Real-world clinical outcomes

  • 文章类型: Journal Article
    背景:关于患者特征的真实世界数据,辅助治疗模式,和长期生存结局需要更好地了解完全切除的早期非小细胞肺癌(NSCLC)患者的未满足需求.
    方法:在2016年3月1日之前接受完全切除的IB-IIIA期非小细胞肺癌患者中,分析了来自美国ConcertAIPatient360™数据库的电子病历。随访患者直至死亡或2021年7月1日。这项研究评估了辅助化疗的使用,使用Kaplan-Meier方法的总生存期(OS)和真实世界无病生存期(rwDFS)结局。使用Kendall秩检验评估OS和rwDFS之间的相关性。在手术后5年没有复发的患者中,对OS和rwDFS进行了具有里程碑意义的分析,以了解保持至少5年无病的后续生存影响.
    结果:纳入了441例完全切除的IB-IIIA期非小细胞肺癌患者的数据。约35%的患者在切除后接受辅助化疗。手术切除的中位OS和rwDFS分别为83.1个月和42.4个月,分别。5年OS和rwDFS率分别为65.7%和42.1%,分别。OS和rwDFS呈正相关(Kendall秩相关系数=0.67;p<0.0001)。在切除后5年内无复发的患者中,随后的5年OS和rwDFS生存率分别为52.9%和36.6%,分别。
    结论:辅助化疗的使用率较低,尽管所有患者都接受了完全切除,但5年总OS率仍然很低.随着时间的推移保持非复发的患者具有良好的后续长期生存率。
    BACKGROUND: Real-world data regarding patient characteristics, adjuvant treatment patterns, and long-term survival outcomes are needed to better understand unmet needs among patients with completely resected early-stage non-small cell lung cancer (NSCLC).
    METHODS: Electronic medical records from the U.S.-based ConcertAI Patient360™ database were analyzed in patients with stage IB-IIIA NSCLC who underwent complete resection prior to March 1, 2016. Patients were followed until death or July 1, 2021. This study evaluated adjuvant chemotherapy use, and overall survival (OS) and real-world disease-free survival (rwDFS) outcomes using the Kaplan-Meier method. The correlation between OS and rwDFS was assessed using the Kendall rank test. Among patients who did not recur 5 years following surgery, landmark analyses of OS and rwDFS were conducted to understand the subsequent survival impact of remaining disease-free for at least 5 years.
    RESULTS: Data from 441 patients with completely resected stage IB-IIIA NSCLC were included. About 35% of patients received adjuvant chemotherapy post-resection. Median OS and rwDFS from resection were 83.1 months and 42.4 months, respectively. The 5-year OS and rwDFS rates were 65.7% and 42.1%, respectively. OS and rwDFS were positively correlated (Kendall rank correlation coefficient = 0.67; p < 0.0001). Among patients without recurrence within 5 years after resection, the subsequent 5-year OS and rwDFS survival rates were 52.9% and 36.6%, respectively.
    CONCLUSIONS: Use of adjuvant chemotherapy was low, and the overall 5-year OS rate remained low despite all patients having undergone complete resection. Patients who remained non-recurrent over time had favorable subsequent long-term survival.
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  • 文章类型: Journal Article
    目的:转移性三阴性乳腺癌(mTNBC)患者预后差,治疗选择有限。Sacituzumabgovitecan(SG),Trop-2定向抗体-药物偶联物,根据ASCENT研究(NCT02574455),已批准用于接受≥2次全身治疗(转移情况下≥1次)的mTNBC患者。目前的研究描述了在美国mTNBC患者的真实世界SG使用和结果。
    方法:本回顾性研究,观察性研究纳入了来自ConcertAIPatient360™数据库的mTNBC成年患者,这些患者在第二行(2L)接受SG治疗,随后于2020年4月至2022年5月接受SG治疗.SG使用模式,有效性,描述了耐受性。
    结果:该分析包括230名患者(中位年龄60岁,26%黑色,ECOG表现状态≥2的占17%,社区环境中占66%;转移环境中2种先前治疗方案的中位数);中位随访时间为7.2个月。所有患者的中位(95%CI)真实世界总生存期为10.0(8.3-11.1)个月,2L亚组为13.9(9.8-不可估计)个月(n=77)。134例(58%)患者与SG同时施用粒细胞集落刺激因子(G-CSF);35例(15%)首次接受G-CSF。从SG开始到G-CSF使用的中位数(IQR)时间为8.5(8.0-29.0)天。17名(7%)患者因毒性而停用SG。
    结论:使用真实世界,不同种族的mTNBC患者预后不良,这些数据强化了ASCENT的发现.在常规临床实践中,SG在2L设置中是一种有效的治疗方法,符合治疗指南。
    OBJECTIVE: Patients with metastatic triple-negative breast cancer (mTNBC) have poor prognosis and limited treatment options. Sacituzumab govitecan (SG), a Trop-2-directed antibody-drug conjugate, is approved for patients with mTNBC who have received ≥ 2 systemic therapies (≥ 1 in the metastatic setting) based on the ASCENT study (NCT02574455). The current study describes real-world SG use and outcomes in patients with mTNBC in the United States.
