Haocheng Li

Conditional Survival of Patients With Metastatic Testicular Germ Cell Tumors Treated With First-Line Curative Therapy

PURPOSE The International Germ Cell Cancer Collaborative Group (IGCCCG) criteria prognosticate survival outcomes in metastatic testicular germ cell tumor (MT-GCT), but how the initial risk changes over time for those who survived since curative treatment is unknown. PATIENTS AND METHODS We assessed patients eligible for first-line therapy for MT-GCT at five tertiary cancer centers from 1990 to 2012 for 2-year conditional overall survival (COS) and conditional disease-free survival (CDFS), defined as the probability of surviving, or surviving and being disease free, respectively, for an additional 2 years at a given time point since the initial diagnosis. RESULTS For all patients (N = 942), 2-year COS increased from 92% (95% CI, 91% to 94%) at 0 months to 98% (95% CI, 97% to 99%), and 2-year CDFS increased from 83% (95% CI, 81% to 86%) at baseline to 98% (95% CI, 97% to 99%) at 24 months after diagnosis. Two-year COS improved by 2% (97% at 0 months, 99% at 24 months) in the IGCCCG favorable-risk group, by 5% (94% at 0 months, 99% at 24 months) in the intermediate-risk group, and by 22% (71% at 0 months to 93% at 24 months) in the poor-risk group. Two-year CDFS improved significantly at 12 months for each risk group (favorable, 91% baseline v 95% at 12 months; intermediate, 84% v 95%; poor, 55% v 85%). Baseline IGCCCG risk stratification was not associated with long-term COS or CDFS for patients who survived to greater than 2 years post therapy. No significant differences in COS and CDFS were noted between seminoma and nonseminoma; patients ≥ 40 years old had inferior 2-year COS from 0 to 12 months, but no differences were noted at 18 months. CONCLUSION Our data suggest that the concept of conditional survival applies to patients with MT-GCT treated with curative therapy. Patients with MT-GCT who survived and remained disease free more than 2 years after the diagnosis had an excellent chance of staying alive and disease free in additional subsequent years, regardless of the initial IGCCCG risk stratification.

First-line sunitinib or pazopanib in metastatic renal cell carcinoma: The Canadian experience

INTRODUCTION Clinical trial data has shown pazopanib to be non-inferior in overall survival (OS) compared to sunitinib as first-line treatment for metastatic renal cell carcinoma (mRCC). The purpose of this study was to evaluate outcomes and compare dose-modifying toxicities of mRCC patients treated with suntinib or pazopanib in the real-world setting. METHODS Data were collected on mRCC patients using the prospective Canadian Kidney Cancer Information System (CKCis) database from January 2011 to November 2015. Statistical analyses were performed using Cox regression adjusted for several risk factors and the Kaplan-Meier method. RESULTS We identified 670 patients treated with sunitinib (n=577) and pazopanib (n=93). There were no significant differences in International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk groups (p=0.807). Patients treated with sunitinib had improved OS compared with pazopanib (median 31.7 vs. 20.6 months, p=0.028; adjusted hazard ratio [aHR] 0.60; 95% confidence interval [CI] 0.38-0.94). Time to treatment failure (TTF) was numerically, but not statistically, improved with sunitinib (medians 11.0 vs. 8.4 months, p=0.130; aHR 0.87; 95% CI 0.59-1.28). Outcomes with individualized dosing on sunitinib were unavailable for this analysis. Patients treated with sunitinib had a higher incidence of mucositis, hand-foot syndrome, and gastroesophageal reflux disease; patients treated with pazopanib had a higher incidence of hepatotoxicity. CONCLUSIONS In Canadian patients with mRCC, treatment with sunitinib appears to be associated with an improved OS compared to pazopanib in the first-line setting. Patient selection factors and the contemporary practice of individualized dosing with sunitinib may contribute to these real-world outcomes and warrant further investigation.

Clinical Outcomes of First-line Abiraterone Acetate or Enzalutamide for Metastatic Castration-resistant Prostate Cancer After Androgen Deprivation Therapy + Docetaxel or ADT Alone for Metastatic Hormone-sensitive Prostate Cancer

Background The CHAARTED (ChemoHormonal Therapy Versus Androgen Ablation Randomized Trial for Extensive Disease in Prostate Cancer) and STAMPEDE (Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy) trials showed that the addition of docetaxel (D) to androgen deprivation therapy (ADT) prolonged longevity of men with metastatic hormone‐sensitive prostate cancer (mHSPC). However, the impact of upfront D on subsequent therapies is still unexplored. As abiraterone acetate (AA) and enzalutamide (E) are the most commonly used first‐line treatment for metastatic castration‐resistant prostate cancer (mCRPC), we aimed to assess whether they maintained their efficacy after ADT+D versus ADT alone. Patients and Methods A cohort of patients with mCRPC treated between 2014 and 2017 with first‐line AA or E for mCRPC was identified from 3 hospitals’ institutional review board‐approved databases. Patients were classified by use of D for mHSPC. This time frame was chosen as ADT+D became a valid therapeutic option for mHSPC in 2014, and it inherently entailed a short follow‐up time on AA/E. The endpoints included overall survival from ADT start, overall survival from AA/E start, and time to AA/E start from ADT start. Differences between groups were assessed using the log‐rank test. Results Of the 102 patients with mCRPC identified, 50 (49%) had previously received ADT alone, while 52 (51%) had ADT+D. No statistically significant difference in any of the evaluated outcomes was observed between the 2 cohorts. Yet, deaths in the ADT+D group were 12 versus 21 in the ADT alone, after a median follow‐up of 24.4 and 29.8 months, respectively. Conclusion In a cohort of ADT/ADT+D‐treated patients with mCRPC with short times to first‐line AA/E and follow‐up, the efficacy of AA/E is similar regardless of previous use of D. Micro‐Abstract Although an androgen deprivation therapy plus docetaxel regimen was shown to extend the survival of some patients with metastatic hormone‐sensitive prostate cancer compared with androgen deprivation therapy alone, currently, there is no report in the literature investigating the impact of upfront docetaxel on subsequent first‐line abiraterone acetate or enzalutamide for metastatic castration‐resistant prostate cancer. This study showed that their activity is maintained regardless of previous use of docetaxel for metastatic hormone‐sensitive prostate cancer. These findings can aid treatment decision‐making.

