Trial Results: ECOG-ACRIN research round-up – Spring 2024

Breast Cancer Survivorship – A survey of survivors and their partners

This study is the first (to the authors' knowledge) to explore the dynamic between breast cancer survivors' relationships with their partners and their physical, mental, emotional, and social well-being. Several hundred couples (220 breast cancer survivors and 167 controls) completed surveys as part of a larger study examining the quality of life of breast cancer survivors. All survivors had previously participated in one of the ECOG-ACRIN Cancer Research Group's clinical trials. This analysis is unique from similar studies investigating the connections between survivorship and wellness, which have excluded the role of partners.

Many other studies have shown that cancer is overwhelmingly associated with mental health issues, particularly depression and anxiety, as well as poor physical outcomes, due to the nature of the disease. But here, researchers show that poor relationship satisfaction and concordance (harmony and agreement) in survivor couples have the potential to exacerbate these physical and psychosocial outcomes. Survivor couples had significantly worse relationship concordance than age-matched control couples. For survivors, poor relationship satisfaction and concordance were significantly associated with poor physical and psychosocial outcomes. The authors recommend that the maintenance of relationships should remain a focus through the difficulties of cancer and into survivorship for survivors, partners, and providers. Vachon EA. Healthcare. January 2024

Financial Hardship – Experiences of cancer patients in the year after diagnosis

This research involved 450 patients with newly diagnosed early-stage colon or rectal cancer. Patients completed surveys at baseline, 3, 6, and 12 months to report changes in financial hardship, employment, and access to resources. Overall, financial hardship was common at diagnosis and decreased over time. However, some groups, such as patients with low self-efficacy, unemployed individuals, or patients with government insurance, did not improve as much as their counterparts. The magnitude of hardship during treatment and residual financial hardship after treatment completion varied by age, sex, race, ethnicity, education, household income, and employment. The authors discuss financial counseling as an intervention to help newly diagnosed patients cope with financial worry. They stress the importance of screening patients to identify those at greater risk for financial hardship. Kircher SM. JAMA Netw Open. January 2024

Related: A new ECOG-ACRIN study is enrolling patients to explore a new way to reduce financial hardship. EAQ222CD/CostCOM aims to provide out-of-pocket cost estimates and remote counseling to assist patients in navigating the economic aspects of cancer treatment. Learn more here.

Health Equity – A new way to improve cancer care for older adults of color

Older adults and older adults of color face exceptional challenges and suffer from inequalities in cancer diagnosis and management, significantly affecting treatment outcomes. For example, many cancer research studies do not represent these patients well, so physicians do not have adequate data to guide their treatment and care. The authors of this analysis urge that efforts for reducing health disparities due to age and race, and providing equity of care, should be a nationwide top priority.

The authors recommend an initial step: better clinical assessment of older adults of color using a guideline-recommended geriatric assessment, enhanced with an evaluation of patients' social determinants of health. This step will allow for early identification and management of health disparities for each patient and reduce the effect of inequalities on patient care and outcomes.

Co-authors include Efrat Dotan, MD (Fox Chase Cancer Center), chair of the ECOG-ACRIN Geriatric Oncology Working Group, part of the Health Equity Committee, and the late Edith P. Mitchell, MD, who co-chaired the Health Equity Committee until her passing. Dotan EE. Cancer Med. February 2024

Lymphoma – 10-year results from an important phase 3 trial

Follicular lymphoma is a slow-growing cancer, and many patients live with the disease for many years with no symptoms. A watch-and-wait strategy (active surveillance without treatment until symptoms appear) is typical for patients with only a few tumors. Not all patients and physicians are comfortable with this approach. For them, rituximab (RITUXAN®) is an FDA-approved drug that is an attractive option because it is effective and tolerable. Rituximab is not chemotherapy (it is a monoclonal antibody).

The randomized phase 3 RESORT trial (or study E4402) compared two rituximab dosing strategies as an alternative to the watch-and-wait approach: maintenance rituximab (MR) every 3 months until symptoms appeared versus rituximab retreatment (RR) only when cancer showed signs of growth. The primary results of the trial were published in 2014, showing that rituximab by either strategy was highly effective at controlling cancer growth—but there was no benefit for MR (in which patients obviously received more rituximab). Now, long-term results are published, showing overall survival at 10 years of 83% for MR vs 84% for RR. What do these findings mean? For patients with low–tumor burden follicular lymphoma who opt for rituximab rather than watch and wait, RR is advisable over MR. Kahl BS. J Clin Oncol. January 2024

NCI-MATCH – A standard breast cancer treatment may help treat other cancers

An important discovery from the NCI-MATCH precision medicine trial shows a potentially broader role for an established breast cancer treatment. The combination of trastuzumab and pertuzumab (Phesgo®) is FDA-approved to treat patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer. Arm J of NCI-MATCH saw this drug combination shrink tumors in patients with several other types of cancer with high levels of the HER2 gene. This treatment is associated with minimal side effects. The results of this small trial signal that this drug combination should move on to a larger trial for confirmation outside of NCI-MATCH. NCI-MATCH is one of the first and largest precision oncology trials ever undertaken globally. Connolly RM. Clin Cancer Res. March 2024

Symptom Science – Clinical trial design

In clinical trials, there is a standard system for reporting adverse events that patients experience, such as side effects from cancer treatment: grades 1-5, with grade 5 being the most severe. However, some clinical trials only report grade 3-5 events. Here, researchers analyzed an ECOG-ACRIN phase 3 trial (E1912) that collected all adverse events experienced by trial participants, of any grade. They found that grade 1-2 adverse events were related to increased odds that patients would discontinue treatment. This finding suggests that limiting the collection of adverse events to grade 3-5 misses significant information. O'Connell N. J Clin Oncol. October 2023

Podcast Highlight: The Journal of Clinical Oncology features this research in its JCO Article Insights Podcast. Learn more here.