    METHODS: This retrospective, observational study included adult patients with mTNBC from the ConcertAI Patient360™ database who received SG in the second line (2L) and later from April 2020 to May 2022. SG use patterns, effectiveness, and tolerability are described.
    RESULTS: This analysis included 230 patients (median age 60 years, 26% Black, 17% with ECOG performance status ≥ 2, 66% in community settings; median of 2 prior lines of treatment in the metastatic setting); median follow-up was 7.2 months. Median (95% CI) real-world overall survival was 10.0 (8.3-11.1) months for all patients and 13.9 (9.8-not estimable) months in the 2L subgroup (n = 77). Granulocyte-colony stimulating factor (G-CSF) was administered concomitantly with SG in 134 (58%) patients; 35 (15%) received G-CSF for the first time. Median (IQR) time from SG start to G-CSF use was 8.5 (8.0-29.0) days. Seventeen (7%) patients discontinued SG due to toxicity.
    CONCLUSIONS: Using a real-world, ethnically diverse population of patients with mTNBC presenting with poor prognosis, these data reinforced the findings from ASCENT. In routine clinical practice, SG is an effective treatment in the 2L setting, consistent with treatment guidelines.
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  • 文章类型: Journal Article
    目的:需要有关早期非小细胞肺癌(NSCLC)结果的真实数据,以更好地了解新疗法的益处。方法:在这项回顾性研究中,使用ConcertAIPatient360™数据库,比较了复发和非复发完全切除的IB-IIIA期NSCLC患者的总生存期和医疗资源利用情况.结果:与非复发相比,复发与中位总生存期较短相关(31.5个月vs75.6个月,分别),切除后5年生存率较低,和更高的医疗资源利用率。与早期复发患者相比,晚期复发患者的受限平均生存时间更长。结论:这项现实世界研究的结果强调了预防或延迟早期NSCLC患者复发的潜在价值。
    这项研究观察了早期非小细胞肺癌患者在手术后如何彻底切除疾病。它比较了两组患者:手术后疾病复发的患者和手术后疾病未复发的患者。手术后疾病复发的人群的寿命不如手术后疾病未复发的人群(31.5个月vs75.6个月)。疾病复发的患者在手术后至少5年存活的机会较低,他们有更多的医院就诊和医生就诊。此外,那些疾病在1年内复发的人的寿命不如那些疾病在手术后1至5年内复发的人。预防或延迟手术后疾病的复发对于改善早期非小细胞肺癌患者的生活至关重要。
    Aim: Real-world data on outcomes for early-stage non-small-cell lung cancer (NSCLC) are needed to better understand the benefits of new therapies. Methods: In this retrospective study using the ConcertAI Patient360™ database, overall survival and healthcare resource utilization were compared among patients with recurrent and non-recurrent completely resected stage IB-IIIA NSCLC. Results: Recurrence was associated with a shorter median overall survival compared with non-recurrence (31.5 months vs 75.6 months, respectively), lower survival probability 5-years post-resection, and higher healthcare resource utilization. Patients with late recurrence had a longer restricted mean survival time versus patients with early recurrence. Conclusion: Results from this real-world study highlight the potential value of preventing or delaying recurrence in patients with early-stage NSCLC.
    This study looked at how people with early-stage non-small-cell lung cancer did after surgery to completely remove the disease. It compared two groups of patients: those whose disease came back after surgery and those whose disease did not come back after surgery. The group of people whose disease came back after surgery did not live as long as those whose disease did not come back after surgery (31.5 months vs 75.6 months). Patients whose disease came back had a lower chance of living at least 5 years after surgery and they had more hospital visits and doctor\'s office visits. In addition, those whose disease came back within 1 year did not live as long as those whose disease came back between 1 and 5 years after surgery. Preventing or delaying the return of disease after surgery is important for improving the lives of patients with early-stage non-small-cell lung cancer.
