Utilization Of Adjuvant Chemotherapy Research Articles

Race/Ethnicity and Social Determinants of Health and Their Impact on Receiving Appropriate Chemotherapy for Colon Cancer.

Despite the heightened understanding and improved treatment for colorectal cancer in the United States, social determinants of health (SDH) play a significant role in the colorectal cancer outcomes. We sought to investigate the relationship between SDH and appropriate utilization of adjuvant chemotherapy in stage III colon cancer. For this retrospective study, we utilized data from the National Cancer Data Base (NCDB). Descriptive statistics are reported, including means and 95% confidence intervals for continuous variables and frequency and proportions for categorical variables. Univariate hypothesis testing to identify categorical level factors associated with treatment used Wilcoxon rank sum or Kruskal-Wallis tests, with multivariate analyses performed using regression analysis. Significant differences were as follows: Metro-non-Hispanic White patients received treatment less frequently (69.7%) when compared to Metro-non-Hispanic Black patients (73.4%) (P < .001). Increasing age was a negative predictor of likelihood to receive with those over 65years old having an 83% decrease in likelihood to receive chemotherapy when compared to those under 65 (P < .001). Medicaid patients were 47% less likely and Medicare patients were 40% less likely to receive chemotherapy when compared to those with private insurance (P < .001). Rural patients were statistically more likely to receive chemotherapy (OR 1.42, 1.32-2.52, P < .001) as were urban patients, (OR 1.26, 1.20-1.31, P < .001) when compared to patients residing in metro areas. Age, living in a Metro area, and government insurance status at diagnosis are negatively correlated with the likelihood of receiving chemotherapy. Race was not associated with differences in receiving chemotherapy.

Survival benefit of adjuvant chemotherapy in patients with resected gallbladder adenocarcinoma: An updated retrospective cohort analysis

BackgroundThe rarity yet high malignancy of gallbladder adenocarcinoma (GBA) endows it with a distinctive nature. Radical resection remains the foremost therapeutic approach for GBA, while the impact of early recurrence and metastasis on patient prognosis necessitates the utilization of adjuvant chemotherapy (AC). Despite numerous previous studies on this topic, a consensus regarding the authentic efficacy of AC has yet to be reached. MethodsWe conducted an updated retrospective cohort analysis utilizing data from the Surveillance, Epidemiology, and End Results (SEER) database spanning from 2010 to 2020 to explore the association between AC and survival outcomes in patients with resected GBA. ResultsOur study included 2782 patients from the SEER database, with further evaluation of 843 patients in each cohort following meticulous execution of a 1:1 propensity score matching. Remarkably, the AC cohort exhibited a significant survival advantage when juxtaposed against the non-AC cohort. Multivariable Cox regression analysis identified age at diagnosis, year at diagnosis, grade, AJCC T stage, AJCC N stage as well as AC as independent prognostic factors. Furthermore, our findings unveiled that poor/undifferentiated tumor histology, pathological T2 or higher category and pathological N1 category were significantly associated with improved survival when treated with AC while simultaneously observing improved survival across all age categories. ConclusionThese results provide additional evidence supporting the survival benefits of AC and offer guidance for personalized therapy in patients with resected GBA.

Prolonged length of stay and omission of adjuvant therapy are associated with early mortality after pancreatic adenocarcinoma resection

BackgroundSurgical resection is the preferred treatment for non-metastatic pancreatic adenocarcinoma, but post-resection survival is highly variable. We use the National Cancer Database Participant Use Files to investigate risk factors associated with early mortality (survival less than one year) after pancreatic adenocarcinoma resection. Methods51,345 cases of pancreatic adenocarcinoma were identified. 16,234 had survival between three months and one year (early mortality), and 35,111 had survival greater than one year. Descriptive analyses and multivariate Cox regression models were performed to identify demographic, perioperative, and tumor biology factors associated with early mortality. A sub-analysis subsequently explored the relationship between the length of stay and chemotherapy utilization. ResultsOf the 51,345 cases of pancreatic adenocarcinoma, 16,234 had early mortality. In multivariate models adjusted for demographic, socioeconomic, facility type, tumor characteristics, and hospital risk factors, patients with early mortality also had longer lengths of stay, more unplanned readmissions. They were more likely to receive treatment at non-academic centers. Adjuvant chemotherapy utilization was lower in patients with early mortality, particularly in those with longer lengths of stay. ConclusionReducing the length of stay, decreasing variability across different forms of health insurance, and increasing access to treatment at academic centers may reduce early mortality. Adjuvant chemotherapy is associated with a reduced risk of early mortality but is highly underutilized, especially in patients with prolonged hospital stays. Given that delays in receiving adjuvant chemotherapy were associated with an increased risk of early mortality, interventions to decrease perioperative complications to ensure timely access to adjuvant chemotherapy may improve survival.

