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Nilsson FOL, Gal P, Houisse I, Ivanova JI, Asanin ST. The cost-effectiveness of dacomitinib in first-line treatment of advanced/metastatic epidermal growth factor receptor mutation-positive non-small-cell lung cancer ( EGFRm NSCLC) in Sweden. J Med Econ 2021; 24:447-457. [PMID: 33754924 DOI: 10.1080/13696998.2021.1901722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS Although the benefit of first-line epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) over chemotherapy in EGFR mutation-positive (EGFRm) non-small-cell lung cancer (NSCLC) has been demonstrated in clinical trials, the optimal treatment sequence remains unclear. The objective of our study was to evaluate the cost-effectiveness of dacomitinib in Sweden vs afatinib and osimertinib in first-line treatment of EGFRm NSCLC. MATERIALS AND METHODS A partitioned survival model was developed with three health states: progression-free, post-progression, and death. Progression-free and overall survival curves were used to inform movements between states. Clinical data were taken from randomized trials, compared via a network meta-analysis (NMA). Utility data were taken from published studies and costs from national Swedish sources. The model used a 15-year time horizon and a Swedish healthcare payer perspective. Sensitivity and scenario analyses were performed. RESULTS The base-case analysis showed that dacomitinib accrued a total of 2.10 quality-adjusted life-years (QALYs) at a total cost of Swedish krona (SEK) 874,615. The incremental cost-effectiveness ratio (ICER) for dacomitinib vs afatinib was SEK 461,556 per QALY gained. The ICER of osimertinib vs dacomitinib, where the small QALY gains of the former came at a high additional cost, was SEK 11,444,709. Deterministic and probabilistic sensitivity analyses confirmed the robustness of these results; changes to drug and medical resource use costs and overall survival had the greatest impact on ICER estimates. LIMITATIONS This model is subject to uncertainty associated with extrapolating long-term treatment effects from shorter trial follow-up periods, although this would also be a limitation when using direct comparison or time-dependent hazard ratios. The NMA was limited by the use of indirect comparison, although sensitivity analyses supported the robustness of our findings. CONCLUSIONS Our model demonstrated that dacomitinib is cost-effective for first-line EGFRm NSCLC treatment in Sweden vs afatinib and osimertinib.
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Affiliation(s)
| | - Peter Gal
- Evidence Synthesis, Modeling & Communication, Evidera, Budapest, Hungary
| | - Ivan Houisse
- Evidence Synthesis, Modeling & Communication, Evidera, Budapest, Hungary
| | - Jasmina I Ivanova
- Global Health Economics and Outcomes Research (Oncology), Pfizer Inc, New York, NY, USA
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Pereira I, Gaspar C, Pina M, Azevedo I, Rodrigues A. Real-World T790M Mutation Frequency and Impact of Rebiopsy in Patients With EGFR-Mutated Advanced Non-Small Cell Lung Cancer. Cureus 2020; 12:e12128. [PMID: 33489541 PMCID: PMC7810175 DOI: 10.7759/cureus.12128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Introduction The T790M resistance mutation is present in about one-half of epidermal growth factor receptor (EGFR)-positive advanced non-small cell lung cancer (NSCLC) patients at disease progression. We aimed to assess the prevalence of this mutation in a real-world setting and the clinical impact of repeated biopsies in its detection. Methods This was a single-center retrospective cohort study of patients with EGFR-positive advanced NSCLC diagnosed between 2016 and 2018, who experienced radiographic disease progression during first-line treatment with first- or second-generation EGFR-tyrosine kinase inhibitor (TKI). The frequency of T790M detection and the number of rebiopsies were determined. Results A total of 88 patients were included, with a median age of 65 years (range: 38-84 years). The majority of the participants were females (63 (72%)) and non-smokers (70 (81%)). Upon disease progression, 80 (91%) patients were tested for T790M mutation, and the resistance mutation was detected in 57 (71%) cases (58% in plasma samples and 42% in tissue/cytology samples). In 14 (25%) cases, T790M mutation was only detected after rebiopsy (57% by liquid biopsy), which increased the rate of mutation detection in 17%. Subsequent treatment with third-generation EGFR-TKI was possible in 42 (74%) of T790M-positive cases. Detection of T790M mutation was more likely in patients who were less than 65 years old, with EGFR exon 19 deletions and duration of first-line treatment of more than 12 months (p < 0.05). Conclusions The frequency of T790M mutation in this study was higher than previously reported, suggesting that repeated biopsies after a negative result are beneficial. This allowed a greater percentage of patients to receive sequential osimertinib in our clinical practice.
