Trainee Evaluations of Preparedness for Clinical Trials in Medical Oncology-A National Questionnaire.

BACKGROUND: A standardized approach to the education of clinical trial investigators across Canadian medical oncology (MO) subspecialty training does not exist. With training programs transitioning to competency-based medical education (CBME), studies assessing education practices and competence are paramount to enhancing trainee education. This study aimed to determine whether current education practices in MO subspecialty training programs in Canada prepare trainees for participating in clinical trials as an investigator. METHODS: From November 2021 to February 2022 a national, bilingual, online questionnaire to understand trainee experiences with self-perceived competence, preparedness, and willingness to participate in clinical trials as investigators was conducted. MO trainees, fellows, and new-to-practice physicians who completed an MO subspecialty training program in Canada were included. RESULTS: A total of 41 responses were received (response rate: 15%). Formal training in how to participate in clinical trials as an investigator was reported by 73% of respondents. At the end of training, 65% of respondents rated competence in clinical trials as fair/poor and 74% rated preparedness in conducting clinical trials as fair/poor. Correlation analysis determined that in-clinic teaching in clinical trials trended toward improved self-evaluations of competence and preparedness (p > 0.05). CONCLUSION: This is the first study in Canada to assess competencies in any residency training program since the establishment of CBME. Training in conducting clinical trials is highly variable across MO programs in Canada, with most trainees finding current practices not translating into self-perceived competence and preparedness. Further assessment into how to produce competent clinical trial investigators is warranted.

Chemo-Immunotherapy in First Line Extensive Stage Small Cell Lung Cancer (ES-SCLC): A Systematic Review and Meta-Analysis.

Small cell lung cancer (SCLC) is an aggressive neuroendocrine carcinoma with early metastatic potential. The standard-of-care treatment has not changed in years. Recent studies report improved progression-free survival (PFS) and overall survival (OS) with combined ICI and chemotherapy in ES-SCLC. We conducted a systematic review and meta-analysis to assess the magnitude of survival benefits. We searched MEDLINE, EMBASE, and Cochrane between 1 January 2010 and 15 July 2022 and conference proceedings from 2018 to 2022, for randomised controlled trials, evaluating chemo-ICI compared with platinum-doublet chemotherapy in untreated ES-SCLC. Outcomes assessed were PFS, OS, objective response rate (ORR), duration of response (DoR), toxicity, and health-related quality of life (HRQoL). The search identified 8061 studies, with 8 (56 publications) included in the final analysis. PFS and OS were significantly improved for patients randomised to chemo-ICI (PFS hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.70-0.80) and (OS HR 0.79, 95% CI 0.73-0.85). Subgroup analysis demonstrated a differential effect between PD-1/PD-L1 and CTLA-4 inhibitors. There was no difference in ORR and DoR. All-grade adverse events (RR 1.06, 95% CI 1.00-1.12) were similar. The addition of ICI to chemotherapy in untreated ES-SCLC results in a 22% risk reduction in death, and a 25% risk reduction in disease progression with a minimal increase in toxicity. These improvements are modest but represent progress beyond the standard of care.

Barriers to Access: Global Variability in Implementing Treatment Advances in Lung Cancer.

Globally, lung cancer is the second most-diagnosed cancer and is the leading cause of cancer death. Advances in science and technology have contributed to improvements in primary cancer prevention, cancer diagnosis, and cancer therapy, leading to an increase in survival and improvement in quality of life. Many of these advances have been seen in high-income countries. Accessibility, availability, and affordability are key domains in barriers to access of care between countries and within countries. The impact of these domains, as they relate to molecular testing, radiation therapy, and systemic therapy, are discussed.

Non-Small-Cell Lung Cancer in 2022: A Review for General Practitioners in Oncology.

Lung cancer is the leading cause of cancer death in Canada and a significant cause of morbidity for patients and their loved ones. There have been rapid advances in preventing, screening and treating this disease. Here, we present a contemporary review of treatment of non-small cell lung cancer in Canada based on current best practices. The focus of this review is to highlight recent data in screening for lung cancer, management of patients with early and locally-advanced non-small cell lung cancer, as well as management of patients with metastatic disease. There is a special focus on the incorporation of immunotherapy into practice and its associated toxicities.