Treatment breaks may extend survival for children with cancer
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Key takeaways:
- Pediatric patients with solid tumors survived longer when given breaks between treatment of more than 30 days.
- Extended breaks allow permit more thoughtful decision-making while promoting quality of care.
CHICAGO — Time between therapy regimens can safely be offered to certain children with cancer to promote quality of life and explore goals of care without negatively affecting survival, according to data presented at ASCO Annual Meeting.
The results, researchers said, point toward a potentially industry-wide underappreciation for delays in treatment among pediatric patients with relapsed or refractory solid tumors.
“Most children with relapsed solid tumors will go on to experience multiple relapse events and subsequent therapy without ever having a break in receiving some kind of therapy,” Matthew T. McEvoy, MD, assistant professor at Baylor College of Medicine, said during a presentation. “Although prognosis is dismal for all, we found in our cohort that patients who have at least one intentional break in their post-relapse course actually lived longer than those who did not.”
Background and methodology
Relapsed or refractory solid tumors present a mortality burden for pediatric patients with cancer.
The effects of up-front therapies have been well-studied; however, little research has examined the cumulative effects of multiple relapses or salvage regimens.
McEvoy and colleagues conducted a retrospective review of electronic health record data for patients with primary, malignant relapsed or refractory extracranial solid tumors treated at Texas Children’s Hospital between 2005 and 2023 to analyze whether breaks larger than 30 days between diagnosis of events and initiation of subsequent therapies have any impact on overall survival.
The study included 466 patients with relapsed or refractory solid tumors (47% women; median age, 8.66 years; median follow-up after first event, 12.9 months). The most common diagnoses included neuroblastoma (21.5%), rhabdomyosarcoma (19.1%) and osteosarcoma (16.1%).
Patients in the study cohort had a median of three relapsed or refractory events, with a median of 93 days (interquartile range, 52-200) between each event.
Post-event OS served as the study’s primary outcome measurement, which comprised time from the first relapse or refractory event until death or last follow-up.
Results, next steps
Results showed that patients who had any type of break between therapies had longer OS than those who did not.
Among 438 patients receiving at least one salvage therapy regimen, 116 (26.5%) took at least more than one break between a relapse or refractory event and subsequent therapy.
Multivariate Cox regression modeling showed a significant association between taking a more than 1-month-long break in disease-directed therapy and prolonged OS, even after adjusting for the number of events and significant covariates (P < 0.05).
The study’s results are limited by its single-center, retrospective design, according to McEvoy. There is also likely a confounder related to performance status that impacted the results, he added.
A future study plans to dive deeper into understanding more about the impact of decision-making by the patient’s family while undergoing pediatric cancer care and to expand the cohort, McEvoy said.
“While we likely have a confounder related to performance status in the accompanying urgency or lack thereof to start new therapy, we suggest that we also may be underestimating the benefits of having a break,” he added. “So, for some patients with relapse, we believe that providers can take their time to explore goals of care with the family and engage in thoughtful sharing of decision-making without compromising overall survival.”
Collapse
McEvoy MT, et al. Abstract 10021. Presented at: ASCO Annual Meeting; May 30–June 4, 2024; Chicago.
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