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Affiliation(s)
- Isabel Pereira
- Medical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, PRT
| | - Cátia Gaspar
- Medical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, PRT
| | - Marta Pina
- Medical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, PRT
| | - Isabel Azevedo
- Medical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, PRT
| | - Ana Rodrigues
- Medical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, PRT
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Westerink L, Nicolai JLJ, Samuelsen C, Smit HJM, Postmus PE, Griebsch I, Postma MJ. Budget impact of sequential treatment with first-line afatinib versus first-line osimertinib in non-small-cell lung cancer patients with common EGFR mutations. Eur J Health Econ 2020; 21:931-943. [PMID: 32328874 PMCID: PMC7366569 DOI: 10.1007/s10198-020-01186-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 04/03/2020] [Indexed: 06/03/2023]
Abstract
BACKGROUND The therapeutic landscape for non-small-cell lung cancer (NSCLC) patients that have common epidermal growth factor receptor (EGFR) mutations has changed radically in the last decade. The availability of these treatment options has an economic impact, therefore a budget impact analysis was performed. METHODS A budget impact analysis was conducted from a Dutch healthcare perspective over a 5-year time horizon in EGFR-mutant NSCLC patients receiving first-line afatinib (Gilotrif®) versus first-line osimertinib (Tagrisso®), followed by subsequent treatments. A decision analysis model was constructed in Excel. Scenario analyses and one-way sensitivity analysis were used to test the models' robustness. RESULTS Sequential treatment with afatinib versus first-line treatment with osimertinib showed mean total time on treatment (ToT) of 29.1 months versus 24.7 months, quality-adjusted life months (QALMs) of 20.2 versus 17.4 with mean cost of €108,166 per patient versus €143,251 per patient, respectively. The 5-year total budget impact was €110.4 million for the afatinib sequence versus €158.6 million for the osimertinib sequence, leading to total incremental cost savings of €48.15 million. CONCLUSIONS First-line afatinib treatment in patients with EGFR-mutant NSCLC had a lower financial impact on the Dutch healthcare budget with a higher mean ToT and QALM compared to osimertinib sequential treatment.
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Affiliation(s)
- Lotte Westerink
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Asc Academics Inc., New York, USA.
- , 12 East 49th Street, New York, NY, 10017, USA.
| | | | | | | | - Pieter E Postmus
- Department of Pulmonary Diseases, University Medical Centre, Leiden, The Netherlands
| | | | - Maarten J Postma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Unit of Pharmacotherapy, -Epidemiology and -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
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Abstract
Introduction: Epidermal growth factor receptor (EGFR) mutations are well-described drivers of non-small cell lung cancer (NSCLC) and EGFR tyrosine kinase inhibitors (TKIs) have become key components of the NSCLC front-line treatment landscape. Tumors inevitably develop resistance to these agents, and development efforts continue to focus on identifying mechanisms of resistance and drugs to target these mechanisms. Areas covered: With several EGFR TKIs approved for use in the first-line or in later-line settings, an understanding of the efficacy and safety of these inhibitors in various populations is warranted. Furthermore, given the frequent emergence of drug resistance in NSCLC, examination of tumor tissue throughout the disease course provides the opportunity to select treatments based on the tumor's mutation profile. Here, we discuss: key efficacy and safety findings for approved and investigational EGFR TKIs; known mechanisms of resistance, particularly the T790M acquired EGFR mutation; and recent advances in EGFR mutational testing that may facilitate less invasive tissue testing and guide treatment selection. Expert commentary: The expanding armamentarium of EGFR TKIs, improvements in the understanding of resistance mechanisms and technological developments in the molecular analysis of tumors may help render EGFR mutation-positive NSCLC a chronic disease in many patients by facilitating optimal sequential therapy.