Patterns of chemotherapy use in muscle-invasive bladder cancer in a tertiary centre.

Although neoadjuvant chemotherapy (NAC) has been demonstrated to have significant benefits to survival in patients with muscle-invasive bladder cancer (MIBC), the current utilization of NAC in Australia is unknown. The aim of this study was to evaluate the patterns of neoadjuvant and adjuvant chemotherapy (AC) use in patients undergoing cystectomy for MIBC at a large tertiary institution in Australia. A retrospective study was conducted using data of patients who underwent a radical cystectomy (RC) at a high-volume centre for MIBC between 2011 and 2021. Of 69 patients who had a cystectomy for ≥ pT2 bladder cancer, 73.9% were eligible for NAC. However, of those eligible, only five patients received NAC (9.8%). Of the total patients who were eligible for AC, only 44.4% received postoperative chemotherapy. Common reasons for the lack of uptake were due to patients being unfit or declining treatment. There was no difference in progression-free survival or overall survival in those who received NAC and AC. The majority of patients undergoing RC for MIBC received AC compared to NAC, reflecting the real-world challenge of NAC uptake. This highlights the need for ongoing improvements in selection and usage of NAC and less reliance of AC utilization post RC.

Prevalence and oncologic impact of chronic kidney disease for upper tract urothelial carcinoma in endemic area

ObjectiveThis study aimed to assess the impact of preoperative chronic kidney disease (CKD) on the oncological outcomes of patients with upper tract urothelial carcinoma (UTUC) who underwent standard radical nephroureterectomy (RNU). MethodsA total of 1172 UTUC patients who received RNU at a single center in Taiwan between February 2005 and August 2019 were included. The patients were categorized into two groups based on their preoperative CKD stage: CKD stage ≤3 (811 patients) and CKD stage >3 (361 patients). The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) formula. The study investigated the oncological outcomes, including intravesical recurrence, metastasis, and cancer-specific mortality, stratified by preoperative CKD status. ResultsThe main findings indicated that UTUC patients with CKD stage >3 in Taiwan exhibited a higher proportion of females (p < 0.001), a greater history of concurrent bladder cancer (p = 0.003), more multifocal tumor behavior (p < 0.001), a higher incidence of carcinoma in situ (p = 0.008), increased rates of intravesical recurrence (p < 0.001), a lower prevalence of smoking history (p = 0.003), lower utilization of adjuvant chemotherapy (p < 0.001), reduced occurrence of distant metastasis (p < 0.001), and lower cancer-specific mortality (p = 0.006) compared to patients with CKD stage ≤3. Multivariate Cox regression analysis revealed significant differences in intravesical recurrence (p = 0.014) and metastasis (p = 0.006) between the CKD stage >3 and CKD stage ≤3 groups. The study also demonstrated that patients with concurrent bladder cancer and variant histology had higher rates of intravesical recurrence, metastasis, and cancer-specific mortality. The CKD stage >3 group exhibited lower rates of intravesical recurrence (p = 0.0014), higher rates of metastasis (p < 0.0001), and increased cancer-specific mortality (p = 0.0091) compared to the CKD stage ≤3 group in the 5-year free survival analysis. ConclusionIn Taiwan, UTUC patients with CKD stage >3 exhibit distinct characteristics compared to the general population with urothelial carcinoma. They are associated with a non-smoking status, a higher proportion of females, and less aggressive pathological features. Additionally, CKD stage >3 can serve as a clinical indicator for intravesical and non-urothelial recurrence. Further investigation into molecular aspects and treatment modifications for these patients is warranted.

Facility type as a prognostic factor? The role of academic centers in outcomes and treatment for patients with leiomyosarcoma.

