Jessica Y Islam, Yi Guo, Kea Turner, Amir Alishahi Tabriz, Yu Chen Lin, Denise C Vidot, Susan T Vadaparampil, Anna E Coghill, Marlene Camacho-Rivera ScD, Gita Suneja
Background: People with HIV (PWH) diagnosed with stage-IV cancer are less likely to receive palliative care (PC) compared to those without HIV. Our objective was to evaluate inequities in PC receipt among PWH with stage IV cancer in the US.
Methods: We used the National Cancer Database (2004-2020), including adult (18-89 years) PWH with the 14 most common cancers that occur among PWH. PC was defined as treatment provided with non-curative intent. Our main exposures included % quartiles of adults without a high school degree (educational attainment) and median income quartiles within the patient's zip code. We used hierarchical multivariable Poisson regression to estimate adjusted prevalence ratios(aPR) with 95% confidence intervals (95% CI), adjusting for age, sex, year of diagnosis, race/ethnicity, and cancer type.
Results: Among the included 10,120 PWH with stage IV cancer, 72% were men, 51% were either non-Hispanic(NH)-Black or Hispanic/Latinx, 38% were aged ≥60 years, and 97% resided in urban areas. Fourteen percent received PC. NH-Black PWH living in zip-codes with lower quartiles of educational attainment were more likely to receive PC compared to those in the highest quartile (Q1vs.Q4: aPR:1.93;95% CI:1.29-2,86) For income overall, compared to those in the highest quartile (Q4) of income, those in the lowest quartile had 26% higher likelihood of receiving PC (Q1vs.Q4: aPR:1.26;95% CI:1.05-1.52), particularly among NH-Black adults (Q1vs.Q4: aPR:1.67;95% CI:1.25-2.22; Q2 vs.Q4; aPR:1.48;95% CI:1.09-2.01).
Conclusions: PC use among PWH with stage-IV cancer is low. Contextual poverty plays a role in PC delivery to PWH and cancer, particularly among NH-Black PWH.
背景:被诊断为 IV 期癌症的艾滋病病毒感染者(PWH)与非艾滋病病毒感染者相比,接受姑息关怀(PC)的可能性较低。我们的目的是评估美国 IV 期癌症患者中接受姑息治疗的不平等现象:我们使用了全国癌症数据库(2004-2020 年),其中包括罹患 14 种最常见癌症的成年(18-89 岁)艾滋病感染者。PC定义为非治愈性治疗。我们的主要暴露因素包括患者所在邮政编码内没有高中学历(受教育程度)的成人比例四分位数和收入中位数四分位数。我们使用分层多变量泊松回归法估算了调整后的患病率(aPR)和 95% 置信区间(95% CI),并对年龄、性别、诊断年份、种族/民族和癌症类型进行了调整:在纳入的 10,120 名 IV 期癌症患者中,72% 为男性,51% 为非西班牙裔黑人或西班牙裔/拉丁裔,38% 年龄≥60 岁,97% 居住在城市地区。14% 接受了 PC 治疗。与教育程度最高的四分位数的人群相比,居住在教育程度较低的四分位数邮政编码下的新罕布什尔州黑人公共卫生人员更有可能接受个人护理(Q1vs.Q4: aPR:1.93;95% CI:1.总体收入方面,与收入最高四分位数(Q4)的人群相比,收入最低四分位数的人群接受 PC 的可能性高出 26%(Q1vs.Q4: aPR:1.26;95% CI:1.05-1.52 ),尤其是在新罕布什尔州黑人成年人中(Q1vs.Q4: aPR:1.67;95% CI:1.25-2.22; Q2 vs.Q4; aPR:1.48;95% CI:1.09-2.01 ):患有 IV 期癌症的残疾人使用 PC 的比例较低。结论:在罹患 IV 期癌症的残疾人中,PC 的使用率很低。贫困环境对向残疾人和癌症患者提供 PC 起到了一定作用,尤其是在新罕布什尔州的黑人残疾人中。
{"title":"Inequities in palliative care delivery to patients with HIV and Stage IV cancers in the US (2004-2020).","authors":"Jessica Y Islam, Yi Guo, Kea Turner, Amir Alishahi Tabriz, Yu Chen Lin, Denise C Vidot, Susan T Vadaparampil, Anna E Coghill, Marlene Camacho-Rivera ScD, Gita Suneja","doi":"10.1093/jncics/pkae118","DOIUrl":"https://doi.org/10.1093/jncics/pkae118","url":null,"abstract":"<p><strong>Background: </strong>People with HIV (PWH) diagnosed with stage-IV cancer are less likely to receive palliative care (PC) compared to those without HIV. Our objective was to evaluate inequities in PC receipt among PWH with stage IV cancer in the US.</p><p><strong>Methods: </strong>We used the National Cancer Database (2004-2020), including adult (18-89 years) PWH with the 14 most common cancers that occur among PWH. PC was defined as treatment provided with non-curative intent. Our main exposures included % quartiles of adults without a high school degree (educational attainment) and median income quartiles within the patient's zip code. We used hierarchical multivariable Poisson regression to estimate adjusted prevalence ratios(aPR) with 95% confidence intervals (95% CI), adjusting for age, sex, year of diagnosis, race/ethnicity, and cancer type.</p><p><strong>Results: </strong>Among the included 10,120 PWH with stage IV cancer, 72% were men, 51% were either non-Hispanic(NH)-Black or Hispanic/Latinx, 38% were aged ≥60 years, and 97% resided in urban areas. Fourteen percent received PC. NH-Black PWH living in zip-codes with lower quartiles of educational attainment were more likely to receive PC compared to those in the highest quartile (Q1vs.Q4: aPR:1.93;95% CI:1.29-2,86) For income overall, compared to those in the highest quartile (Q4) of income, those in the lowest quartile had 26% higher likelihood of receiving PC (Q1vs.Q4: aPR:1.26;95% CI:1.05-1.52), particularly among NH-Black adults (Q1vs.Q4: aPR:1.67;95% CI:1.25-2.22; Q2 vs.Q4; aPR:1.48;95% CI:1.09-2.01).</p><p><strong>Conclusions: </strong>PC use among PWH with stage-IV cancer is low. Contextual poverty plays a role in PC delivery to PWH and cancer, particularly among NH-Black PWH.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heinz-Josef Lenz, Tianshu Liu, Emerson Y Chen, Zsolt Horváth, Igor Bondarenko, Iwona Danielewicz, Michele Ghidini, Pilar García-Alfonso, Robert Jones, Matti Aapro, Yanqiao Zhang, Jufeng Wang, Wayne Wang, Jennifer Adeleye, Andrew Beelen, Joleen Hubbard
Background: In metastatic colorectal cancer (mCRC), improvements in survival from combining leucovorin/fluorouracil/oxaliplatin/irinotecan (FOLFOXIRI) with bevacizumab have come at the risk of increased rates of high-grade toxicities. Trilaciclib is indicated to decrease the incidence of chemotherapy-induced myelosuppression in patients receiving standard-of-care chemotherapy for extensive-stage small cell lung cancer.
