Care For Small Cell Lung Cancer Research Articles

Examining Patient-Centered Small Cell Lung Cancer Care: Patient and Provider Perspectives

Examining Patient-Centered Small Cell Lung Cancer Care: Patient and Provider Perspectives

Association of area-level mortgage discrimination and guideline-concordant non–small cell lung cancer care in the United States.

3 Background: Disparities in receipt of care for non-small cell lung cancer (NSCLC) are well described. Discriminatory mortgage lending, which limits access to home ownership in specific neighborhoods overall and disproportionately for racialized groups, is a marker of systemic racism and lower levels of neighborhood investment. This may, in turn, decrease access to high quality care. We used the mortgage denial rate as a measure of housing discrimination and investigated its association with guideline-concordant NSCLC care. Methods: Mortgage denial rates were estimated at the zip code tabulation areas (ZCTAs) level using the Home Mortgage Disclosure Act (HMDA) database (2014-2019). Mortgage denial rates represent the proportion of denied home loans to total loans and were categorized into quartiles. Individuals ≥ 18 years diagnosed with NSCLC 2014-2019 were identified from the National Cancer Database and combined with HMDA. Multivariable logistic regression models examined associations between mortgage discrimination and receipt of guideline-concordant care, including surgery, chemotherapy, and chemoradiation. A multivariable Cox proportional hazard model examined the association between mortgage discrimination and time to chemotherapy initiation. Results: Cohort included 450,614 patients newly diagnosed with NSCLC resided in 33,120 ZCTAs. Individuals residing in ZCTAs with higher mortgage denial rates were more likely to be aged 45-64 years, male, non-Hispanic White, with private health insurance coverage and income < $40,000/year. 69% of all patients received guideline-concordant care. Likelihood of guideline-concordant care was lower in neighborhoods with higher mortgage denial rates, adjusting for age and sex (Table). This disparity was present in all care subgroups. Time to chemotherapy initiation was longer for patients in neighborhoods with higher mortgage denial rates. Conclusions: Mortgage discrimination is adversely associated with receipt of guideline-concordant NSCLC care. Our examination of institutional practices leading to barriers in access to resources highlights the critical need to understand the pathways through which area-level mortgage denials impact receipt of equitable cancer care.[Table: see text]

Turnaround Time of Plasma Next-Generation Sequencing in Thoracic Oncology Patients: A Quality Improvement Analysis.

Genomic analysis of plasma cell-free DNA has become a widespread tool for advanced non-small-cell lung cancer care. Whereas accuracy has been reported on widely, its usefulness is also tied tightly to its turnaround time (TAT), which is not well studied. We studied the TAT of commercial plasma next-generation sequencing (NGS; Guardant360) for 533 results from 461 patients at our center between August 2016 and October 2019. The study received institutional review board approval as a quality improvement study; therefore, the results of the test and clinical setting were not analyzed. TAT from blood draw to result (median of 9 days) was slightly longer than the TAT from laboratory receipt to result, a median of 7 days. Testing volume at our center increased three-fold over the time of the study. During this period, clinical TAT decreased from an initial median of 12 days to a median of 8 days in 2018, but more recently the median increased slightly to 9 days. During the most recent 12 months, 231 (95%) of 247 cases resulted within 14 days from blood draw, with delayed results usually because of billing, whereas 44 cases (18%) resulted within 7 days of blood draw. Studying 92 cases drawn in the most recent 3-month period, the median time of result receipt was 4:01 pm Eastern Time/1:01 pm Pacific Time; 39 results (43%) were returned after 5:00 pm Eastern Time. In a large single-institution experience, we find that plasma NGS results can routinely be expected within 2 weeks, but uncommonly result within 1 week, supporting the need for new strategies to incorporate plasma NGS into the initial genotyping of advanced non-small-cell lung cancer.

PS01.72: Payer and Patient Out-of-Pocket Costs: A Projection of the Financial Burden of Non–Small Cell Lung Cancer Care in the United States Through 2040

PS01.72: Payer and Patient Out-of-Pocket Costs: A Projection of the Financial Burden of Non–Small Cell Lung Cancer Care in the United States Through 2040

Are oncologists involved in cancer biomarker decisions at their institutions?

