Towards a shared understanding of the concept of cure in early-stage treatment of solid tumors.

Abstract

e13866 Background: Advancement in early-stage solid tumor treatments, notably with potentially curative therapies in (neo)adjuvant settings, underscores the need of establishing common terminology around the concept of cure incorporating different perspectives and audiences. This study explores how various terminologies can enhance communication between stakeholders. Methods: A systematic literature review was conducted in MEDLINE and Embase databases for global English language publications (January 2014 to July 2024) using a PICOTS framework to identify explicit and implicit definitions of cure, clinical criteria for determining cure, and modeling approaches. The focus was on specific solid tumors, including melanoma, non-small cell lung cancer, renal cell carcinoma, triple-negative breast cancer, bladder cancer, and head and neck cancer, where early-stage (neo)adjuvant drug therapies have been approved. This was supplemented with conference abstract searches. Results: Across the 62 articles identified, cure was most discussed in breast, melanoma and lung cancer but there was no consistency in defining cure for (neo)adjuvant therapies. Definitions varied but centered around three concepts alone or in combination: absence of disease progression/recurrence (27%), eradication of cancerous cells (15%), and survival (79%). The different applications, driven by stakeholder perspectives, resulted in heterogeneity and inconsistency. Publications focusing on cure metrics and survival adopted a population-level perspective familiar to payers and public health professionals. Established approaches to modeling cure exist in the economic literature but differences were observed in application influencing payer views on cure. Only one global publication categorized cancer types based on cure metric estimations. Definitions emphasizing absence of disease progression and eradication of cancer cells aligned more with a "medical cure" perspective, resonating with clinicians who prefer describing patients as long-term survivors rather than being cured. Historical population-level evidence on cure may not align with an individual patient’s perspective. Various factors affecting cure assessment were identified, including the audience, patient characteristics (e.g., gender) and disease-related factors (e.g., tumor profiles). Conclusions: There is no clear convergence of opinion on describing cure in early-stage treatment of solid tumors. Stakeholders differ in their perspectives and description of cure, often balancing patient and disease specific considerations with population level evidence. Ensuring standardized terminology and appropriate language to describe potential curative value in early-stage interventions for solid tumors will support more effective communication between stakeholders.