Methods: Patients with untreated mCRC were randomized 1:1 to trilaciclib (n = 164) or placebo (n = 162) prior to FOLFOXIRI/bevacizumab for up to 12 cycles (induction), followed by trilaciclib or placebo prior to fluorouracil/leucovorin/bevacizumab (maintenance). Co-primary endpoints were duration of severe (grade 4) neutropenia (DSN) in cycles 1-4 and occurrence of severe neutropenia (SN) during induction. Secondary endpoints included antitumor efficacy, survival, and safety.
Results: : The study met its co-primary endpoints. Administering trilaciclib prior to FOLFOXIRI/bevacizumab resulted in significant reductions in DSN in cycles 1-4 versus placebo (mean, 0.1 vs. 1.3 days; P < .001) and occurrence of SN during induction (1.3% vs. 19.7%; adjusted relative risk [96% CI], 0.07 [0.0, 0.3]; P < .001). Grade 3/4 adverse events, including neutropenia, diarrhea, and leukopenia, were less frequent with trilaciclib versus placebo (64.8% vs. 73.1%). Trilaciclib was associated with fewer chemotherapy dose reductions and delays, and reduced administration of supportive therapies, compared with placebo. Objective response rate (41.6% vs. 57.1%; P = .009) and median progression-free survival (10.3 vs. 13.1 months; P < .001) were significantly lower with trilaciclib versus placebo.
Conclusions: : Administering trilaciclib prior to FOLFOXIRI/bevacizumab protected the neutrophil lineage from the effects of chemotherapy-induced myelosuppression. However, antitumor efficacy endpoints favored placebo.
背景:在转移性结直肠癌(mCRC)中,亮菌甲素/氟尿嘧啶/奥沙利铂/伊立替康(FOLFOXIRI)与贝伐珠单抗联用可提高患者的生存率,但也有可能增加高毒性反应的发生率。Trilaciclib适用于降低接受标准化疗的广泛期小细胞肺癌患者化疗引起的骨髓抑制发生率:将未经治疗的mCRC患者按1:1随机分组,在FOLFOXIRI/贝伐珠单抗最多12个周期(诱导)前服用曲拉西利布(n = 164)或安慰剂(n = 162),然后在氟尿嘧啶/亮紫杉醇/贝伐珠单抗(维持治疗)前服用曲拉西利布或安慰剂。共主要终点是第1-4周期的严重(4级)中性粒细胞减少症(DSN)持续时间和诱导期间的严重中性粒细胞减少症(SN)发生率。次要终点包括抗肿瘤疗效、生存期和安全性:研究达到了共同主要终点。在FOLFOXIRI/贝伐单抗治疗前服用曲拉西利布可显著减少1-4周期与安慰剂相比的DSN(平均0.1天 vs. 1.3天;P < .001)和诱导期间的SN发生率(1.3% vs. 19.7%;调整相对风险[96% CI],0.07 [0.0, 0.3];P < .001)。曲拉克利与安慰剂相比,3/4级不良事件(包括中性粒细胞减少、腹泻和白细胞减少)发生率较低(64.8% vs. 73.1%)。与安慰剂相比,曲拉西利布导致的化疗剂量减少和延迟以及支持性疗法用药减少的情况更少。与安慰剂相比,trilaciclib的客观反应率(41.6% vs. 57.1%;P = .009)和中位无进展生存期(10.3个月 vs. 13.1个月;P < .001)显著降低:结论:在FOLFOXIRI/贝伐单抗治疗前服用曲拉西利布可保护中性粒细胞免受化疗引起的骨髓抑制的影响。然而,抗肿瘤疗效终点更倾向于安慰剂。
{"title":"Trilaciclib prior to FOLFOXIRI/bevacizumab for patients with untreated metastatic colorectal cancer: phase 3 PRESERVE 1 trial.","authors":"Heinz-Josef Lenz, Tianshu Liu, Emerson Y Chen, Zsolt Horváth, Igor Bondarenko, Iwona Danielewicz, Michele Ghidini, Pilar García-Alfonso, Robert Jones, Matti Aapro, Yanqiao Zhang, Jufeng Wang, Wayne Wang, Jennifer Adeleye, Andrew Beelen, Joleen Hubbard","doi":"10.1093/jncics/pkae116","DOIUrl":"https://doi.org/10.1093/jncics/pkae116","url":null,"abstract":"<p><strong>Background: </strong>In metastatic colorectal cancer (mCRC), improvements in survival from combining leucovorin/fluorouracil/oxaliplatin/irinotecan (FOLFOXIRI) with bevacizumab have come at the risk of increased rates of high-grade toxicities. Trilaciclib is indicated to decrease the incidence of chemotherapy-induced myelosuppression in patients receiving standard-of-care chemotherapy for extensive-stage small cell lung cancer.</p><p><strong>Methods: </strong>Patients with untreated mCRC were randomized 1:1 to trilaciclib (n = 164) or placebo (n = 162) prior to FOLFOXIRI/bevacizumab for up to 12 cycles (induction), followed by trilaciclib or placebo prior to fluorouracil/leucovorin/bevacizumab (maintenance). Co-primary endpoints were duration of severe (grade 4) neutropenia (DSN) in cycles 1-4 and occurrence of severe neutropenia (SN) during induction. Secondary endpoints included antitumor efficacy, survival, and safety.</p><p><strong>Results: </strong>: The study met its co-primary endpoints. Administering trilaciclib prior to FOLFOXIRI/bevacizumab resulted in significant reductions in DSN in cycles 1-4 versus placebo (mean, 0.1 vs. 1.3 days; P < .001) and occurrence of SN during induction (1.3% vs. 19.7%; adjusted relative risk [96% CI], 0.07 [0.0, 0.3]; P < .001). Grade 3/4 adverse events, including neutropenia, diarrhea, and leukopenia, were less frequent with trilaciclib versus placebo (64.8% vs. 73.1%). Trilaciclib was associated with fewer chemotherapy dose reductions and delays, and reduced administration of supportive therapies, compared with placebo. Objective response rate (41.6% vs. 57.1%; P = .009) and median progression-free survival (10.3 vs. 13.1 months; P < .001) were significantly lower with trilaciclib versus placebo.</p><p><strong>Conclusions: </strong>: Administering trilaciclib prior to FOLFOXIRI/bevacizumab protected the neutrophil lineage from the effects of chemotherapy-induced myelosuppression. However, antitumor efficacy endpoints favored placebo.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marco Finati, Alex Stephens, Giuseppe Ottone Cirulli, Giuseppe Chiarelli, Shane Tinsley, Chase Morrison, Akshay Sood, Nicolò Buffi, Giovanni Lughezzani, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Gian Maria Busetto, Craig Rogers, Giuseppe Carrieri, Firas Abdollah
