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10. First-line chemoimmunotherapy and immunotherapy in patients with non-small cell lung cancer and brain metastases: A registry study

Author

Brown, Lauren J., Khou, Victor, Brown, Chris, Alexander, Marliese, Jayamanne, Dasantha, Wei, Joe, Gray, Lauren, Chan, Wei, Smith, Samuel, Harden, Susan, Mersiades, Antony, Warburton, Lydia, Itchins, Malinda, Lee, Jenny H., Pavlakis, Nick, Clarke, Stephen J., Boyer, Michael, Nagrial, Adnan, Hau, Eric, Pires da Silva, Ines, Kao, Steven, Kong, Benjamin Y., Brown, Lauren J., Khou, Victor, Brown, Chris, Alexander, Marliese, Jayamanne, Dasantha, Wei, Joe, Gray, Lauren, Chan, Wei, Smith, Samuel, Harden, Susan, Mersiades, Antony, Warburton, Lydia, Itchins, Malinda, Lee, Jenny H., Pavlakis, Nick, Clarke, Stephen J., Boyer, Michael, Nagrial, Adnan, Hau, Eric, Pires da Silva, Ines, Kao, Steven, and Kong, Benjamin Y.

Abstract

Introduction: Brain metastases commonly occur in patients with non-small cell lung cancer (NSCLC). Standard first-line treatment for NSCLC, without an EGFR, ALK or ROS1 mutation, is either chemoimmunotherapy or anti-PD-1 monotherapy. Traditionally, patients with symptomatic or untreated brain metastases were excluded from the pivotal clinical trials that established first-line treatment recommendations. The intracranial effectiveness of these treatment protocols has only recently been elucidated in small-scale prospective trials. Methods: Patients with NSCLC and brain metastases, treated with first-line chemoimmunotherapy or anti-PD-1 monotherapy were selected from the Australian Registry and biObank of thoracic cancers (AURORA) clinical database covering seven institutions. The primary outcome was a composite time-to-event (TTE) outcome, including extracranial and intracranial progression, death, or need for local intracranial therapy, which served as a surrogate for disease progression. The secondary outcome included overall survival (OS), intracranial objective response rate (iORR) and objective response rate (ORR). Results: 116 patients were included. 63% received combination chemoimmunotherapy and 37% received anti-PD-1 monotherapy. 69% of patients received upfront local therapy either with surgery, radiotherapy or both. The median TTE was 7.1 months (95% CI 5 - 9) with extracranial progression being the most common progression event. Neither type of systemic therapy or upfront local therapy were predictive of TTE in a multivariate analysis. The median OS was 17 months (95% CI 13-27). Treatment with chemoimmunotherapy was predictive of longer OS in multivariate analysis (HR 0.35; 95% CI 0.14 – 0.86; p=0.01). The iORR was 46.6%. The iORR was higher in patients treated with chemoimmunotherapy compared to immunotherapy (58% versus 31%, p=0.01). The use of chemoimmunotherapy being predictive of iORR in a multivariate analysis (OR 2.88; 95% CI 1.68 - 9.98; p=0.04).

Published
2024

11. Adapting to change: exploring perceptions and demands of the coronavirus (COVID-19) workforce changes – an Australian multi-institutional radiation oncology survey.

Author

Magon, Honor, Smith, Justin, Besson, Jacqueline, Hau, Eric, Taylor, Suzanne, Ruben, Jeremy, Jones, Diana, Mabb, Kira, Feldman, Jamie, Gholam Rezaei, Leily, and Lee, Yoo Young

Subjects
WORK, OCCUPATIONAL adaptation, PSYCHOLOGICAL burnout, WORK-life balance, PATIENT care, DESCRIPTIVE statistics, WORKING hours, TELEMEDICINE, JOB satisfaction, MEDICAL radiology, ATTITUDES of medical personnel, RESEARCH, JOB stress, ONCOLOGISTS, MEDICAL needs assessment, DATA analysis software, COVID-19 pandemic, EMERGENCY management, WELL-being, EXPERIENTIAL learning
Abstract

