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- Title
Immuno-Molecular Targeted Therapy Use and Survival Benefit in Patients with Stage IVB Cervical Carcinoma in Commission on Cancer ® -Accredited Facilities in the United States.
- Authors
Sitler, Collin A.; Tian, Chunqiao; Hamilton, Chad A.; Richardson, Michael T.; Chan, John K.; Kapp, Daniel S.; Leath III, Charles A.; Casablanca, Yovanni; Washington, Christina; Chappell, Nicole P.; Klopp, Ann H.; Shriver, Craig D.; Tarney, Christopher M.; Bateman, Nicholas W.; Conrads, Thomas P.; Maxwell, George Larry; Phippen, Neil T.; Darcy, Kathleen M.
- Abstract
Simple Summary: Randomized clinical trials show a survival benefit associated with immuno-molecular therapy (IMT) use in metastatic or recurrent cervical cancer. This study investigated IMT use and survival in stage IVB cervical cancer patients in Commission on Cancer® (CoC)®-accredited facilities. Patients diagnosed with stage IVB cervical cancer in the National Cancer Database and treated with first-line therapy with chemotherapy alone or with radiotherapy ± IMT were studied. Adjusted risks of death were estimated in patients treated with ±IMT after applying a propensity score analysis to balance the clinical covariates. There were 3164 evaluable patients, including 31% who were treated with IMT. The use of IMT increased from 11% in 2013 to 46% in 2019. In propensity-score-balanced patients, the median survival was 5 months longer with vs. without IMT. The adjusted risk of death was 28% lower following treatment with vs. without IMT. IMT was associated with a consistent survival benefit in real-world patients in (CoC)®-accredited facilities with stage IVB cervical cancer. Purpose: To investigate IMT use and survival in real-world stage IVB cervical cancer patients outside randomized clinical trials. Methods: Patients diagnosed with stage IVB cervical cancer during 2013–2019 in the National Cancer Database and treated with chemotherapy (CT) ± external beam radiation (EBRT) ± intracavitary brachytherapy (ICBT) ± IMT were studied. The adjusted hazard ratio (AHR) and 95% confidence interval (CI) for risk of death were estimated in patients treated with vs. without IMT after applying propensity score analysis to balance the clinical covariates. Results: There were 3164 evaluable patients, including 969 (31%) who were treated with IMT. The use of IMT increased from 11% in 2013 to 46% in 2019. Age, insurance, facility type, sites of distant metastasis, and type of first-line treatment were independently associated with using IMT. In propensity-score-balanced patients, the median survival was 18.6 vs. 13.1 months for with vs. without IMT (p < 0.001). The AHR was 0.72 (95% CI = 0.64–0.80) for adding IMT overall, 0.72 for IMT + CT, 0.66 for IMT + CT + EBRT, and 0.69 for IMT + CT + EBRT + ICBT. IMT-associated survival improvements were suggested in all subgroups by age, race/ethnicity, comorbidity score, facility type, tumor grade, tumor size, and site of metastasis. Conclusions: IMT was associated with a consistent survival benefit in real-world patients with stage IVB cervical cancer.
- Subjects
UNITED States; CANCER treatment; ACCREDITATION; STATISTICAL models; CERVIX uteri tumors; INSURANCE; RADIOTHERAPY; T-test (Statistics); RESEARCH funding; IMMUNOTHERAPY; CANCER patients; RADIOISOTOPE brachytherapy; DESCRIPTIVE statistics; AGE distribution; TUMOR grading; RETROSPECTIVE studies; CHI-squared test; ECONOMIC status; POPULATION geography; CANCER chemotherapy; METASTASIS; RACE; LONGITUDINAL method; ODDS ratio; KAPLAN-Meier estimator; SURVIVAL analysis (Biometry); TUMOR classification; CONFIDENCE intervals; DATA analysis software; SPECIALTY hospitals; PROPORTIONAL hazards models; COMORBIDITY
- Publication
Cancers, 2024, Vol 16, Issue 5, p1071
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16051071