Background: Socio-economic and demographical factors contribute to disparity in prostate cancer (PCa) outcomes. We examined the impact of area of deprivation index (ADI) and race on PCa incidence and lethality in a North-American cohort.
Methods: Our cohort included men who received at least one PSA test within our Health System (1995-2022). An ADI score was assigned to each patient based on their residential census block, ranked as a percentile of deprivation relative to the national level. Individuals were further categorized into quartiles, where the fourth one (ADI 75-100) represented those living in the most deprived areas. We investigated PCa incidence and lethality, using cumulative incidence estimates and competing-risk regression. An ADIxRace interaction term examined whether the relationship between ADI and outcomes varied based on race.
Results: We included 134,366 patients, 25% of whom were NHB. Median (IQR) follow-up was 8.8 (5-17) years. At multivariate analysis, individuals from the third (ADI 50-74, 95% CI: 0.83-0.95) and the fourth quartile (ADI ≥ 75, 95% CI: 0.75-0.86) showed significant reduced HRs for PCa incidence, when compared with the first quartile (ADI < 25, all p < .001). In contrast to the overall cohort, PCa incidence increased with ADI in NHB men, who were persistently at higher hazard for both PCa incidence and lethality than NHW, across all ADI strata (all p < .001).
Conclusions: Living in more deprived areas was associated with lower PCa incidence and higher lethal disease rate. Conversely, PCa incidence increased with ADI for NHB, who consistently showed worse outcomes than NHW individuals, regardless of ADI.
{"title":"Association of Race and Area of Deprivation Index with Prostate Cancer Incidence and Lethality.","authors":"Marco Finati, Alex Stephens, Giuseppe Ottone Cirulli, Giuseppe Chiarelli, Shane Tinsley, Chase Morrison, Akshay Sood, Nicolò Buffi, Giovanni Lughezzani, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Gian Maria Busetto, Craig Rogers, Giuseppe Carrieri, Firas Abdollah","doi":"10.1093/jncics/pkae112","DOIUrl":"https://doi.org/10.1093/jncics/pkae112","url":null,"abstract":"<p><strong>Background: </strong>Socio-economic and demographical factors contribute to disparity in prostate cancer (PCa) outcomes. We examined the impact of area of deprivation index (ADI) and race on PCa incidence and lethality in a North-American cohort.</p><p><strong>Methods: </strong>Our cohort included men who received at least one PSA test within our Health System (1995-2022). An ADI score was assigned to each patient based on their residential census block, ranked as a percentile of deprivation relative to the national level. Individuals were further categorized into quartiles, where the fourth one (ADI 75-100) represented those living in the most deprived areas. We investigated PCa incidence and lethality, using cumulative incidence estimates and competing-risk regression. An ADIxRace interaction term examined whether the relationship between ADI and outcomes varied based on race.</p><p><strong>Results: </strong>We included 134,366 patients, 25% of whom were NHB. Median (IQR) follow-up was 8.8 (5-17) years. At multivariate analysis, individuals from the third (ADI 50-74, 95% CI: 0.83-0.95) and the fourth quartile (ADI ≥ 75, 95% CI: 0.75-0.86) showed significant reduced HRs for PCa incidence, when compared with the first quartile (ADI < 25, all p < .001). In contrast to the overall cohort, PCa incidence increased with ADI in NHB men, who were persistently at higher hazard for both PCa incidence and lethality than NHW, across all ADI strata (all p < .001).</p><p><strong>Conclusions: </strong>Living in more deprived areas was associated with lower PCa incidence and higher lethal disease rate. Conversely, PCa incidence increased with ADI for NHB, who consistently showed worse outcomes than NHW individuals, regardless of ADI.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gabriel A Benavidez, Ami E Sedani, Tisha M Felder, Matthew Asare, Charles R Rogers
Background: Despite evidence of the benefit of routine cancer screenings, data show a concerning decline in cancer screening uptake for multiple cancer screenings. This analysis aimed to examine rural-urban differences in recent trends for being up to date with screenings for breast, cervical, and colorectal cancers.
