Differential Effect of Consolidative Thoracic Radiation Therapy in Extensive-Stage Small Cell Lung Cancer Based on Sex.

Autor:	Jairam V; Department of Radiation Oncology, Sutter Medical Group, Sacramento, California., Soulos PR; Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut., K C M; Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut., Gross CP; Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut.; Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut., Slotman BJ; Department of Radiation Oncology, Amsterdam University Medical Center, De Boelelaan, Amsterdam, The Netherlands., Chiang AC; Section of Medical Oncology, Department of Medicine, Yale School of Medicine, New Haven, Connecticut., Park HS; Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut.; Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
Jazyk:	angličtina
Zdroj:	Advances in radiation oncology [Adv Radiat Oncol] 2023 Dec 03; Vol. 9 (4), pp. 101413. Date of Electronic Publication: 2023 Dec 03 (Print Publication: 2024).
DOI:	10.1016/j.adro.2023.101413
Abstrakt:	Purpose: The landmark randomized trial on chest irradiation in extensive disease small cell lung cancer (CREST) demonstrated that consolidative thoracic radiation therapy (cTRT) improved overall (OS) and progression-free survival (PFS) after initial chemotherapy (chemo) in extensive-stage small cell lung cancer, with potentially increased benefit in women compared with men. It is unknown whether similar findings would apply after chemoimmunotherapy became the standard first-line treatment. In this analysis, we report national practice patterns and survival outcomes of cTRT according to patient sex. Methods and Materials: We included patients from de-identified electronic health record-derived database diagnosed with stage IV small cell lung cancer (2014-2021) who completed 4 to 6 cycles of first-line systemic therapy (platinum-doublet chemotherapy or chemoimmunotherapy). We evaluated OS and PFS using multivariable Cox proportional hazards regression with receipt of cTRT as an independent variable and stratified by sex. As a sensitivity analysis, we weighted the models by the inverse probability of receiving cTRT. Results: A total of 1227 patients were included (850 chemotherapy, 377 chemoimmunotherapy). There were no statistically significant differences in baseline characteristics between patients who did and did not receive cTRT. Among women, cTRT was associated with superior OS (adjusted hazard ratio [HR], 0.67; 95% CI, 0.52-0.87) and PFS (HR, 0.63; 95% CI, 0.49-0.82) compared with those not receiving cTRT. Conversely, no OS or PFS benefit with cTRT was observed in men (OS HR, 1.03; 95% CI, 0.80-1.31; PFS HR, 1.12; 95% CI, 0.85-1.47). Findings were similar in weighted analyses. Conclusions: The survival efficacy of cTRT may be moderated by sex, with female patients appearing more likely to benefit than male patients. These findings reflect sex-based survival trends with similar effect sizes to those observed in the CREST trial. Although the underpinnings of this association need to be elucidated, stratification by sex should be considered for randomized-controlled trials studying cTRT in extensive-stage small cell lung cancer. Competing Interests: Pamela R. Soulos reported receiving consulting fees from TARGET PharmaSolutions outside of the submitted work. Cary P. Gross reported receiving grants or contracts from Johnson & Johnson, the National Comprehensive Cancer Network, and Genentech, and a leadership role in the American Society of Clinical Oncology (ASCO)-Quality Annual Meeting planning committee, outside of the submitted work. Anne C. Chiang reported receiving research funding from Bristol Myers Squibb, AbbeVie, and Genentech, and is on the advisory board or consultant to Genentech, AstraZeneca, Regeneron, and Daichi, outside the submitted work. Henry S. Park reported receiving research funding from RefleXion and Merck, consulting fees from AstraZeneca and RefleXion, honoraria from Bristol Myers Squibb and G1 Therapeutics, and serving on the advisory board for AstraZeneca and Galera, outside the submitted work. Vikram Jairam, Ben J. Slotman, and K.C. Madhav reported no disclosures. (© 2023 The Authors.)
Databáze:	MEDLINE
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