185 Background: Leiomyosarcoma is a highly aggressive form of cancer that comprises roughly 10-20% of soft tissue sarcomas. It originates in smooth muscle tissue and its prognosis largely depends on how quickly it is detected – with surgical resection being potentially curative if the cancer is caught before it metastasizes. Previous studies have shown that patients from lower socioeconomic statuses with soft tissue sarcomas have worse survival rates; however, it appears that the relationship between leiomyosarcoma, specifically, and socioeconomic status has yet to be determined. Using the National Cancer Database, we aim to uncover this relationship and define the role of academic centers on the treatment and outcomes of these patients. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with leiomyosarcoma from 2004 to 2019 using the histology codes 8890 and 8891. Socioeconomic and treatment variables were identified as assigned by the Commission on Cancer Accreditation program. Survival data was computed using logrank testing and a Cox proportional hazards model. Data was analyzed using IBM SPSS Statistics for Windows, Version 27.0 software (IBM Corp., Armonk, NY) and statistical significance was set at α = 0.05. Results: Initial search revealed 16,573 patients to be included for analysis. 7,003 patients (42.4%) were treated at an academic facility. Patients treated at academic/research facilities experienced improved overall survival (76.78 months vs. 60.52 months; p&lt;0.001), greater utilization of adjuvant chemotherapy (88.5 vs. 82.2%; p&lt;0.001), and higher rates of complete resection (87 vs. 83.4%; p&lt;0.001) compared with those treated at non-academic facilities. Furthermore, people traveled further for care at academic facilities (62.4 vs. 25.5 miles; p&lt;0.001), and were more likely to be younger, in higher income groups (36.9 vs. 33.2%; p&lt;0.001), Black, carry private insurance (44.9 vs 41.3%; p&lt;0.001), and less likely to have Medicare (42.7 vs. 49.4%; p&lt;0.001) compared with those at non-academic facilities. Extent of disease varied between facility type with patients at academic facilities presenting with higher rates of stages II and III disease, whereas those who presented to non-academic facilities had higher rates of stages I and IV disease. There were no differences observed between rates of palliative treatment, phase I radiation primary treatment volume, or tumor size between the two facility types. Conclusions: This analysis identifies various patient characteristics (e.g., income, race, insurance type) associated with seeking treatment at academic facilities for leiomyosarcoma, as well as the influence of facility type on patient outcomes with this cancer.

Prognosis and trends in chemotherapy use for patients with stage IA triple-negative breast cancer (TNBC): A population-based study.

510 Background: Outcomes for patients with stage IA TNBC in the modern era remain poorly characterized, and the benefit and utilization of adjuvant chemotherapy (chemo) in this setting remains controversial. Methods: We analyzed data from women diagnosed with pathological stage IA TNBC in the Surveillance, Epidemiology, and End Results (SEER) database during 2010 to 2019. We evaluated the associations of adjuvant chemo with breast-cancer specific survival (BCSS) stratified by tumor size, using multivariate cox models adjusted for tumor size (overall cohort only), age at diagnosis, race, tumor grade, histology, radiation, marital status, income, and rurality. Frequency of chemo use over time was examined by tumor size. Multivariate logistic regression assessed variables associated with chemo administration. Results: In total, we examined data from 8,601 women with stage IA TNBC. Median age at diagnosis was 62 years. Most patients had high-grade tumors (70.1%), ductal histology (92.8%), and received adjuvant chemo (61.6%). Median follow up was 48 months (IQR: 20 – 83). The use of chemo significantly increased during 2010-2019 for both T1b tumors (p for trend = 0.001) and T1c tumors (p for trend &lt; 0.001), with 52.5% and 63% of the patients with T1b and T1c TNBCs receiving chemo in 2010, respectively, compared with 60.5% and 71.1% in 2019. No significant differences were observed in the use of chemo for T1mic (p for trend = 0.567) and T1a (p for trend = 0.637) tumors, with low utilization seen in both cohorts (9.5% overall in T1mic, 22.5% overall in T1a). Variables associated with chemo use included younger age, white race, married status, higher income, more recent diagnosis, higher tumor grade, ductal histology, and larger tumor size (all p &lt; 0.02). Overall, 5-year BCSS was high across T groups ( &gt; 90%; Table). Receiving chemo (vs. none/unknown) was associated with an improved 5-year BCSS (adjusted HR for BCSS = 0.70, p = 0.006). For T1c tumors specifically, adjuvant chemo (vs. none/unknown) was also associated with BCSS (adjusted HR 0.64, p = 0.002). The small number of BCSS events precluded comparisons for other tumor size subgroups. Table shows sample sizes and 5-year BCSS rate by chemo receipt for each T group. Conclusions: In a large population-based cohort of patients with stage IA TNBC, we observed excellent 5-year BCSS outcomes, supporting the good prognosis of this patient population. The use of adjuvant chemo increased over time for T1b and T1c TNBCs, and was associated with improved BCSS for T1c tumors, although evaluation of benefit is limited by the inherent treatment bias in registry data. [Table: see text]

National trends in neoadjuvant chemotherapy utilization for cT1-2 N0 triple negative breast cancer: Did the CREATE-X trial impact treatment patterns?