Methods: We used 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System data to assess up-to-date cancer screening status among eligible U.S. adults. We calculated weighted prevalence estimates overall and stratified by county-level rural-urban classification. We used survey-weighted multivariable logistic regression models to examine rural-urban disparities in cancer screening up-to-date status by year.
Results: Prevalence of being up to date with each cancer screening was lower in 2022 than it was in 2018. The largest decline in screening overall was for cervical cancer that dropped from 81.89% in 2018 to 47.71% in 2022. Rural-urban disparities were observed for breast cancer screening from 2018 to 2022 with the odds of up-to-date screening being 14% to 27% lower for rural populations than urban populations. For colorectal and cervical cancer, the odds of being up to date with screenings were lower for rural populations in 2018 and 2020, but there was no significant difference observed in 2022 (colorectal screening OR = 0.96; 95% CI: 0.90, 1.02) (cervical screening OR = 0.97; 95% CI: 0.93, 1.03).
Discussion: There is a concerning trend of decreasing uptake of cancer screenings, which will challenge future efforts in cancer prevention and control efforts. Efforts are needed to better understand factors contributing to the declining uptake of cancer screenings.
{"title":"Rural-Urban Disparities and Trends in Cancer Screening: An Analysis of Behavioral Risk Factor Surveillance System Data (2018-2022).","authors":"Gabriel A Benavidez, Ami E Sedani, Tisha M Felder, Matthew Asare, Charles R Rogers","doi":"10.1093/jncics/pkae113","DOIUrl":"https://doi.org/10.1093/jncics/pkae113","url":null,"abstract":"<p><strong>Background: </strong>Despite evidence of the benefit of routine cancer screenings, data show a concerning decline in cancer screening uptake for multiple cancer screenings. This analysis aimed to examine rural-urban differences in recent trends for being up to date with screenings for breast, cervical, and colorectal cancers.</p><p><strong>Methods: </strong>We used 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System data to assess up-to-date cancer screening status among eligible U.S. adults. We calculated weighted prevalence estimates overall and stratified by county-level rural-urban classification. We used survey-weighted multivariable logistic regression models to examine rural-urban disparities in cancer screening up-to-date status by year.</p><p><strong>Results: </strong>Prevalence of being up to date with each cancer screening was lower in 2022 than it was in 2018. The largest decline in screening overall was for cervical cancer that dropped from 81.89% in 2018 to 47.71% in 2022. Rural-urban disparities were observed for breast cancer screening from 2018 to 2022 with the odds of up-to-date screening being 14% to 27% lower for rural populations than urban populations. For colorectal and cervical cancer, the odds of being up to date with screenings were lower for rural populations in 2018 and 2020, but there was no significant difference observed in 2022 (colorectal screening OR = 0.96; 95% CI: 0.90, 1.02) (cervical screening OR = 0.97; 95% CI: 0.93, 1.03).</p><p><strong>Discussion: </strong>There is a concerning trend of decreasing uptake of cancer screenings, which will challenge future efforts in cancer prevention and control efforts. Efforts are needed to better understand factors contributing to the declining uptake of cancer screenings.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nikhil Grandhi, Lawrence Liu, Mei Wang, Theodore Thomas, Martin Schoen, Kristen Sanfilippo, Feng Gao, Graham A Colditz, Kenneth R Carson, Murali Janakiram, Su-Hsin Chang
Background: In patients with diabetes mellitus (DM) and monoclonal gammopathy of undetermined significance (MGUS), the impact of GLP-1 receptor agonists (GLP-1RAs) on the natural history of MGUS is unknown. We aimed to assess the association of GLP-1RA use in the progression of MGUS to multiple myeloma (MM) in patients with DM.
Methods: This is a population-based cohort study of Veterans diagnosed with MGUS from 2006-2021 with a prior diagnosis of DM. A validated natural language processing-algorithm was used to confirm MGUS and progression to MM. Gray's test was performed to detect the difference in cumulative Incidence functions (CIFs) for progression by GLP-1RA use status. The association between time-varying GLP-1RA use and progression was estimated in the 1 (exposed):2 (unexposed) matched cohort via multivariable-adjusted hazard ratio (aHR) using stratified Fine-Gray distribution hazard model with death as a competing event and stratum for the matched patient triad.
Results: Our analytic cohort included 1,097 MGUS patients who ever used GLP-1RAs, and the matched 2,194 patients who never used GLP-1RAs. Overall, 2.55% progressed in the GLP-1RA ever use group, compared to 5.01% in the GLP-1RA never use group. CIFs were significantly different between the exposed and unexposed groups (P = .02). GLP-1RA use, compared to no-use, was associated with decreased progression to MM (aHR 0.45, 95% confidence interval 0.22 to 0.93, P = .03).
Conclusions: For patients with DM and MGUS, GLP-1RA use is associated with a 55% reduction in risk of progression from MGUS to MM, compared to no use.