6617 Background: Biomarkers play a critical role in oncology, but differences in accuracy and quality exist between different testing methods for specific markers. ASCO/CAP guidelines call for oncologists, on behalf of patients, to seek information on testing quality and to obtain assurance that testing laboratories are appropriately accredited (Wolff et al, JCO, 2007). We surveyed oncologists and pathologists from the NCI designated cancer centers to collect individual perception of their institution’s decision making on biomarkers, and awareness of lab quality accreditation. Methods: We conducted an IRB approved web survey of pathologists and oncologists at the 58 NCI designated cancer centers providing adult breast, gastric, esophageal and non small cell lung cancer care. The survey included 12 questions on institutional decision processes and lab quality accreditation. We analyzed results using simple frequencies and the Fisher's exact test. Results: The study achieved a response rate of 98% (57/58 sites), with survey responses from 115 pathologists and 156 oncologists. The perception that their institution uses a formal organizational review and decision process on new biomarker tests was reported by 47% (54/115) of pathologists and 31% (48/156) of oncologists (p= .0078). 22% (33/153) of oncologists report they are always involved in institutional decision making on biomarker method selection for their specialty. Awareness of CAP certification status for their institutional laboratory was reported by 88% (99/112) of pathologists and 46% (65/142) of oncologists (p <0.0001). Awareness of whether their institutional laboratory underwent CAP HER2 IHC and/or FISH proficiency testing was reported by 70% (53/76) of pathologists and by 21% (13/63) of oncologists who treat breast cancer (p<.0001). Conclusions: Oncologists are typically not actively involved in their institution’s decision making process to select biomarker testing methods, nor are many of them aware of their institutional lab’s quality accreditation. With the ever increasing role of biomarkers in cancer care, oncologists’ awareness of biomarker testing performance and their participation in decision making related to biomarkers will become critical.

911 POSTER Changes in the process of care for small-cell lung cancer (SCLC): Results of the 99-01 Patterns of Care Study (PCS) nationwide survey in Japan

911 POSTER Changes in the process of care for small-cell lung cancer (SCLC): Results of the 99-01 Patterns of Care Study (PCS) nationwide survey in Japan

Evaluation of the Use of Prophylactic Cranial Irradiation in Small-Cell Lung Cancer

<h3>Background</h3> Prophylactic cranial irradiation (PCI) is used in patients with small-cell lung cancer (SCLC) to reduce the incidence of brain metastasis after primary therapy. Our purpose was to evaluate the effects of PCI on overall survival (OS) and cause-specific survival. <h3>Patients and Methods</h3> A total of 7995 patients with limited-stage SCLC diagnosed between 1988 and 1997 were retrospectively identified from centers participating in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. Six hundred seventy patients were identified as having received PCI as a component of their first course of therapy. Overall survival and cause-specific survival were estimated by the Kaplan-Meier method, comparing patients treated with or without prophylactic whole-brain radiation therapy. The Cox proportional hazards model was used in the multivariate analysis to evaluate potential prognostic factors. <h3>Results</h3> The median follow-up time was 13 months (range, 1-180 months). Overall survival at 2 years and 5 years was 23% and 11%, respectively, in patients who did not receive PCI. In patients who received PCI, 2-year and 5-year OS was 42% and 19%, respectively (<i>P</i> < 0.001). Cause-specific survival at 2 and 5 years was 28% and 15%, respectively, in patients who did not receive PCI and 45% and 24%, respectively, in patients who did receive PCI (<i>P</i> < 0.001). On multivariate analysis of cause-specific and OS, age at diagnosis, sex, grade, extent of primary disease, size of disease, extent of nodal involvement, and PCI were significant (<i>P</i> < 0.001). The hazard ratios for disease-specific and all-cause mortality were 1.13 and 1.11 for those not receiving PCI, respectively. <h3>Conclusion</h3> Significantly improved overall and cause-specific survival were observed in patients treated with PCI on unadjusted and adjusted analyses. This study concurs with the European experience, which has been published. Prophylactic cranial irradiation should be considered the standard of care in SCLC.

