Patterns of care for stage III non–small cell lung cancer in Australia

Parente, Phillip; Chan, Bryan; Hughes, Brett; Jasas, Kevin; Joshi, Rohit; Kao, Steven; Hegi‐Johnson, Fiona; Hui, Rina; McLaughlin‐Barrett, Sara; Nordman, Ina

doi:10.1111/ajco.13140

Cited by 5 publications

(7 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Positron emission tomography (PET) is also used in diagnosis of NSCLC, thereby providing greater knowledge of the tumor metabolism (39). Most guidelines recommend early performance of PET to complete mediastinal staging (40), which, completed with the CT scan (PET/CT), not only enables better classification of lymph node involvement (41,42) but has also assumed greater importance with the new TNM classification. Given the frequency of brain metastasis of lung cancer, it is considered advisable to rule out brain metastases through the use of magnetic resonance imaging (MRI) in such patients, with curative intent (43).…”

Section: Clinical Characteristics Of and Therapeutic Approach To Stage IIImentioning

confidence: 99%

“…Different reviews have shown that MDT-led management improves the quality of care, survival and quality of life of patients with stages III and IV. It is recommended that such committees include at least one pneumologist, one surgeon, one oncologist, one radiotherapist, one radiologist and one pathologist (40).…”

Section: Clinical Characteristics Of and Therapeutic Approach To Stage IIImentioning

confidence: 99%

See 1 more Smart Citation

Epidemiology of stage III lung cancer: frequency, diagnostic characteristics, and survival

Casal-Mouriño¹,

Ruano-Raviña²,

Lorenzo-González³

et al. 2021

Transl Lung Cancer Res

View full text Add to dashboard Cite

Stage III non-small cell lung cancer (NSCLC) includes a highly heterogeneous group of patients with differences in the extent and localization of disease. Many aspects of stage III disease are controversial. The data supporting treatment approaches are often subject to a number of limitations, due to the heterogeneous patient populations involved in the trials. Furthermore, the definition of stage III disease has changed over time, and early studies were frequently inadequately powered to detect small differences in therapeutic outcome, were not randomized, or had a limited follow-up times. Major improvements in therapy, including the use of more active chemotherapy agents and refinements in radiation and surgical techniques, also limit the interpretation of earlier clinical trials. Lastly, improvements in pretreatment staging have led to reclassification of patients with relatively minimal metastatic disease as stage IV rather than stage III, leading to an apparent increase in the overall survival of both stage III and IV patients. Median overall stage III NSCLC survival ranges from 9 to 34 months. Higher survival rates are observed in younger Caucasian women with good performance status, adenocarcinoma, mutations, stage IIIA, and in patients with multidisciplinary-team-based diagnoses.

show abstract

Section: Clinical Characteristics Of and Therapeutic Approach To Stage IIImentioning

confidence: 99%

Section: Clinical Characteristics Of and Therapeutic Approach To Stage IIImentioning

confidence: 99%

Epidemiology of stage III lung cancer: frequency, diagnostic characteristics, and survival

Casal-Mouriño¹,

Ruano-Raviña²,

Lorenzo-González³

et al. 2021

Transl Lung Cancer Res

View full text Add to dashboard Cite

show abstract

“…Currently, there is no national lung cancer screening program in Australia due to the potentially high false-positive rates and variability of follow-up guidelines for positive results. 49 Although surgery is con-…”

Section: Interpretation Of Results and Comparison With Other Studiesmentioning

confidence: 99%

“…Currently, there is no national lung cancer screening program in Australia due to the potentially high false‐positive rates and variability of follow‐up guidelines for positive results 49 . Although surgery is considered an essential treatment in early stage lung cancer, waiting times in Australia are prioritized using an administrative rather than clinical categorization system as other elective non‐cancer surgery.…”

Section: Discussionmentioning

confidence: 99%

Influence of timeliness and receipt of first treatment on geographic variation in non‐small cell lung cancer mortality