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Affiliation(s)
- Lara Kujtan
- a Department of Medicine , University of Missouri Kansas City , Kansas City , MO , USA.,b The Richard and Annette Bloch Cancer Center at Truman Medical Center , Kansas City , MO , USA
| | - Janakiraman Subramanian
- a Department of Medicine , University of Missouri Kansas City , Kansas City , MO , USA.,c Division of Oncology , Saint Luke's Cancer Institute , Kansas City , MO , USA
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Hochmair MJ. How can better identification of T790M help to inform treatment sequencing decisions in EGFR mutation-positive non-small-cell lung cancer? Future Oncol 2019; 15:2895-2898. [PMID: 31030557 DOI: 10.2217/fon-2019-0142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Maximilian J Hochmair
- Department of Respiratory & Critical Care Medicine & Ludwig Boltzmann Institute for COPD & Respiratory Epidemiology, Otto Wagner Hospital, 1140 Vienna, Austria
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Park K, Wan-Teck Lim D, Okamoto I, Yang JCH. First-line afatinib for the treatment of EGFR mutation-positive non-small-cell lung cancer in the 'real-world' clinical setting. Ther Adv Med Oncol 2019; 11:1758835919836374. [PMID: 31019567 PMCID: PMC6466470 DOI: 10.1177/1758835919836374] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/15/2019] [Indexed: 01/28/2023] Open
Abstract
Afatinib is an ErbB family blocker that is approved for the treatment of epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer (NSCLC). Pivotal randomized clinical studies demonstrated that afatinib significantly prolonged progression-free survival compared with platinum-based chemotherapy (LUX-Lung 3, LUX-Lung 6), and with gefitinib (LUX-Lung 7), with manageable side effects. However, these results were derived from controlled studies conducted in selected patients and are not necessarily representative of real-world use of afatinib. To gain a broader understanding of the effectiveness and safety of first-line afatinib, we have undertaken a literature review of real-world studies that have assessed its use in a variety of patient populations. We focused on patients with uncommon EGFR mutations, brain metastases, or those of advanced age, as these patients are often excluded from clinical studies but are regularly seen in routine clinical practice. The available real-world studies suggest that afatinib has clinical activity, and is tolerable, in diverse patient populations in an everyday clinical practice setting. Moreover, consistent with LUX-Lung 7, several real-world comparative studies indicate that afatinib might confer better efficacy than first-generation EGFR tyrosine kinase inhibitors. Tolerability-guided dose adjustment, undertaken in 21-68% of patients in clinical practice, did not appear to reduce the efficacy of afatinib. Taken together, these findings provide further support for the use of afatinib as a treatment option in patients with EGFR mutation-positive NSCLC.
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Affiliation(s)
- Keunchil Park
- Division of Hematology/Oncology, Innovative
Cancer Medicine Institute, Department of Medicine, Samsung Medical Center,
Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul
135-710, South Korea
| | | | - Isamu Okamoto
- Research Institute for Diseases of the Chest,
Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - James Chih-Hsin Yang
- Department of Oncology, National Taiwan
University Hospital and National Taiwan University Cancer Center, Taipei,
Taiwan
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Abstract
The advance of tyrosine kinase inhibitors has profoundly changed the therapeutic algorithm of non-small-cell lung cancer in molecularly selected patients. However, benefit from these agents is often transient and usually most patients progress within 12 months from treatment. Novel and more potent and selective tyrosine kinase inhibitors have been developed to overcome acquired resistance; however, these agents are once again associated with only temporary benefit and patients frequently develop secondary resistance, a heterogeneous phenomenon that involves different molecular mechanisms simultaneously. The aim of our paper is to provide a comprehensive overview of the mechanisms of acquired resistance in oncogene-addicted non-small-cell lung cancer, focusing on the two most studied target, EGFR mutations and ALK translocation, and reviewing the main challenges in clinical practice.
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Affiliation(s)
- Claudio Sini
- Medical Oncology, Ospedale Giovanni Paolo II, Olbia, Italy
| | | | - Giovanni Rossi
- Lung Unit, Ospedale Policlinico San Martino, Genova, Italy
| | - Alessandro Russo
- Medical Oncology Unit, AO Papardo & Department of Human Pathology, University of Messina, Messina, Italy.,Borsa Dottorati FSE XXXII Ciclo Unime, University of Messina, Messina, Italy
| | - Aldo Pezzuto
- Cardiovascular & Thoracic Department, AOU Sant'Andrea, Sapienza - Università di Roma, Roma, Italy
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