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  • 文章类型: Journal Article
    RE-COVERY DVT/PE is a two-phase, international, observational study of anticoagulant therapy in patients with deep vein thrombosis and/or pulmonary embolism (DVT/PE). The objective of the second phase was to compare the safety and effectiveness of dabigatran versus a vitamin K antagonist (VKA) over 1 year of follow-up. Primary safety and effectiveness outcomes were major or clinically relevant nonmajor bleeding events (MBE/CRNMBEs) and symptomatic recurrent venous thromboembolism (VTE) (including deaths related to recurrent VTE). To minimize bias due to unbalanced patient characteristics, only patients in an overlapping range of estimated propensity scores were included (analytic set), and propensity score weighting was applied to compare outcomes. Outcome analysis used an as-treated approach, censoring patients after they stopped or switched their initial anticoagulant. Overall, 3009 patients enrolled from 2016 to 2018 were eligible: 60% were diagnosed with DVT alone, 21% with PE alone, and 19% with DVT plus PE. The analytic set consisted of 2969 patients. The incidence rate in %/year (95% confidence interval [CI]) of MBE/CRNMBEs was 2.63 (1.79-3.74) with dabigatran versus 4.48 (3.23-6.06) with warfarin; hazard ratio 0.63 (95% CI 0.32-1.25). For symptomatic recurrent nonfatal or fatal VTE the incidence rate was 1.53 (0.91-2.42) with dabigatran versus 2.01 (1.21-3.14) with VKAs; hazard ratio 0.78 (95% CI 0.30-2.02). In conclusion, we found lower annualized rates of MBE/CRNMBEs with dabigatran than VKA, although the difference was not statistically significant. Annualized rates of symptomatic VTE or related mortality were similar with dabigatran and VKA. These observational results with 1 year of follow-up reflect those of the randomized clinical trials. Trial registration: ClinicalTrials.gov identifier NCT02596230, first registered November 4, 2015.
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  • 文章类型: Journal Article
    Aim: To assess clinical outcomes in patients with locally advanced (la) or metastatic (m) Merkel cell carcinoma (MCC) initiating first-line (1L) avelumab in a USA community oncology setting. Materials & methods: Adults with laMCC or mMCC initiating 1L avelumab were identified from The US Oncology Network electronic health record database and chart review. Results: Median overall survival and progression-free survival were not reached in laMCC (n = 9) vs 20.2 and 10.0 months in mMCC (n = 19); response rates were similar (66.7% vs 63.2%). Conclusion: This is the first study to show clinical benefit in patients with laMCC receiving 1L avelumab in a US real-world setting. Response rates in patients with mMCC were consistent with pivotal trials.
    Lay abstract Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer. Because MCC progresses quickly, many patients have a poor prognosis. Avelumab is a type of drug that helps the patient\'s immune system to fight cancer. Avelumab was the first such drug approved by the US FDA for treating metastatic MCC based on the results of the JAVELIN Merkel 200 clinical trial. In SPEAR-Merkel, we studied how MCC patients with locally advanced as well as metastatic disease responded when they were treated with first-line avelumab in a real-world setting. These patients were from oncology practices in communities throughout the USA. Overall response rates in SPEAR-Merkel were comparable between patients with locally advanced and metastatic MCC. Importantly, we found that these patients experienced survival benefit similar to patients in the JAVELIN Merkel 200 (part B) study and other real-world studies.
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  • 文章类型: Journal Article
    UNASSIGNED: Clinical trial evidence has affirmed the role for immuno-oncology (IO) treatment for locally advanced or metastatic urothelial carcinoma (la/mUC). This Study informing treatment Pathway dEcision in bladder cAnceR (SPEAR-Bladder) aimed to provide insight into the optimal sequencing of IO treatments among la/mUC patients treated in the US Oncology Network.
    UNASSIGNED: This was a retrospective analysis of adult patients with la/mUC who initiated first-line chemotherapy followed by either IO therapy (C-IO subgroup) or chemotherapy (C-C subgroup) between 01/01/2015 and 04/30/2017 and included a potential follow-up period through 06/30/2017. Data were sourced from iKnowMed electronic health records. Patient and treatment characteristics were assessed descriptively, with Kaplan-Meier methods used to evaluate time-to-event outcomes, including overall survival (OS).
    UNASSIGNED: A total of 117 patients were included in this analysis (median age 69 years, 74.4% male, 88.0% Caucasian): 79 and 38 patients were in the C-IO and C-C subgroups, respectively. The median OS was 19.2 months among patients who received the C-IO sequence and 11.9 months among those who received the C-C treatment sequence.
    UNASSIGNED: These results suggest that patients who received the C-IO treatment sequence had notable improvement in OS compared with those who received the C-C sequence. In light of the rapidly evolving therapeutic landscape, further investigation will be required to determine how best to select the optimal therapeutic regimen and sequencing for patients with la/mUC.
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