{"title":"Association between GLP-1RA use and progression of MGUS to Multiple Myeloma among diabetic patients.","authors":"Nikhil Grandhi, Lawrence Liu, Mei Wang, Theodore Thomas, Martin Schoen, Kristen Sanfilippo, Feng Gao, Graham A Colditz, Kenneth R Carson, Murali Janakiram, Su-Hsin Chang","doi":"10.1093/jncics/pkae095","DOIUrl":"https://doi.org/10.1093/jncics/pkae095","url":null,"abstract":"<p><strong>Background: </strong>In patients with diabetes mellitus (DM) and monoclonal gammopathy of undetermined significance (MGUS), the impact of GLP-1 receptor agonists (GLP-1RAs) on the natural history of MGUS is unknown. We aimed to assess the association of GLP-1RA use in the progression of MGUS to multiple myeloma (MM) in patients with DM.</p><p><strong>Methods: </strong>This is a population-based cohort study of Veterans diagnosed with MGUS from 2006-2021 with a prior diagnosis of DM. A validated natural language processing-algorithm was used to confirm MGUS and progression to MM. Gray's test was performed to detect the difference in cumulative Incidence functions (CIFs) for progression by GLP-1RA use status. The association between time-varying GLP-1RA use and progression was estimated in the 1 (exposed):2 (unexposed) matched cohort via multivariable-adjusted hazard ratio (aHR) using stratified Fine-Gray distribution hazard model with death as a competing event and stratum for the matched patient triad.</p><p><strong>Results: </strong>Our analytic cohort included 1,097 MGUS patients who ever used GLP-1RAs, and the matched 2,194 patients who never used GLP-1RAs. Overall, 2.55% progressed in the GLP-1RA ever use group, compared to 5.01% in the GLP-1RA never use group. CIFs were significantly different between the exposed and unexposed groups (P = .02). GLP-1RA use, compared to no-use, was associated with decreased progression to MM (aHR 0.45, 95% confidence interval 0.22 to 0.93, P = .03).</p><p><strong>Conclusions: </strong>For patients with DM and MGUS, GLP-1RA use is associated with a 55% reduction in risk of progression from MGUS to MM, compared to no use.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ana Ferrigno Guajardo, Bryan F Vaca-Cartagena, Fernanda Mesa-Chavez, Alejandra Platas, Alan Fonseca, Marlid Cruz-Ramos, Melina Miaja Avila, Ana Laura Rodriguez, Paula Cabrera-Galeana, Alejandro Mohar, Cynthia Villarreal-Garza
Background: Young women with breast cancer (YWBC) face unique challenges that can impact their sexual health. This study aimed to identify factors associated with sexual activity, function, and satisfaction in YWBC up to five years post-diagnosis.
Methods: We conducted a prospective cohort study of 474 women aged ≤40 years diagnosed with non-metastatic breast cancer in Mexico. Sexual function and satisfaction were assessed using the Female Sexual Function Index and the Sexual Satisfaction Inventory, respectively. Factors associated with sexual health outcomes were examined using mixed-effects models.
Results: The prevalence of sexual dysfunction increased from 33.6% at baseline to 52.9% at 4-5 years post-diagnosis. Factors associated with worse sexual function included older age (mean predicted FSFI score -1.35, p = .037), treatment-induced amenorrhea (-2.86, p < .001), depression (-4.11, p < .001), and anxiety (-2.13, p < .001). Lower sexual satisfaction was associated with lower educational attainment (mean predicted SSI score -5.61, p = .002), being single (-6.41, p < .001), treatment induced amenorrhea (-3.76, p = .004), bilateral oophorectomy (-8.21, p = .017), depression (-11.29, p < .001), and anxiety (-7.50, p < .001). Quality of life, body image, and systemic therapy side effects significantly impacted both outcomes. Three distinct trajectories of sexual function were identified: high (62.2%), intermediate (24.3%), and markedly declining (13.5%). Four trajectories of sexual satisfaction were found, ranging from intermediate-to-high (57.3%) to progressively worsening (27.5%).
Conclusion: Sexual dysfunction is prevalent and persistent among YWBC. Multiple biological, psychological, and social factors influence sexual health outcomes in this population. These findings highlight the importance of routine screening and tailored interventions to address the sexual health of YWBC throughout survivorship.
{"title":"Sexual Function and Satisfaction in Young Women with Breast Cancer: A Five-Year Prospective Study.","authors":"Ana Ferrigno Guajardo, Bryan F Vaca-Cartagena, Fernanda Mesa-Chavez, Alejandra Platas, Alan Fonseca, Marlid Cruz-Ramos, Melina Miaja Avila, Ana Laura Rodriguez, Paula Cabrera-Galeana, Alejandro Mohar, Cynthia Villarreal-Garza","doi":"10.1093/jncics/pkae111","DOIUrl":"https://doi.org/10.1093/jncics/pkae111","url":null,"abstract":"<p><strong>Background: </strong>Young women with breast cancer (YWBC) face unique challenges that can impact their sexual health. This study aimed to identify factors associated with sexual activity, function, and satisfaction in YWBC up to five years post-diagnosis.</p><p><strong>Methods: </strong>We conducted a prospective cohort study of 474 women aged ≤40 years diagnosed with non-metastatic breast cancer in Mexico. Sexual function and satisfaction were assessed using the Female Sexual Function Index and the Sexual Satisfaction Inventory, respectively. Factors associated with sexual health outcomes were examined using mixed-effects models.</p><p><strong>Results: </strong>The prevalence of sexual dysfunction increased from 33.6% at baseline to 52.9% at 4-5 years post-diagnosis. Factors associated with worse sexual function included older age (mean predicted FSFI score -1.35, p = .037), treatment-induced amenorrhea (-2.86, p < .001), depression (-4.11, p < .001), and anxiety (-2.13, p < .001). Lower sexual satisfaction was associated with lower educational attainment (mean predicted SSI score -5.61, p = .002), being single (-6.41, p < .001), treatment induced amenorrhea (-3.76, p = .004), bilateral oophorectomy (-8.21, p = .017), depression (-11.29, p < .001), and anxiety (-7.50, p < .001). Quality of life, body image, and systemic therapy side effects significantly impacted both outcomes. Three distinct trajectories of sexual function were identified: high (62.2%), intermediate (24.3%), and markedly declining (13.5%). Four trajectories of sexual satisfaction were found, ranging from intermediate-to-high (57.3%) to progressively worsening (27.5%).</p><p><strong>Conclusion: </strong>Sexual dysfunction is prevalent and persistent among YWBC. Multiple biological, psychological, and social factors influence sexual health outcomes in this population. These findings highlight the importance of routine screening and tailored interventions to address the sexual health of YWBC throughout survivorship.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samuel L Washington, Mary Fakunle, Lufan Wang, Avery E Braun, Michael Leapman, Janet E Cowan, Matthew R Cooperberg
Background: Local conditions where people live continue to influence prostate cancer outcomes. By examining local characteristics associated with trends in Black-White differences in prostate cancer specific mortality (PCSM) over time, we aim to identify factors driving county-level PCSM disparities over a 15-year period.
