Substantial Differences in Proportion of Cancer Drugs for Metastatic Disease, Adjuvant Use

For patients with non–small-cell lung cancer (NSCLC), breast cancer, and colon cancer, there are considerable differences in the number of drugs available for use, as well as the timing of supporting evidence, in the metastatic and adjuvant settings, according to findings from a cross-sectional study (JAMA Netw Open. 2020;3[4]:e202488).

“Drugs are used in the adjuvant, metastatic, or both settings in cancer, but the rate, direction, and speed with which drugs are tested and indicated in each setting are unknown,” explained Scott Parsons, DO, Department of Medicine, Oregon Health and Science University, Portland, and colleagues.

Therefore, Dr Parsons et al sought to identify the number of unique drugs that are category 1 or 2A per National Comprehensive Cancer Network (NCCN) guidelines in metastatic and adjuvant settings of NSCLC, breast cancer, and colon cancer. They also aimed to determine the mean delay between use in these 2 settings and review the quality of supporting evidence.

Clinical trials published between 1970 and 2019 that were cited by NCCN treatment guidelines (current as of May 15, 2019) or within corresponding drug labels were included in the analysis.

Dr Parsons and co-investigators analyzed the data between March 2019 and May 2019.

Ultimately, 69 and 25 agents recommended for use in metastatic disease and as adjuvant therapy were identified, respectively. The mean delay between use in metastatic disease and as adjuvant therapy for drugs utilized in both settings was 10 years.

Based on trials with positive outcomes, 39 (56.5%) of 69 agents were approved or recommended in the metastatic setting versus 23 (92.0%) of 25 that were approved for use as adjuvant therapy.

“There is a substantial difference in the number of agents available for use, as well as the timing of supporting evidence, in the metastatic and adjuvant settings for NSCLC, breast cancer, and colon cancer,” Dr Parsons and colleagues said.

“Given the potential benefit of adjuvant therapy in these cancer types, further investigation into additional adjuvant systemic therapy options is warranted,” they concluded.—Hina Porcelli