e12599 Background: Neoadjuvant chemotherapy (NAC) for operable breast cancer allows for in-vivo assessment of chemotherapy response with survival and therapeutic implications. In 2017, the Capecitabine for Residual Cancer as Adjuvant Therapy (CREATE-X) trial demonstrated significant improvement in survival with the addition of adjuvant capecitabine in patients with triple negative breast cancer (TNBC) and residual disease after NAC. These results provided the rationale for NAC even in early stage TNBC. The aim of this study was to assess U.S. national rates of NAC utilization in early-stage node-negative TNBC patients before and after the release of CREATE-X and to assess factors associated with receiving NAC vs adjuvant chemotherapy (AC). Methods: The National Cancer Database was queried for women with cT1-2N0M0 TNBC from 2014–19. NAC utilization was collected and categorized as 2014-15 (pre-CREATE-X), 2016-17 (transition yrs), and 2018-19 (post-CREATE-X). Those who did not receive chemotherapy were excluded. NAC use over time was analyzed via multivariable logistic regression (MLR). Clinical and demographic factors associated with NAC vs AC utilization were assessed using ANOVA, Chi-squared, and Fisher Exact tests. A MLR model was used to determine predictors of receipt of NAC vs AC. Results: 55,633 women were treated from 2014-19: 26.9% with NAC, 52.4% with AC, and 20.7% received no chemotherapy (median ages 53, 59, and 71yrs, respectively, p &lt; 0.01). Most had cT1c (32.7%, n = 18,190) or cT2 (41.95%, n = 23,331) tumors and 99% had invasive ductal pathology. NAC utilization significantly increased over time, 19.5% (n = 3,465 of 17,777) in 2014-15, 27.1% (n = 5,140 of 18,985) in 2016-17, and 33.6% (n = 6,337 of 18,871) in 2018-19 (p &lt; 0.01). On MLR analysis, increased use of NAC was associated with younger age ( &lt; 50yrs), non-Hispanic white patients, having no comorbidities, having a cT2 tumor, grade 2 disease, and care at an academic or integrated network cancer program (p &lt; 0.05 for all). Patients with Medicare and Medicaid insurance were less likely to receive NAC (p &lt; 0.01). Patients who traveled &gt; 60 miles to their treating facility were more likely to receive NAC (p &lt; 0.01). Conclusions: From 2014–19, NAC utilization increased for patients with cT1-2N0M0 TNBC coinciding with the release of the CREATE-X results. Findings demonstrate the significance of the multidisciplinary oncology team in developing individualized treatment plans based on emerging clinical trial evidence. Racial, socioeconomic, and access disparities were observed in NAC utilization and warrants further investigation and interventions to ensure equitable care. [Table: see text]

Effect of operative time and blood lost on overall survival after pancreaticoduodenectomy.

e16270 Background: Blood transfusion is associated with a negative impact on cancer survival. This study aims to evaluate intra-operative time (OR time) and estimated blood loss (EBL) and their impact on survival. Methods: A retrospective review was undertaken to identify patients who had pancreaticoduodenectomy, treated at one of our 4 HPB centers of excellence for Northern California Kaiser Permanente members. All patients received their treatments between January 2015 and July 2022. The two parameters of OR time and EBL were assigned into a 2x2 grid with the creation of four separate groups. The 4 combination groups identified patients with an OR time of more than 400 minutes as time being compared and EBL of more than 600 ml as the absolute volume compared. Results: We identified 999 patients who underwent a pancreaticoduodenectomy. The mean OR time was 377 minutes, and the mean EBL was 349 ml. Portal vein resection was performed on 10.8% of patients. Neoadjuvant chemotherapy (NAT) was used in 27.8% of patients and associated with longer OR time, EBL, and portal vein resection (p&lt;.001). Patients with OR time &gt;400 minutes and EBL &gt;600 ml was associated with male, higher percentage of pancreatic/bile duct cancer, portal vein resection, a longer length of stay, re-admission at 7- and 30-days post-op, neoadjuvant chemotherapy, and adjuvant chemotherapy (Table 1). Mean overall survival for the patients with an OR time &gt;400 minutes and EBL &gt;600 ml was 37 months, while for those with an OR time &lt;400 minutes and EBL &lt;600 ml was 59 months (p&lt;.001). Conclusions: The combination of prolonged intra-operative time and blood loss is associated with decreased overall survival. The two parameters of EBL and OR time are a proxy for advanced tumors and vascular involvement gave the need for portal vein resection and higher utilization of adjuvant and neoadjuvant chemotherapy.