Neoadjuvant chemotherapy in non small cell lung cancer

Standards of care for non small cell lung cancer (NSCLC) are not, yet, totally established. The role of induction chemotherapy is still debated while it has been established that adjuvant cisplatin based chemotherapy improve overall survival in completely resected patients. We will review the feasibility and efficacy of induction chemotherapy for patients with early-stage and locally advanced NSCLC, particularly with N2 disease. In the neoadjuvant setting, a 32 to 60% response rate is awaited considering the high treatment compliance. Near to 10% pathologic complete response rate is reported. Nevertheless, no large randomised phase III trial has demonstrated that induction chemotherapy could prolong patients overall survival. Suboptimal cytotoxic combinations and an increased surgical mortality might explain this result. Studies suggested that patient's subgroups (as downstaged N2 disease) could benefit from induction treatment. This still need to be confirmed in randomised trial and meta-analysis based on individual data.

Compliance with oral topotecan in patients with non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC)

7092 Background: Compliance with chemotherapy can affect treatment efficacy and patient safety. Selecting an oral chemotherapy regimen with good tolerability in appropriate patients is important. To determine general level of compliance of oral topotecan, a retrospective analysis was conducted on 3 international open-label, multicenter, 2-arm randomized, phase III studies of patients with NSCLC and SCLC. Methods: Patients were randomized to receive oral topotecan d1–5 q21d as follows: Study 387 (Ramlau et al, Proc ASCO, 2005) 2.3 mg/m2/d second-line vs IV docetaxel for NSCLC; Study 389 (Eckardt et al, Proc ASCO, 2005) 1.7 mg/m2/d first-line with cisplatin vs etoposide/cisplatin for extensive-disease SCLC; and Study 478 (O’Brien et al, Lung Cancer 2005) 2.3 mg/m2/d second-line vs best supportive care for SCLC. Oral topotecan was administered to the patient in the clinic on day 1 of each course and the patient was responsible for self-administering the oral capsules the remaining 4 days of dosing. Patient compliance was defined as 100x(sum of number of caps taken across courses)/(sum of number of caps dispensed across courses), where number of caps taken = number of caps dispensed-number of caps returned. Results: Accrual per arm was (387), 414 patients; (389) 389; (478) 71. In the treated population for all three groups, adherence to oral topotecan was high, with &gt;90% of patients recording at least 90% overall compliance (Table). Mean age (% ≥65 years/%PS 2) was (387) 58.8 years (29.2%/14%), (389) 59.7 (32.6%/13%), and (478) 59.8 (33.8%/27%). Median oral topotecan dose intensity (% target) for each course was (387) 87%, (389) 95%, and (478) 98%. The most common reason for dose reductions or delays was hematological toxicity. Conclusions: Oral topotecan can be administered on an outpatient basis with a high degree of patient compliance in the treated population, which included those ≥65 years and those with poor PS. [Table: see text] [Table: see text]

Current and evolving treatment options for limited stage small cell lung cancer

About one-third of small cell lung cancer cases are classified as limited stage. Trials have attempted to establish the most effective, least toxic regimen of combined modality treatment. Recently, issues like the role of the positron emission tomography scan, elderly patient management and the timing and delivery of radiotherapy have been addressed. Several targeted agents have also been evaluated. This review will highlight the data that have greatly impacted on the standard of limited stage small cell lung cancer care. Trials have concluded that small cell lung cancer is fluorodeoxy-D-glucose avid and that positron emission tomography has potential for utility in staging and radiation therapy planning, though it is not recommended. Recent trials confirm no benefit to adding chemotherapeutic agents to standard cisplatin and etoposide. To date, all targeted therapies have failed to show impressive results. Two analyses of outcomes in elderly patients argue that combined modality therapy should be considered, with patients carefully monitored. Two meta-analyses demonstrate thoracic radiotherapy should be delivered, with increased dose and schedule intensity. Current data demonstrate that combined modality therapy with early administration of thoracic radiotherapy remains the care standard in limited stage small cell lung cancer care. Cisplatin and etoposide continue to be the chosen cytotoxic agents. Targeted therapies and advances in the radiotherapy technological aspects represent opportunities for improved outcomes in the future management of this aggressive disease.