Objective: To evaluate the perceptions of the coronavirus disease 2019 (COVID-19) initiated workplace strategies implemented in radiation oncology departments across Australia. Methods: A multidisciplinary team from Princess Alexandra Hospital developed a survey to address the impact of the pandemic strategies on areas such as patient care, staff education, well-being, flexible working arrangements, and research. The survey was conducted from November 2020 to April 2021. Results: Out of 210 respondents from seven institutions, 45% reported burnout and 57% experienced work work-related stress. A significant majority of respondents were in favour of continued remote work (86%, 131/153). Radiation oncologists identified administrative or non-clinical work (92%, 34/37), telehealth clinics (32%, 12/37), or radiation therapy planning (22%, 8/37) as suitable for remote work. Additionally, 54% (21/39) of the radiation oncologists plan to use telehealth more frequently, with 67% (26/39) feeling more confident with the technology. The majority (81%, 171/210) of participants favoured continuation of hybrid in-person and virtual meetings. Virtual solutions were adopted for quality assurance activities (72%, 118/165) and 52% (60/116) indicated preference for ongoing utility of virtual platforms. However, 38% (79/210) of the respondents expressed concerns about the negative impact on junior staff training. Conclusion: These findings reveal a strong inclination towards technological advancements and remote work arrangements to enable flexible working conditions. Our study suggests the need for ongoing reforms, focusing on improving clinical service delivery efficiencies and enhancing job satisfaction among clinicians. What is known about the topic? During the coronavirus disease 2019 (COVID-19) pandemic there were significant adaptations required to the delivery of clinical care. What does this paper add? There is a strong preference for ongoing work from home arrangements, especially for administrative and non-clinical work. Most radiation oncologists feel more confident using telehealth and favour its ongoing use post-pandemic. Burnout and stress remain prevalent within the workforce. What are the implications for practitioners? There is a high demand among the radiation oncology workforce for adoption of technological advances to improve work satisfaction including remote access to enable flexible work arrangements. [ABSTRACT FROM AUTHOR]

Published
2024
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12. First-line chemoimmunotherapy and immunotherapy in patients with non-small cell lung cancer and brain metastases: a registry study

Author

Brown, Lauren Julia, primary, Khou, Victor, additional, Brown, Chris, additional, Alexander, Marliese, additional, Jayamanne, Dasantha, additional, Wei, Joe, additional, Gray, Lauren, additional, Chan, Wei Yen, additional, Smith, Samuel, additional, Harden, Susan, additional, Mersiades, Antony, additional, Warburton, Lydia, additional, Itchins, Malinda, additional, Lee, Jenny H., additional, Pavlakis, Nick, additional, Clarke, Stephen J., additional, Boyer, Michael, additional, Nagrial, Adnan, additional, Hau, Eric, additional, Pires da Silva, Ines, additional, Kao, Steven, additional, and Kong, Benjamin Y., additional

Published
2024
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21. Stereotactic Ablative Body Radiotherapy for Early NSCLC: Changes in Pulmonary Function, Dyspnoea and Quality of Life

Author

Ahn, Julie, primary, Yeghiaian-Alvandi, Roland, additional, Hegi-Johnson, Fiona, additional, Browne, Lois H., additional, Graham, Peter Henry, additional, Chin, Yaw, additional, Gee, Harriet, additional, Vinod, Shalini, additional, Ludbrook, Jane, additional, Last, Andrew, additional, Dwyer, Patrick, additional, Ong, Anselm, additional, Aherne, Noel, additional, Azzi, Maria, additional, and Hau, Eric, additional

Published
2023
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35. Use of durvalumab in stage III non‐small‐cell lung cancer based on eligibility for the PACIFIC study.

Author

Boys, Emma, Gao, Bo, Hui, Rina, da Silva, Inês, Hau, Eric, Gee, Harriet, and Nagrial, Adnan

Subjects
THERAPEUTIC use of monoclonal antibodies, LUNG cancer, TERTIARY care, METASTASIS, CANCER relapse, TUMOR classification, TREATMENT effectiveness, CHEMORADIOTHERAPY, ELIGIBILITY (Social aspects), RESEARCH funding, PROGRESSION-free survival, DEATH, PROPORTIONAL hazards models, OVERALL survival
Abstract