Treatment patterns for leiomyosarcomas, endometrial stromal sarcomas and adenosarcomas: a national cancer database study

Uterine sarcomas are a rare, heterogenous, group of cancers with limited data on optimal adjuvant treatment. We examined patterns of care for leiomyosarcomas (LMS), endometrial stromal sarcomas (ESS), adenosarcomas (AS), and mixed uterine sarcomas and assessed the utilization of adjuvant therapy for each histology. The National Cancer Database (NCDB) was queried for patients with non-metastatic uterine sarcoma diagnosed between 2004 and 2018 treated with surgery. Uterine carcinosarcomas were excluded. Adjuvant patterns of care and temporal treatment trends are evaluated, stratified by histology. Multivariable logistic regression model was constructed to identify predictors of receipt of radiation adjuvant therapy. Among 12,806 patients, 88% received a total hysterectomy and bilateral salpingo-oophorectomy (TH+BSO) and 42% received lymph node sampling (LNS). Surgery alone was the most common treatment modality for all histology groups (59.0%). Surgery with chemotherapy was the second most common form of treatment for LMS (33.1%) and mixed type tumors (29.6%). Surgery with radiation was the second most common treatment for high-grade ESS (10.8%) and AS (11.8%). External beam radiation therapy (EBRT) was the most common type of adjuvant radiation therapy utilized. Adjuvant radiation therapy (RT) has declined in LMS, from 27% in 2004 to 3% in 2018. Adjuvant chemotherapy for all histology groups has increased in use from 10% in 2004 to 28% in 2018. For uterine sarcomas, TH+BSO without LNS was the main surgical modality. Adjuvant therapy for uterine sarcomas is not commonly used, however high risk features including stage II/III, high grade, and more extensive lymph node sampling appear to increase the likelihood of adjuvant RT. The utilization of adjuvant chemotherapy in uterine sarcomas has increased over time, while RT has been decreasing.

Trends in receipt of adjuvant chemotherapy and impact on survival in resected biliary tract cancers

Background: Resection remains the cornerstone of curative-intent treatment for biliary tract cancer (BTC), however, recent randomized data support a survival benefit with the addition of adjuvant chemotherapy (AC) in these patients. Herein, we aimed to characterize trends and disparities in the utilization of AC and subsequent outcomes in gallbladder cancer and cholangiocarcinoma (CCA).

Adoption of adjuvant chemotherapy in high-risk salivary gland malignancies.

The present study characterizes national trends in the utilization of adjuvant chemotherapy to treat salivary gland malignancies. The National Cancer Database was queried for salivary gland malignancies treated by surgery with radiation in 2004-2019. Proportions of patients receiving adjuvant chemotherapy over the study period were analyzed by linear regression. The impact of chemotherapy on overall survival was assessed using Kaplan-Meier and Cox proportional hazards analyses. Among 15 965 patients meeting inclusion criteria, 2355 (14.8%) received adjuvant chemotherapy. Chemotherapy utilization significantly increased from 4.9% to 16.5% over the study period (p < 0.001). No survival benefit was observed with adjuvant chemotherapy on propensity score-matched Kaplan-Meier analysis (HR: 0.98; 95% CI: 0.86-1.11; p=0.72) or multivariable Cox regression (HR: 0.92; 95% CI: 0.78-1.09; p=0.34). Adjuvant chemotherapy has been increasingly utilized to treat salivary gland malignancies in recent years. Our findings highlight the importance of obtaining high-quality prospective data regarding the benefit of chemotherapy.

Trends in Adjuvant Chemotherapy Use Among Stage III Colon Cancer in Non-Elderly and Low Comorbidity Patients

BackgroundAdjuvant chemotherapy for stage III colon cancer is underutilized in the United States. The aim of this study was to assess the use of adjuvant chemotherapy in younger and medically fit patients and analyze the socioeconomic factors associated with its utilization. MethodsUsing the National Cancer Database from 2004 to 2015, we selected stage III colon cancer patients between age 18 to 65, Charlson-Deyo Comorbidity Index (CDCI) of 0 or 1, and those that survived at least 12 months after surgery. We then compared patients that underwent surgery only with those that received adjuvant chemotherapy. Multivariable logistic regression analysis was performed to identify variables associated with adjuvant chemotherapy use in the population. Overall survival was estimated by Kaplan-Meier curves. ResultsOf the 48,336 patients that met inclusion criteria, 43,315 (90%) received adjuvant chemotherapy. The utilization of adjuvant chemotherapy increased from 87% in 2004 to 91% in 2015. On multivariable regression analysis, the use of adjuvant chemotherapy was lower among males, Non-Hispanic Blacks and Hispanics, low-grade cancer, left-sided tumors, CDCI 1, those who travel ≥ 50 miles, yearly income < $40,227, and uninsured patients. The most common reason for the omission of adjuvant chemotherapy was the patient or caregiver's choice (40% between 2013 and 2015). The 5-year and 10-year overall survival rates were 76.7% and 63.8% respectively, in those who received adjuvant chemotherapy as compared to 65.1% and 49.3% in those who underwent surgery only (P < .001). ConclusionIn young and medically fit stage III colon cancer patients, most patients received guideline-compliant care in the United States. However, socioeconomic disparities adversely impacted the use of adjuvant chemotherapy. The patient or caregiver's decision was the most common reason for non-adherence to adjuvant chemotherapy and lead to poor survival outcomes. Emphasis should be placed on developing patient-centered strategies to improve adherence to chemotherapy in all patients.

