Time to treatment initiation and its impact on real‐world survival in metastatic colorectal cancer and pancreatic cancer

Abstract

Background Given the dearth of data regarding the time to treatment initiation (TTI) in the palliative setting, and its impact on survival outcomes, we sought to determine TTI in a real‐world cohort of metastatic colorectal cancer (mCRC) and metastatic pancreatic cancer (mPC) patients and evaluate the impact of TTI on real‐world survival outcomes. Methods We collected survival and treatment data for mCRC and mPC from the Flatiron Health electronic health records (EHR) derived database. We divided TTI into 3 categories: < 2 weeks, 2–< 4 weeks, and 4–8 weeks, from diagnosis to first‐line therapy. Outcome measures were median TTI, real‐world overall survival (RW‐OS) based on TTI categories by Kaplan–Meier method, and impact of TTI on survival using cox proportional hazard models. Results Among 7108 and 3231 patients with mCRC and mPC treated within 8 weeks of diagnosis, the median TTI were 28 days and 20 days. Median RW‐OS for mCRC was 24 months; 26.9 months versus 22.6 and 18.05 months in the 4–8‐week, 2–< 4 week (control) and < 2‐week groups, respectively ( p < 0.0001). For mPC, median RW‐OS was 8 months, without significant difference in RW‐OS among the groups ( p = 0.05). The 4–8‐week group was associated with lower hazard of death (HR 0.782, 95% CI 0.73–0.84, p < 0.0001) and the < 2‐week group was associated with a higher hazard of death (HR 1.26, 95% CI 1.15–1.38, p < 0.0001) in mCRC. The 4–8‐week group was associated with lower hazard of death for mPC (HR 0.88, 95% CI 0.8–0.97, p = 0.0094). Conclusion In a real‐world cohort of patients treated within 8 weeks of diagnosis, and with the limitations of a retrospective study, later TTI did not have a negative impact on survival outcomes in mCRC and mPC.

Hepatopancreatobiliary malignancies: time to treatment matters

“…With respect to the current literature, our EHBD cancer results stand in contrast to a study in a related population, which retrospectively reviewed 355 patients with periampullary adenocarcinoma and found that timing of resection was not associated with survival ( 9 ). Regarding pancreatic adenocarcinoma, the results of our study corroborate existing evidence that prompt treatment of early stage disease is associated with slightly improved survival, on the order of 1–3 months ( 1 , 38 ), while timing of treatment for late-stage disease is of lesser or no importance ( 1 , 10 , 12 ). This finding is possibly attributable to low overall survival rates for patients with late-stage pancreatic cancer regardless of therapy ( 25 ).…”

“…The association between time to treatment initiation (TTI) and survival has been investigated in multiple cancer types previously. Studies in head and neck cancer and some gastrointestinal (GI) cancers have concluded that there is no association between treatment delay and survival (8)(9)(10)(11)(12)(13)(14), while investigations in renal, endometrial, bladder, and other GI cancers have suggested that survival decreases with longer TTI (1,11,(15)(16)(17)(18). For some cancers, including breast, prostate, testicular, and non-small cell lung cancer, the existing literature is conflicting (11,15,(19)(20)(21)(22).…”

A self-healable metallohydrogel for drug encapsulations and drug release

“… 26 Among the currently available therapies (surgery, radiotherapy, chemotherapy, hormone therapy, immunological therapy, gene therapy, targeted therapy), each has its drawbacks. 27 Chemotherapy is the most effective treatment method to eradicate cancer cells. Chemotherapy uses cytotoxic chemicals.…”