Five-year Survival Rate For Nivolumab-treated Advanced Lung Cancer Patients Much Higher Than Historical Rate

Excerpt:

“Treatment with the immune checkpoint inhibitor nivolumab (Opdivo) yielded durable responses in some patients with advanced non-small cell lung cancer (NSCLC), with a five-year survival rate of 16 percent, according to data from a phase I clincal trial presented here at the AACR Annual Meeting 2017, April 1-5.

“According to the National Cancer Institute’s SEER data, five-year survival rate for patients with advanced lung and bronchus cancer is 4.3 percent, and for those with advanced NSCLC, it is 4.9 percent.

” ‘This is the first report of the long-term survival rate in patients with metastatic NSCLC treated with an immune checkpoint inhibitor. Our study results show that for a small subset of patients, immunotherapy can work for a very long time,’ said Julie Brahmer, MD, associate professor of oncology at the Bloomberg~Kimmel Institute for Cancer Immunotherapy at Johns Hopkins.”

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DCIS Survival Benefit from Surgery Varies by Nuclear Grade

“Surgical management of ductal carcinoma in situ improved survival outcomes compared with non-operative management among patients with high-grade disease but not among those with low-grade disease, according to results of a SEER analysis presented at the ASCO Annual Meeting.

“Although the current standard of care for ductal carcinoma in situ (DCIS) includes lumpectomy or mastectomy, surgical benefit was never fully established in this setting, according to study background.

“ ‘Our objective was to investigate whether there is a survival benefit offered by surgical treatment in patients with DCIS based on nuclear grade,’ Yasuaki Sagara, MD, a research fellow in surgery in the department of surgery at Brigham and Women’s Hospital in Boston, said during his presentation.

“Sagara and colleagues identified 57,222 eligible cases of DCIS that occurred between 1998 and 2011 using data from the SEER database.”


Adjuvant Chemotherapy May Improve Lung Cancer Outcomes in Older Patients

“Adjuvant chemotherapy may improve survival for older patients with stage I non–small cell lung cancer, according to an analysis of the SEER–Medicare database.

“However, the regimen also is associated with serious adverse events, according to an analysis of the SEER-Medicare database.

“Weighing the risks vs. benefits of adjuvant chemotherapy is more difficult in older patients, as they have a greater risk for disease recurrence after surgical resection but also have a more limited life expectancy.

“Jyoti Malhotra, MD, of the department of hematology and oncology at Tisch Cancer Institute at Icahn School of Medicine at Mount Sinai, and colleagues conducted a population-based study to compare survival and rates of serious adverse events among elderly patients with T2N0 NSCLC. The analysis included 3,289 patients aged older than 65 years who were treated between 1992 and 2009. All patients had tumors at least 4 cm, and they underwent surgical resection followed by either observation or adjuvant platinum chemotherapy with or without postoperative radiation.”


Men with Short Life Expectancies Often Undergo Aggressive Prostate Cancer Treatment

Editor’s note: Patients with low- or intermediate-risk prostate cancer may sometimes choose to undergo less aggressive treatment so as to maintain quality of life. A recent study found that men with short life expectancies often undergo aggressive prostate cancer treatment. There are concerns that these men are unlikely to live long enough to benefit, and may experience unnecessary harmful side effects.

“Men with low- or intermediate-risk prostate cancer who had life expectancies of fewer than 10 years frequently underwent aggressive treatment with radiation therapy or less frequently with surgery, according to results of a SEER analysis.

“Timothy J. Daskivich, MD, MSHPM, of the department of urology at the University of California, Los Angeles, and colleagues used the SEER database to identify 96,032 men diagnosed with early-stage prostate cancer between 1991 and 2007. All men were aged at least 66 years and had a Gleason score of 7 or lower.

“Fifty-two percent of the study population (n=50,049) had a life expectancy that was shorter than 10 years.

“Results showed life expectancy decreased with older age and greater Charlson Comorbidity Index score. Life expectancy was less than 10 years among the following cohorts: men aged 66 to 69 years with a Charlson score ≥2; men aged 70 to 74 years with a Charlson score ≥1; and all men aged 75 to 79 years, as well as those aged at least 80 years, regardless of Charlson score.”


Adjuvant Radiation Therapy Improved Survival in Diffuse-Type Gastric Cancer

Editor’s note: Researchers conducted a clinical trial with volunteer patients to test whether giving radiation after tumor-removal surgery could stave off recurrence for people with diffuse-type gastric cancer. A treatment that follows an initial treatment to reduce the risk of the cancer returning is known as an “adjuvant therapy.” In this clinical trial, patients who received adjuvant radiation therapy after surgery survived significantly longer than patients who did not.

“Patients with diffuse-type gastric cancer demonstrated prolonged OS when they received adjuvant radiation therapy, according to results of a SEER analysis.

“Alexander M. Stessin, MD, PhD, of the department of radiation oncology at Weill Cornell Medical College, and colleagues used the 2002 to 2005 SEER database to identify 1,889 patients with newly diagnosed diffuse-type gastric cancer who underwent surgical resection. Of these patients, 782 received adjuvant radiation therapy and 1,107 did not.

“Patients who received adjuvant radiation therapy were younger, more likely to have ≥15 dissected lymph nodes and more likely to have N3 lymph node status. They also had a higher American Joint Committee on Cancer disease stage.”


Minority of Older Patients With Low-Risk Prostate Cancer Managed by Observation Rates Vary Widely Among Urologists and Radiation Oncologists

“Most older men with low-risk prostate cancer receive upfront treatment, despite absence of clear survival benefit and potential for morbidity. In a retrospective cohort study reported in JAMA Internal Medicine, Hoffman et al found that use of observation as management in this setting varied widely among urologists and radiation oncologists. Patients diagnosed by urologists who treat prostate cancer were more likely to receive upfront treatment, which was also likely to be a treatment that the urologist performed.”


Older, Sicker Men with Early-Stage Prostate Cancer Do Not Benefit from Aggressive Treatment

“Treating older men with early-stage prostate cancer who also have other serious underlying health problems with aggressive therapies such as surgery or radiation therapy does not help them live longer and, in fact, can be detrimental, according to a study by UCLA researchers.

“The study followed the cases of more than 140,500 men aged 66 and older diagnosed with early-stage prostate cancer between 1991 and 2007 from the Surveillance, Epidemiology and End Results (SEER) Medicare database. Men who also suffered from multiple major medical conditions such as a history of heart attack, chronic obstructive pulmonary disease (COPD) and diabetes in combination did not live any longer after receiving aggressive therapy compared with men receiving no treatment. Additionally, these men were at risk for side effects such as impotence, urinary incontinence and bowel problems that can result from surgery and radiation treatments.”