Methods: We linked county-level data (Area Health Resource File) with clinicodemographic data of men with prostate cancer (Surveillance, Epidemiology, and End Results registry) from 2005 to 2020. Generalized linear mixed models evaluated associations between race and county-level age-standardized PCSM, adjusting for age, year of death, rurality, and county-level education, income, uninsured rates, and densities of urologists, radiologists, primary care providers, and hospital beds.
Results: 185,390 patients in 1085 counties were identified, of which 15.8% were non-Hispanic Black. Racial disparities in PCSM narrowed from 2005 to 2020 (25.4 per 100,000 to 19.2 per 100,000 overall; 57.9 per 100,000 to 38 per 100,000 for Non-Hispanic Black patients and 23.4 per 100,000 to 18.3 per 100,000 for Non-Hispanic White patients). For both Non-Hispanic Black and Non-Hispanic White patients, county PCSM changes varied greatly (-65% to + 77% and -61% to + 112%, respectively). From 2016 to 2020, Non-Hispanic Black harbored greater PCSM risk (RR 2.09, 95% CI 2.01-2.18); higher radiation oncologist density was significantly associated with lower mortality risk (RR 0.93, 95% CI 0.89-0.98) while other provider densities were not.
Conclusion: Although overall rates improved, specific counties experienced worsening race-based disparities over time. Identifying locations of highest (and lowest) mortality disparities remains critical to development of location-specific solutions to racial disparities in prostate cancer outcomes.
{"title":"County-level racial disparities in prostate cancer specific mortality from 2005 to 2020.","authors":"Samuel L Washington, Mary Fakunle, Lufan Wang, Avery E Braun, Michael Leapman, Janet E Cowan, Matthew R Cooperberg","doi":"10.1093/jncics/pkae109","DOIUrl":"https://doi.org/10.1093/jncics/pkae109","url":null,"abstract":"<p><strong>Background: </strong>Local conditions where people live continue to influence prostate cancer outcomes. By examining local characteristics associated with trends in Black-White differences in prostate cancer specific mortality (PCSM) over time, we aim to identify factors driving county-level PCSM disparities over a 15-year period.</p><p><strong>Methods: </strong>We linked county-level data (Area Health Resource File) with clinicodemographic data of men with prostate cancer (Surveillance, Epidemiology, and End Results registry) from 2005 to 2020. Generalized linear mixed models evaluated associations between race and county-level age-standardized PCSM, adjusting for age, year of death, rurality, and county-level education, income, uninsured rates, and densities of urologists, radiologists, primary care providers, and hospital beds.</p><p><strong>Results: </strong>185,390 patients in 1085 counties were identified, of which 15.8% were non-Hispanic Black. Racial disparities in PCSM narrowed from 2005 to 2020 (25.4 per 100,000 to 19.2 per 100,000 overall; 57.9 per 100,000 to 38 per 100,000 for Non-Hispanic Black patients and 23.4 per 100,000 to 18.3 per 100,000 for Non-Hispanic White patients). For both Non-Hispanic Black and Non-Hispanic White patients, county PCSM changes varied greatly (-65% to + 77% and -61% to + 112%, respectively). From 2016 to 2020, Non-Hispanic Black harbored greater PCSM risk (RR 2.09, 95% CI 2.01-2.18); higher radiation oncologist density was significantly associated with lower mortality risk (RR 0.93, 95% CI 0.89-0.98) while other provider densities were not.</p><p><strong>Conclusion: </strong>Although overall rates improved, specific counties experienced worsening race-based disparities over time. Identifying locations of highest (and lowest) mortality disparities remains critical to development of location-specific solutions to racial disparities in prostate cancer outcomes.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lukas Owens, Ojas Brahme, Roman Gulati, Ruth Etzioni
Recent studies have shown that de novo metastatic prostate cancer incidence in the United States increased from 2010 to 2019. Plausible explanations include delayed detection after recommendations against prostate cancer screening or upstaging associated with use of more sensitive imaging technologies. Using Surveillance, Epidemiology, and End Results patient cases and controlling for aging of the population, we found the median age and prostate-specific antigen (PSA) level at prostate cancer diagnosis increased by 1.4 years of age (95% CI = 1.3 to 1.5 years) and 1.4 ng/mL (95% CI = 1.4 to 1.5 ng/mL) over this period, consistent with the delayed detection hypothesis. Racial differences were noted, with 75th percentiles of PSA at diagnosis increasing by 4.3 ng/mL (95% CI = 3.7 to 4.8 ng/mL) over this time period for non-Hispanic Black men compared with 3.0 ng/mL (95% CI = 2.8 to 3.2 ng/mL) for non-Hispanic White men. Overall, patient characteristics at diagnosis suggest that delayed detection contributed at least in part to increases in de novo metastatic disease.
