Asia-Pacific journal of clinical oncology最新文献

Aim: Molecular tumor profiling (MTP) aims to link biomarker targets to corresponding treatments, usually via clinical trials. The usefulness of offering MTP for patients in a regional/rural setting is unknown, including assessment of outcomes of commencement on a clinical trial and potential cost savings.

Methods: Patients with advanced or rare cancers at a regional cancer center underwent MTP of their biopsy specimens, which was organized and conducted by a central laboratory, as part of the Garvan Research Institute Cancer Molecular Screening and Therapeutics Program (MoST) research study. Treating clinicians then received a report of mutations, alongside potential clinical trials, after discussion of the case at a molecular tumor board. Available trials were then offered to patients. The cost of potentially travelling to a tertiary center was compared to travelling locally for the patients who went on a clinical trial.

Results: Potential clinical trials were found for 69 of 89 participants as a result of MTP. Eleven patients accepted a trial, with 10 of these being a trial delivered locally. The average cost saving to a patient on average for a return trip to a regional center rather than a metropolitan center was $592.04.

Conclusion: While somatic mutations are common and trials are available for patients with advanced and/or rare cancer, trials administered locally are favored, and cost savings may contribute to this.

Purpose: This study aims to evaluate real-world survival outcomes of patients with epidermal growth factor receptor (EGFR)-mutant advanced non-small cell lung cancer (NSCLC) by the generation of EGFR tyrosine kinase inhibitor (TKI) as a first-line treatment.

Methods: A total of 893 patients with advanced EGFR-mutant NSCLC between January 2010 and June 2020 were identified through the clinical data warehouse-fully aligned with the electronic medical records-at Seoul National University Hospital in South Korea. Kaplan-Meire and multivariate Cox proportional hazard regression analyses were conducted to explore the overall survival (OS) between patients treated with first-/second-generation as their first-line treatment (1G/2G first) and third generation first-line EGFR TKIs (3G first).

Results: Of the 893 patients, 831 patients (93.1%) were in the 1G/2G first group, and 62 patients (6.9%) were in 3G first group. In 1G/2G first group, 324 (39.0%) switched to the next therapy with 3G EGFR TKI. The median OS for 1G/2G first group was 35.6 months (95% confidence interval [CI]: 31.1-39.1) and those for 3G first group was 47.6 months (95% CI: 41.4-not estimable [NE]). Multivariate Cox regression analysis revealed that first-line treatment with 3G EGFR TKIs conferred a significant survival benefit compared with 1G/2G TKIs (HR: 0.64; 95% CI: 0.45-0.92; p = 0.015). In addition, subgroup analysis showed that patients with brain metastases had significantly better survival with first-line 3G EGFR TKIs than with 1G/2G agents (HR: 0.54; 95% CI, 0.31-0.94; p = 0.031).

Conclusion: Based on real-world data, first-line treatment with 3G EGFR TKIs demonstrated a significant survival benefit compared with 1G/2G EGFR TKIs.

Aims: Anaplastic thyroid cancer (ATC) is a rare and aggressive malignancy with limited treatment options and a poor prognosis. This study evaluates the outcomes of patients with locally advanced or metastatic ATC treated at two tertiary centres, focusing on the efficacy of pembrolizumab and lenvatinib, and the impact of BRAF status.

Method: A retrospective review of 16 ATC patients treated between January 2018 and June 2024 at two tertiary Australian hospitals was conducted. Pathological confirmation was required for inclusion. Clinical data, including treatment regimens, response rates assessed by Response Evaluation Criteria in Solid Tumours version 1.1 (RECIST 1.1), progression-free survival (PFS), and overall survival (OS), were analysed.

Results: Fifteen out of 16 patients (94%) had metastatic disease. Five patients (31%) had a BRAFV600E mutation, with four receiving first-line (1L) dabrafenib/trametinib, achieving a 75% (3/4) objective response rate. Eleven patients (50%) were BRAF wildtype, and eight received pembrolizumab and lenvatinib as both 1L and second-line (2L) settings, with an objective response rate of 75% (6/8) in both 1L and 2L settings, including three complete responses. Programmed death-ligand 1 tumour proportional score ≥50% was found in 64% (9/14) of patients, correlating with better outcomes. Median time on treatment for the pembrolizumab and lenvatinib group was not reached, with the longest survival exceeding 12 months at the time of data cut-off.