Wah

Stirling

Ahern

et al. 2020

Intl Journal of Cancer

View full text Add to dashboard Cite

Mortality from non‐small cell lung cancer (NSCLC) exhibits substantial geographical disparities. However, there is little evidence on whether this variation could be attributed to patients' clinical characteristics and/or socioeconomic inequalities. This study evaluated the independent and relative contribution of the individual‐ and area‐level risk factors on geographic variation in 2‐year all‐cause mortality among NSCLC patients. In the Hierarchical‐related regression approach, we used the Bayesian spatial multilevel logistic regression model to combine individual‐ and area‐level predictors with outcomes while accounting for geographically structured and unstructured correlation. Individual‐level data included 3330 NSCLC cases reported to the Victoria Lung Cancer Registry between 2011 and 2016. Area‐level data comprised socioeconomic disadvantage, remoteness and pollution data at the postal area level in Victoria, Australia. With the inclusion of significant individual‐ and area‐level risk factors, timely (≤14 days) first definitive treatment (odds ratio [OR] = 0.73, 95% credible interval [Crl] = 0.56‐0.94) and multidisciplinary meetings (MDM) (OR = 0.74, 95% Crl = 0.59‐0.93) showed an independent association with a lower likelihood of NSCLC 2‐year all‐cause mortality. Timely and delayed (>14 days) first nondefinitive treatment, no treatment, advanced clinical stage, smoking, poor performance status, public hospital insurance and area‐level deprivation were independently associated with a higher likelihood of 2‐ and 5‐year all‐cause mortality. NSCLC's 2‐year all‐cause mortality exhibited substantial geographic variation, mainly associated with timeliness and receipt of first definitive treatment, no treatment followed by patient prognostic factors with some contribution from area‐level deprivation, MDM and public hospital insurance. This study highlights NSCLC patients should receive the first definitive treatment within the recommended 14‐days from diagnosis.

show abstract

“…This has resulted in reliance on limited cytotoxic chemotherapies and in particular platinum-based alkylating agents (e.g., cisplatin or carboplatin) as the backbone chemotherapy for both limited and extensive stage disease [ 9 , 10 , 12 , 13 ]. Similarly, international guidelines recommend cytotoxic chemotherapy, particularly platinum agents, as the standard of care for first-line therapy of advanced NSCLC in conjunction with targeted therapy and immunotherapy [ 2 , 12 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Carboplatin dose calculations for patients with lung cancer: significant dose differences found depending on dosing equation choice

2022

Self Cite

View full text Add to dashboard Cite

Background Carboplatin is the backbone cytotoxic agent for many chemotherapy regimens for lung cancer. Dosing of carboplatin is complicated due to its relationship to renal function and narrow therapeutic index. Overestimation of renal function may lead to supratherapeutic dosing and toxicity, while underestimation may lead to underdosing and therapeutic failure. Although the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations have higher accuracy in estimating glomerular filtration rate (eGFR), the Cockcroft Gault (CG) formula has been historically used for carboplatin dosing internationally. Methods We compared these formulae to identify patient profiles that were associated with significant carboplatin dose variation by retrospectively analysing the carboplatin dosing of 96 patients with lung cancer. Carboplatin doses were calculated using eGFR generated by MDRD, CKD-EPI 2009 and CKD-EPI 2021 equations. These three hypothetical doses were compared to actual CG-based doses prescribed. Results MDRD and CKD-EPI equations resulted in comparable carboplatin doses; however, CG doses diverged markedly with up to 17% of the patients receiving a carboplatin dose that was at least 20% higher than a non-CG formula would have predicted, and 20% received a dose that was at least 20% lower than a non-CG formula would have predicted. Our data suggest CG use overestimates kidney function in patients with a higher bodyweight and body surface area (BSA) while underestimating it in patients with a lower bodyweight and BSA. Importantly, we demonstrate potential real-world benefit as CKD-EPI predicted lower doses for patients whose (CG-derived) carboplatin dose was later reduced following clinical assessment prior to infusion. Conclusions We have therefore confirmed significant differences in carboplatin dosing depending on the equation used in our modern patient population and suggest that use of CKD-EPI provides the most clinically appropriate carboplatin dosing and should be implemented as the new standard of care internationally.

show abstract

Patterns of care for stage III non–small cell lung cancer in Australia

Cited by 5 publications

References 47 publications

Epidemiology of stage III lung cancer: frequency, diagnostic characteristics, and survival

Epidemiology of stage III lung cancer: frequency, diagnostic characteristics, and survival

Influence of timeliness and receipt of first treatment on geographic variation in non‐small cell lung cancer mortality

Carboplatin dose calculations for patients with lung cancer: significant dose differences found depending on dosing equation choice

Contact Info

Product

Resources

About