Katherine Yoh

Patterns of pembrolizumab use for recurrent cervical cancer

This study aimed to examine the real-world use of pembrolizumab for recurrent cervical cancer as part of first-line or recurrence treatment, and its associated health care utilization. The Merative MarketScan Research Databases were used to identify newly diagnosed patients with cervical cancer who underwent primary hysterectomy or radiation from 2017 to 2022. Systemic therapy utilization, including pembrolizumab, was assessed at first recurrence. Health care utilization (hospitalization, emergency department visits, and costs) during first-line treatments for recurrence was described for patients treated with and without pembrolizumab. Multivariable regression models explored factors associated with pembrolizumab adoption and differences in health care utilization. A total of 2727 patients were identified, including 1259 (46.2%) who underwent primary hysterectomy and 1468 (53.8%) who received primary radiotherapy. Chemotherapy for recurrence was initiated in 339 patients (12.4%). Recurrence treatment was noted in 9.7% of patients initially treated with hysterectomy and in 14.8% of those receiving primary radiotherapy. Among patients treated for recurrence, 24.8% received platinum alone, 52.5% a platinum-based combination therapy, and 22.7% non-platinum regimens. Forty-one patients (12.1%) received pembrolizumab. The median duration of first-line chemotherapy for recurrence was 2.3 months (interquartile range; 1.0-5.8) overall, and 4.3 months (interquartile range; 2.4-9.8) for patients treated with pembrolizumab. Pembrolizumab utilization was associated with more recent years of recurrence, advanced age, and prior chemotherapy. While pembrolizumab use was not associated with increased inpatient stays or emergency department visits, it was associated with significantly higher total costs and chemotherapy-related expenses. Platinum-based chemotherapy is the predominant treatment for recurrent cervical cancer. Pembrolizumab utilization, although increasing, remains limited, highlighting a significant opportunity to optimize guideline-recommended therapies with proven efficacy in clinical trials.

Use and outcomes of hormonal therapy for advanced-stage, low-grade serous ovarian cancer.

To examine trends in the use of hormonal therapy for advanced-stage, low-grade serous ovarian carcinoma and to compare survival outcomes of patients who received traditional chemotherapy, hormonal therapy alone, or the combination of both. Women with stage II to IV low-grade serous ovarian cancer diagnosed between 2011 and 2020 were identified from the National Cancer Data Base. Patients undergoing primary surgery followed by adjuvant chemotherapy, hormonal therapy, or both were included. A multinomial logistic regression model was used to examine factors associated with treatment. Propensity score-weighted Cox proportional hazards models (via inverse probability of treatment weighting) were applied to compare overall survival across the treatment groups. Among 1532 women, 68.0% received chemotherapy alone, 12.3% received hormonal therapy alone, and 19.8% received combination therapy. Use of hormonal monotherapy increased from 0.8% in 2011 to 27.4% in 2020, and use of combination therapy increased from 0.8% to 32.6% (p 70 years) (p = .001) and those with Medicare insurance (p < .001), while combination therapy was more common in women with stage III to IV disease (p = .001). After applying propensity score weighing, 5-year survival was 76.6% (95% CI 73.2% to 79.7%) for chemotherapy alone, 85.5% (95% CI 66.1% to 94.3%) for hormonal therapy alone, and 75.8% (95% CI 59.7% to 86.2%) for combination therapy. Compared to chemotherapy alone, the HR for all-cause mortality was 0.74 (95% CI 0.46 to 1.19) for hormonal therapy alone and 0.88 (95% CI 0.63 to 1.24) for combination therapy. In advanced-stage low-grade serous ovarian cancer, the use of hormonal therapy increased substantially over time. Comparable survival outcomes across modalities suggest hormonal therapy may be a viable treatment option, particularly for patients who will not tolerate the side effects of cytotoxic chemotherapy.