medwireNews: In this month’s roundup we cover pharmaceutical smoking-cessation aids, the effects of TP53 mutations in children with acute lymphoblastic leukemia (ALL), and the barriers to receiving standard of care treatment in US patients with limited-stage small-cell lung cancer (SCLC).
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Using data on 2129 responders of the US Current Population Survey–Tobacco Use Supplement, researchers show that the lack of population effectiveness of pharmaceutical smoking-cessation aids, despite strong evidence from clinical trials, is likely not due to confounding.
They applied propensity score-matched models to show that use of varenicline, bupropion, or nicotine replacement did not increase the likelihood of abstaining from smoking for at least 30 days.
John Pierce (University of California, San Diego, La Jolla, USA) and team write in the Journal of the National Cancer Institute: “A possible explanation is that counseling and support interventions provided in efficacy trials are rarely delivered in the general population.”
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An analysis of 3801 children with ALL enrolled in the Children’s Oncology Group AALL0232 and P9900 frontline trials suggests that germline loss of function variants of TP53 are associated with adverse treatment outcomes.
Participants with versus without the pathogenic variants had significantly shorter event-free and overall survival, at hazard ratios of 4.2 and 3.9, respectively, and were also at significantly increased risk for second malignancies, with corresponding 5-year cumulative incidence rates in the AALL0232 cohort of 25.1% and 0.7%.
Our findings warrant clinical consideration, “in particular, pre-emptive surveillance for second cancers,” conclude Jun Yang (St Jude Children’s Research Hospital, Memphis, Tennessee, USA) and colleagues in the Journal of Clinical Oncology.
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Stephen Chun (The University of Texas MD Anderson Cancer Center, Houston, USA) and co-investigators report in JAMA Oncology that even though concurrent chemotherapy and radiotherapy is the standard of care for the initial management of limited-stage SCLC, “substantial proportions of patients” do not receive one or the other, at 23% and 41%, respectively.
The study also showed that government insurance (Medicaid or Medicare) was significantly associated with a reduced likelihood of receiving radiotherapy, which in turn predicted worse survival.
These results – based on data from 70,247 patients registered in the US National Cancer Database – provide “impetus for health care reform to improve access,” write Chun et al.
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