Conclusion: This case series highlights promising outcomes with systemic treatment options in ATC, but the analysis is limited by a small sample size, emphasising the need for further research and collaboration to improve clinical outcomes.

Aim: OTUD7B (ovarian tumor domain-containing 7B) is a deubiquitinase that has established prognostic significance in diffuse large B-cell lymphoma and various solid tumors. In our present work, we aimed to explore its role in NK/T cell lymphoma (NKTCL).

Methods: Expression level of OTUD7B was assessed through immunohistochemistry in 53 NKTCL tissue samples. Statistical analyses were conducted to elucidate correlations between its expression and clinicopathological parameters of patients. Kaplan-Meier survival curves were constructed for survival analyses.

Results: OTUD7B was overexpressed in 41 (77.4%) NK/T tissue samples. Remarkably, patients with OTUD7B overexpression exhibit improved progression-free survival (PFS) (p = 0.021) and overall survival (OS) compared to those with low OTUD7B expression (p = 0.007). Multivariate Cox regression analysis demonstrated that OTUD7B was an independent prognostic indicator for both PFS (p = 0.037, HR = 0.401, 95% CI: 0.169-0.947) and OS (p = 0.043, HR = 0.278, 95% CI: 0.081-0.961) in NTKCL patients.

Conclusion: OTUD7B could act as a prognostic indicator in NTKCL patients; further investigations remain imperative.

Aim: Locoregionally advanced oral cavity squamous cell carcinoma (LA-OCSCC) imposes a high disease burden, significantly affecting patients' quality of life. We aimed to identify unmet needs and challenges faced by patients, caregivers, and healthcare professionals (HCPs) in diagnosis and managing LA-OCSCC.

Methods: In-depth interviews were conducted across Australia, Hong Kong, South Korea, Taiwan, and Vietnam with LA-OCSCC patients (n = 28), caregivers (n = 27), and HCPs (surgeons, clinical, radiation, and medical oncologists [n = 30]; nurses, case managers/coordinators, psychologists, speech therapists, dieticians, and dentists [n = 30]). Patients who received post-operative chemoradiotherapy for Stage III-IVB LA-OCSCC, their caregivers, and HCPs were eligible. The interview guide, design, and analysis were based on the Capability, Opportunity, Motivation, Behavior (COM-B) model.

Results: Major service gaps in timely diagnosis, treatment, patient-centered care, and therapeutic alliance were identified. Limited awareness of LA-OCSCC led to overlooked symptoms, delaying medical attention. General practitioners were perceived as less experienced in identifying LA-OCSCC symptoms accurately and promptly, with dentists being more informed. A shortage of nurses to support integrated multidisciplinary team discussions, patient education, and to relay patients' needs to specialists, compromised patient-centric care. Psychotherapeutic services were scarce, with supportive care professionals overextending to bridge the gap.

Conclusion: This study examined LA-OCSCC care management in five Asia-Pacific countries/territories with varying healthcare systems and infrastructure. Given LA-OCSCC's aggressive nature and high burden from disease and treatment, patients and caregivers require support beyond medical interventions. A multi-stakeholder approach with clinical and community care is essential to ensure a comprehensive and sustainable approach to patient-centered care within the different health systems.

Aim: This study aims to better understand factors driving the rising burden and costs of primary liver cancer (PLC) in Australia, identify key epidemiological trends, and ascertain investment in PLC research, relative to its disease burden.

Methods: Funding statistics of the National Health and Medical Research Council and the Medical Research Future Fund were adapted from published reports. Grant-related statistics are based on applications containing the relevant search terms for each cancer. Epidemiological data in Australia are based on cancer reports of the Australian Institute of Health and Welfare. Cancer mortality data are based on those reported by the National Mortality Database.