Adjuvant chemotherapy for patients with locally advanced cervical carcinoma receiving definitive chemoradiation; utilization and outcomes before the OUTBACK trial (361)

Adjuvant chemotherapy for patients with locally advanced cervical carcinoma receiving definitive chemoradiation; utilization and outcomes before the OUTBACK trial (361)

Evaluation of the efficiency and safety of adjuvant chemotherapy alone for patients with advanced endometrial carcinoma: A protocol for systematic review and meta-analysis.

Endometrial cancer is a tumor that affects many women. Essentially, patients who have high-risk endometrial cancer tend to have a disproportionately high rate of metastasis as well as relapse than the general population. Regardless of complete resection, individuals who are having stages III or IV cancer appear to be at substantial risk of recurrence, either locally or distantly. Chemotherapy and radiation therapy are examples of systemic adjuvant treatment. However, the ideal scheduling strategy remains a mystery. Undertaking this research can help in examining the efficacy as well as safety of adjuvant chemotherapy alone in patients with advanced endometrial cancer in the future. To recognize all randomized controlled trials evaluating the efficacy and safety of adjuvant chemotherapy alone in those patients with advanced endometrial carcinoma, a comprehensive systematic review along with meta-analysis were undertaken in PubMed, EMBASE, Cochrane Library, Web of Science, Wanfang, China National Knowledge Infrastructure (CNKI), and Chinese Biological Medical Database (CBM). In accordance with traditional Cochrane methodology, 2 independent authors will review search results, choose studies for inclusion, extract study characteristics and outcome data, and examine the risk of bias in the researches they pick. The P values and the I² statistic shall be employed in determining the levels of heterogeneity. Meanwhile, the heterogeneity will be explored via the use of sensitivity analyses, and the meta-analysis will be conducted utilizing the RevMan 5.3 software package. Patients with advanced endometrial cancer will benefit from this research since it will offer a high-quality synthesis of existing information on the utilization of adjuvant chemotherapy alone. The outcomes of the proposed investigation will summarize the current evidence of adjuvant chemotherapy alone for patients with advanced endometrial carcinoma.

Utilization and outcomes of adjuvant therapy for stage II and III uterine leiomyosarcoma

ObjectivesThe optimal adjuvant therapy for uterine leiomyosarcoma (uLMS) remains uncertain. We analyzed the utilization of adjuvant chemotherapy and radiation therapy for stage II and III uLMS and explored the association between use of adjuvant therapy and survival. MethodsPatients with stage II or III uLMS treated from 2004 to 2016 and recorded in the National Cancer Database were identified. Multivariable regression models were fit to estimate predictors of use of either adjuvant radiation therapy or chemotherapy. To analyze the impact of chemotherapy on all-cause mortality, an inverse probability of treatment weighted (IPTW) propensity score method was used to account for measured confounders, and the receipt of radiation therapy was adjusted in the outcome model. The process was repeated to analyze the impact of radiation therapy on all-cause mortality by using an IPTW propensity score method and adjusting for the receipt of adjuvant chemotherapy. ResultsA total of 890 patients were identified. Adjuvant chemotherapy use increased from 62.2% in 2010 to 70.4% in 2016, whereas radiation usage decreased from 26.7% in 2010 to 10.4% in 2016. Patients with stage III (vs. stage II) disease were less likely to receive radiation therapy. After propensity score weighting, chemotherapy was associated with a 30% decreased risk of all-cause mortality in stage III patients (HR 0.70, 95% CI 0.45–0.98) but had no effect on mortality for stage II patients (HR 0.93, 95% CI 0.70–1.20). Radiation therapy was associated with a 26% decreased risk of mortality for stage II tumors (HR 0.74; 95% CI, 0.53–0.99) and a 57% decrease in mortality for stage III disease (HR 0.43, 95% CI 0.18–0.99). ConclusionsAmong women with stage II-III uLMS, use of chemotherapy is increasing while use of radiation therapy is decreasing. Radiation therapy is associated with improved survival in both stage II and III disease, while there was no association between use of adjuvant chemotherapy and survival in stage II patients.