最近的研究表明,美国新发转移性前列腺癌的发病率在 2010 年至 2019 年期间有所上升。合理的解释包括:建议不要进行前列腺癌筛查后,发现时间推迟;或使用更敏感的成像技术后,发现时间提前。利用监测、流行病学和最终结果病例并控制人口老龄化,我们发现在此期间,前列腺癌诊断时的中位年龄和前列腺特异性抗原(PSA)水平分别增加了 1.4 岁(95% CI 1.3-1.5)和 1.4 纳克/毫升(95% CI 1.4-1.5),与延迟检测假说一致。在这一时期,非西班牙裔黑人男性诊断时 PSA 的第 75 百分位数增加了 4.3 纳克/毫升(95% CI 3.7-4.8),而非西班牙裔白人男性则为 3.0 纳克/毫升(95% CI 2.8-3.2)。总体而言,诊断时的患者特征表明,延迟检测至少在一定程度上导致了新发转移性疾病的增加。
{"title":"Trends in age and prostate-specific antigen at prostate cancer diagnosis between 2010 and 2019.","authors":"Lukas Owens, Ojas Brahme, Roman Gulati, Ruth Etzioni","doi":"10.1093/jncics/pkae106","DOIUrl":"10.1093/jncics/pkae106","url":null,"abstract":"<p><p>Recent studies have shown that de novo metastatic prostate cancer incidence in the United States increased from 2010 to 2019. Plausible explanations include delayed detection after recommendations against prostate cancer screening or upstaging associated with use of more sensitive imaging technologies. Using Surveillance, Epidemiology, and End Results patient cases and controlling for aging of the population, we found the median age and prostate-specific antigen (PSA) level at prostate cancer diagnosis increased by 1.4 years of age (95% CI = 1.3 to 1.5 years) and 1.4 ng/mL (95% CI = 1.4 to 1.5 ng/mL) over this period, consistent with the delayed detection hypothesis. Racial differences were noted, with 75th percentiles of PSA at diagnosis increasing by 4.3 ng/mL (95% CI = 3.7 to 4.8 ng/mL) over this time period for non-Hispanic Black men compared with 3.0 ng/mL (95% CI = 2.8 to 3.2 ng/mL) for non-Hispanic White men. Overall, patient characteristics at diagnosis suggest that delayed detection contributed at least in part to increases in de novo metastatic disease.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11578289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ronald C Chen, Ramsankar Basak, Stacie Dusetzina, Deborah S Usinger, Zahed Mohammed, Aaron D Falchook, Jessica R Schumacher, Amanda B Francescatti, Amanda Cuddy, George J Chang, Benjamin D Kozower, Caprice C Greenberg, Anne K Barber, Aaron J Katz
Background: Posttreatment surveillance affects millions of cancer survivors, but empiric data to guide clinical practice are lacking. This study assessed whether the intensity of surveillance testing after radical prostatectomy or radiation therapy for localized prostate cancer is associated with overall survival.
Methods: Men diagnosed with localized prostate cancer between 2005 and 2010 who underwent radical prostatectomy or radiation therapy at a Commission on Cancer-accredited facility were randomly sampled. Primary data collected from 10 147 patients sampled across 1007 facilities were linked with existing data from the National Cancer Database. Analysis examined whether intensity of surveillance measured as the number of prostate-specific antigen (PSA) tests in the first year after primary treatment (categorized as 0-1 [low intensity], 2 [medium], or ≥3 [high intensity] PSA tests) was associated with overall survival. Secondary outcomes included recurrence-free survival (RFS) and subsequent use of imaging tests, biopsy procedures, and salvage treatment.
Results: Median follow-up exceeded 8 years from prostate cancer diagnosis. Overall survival was not statistically significantly different across surveillance intensity groups among radiation therapy (P = .59) or radical prostatectomy (P = .29) patients. RFS was not statistically significantly different across surveillance intensity groups for radiation therapy (P = .13) patients but was for radical prostatectomy (P = .01) patients with high intensity associated with the worst RFS. In both treatments, higher surveillance intensity was associated with more procedures and salvage treatments.
Conclusions: In patients with localized prostate cancer, more frequent PSA surveillance testing after radical prostatectomy or radiation therapy was associated with increased procedures and salvage treatments but not overall survival.
{"title":"Posttreatment surveillance intensity and overall survival in prostate cancer survivors (AFT-30).","authors":"Ronald C Chen, Ramsankar Basak, Stacie Dusetzina, Deborah S Usinger, Zahed Mohammed, Aaron D Falchook, Jessica R Schumacher, Amanda B Francescatti, Amanda Cuddy, George J Chang, Benjamin D Kozower, Caprice C Greenberg, Anne K Barber, Aaron J Katz","doi":"10.1093/jncics/pkae099","DOIUrl":"10.1093/jncics/pkae099","url":null,"abstract":"<p><strong>Background: </strong>Posttreatment surveillance affects millions of cancer survivors, but empiric data to guide clinical practice are lacking. This study assessed whether the intensity of surveillance testing after radical prostatectomy or radiation therapy for localized prostate cancer is associated with overall survival.</p><p><strong>Methods: </strong>Men diagnosed with localized prostate cancer between 2005 and 2010 who underwent radical prostatectomy or radiation therapy at a Commission on Cancer-accredited facility were randomly sampled. Primary data collected from 10 147 patients sampled across 1007 facilities were linked with existing data from the National Cancer Database. Analysis examined whether intensity of surveillance measured as the number of prostate-specific antigen (PSA) tests in the first year after primary treatment (categorized as 0-1 [low intensity], 2 [medium], or ≥3 [high intensity] PSA tests) was associated with overall survival. Secondary outcomes included recurrence-free survival (RFS) and subsequent use of imaging tests, biopsy procedures, and salvage treatment.</p><p><strong>Results: </strong>Median follow-up exceeded 8 years from prostate cancer diagnosis. Overall survival was not statistically significantly different across surveillance intensity groups among radiation therapy (P = .59) or radical prostatectomy (P = .29) patients. RFS was not statistically significantly different across surveillance intensity groups for radiation therapy (P = .13) patients but was for radical prostatectomy (P = .01) patients with high intensity associated with the worst RFS. In both treatments, higher surveillance intensity was associated with more procedures and salvage treatments.</p><p><strong>Conclusions: </strong>In patients with localized prostate cancer, more frequent PSA surveillance testing after radical prostatectomy or radiation therapy was associated with increased procedures and salvage treatments but not overall survival.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angelina Tjokrowidjaja, Peey-Sei Kok, Yoland C Antill, Clare L Scott, Linda R Mileshkin, Michael L Friedlander, Chee K Lee
Background: Chemo-immunotherapy is standard of care for women with recurrent or advanced mismatch repair deficient endometrial carcinoma. However, it is uncertain whether patients with mismatch repair deficient advanced or recurrent endometrial carcinoma derive less benefit from chemotherapy than those with mismatch repair proficient endometrial carcinoma.
