectable NSCLC. This survey was done electronically and sponsored by the Thoracic Oncology Group of Australia (TOGA).

Results: Thirty-two medical oncologists completed the survey. In patients with EGFR-mutated stage III unresectable NSCLC, 6% of respondents stated that they prescribed durvalumab for all patients, while an additional 6% strongly recommended treatment. Forty-four percent suggested little benefit of consolidation durvalumab in this cohort, with an additional 19% advocating for observation only. In patients with PD-L1 negative (0%) stage III unresectable NSCLC, 13% of respondents prescribed durvalumab for all patients, while an additional 56% strongly recommended treatment. Interestingly, 18%, 10%, and 10% of prescribers discussed self-funded oral tyrosine kinase inhibitor therapy in patients with EGFR, ALK, or ROS-1-mutated NSCLC respectively as a substitute for consolidation durvalumab.

Conclusion: Overall, the clinical practice of Australian and New Zealand Medical Oncologists is variable, but remains consistent with either the ASCO or ESMO guidelines. Local practice guidelines are required to ensure consistency in prescribing patterns across Australia, as well as providing evidence for self-funded treatments outside standard of care.

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肺癌 III 期患者使用杜伐单抗处方模式的变化：澳大利亚肿瘤内科医生调查。

背景：澳大利亚当地缺乏有关 III 期不可切除 NSCLC 最佳治疗的指南。美国临床肿瘤学会（ASCO）指南建议所有不可切除的 III 期 NSCLC 患者，无论其 PD-L1 表达或驱动基因突变状态如何，均应使用达伐单抗进行巩固治疗。欧洲肿瘤内科学会（ESMO）则有所不同，仅推荐肿瘤表达 PD-L1 的患者使用达伐单抗进行巩固治疗：由于全球指南不尽相同，我们对澳大利亚和新西兰的胸部肿瘤专科肿瘤内科医生进行了一次广泛调查，以确定 III 期不可切除 NSCLC 中杜伐单抗处方模式的差异。该调查由澳大利亚胸腔肿瘤组织（TOGA）赞助，以电子方式进行：32名肿瘤内科医生完成了调查。对于表皮生长因子受体（EGFR）突变的III期不可切除NSCLC患者，6%的受访者表示他们会为所有患者开具度伐单抗处方，另有6%的受访者强烈建议进行治疗。44%的受访者认为，在这一人群中，达伐单抗的巩固治疗获益甚微，另有19%的受访者主张仅进行观察。在 PD-L1 阴性（0%）的 III 期不可切除 NSCLC 患者中，13% 的受访者为所有患者开具了杜伐单抗处方，另有 56% 的受访者强烈建议进行治疗。有趣的是，分别有18%、10%和10%的处方医生讨论过为表皮生长因子受体（EGFR）、ALK或ROS-1突变的NSCLC患者提供自费口服酪氨酸激酶抑制剂（TKI）治疗，以替代达伐单抗的巩固治疗：总体而言，澳大利亚和新西兰肿瘤内科医生的临床实践各不相同，但仍与 ASCO 或 ESMO 指南保持一致。澳大利亚和新西兰肿瘤内科医生的临床实践总体上各不相同，但与 ASCO 或 ESMO 指南保持一致。需要制定当地的实践指南，以确保澳大利亚各地处方模式的一致性，并为标准治疗之外的自费治疗提供证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Oncology 医学-肿瘤学

CiteScore

6.00

自引率

2.90%

发文量

审稿时长

6-12 weeks

期刊介绍： Although laboratory and clinical cancer research need to be closely linked, observations at the basic level often remain removed from medical applications. This journal works to accelerate the translation of experimental results into the clinic, and back again into the laboratory for further investigation. The fundamental purpose of this effort is to advance clinically-relevant knowledge of cancer, and improve the outcome of prevention, diagnosis and treatment of malignant disease. The journal publishes significant clinical studies from cancer programs around the world, along with important translational laboratory findings, mini-reviews (invited and submitted) and in-depth discussions of evolving and controversial topics in the oncology arena. A unique feature of the journal is a new section which focuses on rapid peer-review and subsequent publication of short reports of phase 1 and phase 2 clinical cancer trials, with a goal of insuring that high-quality clinical cancer research quickly enters the public domain, regardless of the trial’s ultimate conclusions regarding efficacy or toxicity.