63 Microsatellite instability/mismatch repair biomarker testing disparities in patients with advanced colorectal cancer: Implications for immune checkpoint inhibitors
| Autor: | Bryan Iorgulescu |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Oncology
congenital hereditary and neonatal diseases and abnormalities medicine.medical_specialty business.industry Colorectal cancer Cancer Microsatellite instability Odds ratio medicine.disease lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens lcsh:RC254-282 digestive system diseases Immune checkpoint Internal medicine medicine Biomarker (medicine) DNA mismatch repair Stage (cooking) business |
| Zdroj: | Journal for ImmunoTherapy of Cancer, Vol 8, Iss Suppl 3 (2020) |
| ISSN: | 2051-1426 |
| Popis: | Background Immune checkpoint inhibitors have revolutionized outcomes for patients with a spectrum of cancer types, including the first tissue/site-agnostic FDA approvals (in 2017 for 2nd-line and 2020 for 1st-line) for advanced cancers with DNA microsatellite instability-high/mismatch repair deficiency (MSI-High/MMRd). However, the factors associated with patients‘ access to MSI/MMR testing are unknown. Methods Patients ≥20-years-old who newly presented with histopathologically-confirmed stage 4 colorectal adenocarcinoma from 2010–2016 were identified from the National Cancer Database, which comprises >70% of all newly-diagnosed cancer patients in the U.S. Patients were excluded if they lacked data about MSI/MMR testing or were initially diagnosed at another institution. The primary outcome was receiving MSI/MMR testing, either via immunohistochemistry or molecular diagnostic. Patient demographic, socioeconomic, and care setting characteristics were evaluated for association with MSI/MMR testing, as well as between MSI/MMR testing and immunotherapy receipt, using multivariable logistic regression. Results Of 45,326 newly-diagnosed stage 4 colorectal adenocarcinoma patients, only 26.5% (n=11,998) received MSI/MMR testing – rising from 14.4% in 2010 to 41.1% in 2016 (adjusted odds ratio [aOR] 1.26/year, 95% confidence interval [95%CI] 1.25–1.29, p Conclusions MSI/MMR testing rates for stage 4 colorectal cancer patients have dramatically improved in recent years, but appeared underutilized in patients that were older, of Black non-Hispanic race/ethnicity, uninsured or Medicaid-insured, or diagnosed at community programs. Our findings suggest that socioeconomic and care setting opportunities exist for improving access to testing of this important predictive biomarker for immune checkpoint blockade. |
| Databáze: | OpenAIRE |
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