Management of Medical Oncology Services in Canada: Redefined Workload With a Novel Supply-and-Demand Workforce Projection Model

PURPOSE We developed a workforce-planning model to predict Canadian medical oncologist (MO) supply and clinical demand during the next 10 years. MATERIALS AND METHODS A forward calculation model was created to forecast the balance of MO supply and demand. MO supply was estimated by using Canadian Institute for Health Information, Canadian Medical Association, and Canadian Post-MD Education Registry data. Care demand was estimated by using data from Canadian Cancer Statistics and Alberta Cancer Registry. The Canadian Royal College MO Committee confirmed its face validity. RESULTS The MO workforce is expected to grow from 541 staff in 2016 to 830 staff in 2026. During this period, new hires will increase from 39 to 56 per year, and departures will increase from 15 to 24 per year. Although cancer incidence rates will grow from 202,149 to 257,497, a projected increase in MO supply will mean fewer initial consultations, from an average of 168.5 consultations per MO in 2016 to 129.2 consultations per MO in 2026. The initiation of systemic therapy is projected to remain stable at 102.3 new systemic therapy starts per MO per year. CONCLUSION We have developed a forward calculation MO workforce model that predicts a growing Canadian MO workforce and redefines MO workload dynamics. MO providers will increasingly support more follow-up care with the initiation of multiple lines of systemic therapy relative to the medical management of patients at the time of initial cancer diagnosis. Workload metrics, including follow-up and new therapy initiation rates, must be measured to appropriately to meet increasingly complex and growing care demands.

Real world outcomes in advanced urothelial cancer and the role of neutrophil to lymphocyte ratio.

e16020Background: Advanced urothelial carcinoma (UC) patients have a poor prognosis. In the first and second line UC treatment setting, we investigated real world outcomes and evaluated the prognos...

Real World Outcomes in Advanced Urothelial Cancer and the Role of Neutrophil to Lymphocyte Ratio

&NA; In the first‐ and second‐line metastatic urothelial carcinoma (mUC) treatment setting, we investigated real‐world outcomes and evaluated the prognostic role of neutrophil to lymphocyte ratio (NLR). A retrospective analysis was performed on 233 mUC patients. In this real‐world mUC analysis, first‐line outcomes were lower than expected. Low NLR in the first‐ and second‐line is associated with improved mTTF and mOS. Introduction: In the first‐ and second‐line metastatic urothelial carcinoma (mUC) treatment setting, we investigated real‐world outcomes and evaluated the prognostic role of neutrophil to lymphocyte ratio (NLR). Methods: A retrospective analysis was performed on patients with mUC treated with systemic therapy. Overall response rates (ORRs), median time to treatment failure (mTTF), and median overall survival (mOS) were calculated. The association between baseline NLR (using a literature‐derived cut‐off of 3, as well as the best cut‐off NLR value of 5.45 as identified by X‐Tile software from this dataset) and mTTF and mOS were evaluated using Cox regression analysis. Results: We evaluated 233 patients. In the first‐line, the ORR was 25%. mTTF and mOS were 6.9 months and 9.0 months, respectively. Low baseline NLR was significantly associated with improved 8.3‐month mTTF, in contrast to 5.8 months for patients with high NLR (P = .046). Low NLR was significantly correlated with a longer mOS of 13.1 months, compared with high NLR (8.2 months; P = .007). In the second‐line, an ORR of 22%, an mTTF of 4.1 months, and an mOS of 8 months were observed. Low NLR in the second‐line was significantly associated with improved mTTF at 7.9 months versus high NLR patients (3.3 months; P = .023). Second‐line low NLR was significantly associated with a longer mOS of 12.2 months, in comparison to 6.8 months with high NLR (P = .003). Conclusion: In this real‐world analysis of patients with mUC, first‐line outcomes were lower than expected. Low NLR in the first‐ and second‐line is associated with improved mTTF and mOS.

Baseline neutrophil to lymphocyte ratio as a prognostic marker for patients with muscle-invasive bladder cancer being treated with neoadjuvant chemotherapy.

468 Background: The neutrophil-to-lymphocyte ratio (NLR), an inflammatory marker, has been associated with a poor prognosis in several solid malignancies. In muscle-invasive bladder cancer (MIBC), an elevated pre-cystectomy NLR has been shown to predict for poor survival; however, its role in prognostication for patients being treated with neoadjuvant chemotherapy (NAC) is unknown. We evaluated the baseline NLR as an independent prognostic factor in patients with MIBC treated with NAC. Methods: Patients with MIBC treated with NAC in Alberta from 2005 to 2015, and at the Princess Margaret Hospital in Ontario from 2005 to 2013 were evaluated. All 290 patients treated with NAC were included; 272 were evaluable for NLR and outcomes. Patient, disease, and treatment-related factors were evaluated. NLR was examined prior to initiation of preoperative chemotherapy. The prognostic role of NLR on overall survival (OS) and progression-free survival (PFS) was determined using Cox proportional hazard regression analys...