Impact of Prior Cancer on Eligibility for Lung Cancer Clinical Trials

Gerber, David E.; Laccetti, Andrew L.; Liu, Xuan; Halm, Ethan A.; Pruitt, Sandi L.

doi:10.1093/jnci/dju302

Cited by 101 publications

(132 citation statements)

References 27 publications

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“…In each model, the size, direction, and significance of hazard ratio demonstrating article the impact of prior cancer was virtually unchanged. We further examined outcomes by charactersitics representative of common clinical trial eligbility criteria (20) as follows: 1) patients with no prior cancer, 2) patients with in situ/localized cancers diagnosed five or more years ago and who are likely to be eligible for clinical trials, and 3) all other patients with prior cancer and who are likely to be ineligible for clinical trials. In a sensitivity analysis, we compared multiple methods of propensity score adjustment (Supplementary Methods, available online).…”

Section: Discussionmentioning

confidence: 99%

“…A history of prior cancer was determined as described in our previous study (20). In brief, the index lung cancer was defined as the first of any primary lung cancers diagnosed while the patient lived in a SEER registry area (see the Supplementary Methods, available online, for further details).…”

Section: Methodsmentioning

confidence: 99%

“…Indeed, in an earlier study, we determined that for some lung cancer clinical trials, up to 18% of patients may be excluded for this reason alone (20 article treatments improve and the number of survivors grows, this proportion will likely increase (22,. Compared with other common exclusion criteria, prior cancer may be one of the most substantial factors limiting accrual.…”

Section: Articlementioning

confidence: 99%

“…Group (ECOG) exclude prior malignancy (20). Across trials, this restriction is variably defined, but is most commonly applied to patients with a prior cancer diagnosed within five years of the current cancer.…”

mentioning

confidence: 99%

“…Across trials, this restriction is variably defined, but is most commonly applied to patients with a prior cancer diagnosed within five years of the current cancer. For this reason alone, it is estimated that up to 18% of lung cancer patients are excluded from clinical trials (20). Given the near four-fold increase in the number of US cancer survivors over the past 30 years (21), the extent to which this practice limits trial accrual will likely increase.…”

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confidence: 99%

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Effect of Prior Cancer on Outcomes in Advanced Lung Cancer: Implications for Clinical Trial Eligibility and Accrual

Gerber

Laccetti

Liu

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Articlementioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Effect of Prior Cancer on Outcomes in Advanced Lung Cancer: Implications for Clinical Trial Eligibility and Accrual

Gerber

Laccetti

Liu

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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Racial and Ethnic Disparities in Survival Among People With Second Primary Cancer in the US

et al. 2023

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ImportanceComprehensive data for racial and ethnic disparities after second primary cancers (SPCs) are lacking despite the growing burden of SPCs.ObjectiveTo quantify racial and ethnic disparities in survival among persons with SPCs.Design, Setting, and ParticipantsThis population-based, retrospective cohort study used data from 18 Surveillance, Epidemiology, and End Results registries in the US for persons diagnosed with the most common SPCs at age 20 years or older from January 1, 2000, to December 31, 2013 (with follow-up through December 31, 2018). Data were analyzed between January and April 2023.ExposureRace and ethnicity (Hispanic, non-Hispanic Asian or Pacific Islander, non-Hispanic Black, and non-Hispanic White).Main Outcomes and MeasuresThe main outcomes were 5-year relative survival and cause-specific survival. Cause-specific hazard ratios (HRs) were calculated for death from cancer or cardiovascular disease (CVD) in each racial and ethnic minority population compared with the White population overall and stratified by SPC type, with adjustment for sex, year and age at SPC diagnosis, and prior cancer type and stage (baseline model) and additionally for county attributes (household income, urbanicity), SPC characteristics (stage, subtype), and treatment.ResultsAmong 230 370 persons with SPCs (58.4% male), 4.5% were Asian or Pacific Islander, 9.6% were Black, 6.4% were Hispanic, and 79.5% were White. A total of 109 757 cancer-related deaths (47.6%) and 18 283 CVD-related deaths (7.9%) occurred during a median follow-up of 54 months (IQR, 12-93 months). In baseline models, compared with the White population, the risk of cancer-related death overall was higher in the Black (HR, 1.21; 95% CI, 1.18-1.23) and Hispanic (HR, 1.10; 95% CI, 1.07-1.13) populations but lower in the Asian or Pacific Islander population (HR, 0.93; 95% CI, 0.90-0.96). When stratified by 13 SPC types, the risk of cancer-related death was higher for 10 SPCs in the Black population, with the highest HR for uterine cancer (HR, 1.87; 95% CI, 1.63-2.15), and for 7 SPCs in the Hispanic population, most notably for melanoma (HR, 1.46; 95% CI, 1.21-1.76). For CVD-related death, the overall HR was higher in the Black population (HR, 1.41; 95% CI, 1.34-1.49), with elevated risks evident for 11 SPCs, but lower in the Asian or Pacific Islander (HR, 0.75; 95% CI, 0.69-0.81) and Hispanic (HR, 0.90; 95% CI, 0.84-0.96) populations than in the White population. After further adjustments for county attributes and SPC characteristics and treatment, HRs were reduced for cancer-related death and for CVD-related death and associations in the same direction remained.Conclusions and RelevanceIn this cohort study of SPC survivors, the Black population had the highest risk of both death from cancer and death from CVD, and the Hispanic population had a higher risk of death from cancer than the White population. Attenuations in HRs after adjustment for potentially modifiable factors highlight opportunities to reduce survival disparities among persons with multiple primary cancers.

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Prevalence of Prior Cancer Among Persons Newly Diagnosed With Cancer

2018

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A substantial proportion of patients diagnosed with incident cancer in the United States have survived a prior cancer. These patients may be excluded from clinical trials and underrepresented in observational research, and little is known about their treatment and survivorship needs. Understanding the nature and impact of prior cancer is critical to improving clinical trial accrual and generalizability, disease outcomes, and patient experience.

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Impact of Prior Cancer on Eligibility for Lung Cancer Clinical Trials

Cited by 101 publications

References 27 publications

Effect of Prior Cancer on Outcomes in Advanced Lung Cancer: Implications for Clinical Trial Eligibility and Accrual

Effect of Prior Cancer on Outcomes in Advanced Lung Cancer: Implications for Clinical Trial Eligibility and Accrual

Racial and Ethnic Disparities in Survival Among People With Second Primary Cancer in the US

Prevalence of Prior Cancer Among Persons Newly Diagnosed With Cancer

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