286 Background: Since 2005 we at Xcenda, LLC have studied prescribing plans of American medical oncologists for first-line therapy in patients with MPC. In 2008 we reported the steady growth of prescribing plans for the gemcitabine-erlotinib (GE) combination from 23% in late 2005 to 46% in 2007. In 2007, gemcitabine (G) alone was the second most common regimen planned (27%) (Green MR. Proc GI ASCO 2008). No cytotoxic doublet consistently garnered >10% prescribing share in this clinical setting. At ASCO 2010 Conroy et al. (J Clin Oncol. 2010;28(15s): Abstract 4010) reported a survival advantage for the FOLFIRINOX regimen compared to package insert dose and schedule of G alone as first-line therapy in patients with MPC and excellent PS (0-1). Methods: Between 7/31 and 8/28/2010 we again used our extensively tested, live research vehicle, NMCR Challenging Cases, to assess current prescribing plans of over 370 American medical oncologists for first-line therapy in a patient with metastatic pancreas cancer and either PS 1 or PS 2. Results: The FOLFIRINOX data have produced an immediate change in the distribution of planned first-line prescribing with 18% share for the PS 1 scenario, largely substituted for previous use of GE for this setting (Table). In PS 2, plans for FOLFIRINOX are minimal with G alone followed by GE as the dominant selections. Conclusions: The recently reported phase III FOLFIRINOX data are impacting first-line prescribing plans for patients with MPC. We will continue to quantitate physician-prescribing plans to more fully understand the additional impact the FOLFIRINOX data may have on overall chemotherapy management of these patients. [Table: see text] [Table: see text]
10510 Background: Clinically impactful therapies for malignancies require the identification of specific molecular alterations. Onc must be aware of these targets and how to interpret them to provide optimum care. The use of MP has become the standard of care for many cancers, and is recently FDA approved. Using 2 data sets, we assessed the current awareness and incorporation of MP in the treatment of cancer; comparing data from community based Onc (C) to academic Onc (A). Methods: C consisted of 292 physicians polled using an audience response system during 6 case-based research events across the US. Questions focused on various aspects of molecular testing. Data for A was obtained from a chart review focused on timing and extent of MP in disease specific academic practices (lung, breast, GI) (N = 59). Results: Within C, 257 (88%) were Onc from community-based practices. The frequency at which Onc ordered MP significantly varied depending on tumor type; 33% in lung cancer (LC), 18% in colorectal cancer (CRC) and less commonly in breast cancer (BC) (8%). In A, MP was ordered more frequently; 74% in LC, 27% in CRC and 0% in BC. These results reflect a gap in practice among community versus academic Onc, as C had lower utilization of MP for both LC and CRC. In C, Onc were also asked to match the molecular alteration with the appropriate targeted therapy. Onc incorrectly matched the molecular alteration to the targeted therapy or marked unknown in up to 69%. This reflects a large knowledge gap among community Onc with regards to the correct application of MP to currently FDA approved targeted therapies. Conclusions: Given the significant knowledge and practice gap, we conclude there is an urgent need for focused educational activities that facilitate improved knowledge of MP and corresponding personalized therapeutic strategies for Onc in the US.
492 Background: During 2013 we assessed PPrefs for 2nd line therapy among 294 MOs based on age and outcome with 1st line TKI management for mccRCC using a validated, proprietary, live, case-based market research tool. A core case scenario with 3 1st line therapy outcomes - objective response; stable disease (SD); progressive disease (PD) -was constructed. Data were acquired using blinded audience response technology. Research support sources were double blinded. Methods: Core case–43 y.o.with recurrent disease in lung and bone 4 years after nephrectomy for ccRCC. PS 1. No brain mets. CrCl 79 ml/min. Scenarios tested (S1, S2, etc.): S1: 9 month objective PR with sunitinib/pazopanib 1st line. S2: 4 months stable disease with pazopanib 1st line. S3: Progression at 8 weeks with sunitinib 1st line. Results: Data from events 1 - 3 are shown in Table. Conclusions: Majority of 2nd line prescribing is mTOR-based with everolimus preferred over temsirolimus. Use of a TKI as 1st salvage after 1st line TKI is preferred by 38–51% of MOs when 1st line response is an extended objective PR. There is very limited preference for sequential TKIs when the best initial response is SD for < 6 months or PD as best response. Current no specific TKI is the dominant PPrefs among MOs in this 1st salvage setting. [Table: see text]
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