Results: Compared to other common cancers, the incidence and mortality rates of PLC have increased in the past 10 years and are more evident among populations of lower socioeconomic status, Indigenous Australians, residents in remote areas, and culturally and linguistically diverse populations. In contrast to the downward trend in disability-adjusted life years (DALYs) in other common cancers, PLC shows a significant increase in DALYs between 2015 and 2022; 23.3% of total DALYs loss occurred in those aged 40-59 years. The health, social, and economic impacts are disproportionally reflected in research investment.

Conclusion: In Australia, PLC is a significant health, social, and economic burden. Disparities between the burden of PLC and research investment reinforce the need for greater awareness and targeted investment. Collaborative efforts involving multiple stakeholders spanning policy, public health, implementation, and funded research are required to tackle the challenge.

Aim: Avelumab first-line (1L) maintenance was approved for treatment of advanced urothelial carcinoma (UC) based on results from the JAVELIN Bladder 100 Phase 3 trial. We report real-world data from an early access program (EAP) for avelumab 1L maintenance treatment in Malaysia.

Methods: Data from patients with locally advanced or metastatic UC who received ≥ 1 dose of avelumab 1L maintenance treatment between September 2021 and January 2023 were obtained retrospectively. Patient and treatment characteristics, best response to treatment, and safety were assessed.

Results: Data were provided from 13 patients treated at 9 hospitals in Malaysia. Seven patients (53.8%) were female, and ECOG performance status prior to 1L chemotherapy was 0-1 in 11 patients (84.6%) and 2 in 2 patients (15.4%). Chemotherapy included cisplatin in 6 patients (46.2%) and carboplatin in 7 patients (53.8%), and the best response was complete response in 1 patient (7.7%), partial response in 7 patients (53.8%), and stable disease in 5 patients (38.5%). The median duration of avelumab treatment was 9 months, with treatment ongoing in 4 patients (30.8%) at last follow-up. The objective response rate was 30.8% and an additional 5 patients (38.5%) had stable disease as the best response. Median PFS was 10.4 months. Reasons for discontinuation were disease progression in 8 patients (61.5%) and patient withdrawal in 1 patient (7.7%). Treatment-related adverse events occurred in 3 patients (23.1%) and were grade 2 in 1 patient (7.7%) and grade 1 in 2 (15.4%).

Conclusions: Data from this small EAP population support the use of avelumab 1L maintenance treatment in patients with advanced UC in Malaysia.

Aim: The cost of treating cancer, especially metastatic disease, can place a financial burden on patients, caregivers, and the healthcare system. A previous systematic review assessing the cost of treating metastatic colorectal cancer in the era of personalized medicine showed that this was approximately 300,000 USD. Surprisingly, there is little data on the cost of treating patients with colorectal liver metastases (CRLM). The aim of this study was to conduct a pilot cost-of-illness study on patients who undergo liver resection for CRLM in Australia.

Methods: This was a retrospective cohort study examining the direct medical costs to the healthcare system and out-of-pocket costs to patients who underwent resection for CRLM in 1 year (2018). These costs were calculated in 2022 Australian dollars from the time of the diagnosis of the liver metastases to the time of the last follow-up.

Results: A total of 25 patients underwent resection in 2018, but only 16 received all their treatment at the Northern Campus. The median total cost of treating each patient was $328,773.59 (range: $63,244.40-$525,873.10). The highest cost was for medical oncology treatment, with a median of $90,228.87 per patient (range: $2087.06-$241,514.80), followed by liver surgery and consultations, $57,131.76 (range: $12,455.10-$319,178.90), and colorectal surgery and consultations, $55,990.29 (range: $7234.19-$200,755.60). Patients considered to be cured of their disease had a lower median cost than patients who had either died from their disease or were undergoing treatment for recurrent disease ($152,476.50 vs. $351,487.50, p = 0.030).

Conclusion: This study demonstrates that the cost of treating patients with CRLM in Australia is moderate but is considerably lower than many other cancer types, especially for those who are cured, reflecting good value care.