Off study utilization of an unpublished trial regimen: A real-world analysis of GOG258-eligible cohorts.

e18763 Background: Practice patterns in the management of advanced endometrial cancer are widely variable and treatment paradigms are rapidly changing given the evolving clinical trial landscape. Prior studies have demonstrated “medical reversals” where clinicians favor or utilize the experimental approach only to find inferiority on publication of results. The objective of this study was to examine the utilization of the GOG 258 arms-- (adjuvant chemotherapy (CT) vs chemoradiotherapy (CRT)-- for patients with advanced or high-risk endometrial cancer. Methods: Patients 18 years or older who underwent staging surgery with stage III/IVA endometrial carcinoma of any histology or stage I/II clear cell or serous histologies with positive washings diagnosed between 2004 and 2018 were identified in the National Cancer Database. Utilization of adjuvant CT and CRT were examined in the pre-GOG 258 era (before 2009), during GOG 258 enrollment (2010-2017), and after publication of results (2018). Two-sided Cochrane-Armitage test assessed trends over time. T-test and chi-square tests assessed differences in groups receiving CT alone vs CRT. Multivariable logistic regression assessed factors associated with receipt of CRT. Propensity score matching accounted for baseline differences in groups receiving CT vs CRT. Results: 40,028 patients were included. 16,342 (41%) received adjuvant CT and 23,686 (59%) received adjuvant CRT. The majority of patients (39,185, 98%) were advanced stage and 19,616 (49%) were endometrioid histology. 90% of patients receiving both CT and CRT received multiagent therapy. Utilization of CRT was 54% before GOG 258 opening, 60% during GOG 258 enrollment, and 67% after publication of results (p &lt; 0.001). Factors associated with receipt of CT alone were age greater than 70 (adjusted odds ratio [aOR] 0.68, 95% confidence interval [CI] 0.46-0.99), non-Hispanic Black race (aOR 0.84, CI 0.77-0.92), serous and clear cell histologies (aOR 0.68, CI 0.59-0.77; aOR 0.74, CI 0.57-0.95), living greater than 50 miles from treatment facility (aOR 0.84, CI 0.77-0.92), and receiving care in the Midwest, South, and West regions (aOR 0.84, CI 0.78-0.90; aOR 0.69, CI 0.64-0.76; aOR 0.72, CI 0.66-0.78). Compared to an academic medical center, receiving care at a comprehensive community cancer center was associated with receipt of CRT (aOR 1.2, CI 1.2-1.3). Compared to pre-GOG 258 opening in 2009, patients were more likely to receive CRT during GOG 258 enrollment (aOR 1.2, CI 1.1-1.3) and immediately after results announcement in 2018 (aOR 1.7, CI 1.5-1.8), despite results showing that CRT was not associated with longer relapse-free or overall survival. Conclusions: For patients with advanced endometrial cancer, there was significant use of both study arms with increases in CRT use during the study enrollment period and immediately after reporting of GOG 258 results, despite lack of benefit in the CRT arm.

Utility of adjuvant chemotherapy in early-stage, estrogen receptor-positive breast cancer patients under 50 years with a 21-gene recurrence-score of 16-25: A retrospective analysis using the National Cancer Database.

e12501 Background: The TAILORx trial showed that addition of adjuvant chemotherapy (AC) to endocrine therapy (ET) had no advantage in estrogen receptor (ER)+, HER2-, node negative (N0) breast cancer (BC) patients with an intermediate (11-25) 21-gene recurrence-score (RS). However, a subgroup analysis revealed that in women ≤ 50 years, AC had a lower rate of distant recurrence if the RS was 16-25. Using a large national database, we studied the utilization of AC in the aforementioned subset. Methods: The 2004-2018 National Cancer Database BC cohort was used to include female patients of 18-50 years. Inclusion criteria were N0, M0 patients with any T stage, RS 16-25, ER+/PR± and HER2-. Patients who received neoadjuvant chemotherapy were excluded. Logistic regression was used to evaluate AC utility trends. Kaplan-Meier (KM) and multivariate (MV) propensity score (PS) weighted Cox model were used to compare survival between patients without and with AC use. Results: Of the 15,792 patients, 4808 (30.45%) received AC. Median RS was 18 and 21 in patients without and with AC. Factors associated with AC use were higher T stage, poor and moderately differentiated tumors, age &lt;40, care at an academic center, Caucasian race, patients undergoing mastectomy, regional lymph node (RLN) surgery, ET and Radiation Therapy (RT). KM survival at 10 years was better with AC [96.2% vs 91.6%]. Patients without AC had worse survival [Hazard Ratio (HR)=1.683, 95% Confidence Interval (CI): 1.392-2.036, p&lt;0.0001] (Table). Conclusions: In this analysis,AC use had a 5% improvement in 10 year overall survival, in contrast to TAILORx trial which only showed a disease free survival benefit. Whether the benefit was due to direct cytotoxicity or ovarian function suppression effect of AC remains to be seen. In clinical practice, AC use is determined based on patient and tumor characteristics. Limitations of our study include non-population-based data and the possibility of cofounding despite the use of PS matching. [Table: see text]

EPR22-111: Outcomes and Utilization of Adjuvant Chemotherapy With and Without an Anthracycline in Node-Positive, Triple-Negative Breast Cancer: Analysis of SEER-Medicare Data

"EPR22-111: Outcomes and Utilization of Adjuvant Chemotherapy With and Without an Anthracycline in Node-Positive, Triple-Negative Breast Cancer: Analysis of SEER-Medicare Data" published on 31 Mar 2022 by National Comprehensive Cancer Network.