Background: Durvalumab following concurrent chemoradiotherapy is standard treatment for unresectable stage III non‐small‐cell lung cancer based on the results of the PACIFIC trial. Based on trial criteria, not all patients are eligible for durvalumab in routine clinical practice. Methods: We evaluated eligibility for durvalumab in a real‐world clinical setting and the impact of eligibility on outcomes. Consecutive patients treated with concurrent chemoradiotherapy at two tertiary centers between January 2015 and June 2022 were assessed. Clinical characteristics and outcomes were evaluated based on eligibility criteria for the PACIFIC trial. Results: A total of 126 patients were included. Seventy patients (56%) were eligible for durvalumab. Ineligibility was associated with shorter progression‐free survival of 9.7 months versus 18.4 months (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.39–0.95, p = 0.029) and overall survival of 26.4 months versus 58.7 months (HR 0.47, 95% CI 0.28–0.80, p = 0.005). Common reasons for ineligibility were history of previous malignancy (32%) and progressive disease or death during chemoradiotherapy (25%). Ineligible patients who received durvalumab had similar outcomes to eligible patients who received durvalumab. Conclusions: In a real‐world cohort, adjuvant durvalumab is safe and beneficial in a substantial proportion of patients who would not have been eligible for the PACIFIC trial. [ABSTRACT FROM AUTHOR]

Published
2023
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37. EXTH-41. IMPROVING THE RADIOSENSITIVITY OF DIFFUSE INTRINSIC PONTINE GLIOMAS (DIPG) BY TARGETING HYPOXIA AND MITOCHONDRIAL METABOLISM

Author

Shen, Han, primary, Chang, Cecilia, additional, Ing, Prunella, additional, Cook, Kristina, additional, McKelvey, Kelly, additional, Lai, Joey, additional, Gloss, Brian, additional, Prior, Victoria, additional, O'Neill, Geraldine, additional, Blackburn, Anneke, additional, Gee, Harriet, additional, and Hau, Eric, additional

Published
2021
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39. Implementation of the Australian Computer‐Assisted Theragnostics (AusCAT) network for radiation oncology data extraction, reporting and distributed learning

Author

Field, Matthew, primary, Vinod, Shalini, additional, Aherne, Noel, additional, Carolan, Martin, additional, Dekker, Andre, additional, Delaney, Geoff, additional, Greenham, Stuart, additional, Hau, Eric, additional, Lehmann, Joerg, additional, Ludbrook, Joanna, additional, Miller, Andrew, additional, Rezo, Angela, additional, Selvaraj, Jothybasu, additional, Sykes, Jonathan, additional, Holloway, Lois, additional, and Thwaites, David, additional

Published
2021
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41. Additional file 1 of Personal innovative approach in radiation therapy of lung cancer- functional lung avoidance SPECT-guided (ASPECT) radiation therapy: a study protocol for phase II randomised double-blind clinical trial

Author

Khalil, Azza Ahmed, Hau, Eric, Gebski, Val, Grau, Cai, Gee, Harriet, Nyeng, Tine Bisballe, West, Katrina, Kramer, Stine, Farlow, David, Knap, Marianne, Møller, Ditte Sloth, Hoffmann, Lone, and Farr, Katherina P.

Subjects
Data_FILES
Abstract

Additional file 1.

Published
2021
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50. Collaborative implementation of stereotactic ablative body radiotherapy: A model for the safe implementation of complex radiotherapy techniques in Australia

Author

Hau, Eric, primary, Hegi‐Johnson, Fiona, additional, Atkinson, Charlotte, additional, Barber, Jeffrey, additional, Browne, Lois H, additional, Chin, Yaw, additional, Dwyer, Patrick, additional, Graham, Peter H, additional, O'Hare, Jolyne, additional, Lu, Dan, additional, Rains, Melissa, additional, Ragusa, Carolina, additional, Schmidth, Laurel, additional, Small, Katherine, additional, Unicomb, Kylie, additional, West, Katrina, additional, White, Sean, additional, Last, Andrew, additional, Ludbrook, Jane, additional, Azzi, Maria, additional, Aherne, Noel J, additional, Van Tilburg, Kevin, additional, Vinod, Shalini, additional, Ma, Xiaobing, additional, and Yeghiaian Alvandi, Roland, additional

Published
2019
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