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DELAYS IN ADJUVAN IMMUNOTHERAPY POST ESOPHAGECTOMY
Mazin Abdalgadir, Ahmed A. Elkamel
*, Evelyn V. Alexander, Shamele Battan-Wraith, Kevin Wang, Jonathan Rice, Praveen Sridhar, Stephanie Worrell
The University of Arizona, Tucson, AZ
Background
Adjuvant immunotherapy is a critical component of treatment for esophageal cancer, aiming to improve survival outcomes in high-risk patients. However, in real-world settings, delays in initiating immunotherapy following esophagectomy are common, potentially compromising its efficacy. This study investigates the factors contributing to these delays and their implications for patient outcomes.
Methods
We conducted a retrospective analysis of esophageal cancer patients treated with adjuvant immunotherapy following esophagectomy. Patients were divided into two groups: those with no interruptions and those with interruptions or delays in immunotherapy. Variables analyzed included demographic and clinical characteristics, reasons for treatment delays, and associated outcomes. Statistical analysis was performed to identify significant differences between the groups.
Results
Among the patients, interruptions or delays in immunotherapy occurred in 66.7% (n=14), compared to 33.3% (n=7) who completed therapy without interruptions. The median duration between surgery and the start of immunotherapy was longer in the interrupted group (9.14 vs. 7.00 weeks; p=0.535). Causes of delay included rash (35.7%), disease progression (14.3%), postoperative interventions (14.3%), insurance issues (7.1%), and patient refusal (7.1%). Notably, 78.6% of patients with interruptions discontinued therapy (p=0.001). Clinical parameters, including ECOG scores, tumor stage, and histological differentiation, were not significantly associated with treatment interruptions. However, patients with delays demonstrated poorer recurrence-free survival.
Conclusion
Delays in initiating adjuvant immunotherapy following esophagectomy are multifactorial, arising from both clinical and logistical challenges. These delays, often driven by postoperative complications and systemic barriers, emphasize the need for optimized perioperative care and enhanced multidisciplinary coordination. Real-world evidence reveals a gap between clinical trial outcomes and practical implementation, suggesting that delays may significantly undermine the therapeutic benefits of immunotherapy as highlighted the potential adverse impact of interruptions. Future efforts should focus on developing personalized strategies to minimize delays, improve adherence, and maximize patient outcomes in routine practice.
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