Importance: Chemoimmunotherapy is the standard first-line therapy for patients with extensive-stage small cell lung cancer (ES-SCLC). However, whether findings from pivotal trials can be extrapolated to the clinical practice setting remains unclear.
Objective: To compare treatment outcome gaps following first-line chemoimmunotherapy for patients with ES-SCLC between those who met and did not meet the eligibility criteria used in previous clinical trials.
Design, Setting, And Participants: A prospective cohort study was conducted from September 1, 2019, to September 30, 2020, at 32 hospitals in Japan, with at least 12 months of follow-up. Participants included consecutive patients with ES-SCLC who received carboplatin and etoposide with atezolizumab as first-line therapy.
Exposures: Patients who met eligibility criteria for pivotal phase 3 clinical trials were considered trial-eligible.
Main Outcomes And Measures: The primary outcome was 6-month progression-free survival. The secondary outcomes were differences in progression-free survival, overall survival, and safety according to whether key clinical trial eligibility criteria were met.
Results: A total of 207 patients were analyzed (median age, 72 years; range, 46-87 years; 170 [82%] were male). Sixty-four patients (31%) were older adults (age ≥75 years), and most (184 [89%]) had an Eastern Cooperative Oncology Group performance status of 0 or 1. There were 132 (64%) trial-eligible patients. The 6-month progression-free survival rate for all patients was 38.8% (95% CI, 32.4%-45.7%). The median progression-free survival was 5.1 months in trial-eligible patients and 4.7 months in trial-ineligible patients (hazard ratio, 0.72; 95% CI, 0.53-0.97; P = .03). The proportion of patients who achieved disease control was 93% (118 of 127) in trial-eligible patients and 77% (55 of 71) in trial-ineligible patients (P = .002). The median overall survival was 15.8 months in trial-eligible patients and 13.1 months in trial-ineligible patients (hazard ratio, 0.73; 95% CI, 0.51-1.07; P = .10). The rate of severe adverse events was numerically higher among trial-ineligible patients than among trial-eligible patients (39% vs 27%; P = .07).
Conclusions And Relevance: In this cohort study, the overall treatment outcome was comparable to that reported in pivotal clinical trials. However, treatment outcomes after chemoimmunotherapy might differ between trial-eligible and trial-ineligible patients. These findings suggest that trial-eligibility criteria may be useful in clinical practice, and further studies using data from clinical practice settings are required to inform regulatory approval and clinical decision-making.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9958526 | PMC |
http://dx.doi.org/10.1001/jamanetworkopen.2023.0698 | DOI Listing |
Rep Pract Oncol Radiother
December 2024
Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States.
Lung Cancer
December 2024
Internal Medicine III, Wakayama Medical University, Wakayama, Japan.
Ann Surg Oncol
December 2024
The University of Alabama at Birmingham Heersink School of Medicine, Surgery, Birmingham, AL, USA.
Introduction: Therapeutic clinical trials frequently lack diverse representation, hindering generalizability and exacerbating preexisting disparities in clinical outcomes. This study explored associations between breast cancer patient demographics, clinical trial eligibility, and enrollment in a National Cancer Institute (NCI)-designated cancer center.
Patients And Methods: This prospective cohort study included patients with breast cancer screened for therapeutic clinical trials from July 2020 to January 2024.
Compend Contin Educ Dent
November 2024
Director Clinical Research, Colgate-Palmolive Co., Piscataway, New Jersey.
Background: Dentin hypersensitivity is a global oral health concern. This in vitro study and clinical evaluation tested the efficacy of 0.454% stannous fluoride toothpaste stabilized with nitrate and phosphates (SNaP) to occlude dentin and reduce dentin hypersensitivity.
View Article and Find Full Text PDFEur Respir J
November 2024
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Background: Progressive pulmonary fibrosis (PFF) is of substantial interest for novel pharmacotherapy discovery, but little is known about clinical trial eligibility criteria. We evaluated eligibility criteria of PPF randomized controlled trials (RCTs), their representativeness in registry patients, and forced vital capacity (FVC) changes and mortality according to trial eligibility.
Methods: A systematic search was used to identify completed and in-progress phase II and III PPF RCTs.
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