News in brief: Immunotherapy falls short in real world OS results; Methotrexate mutes vaccine response; Shared care trialled for prostate cancer patients


31 May 2021

Real world immunotherapy outcomes don’t match RCT results

Older patients with advanced non–small cell lung cancer treated with immunotherapy show lower survival rates in real world settings compared to those reported in key clinical trials, a study of US Medicare patients shows.

A cohort study that included 19,529 patients who started first systemic therapy for advanced lung cancer found that the median overall survival was 11.4 months among patients receiving pembrolizumab monotherapy  – about 15 months shorter than observed among pembrolizumab-treated participants in the KEYNOTE-024 trial.

The 12.9 months median OS observed in patients receiving platinum/ pemetrexed/pembrolizumab chemoimmunotherapy was about 10 months shorter than reported in the KEYNOTE-189 trial.

“These results may inform prognostic considerations in practice,” said the authors of the study published in JAMA Network Open.

Methotrexate users have to poor COVID vaccine responses

Many patients taking methotrexate fail to achieve an adequate immune response to mRNA COVID-19 vaccines, a study in patients with autoimmune diseases has found.

Published in the Annals of the Rheumatic Diseases the trial involved more than 200 patients with rheumatoid arthritis, psoriatic arthritis or psoriasis who were taking methotrexate, anti-TNFs or biologics from the US and Germany.

It found that patients taking methotrexate showed up to a 62% reduced rate of adequate immunogenicity to the BNT162b2 mRNA vaccination, whereas those on non-methotrexate medications showed similar levels of immunogenicity as healthy controls. Similarly, vaccination did not induce an activated CD8+ T cell response in participants on background methotrexate, unlike healthy controls and patients not receiving methotrexate.

“These results suggest that patients on methotrexate may need alternate vaccination strategies such as additional doses of vaccine, dose modification of methotrexate, or even a temporary discontinuation of this drug,” the study authors said.

Shared care trial for prostate cancer patients

A national implementation trial of a shared care model for men with prostate cancer aims to build on similar models that have been developed for people with breast cancer and lymphoma.

About 890 men will participate in the MOSES Trial, which will implement and evaluate an integrated model of follow-up care shared between six acute cancer care centres and more than 800 general practices across Queensland, South Australia and Victoria.

“Due to the improved survival in prostate cancer, men with prostate cancer are now living longer and require good supportive care as well as life-long routine surveillance to make sure the cancer hasn’t come back or metastasized to another organ.” said lead study investigator Professor Ray Chan from the QUT Cancer and Palliative Care Outcomes Centre.

“Because it’s so treatable, numbers continue to grow. In the current care model, we keep adding new patients into the system but we’re not discharging them fast enough to community care when they finish cancer treatment.

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