Methods: We performed a meta-analysis of randomized controlled trials (RCTs) in advanced or recurrent endometrial carcinoma to determine the difference in the benefit of chemotherapy in mismatch repair deficient vs mismatch repair proficient endometrial carcinoma. Data on chemotherapy outcomes including objective response rate, progression-free survival (PFS), and overall survival were retrieved. We pooled these data using the inverse variance method and examined subgroup difference by mismatch repair status. We also compared differences in PFS and overall survival outcomes by creating individual patient data from the Kaplan-Meier curves of trial publications for sensitivity analyses.
Results: A total of 5 RCTs with 1137 participants (mismatch repair deficient, 26%; mismatch repair proficient, 74%) were included. All participants were treated with carboplatin-based chemotherapy. There was no difference between the mismatch repair deficient and mismatch repair proficient subgroups for objective response rate (66.5% vs 64.0%; P = .20 for subgroup difference), PFS (hazard ratio [HR] = 0.93, 95% confidence interval [CI] = 0.77 to 1.12; P = .44; median PFS = 7.6 vs 9.5 months) or overall survival (HR = 1.03, 95% CI = 0.73 to 1.44; P = .88; median overall survival = not reached vs 28.6 months).
Conclusions: Objective response rate, PFS, and overall survival were similar among those with mismatch repair deficient vs mismatch repair proficient endometrial cancer treated with front-line, platinum-doublet chemotherapy in RCTs. These findings reinforce the importance of combining chemotherapy together with immune checkpoint inhibitors until the results of trials comparing immune checkpoint therapy alone with combination therapy are available.
简介:化疗免疫疗法是治疗复发或晚期错配修复缺陷(dMMR)子宫内膜癌(EC)妇女的标准疗法。然而,目前还不确定dMMR晚期或复发性子宫内膜癌患者从化疗中获得的益处是否少于错配修复熟练型(pMMR)子宫内膜癌患者:我们对晚期/复发性EC的随机对照试验(RCT)进行了荟萃分析,以确定dMMR与pMMR EC化疗获益的差异。我们检索了化疗结果数据,包括客观反应率(ORR)、无进展生存期(PFS)和总生存期(OS)。我们使用逆方差法汇总了这些数据,并根据 MMR 状态研究了亚组差异。我们还通过从试验出版物的 Kaplan-Meier 曲线中创建单个患者数据来比较 PFS 和 OS 结果的差异,以进行敏感性分析:共纳入了 5 项 RCT,1137 名参与者(dMMR,26%;pMMR,74%)。所有参与者均接受了以卡铂为基础的化疗。dMMR亚组和pMMR亚组在ORR(66.5% vs 64.0%,亚组差异P = .20)、PFS(HR 0.93,95% CI 0.77-1.12,P = .44;中位PFS 7.6 vs 9.5个月)或OS(HR 1.03,95% CI 0.73-1.44,P = .88;未达到中位OS vs 28.6个月)方面没有差异:结论:在随机临床试验中,dMMR与pMMR子宫内膜癌患者接受一线铂双药化疗的ORR、PFS和OS相似。这些发现加强了化疗与免疫检查点抑制剂联合治疗的重要性,直到将免疫检查点疗法单独与联合疗法进行比较的试验结果出来为止。
{"title":"Impact of chemotherapy on patients with mismatch repair deficient advanced endometrial carcinomas-a meta-analysis.","authors":"Angelina Tjokrowidjaja, Peey-Sei Kok, Yoland C Antill, Clare L Scott, Linda R Mileshkin, Michael L Friedlander, Chee K Lee","doi":"10.1093/jncics/pkae101","DOIUrl":"10.1093/jncics/pkae101","url":null,"abstract":"<p><strong>Background: </strong>Chemo-immunotherapy is standard of care for women with recurrent or advanced mismatch repair deficient endometrial carcinoma. However, it is uncertain whether patients with mismatch repair deficient advanced or recurrent endometrial carcinoma derive less benefit from chemotherapy than those with mismatch repair proficient endometrial carcinoma.</p><p><strong>Methods: </strong>We performed a meta-analysis of randomized controlled trials (RCTs) in advanced or recurrent endometrial carcinoma to determine the difference in the benefit of chemotherapy in mismatch repair deficient vs mismatch repair proficient endometrial carcinoma. Data on chemotherapy outcomes including objective response rate, progression-free survival (PFS), and overall survival were retrieved. We pooled these data using the inverse variance method and examined subgroup difference by mismatch repair status. We also compared differences in PFS and overall survival outcomes by creating individual patient data from the Kaplan-Meier curves of trial publications for sensitivity analyses.</p><p><strong>Results: </strong>A total of 5 RCTs with 1137 participants (mismatch repair deficient, 26%; mismatch repair proficient, 74%) were included. All participants were treated with carboplatin-based chemotherapy. There was no difference between the mismatch repair deficient and mismatch repair proficient subgroups for objective response rate (66.5% vs 64.0%; P = .20 for subgroup difference), PFS (hazard ratio [HR] = 0.93, 95% confidence interval [CI] = 0.77 to 1.12; P = .44; median PFS = 7.6 vs 9.5 months) or overall survival (HR = 1.03, 95% CI = 0.73 to 1.44; P = .88; median overall survival = not reached vs 28.6 months).</p><p><strong>Conclusions: </strong>Objective response rate, PFS, and overall survival were similar among those with mismatch repair deficient vs mismatch repair proficient endometrial cancer treated with front-line, platinum-doublet chemotherapy in RCTs. These findings reinforce the importance of combining chemotherapy together with immune checkpoint inhibitors until the results of trials comparing immune checkpoint therapy alone with combination therapy are available.</p>","PeriodicalId":14681,"journal":{"name":"JNCI Cancer Spectrum","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}