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    How rapid adoption of IO impacted outcomes in the real world

    Summary of: Khozin S, Miksad RA, Adami J, Boyd M, Brown NR, Gossai A, Kaganman I, Kuk D, Rockland JM, Pazdur R, Torres AZ, Zhi J, Abernethy AP. Real-world progression, treatment, and survival outcomes during rapid adoption of immunotherapy for advanced non-small cell lung cancer. Cancer. 2019;125(22):4019-4032.

    Our summary

    With FDA collaborators, Flatiron researchers applied a previously published method for capturing cancer progression from EHRs to a large group of de-identified patients with aNSCLC treated with immune checkpoint inhibitors.

    The current analysis provides rich insights on early adoption of immunotherapy. Some notable findings include rapid shifts in practice patterns (0 percent in Q3 2014 to 42 percent in Q2 2017), outcomes in patient subsets underrepresented in trials (hepatic dysfunction associated with worse survival) and relevance of intermediate endpoints: real-world time to treatment discontinuation may correlate more closely with overall survival than real-world progression-free survival.

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    Why this matters

    Clinical trials showed that immuno-oncology agents had the potential to revolutionize NSCLC treatment, and this study bears out their tremendous impact in practice, even as outcomes in real-world patients may slightly lag relative to clinical trials. Furthermore, these results delve deep into how clinical practices surrounding these agents have evolved in response to trial data, from the shift in adoption towards earlier lines of therapy, to refinements in molecular testing.

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