Abstract P1-08-18: Impact of gene expression profile testing for lymph node positive (LN+) , hormone receptor positive (HR+), HER2 negative (HER2-) breast cancer (BC) patients on the use of adjuvant chemotherapy in a large community cancer center

Abstract Background: Use of gene expression profiling (GEP) is considered standard of care, in deciding use of adjuvant chemotherapy in patients with LN negative breast cancer. However, there are limited data for the use of GEP in LN+ disease. Both Mammaprint™ and Oncotype Dx 21 gene recurrence score™ (RS) have been evaluated in LN+ disease, the data are not as robust as in the LN- population. Based on data from the RXPONDER trial and the MINDACT trial, the NCCN has recently recommended the use of Oncotype Dx to help decide the utility and benefit of adjuvant chemotherapy after resection in LN- , Hormone receptor Positive (HR+), HER2 negative (HER2-) breast cancer patients. Because of the potential major impact of these data on patient management and healthcare utilization, we decided to explore the uptake and implementation of this testing at a large community cancer center in order to assess and report real world data pertaining to this novel standard of care. Methods: Database search of the Electronic Medical Records used at Ironwood Cancer Center, revealed 2455 newly diagnosed patients with early stage breast cancer during the period from 1/1/2018 till 6/1/2021. HIPAA deidentified data was extracted with inclusion criteria of newly diagnosed women with LN+ (1-3 nodes), HR+, and Her2- which yielded 403 patients. Demographics &amp; treatment data: Characteristics included menopausal status (Premenopausal 23%, Post Menopausal 77%), Surgery type (mastectomy 44%, breast conservation surgery 56%), size of primary tumor (0-1 cm 16 %, 1-2 cm 28%, 2-5 cm 43%, and &amp;gt; 5 cm 13%), LNs resected (Range 0-37, Median 4), # of LNs +(1-60%, 2-25%, 3-15%), and Tumor Grade (Grade 1-23%, 2-56%, 3-21%). GEP was performed in 62% of the patients. 49% received adjuvant chemotherapy (61% anthracycline based, 39% non anthracycline based). Of the patients tested, 41% received adjuvant chemotherapy. Adjuvant antihormonal therapy included aromatase inhibitors in 86% and Tamoxifen in 14%. 81% of the pre-menopausal patients received complete ovarian suppression. Results: Logistical Regression analysis in a non linear fashion, R2 data and Chi-square analysis was used to test the statistical significance of the observed relationship with respect to the expected relationship. The data was divided into 6 monthly intervals to allow comparison of the uptake of the test and impact on adjuvant chemotherapy decision making. There was a significant increase in GEP profile testing percentages when these intervals were compared across the years (R2 =0.69). Increase in GEP profiling was associated with lower utilization of adjuvant chemotherapy (R2= 0.84). There was a non-significant decline in the use of adjuvant chemotherapy (Chi2 NS, p value 0.22). Menopausal status, grade/size of tumor did not meet the statistical significance for the likelihood of utilization of the test. Currently multivariate analysis is being performed to examine the interplay between the numerous clinical factors on which the data was collected. This analysis will allow us to decide if we can longitudinally explore recurrence rates in each of these subsets. Conclusion: GEP has seen a significant uptake to help with adjuvant chemotherapy decision making in LN + (1-3) patients in the community cancer center setting over the last 4 years. These real world data also showed that increased testing was associated with decreased chemotherapy use which has translated to lowering health care resources and minimizing patient morbidity. Recommendations from the expert guidelines and clinical trial data have helped accelerate the use of this technology in the decision making to undergo adjuvant chemotherapy in the LN+, HR+, HER2- patients with breast cancer. Citation Format: Nisha Rao Kalmadi, Andrew Brown, Manas Sharma, Mikhail Shtivelband, Joshua Rifkind, Sujith Kalmadi, Rajesh Bagai, Emily Ho, Patricia Clark, Christopher Kellogg, Parvinderjit Khanuja. Impact of gene expression profile testing for lymph node positive (LN+) , hormone receptor positive (HR+), HER2 negative (HER2-) breast cancer (BC) patients on the use of adjuvant chemotherapy in a large community cancer center [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-08-18.