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Waser NA, Quintana M, Schweikert B, Chaft JE, Berry L, Adam A, Vo L, Penrod JR, Fiore J, Berry DA, Goring S. Pathologic response in resectable non-small cell lung cancer: a systematic literature review and meta-analysis. JNCI Cancer Spectr 2024:pkae021. [PMID: 38521542 DOI: 10.1093/jncics/pkae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/06/2023] [Accepted: 03/15/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Surrogate endpoints for overall survival (OS) in patients with resectable non-small cell lung cancer (NSCLC) receiving neoadjuvant therapy are needed to provide earlier treatment outcomes indicators and accelerate drug approval. This study's main objectives were to investigate the association between pathologic complete response (pCR), major pathologic response (MPR), event-free survival (EFS) and OS, and to determine whether treatment effects on pCR and EFS correlate with treatment effects on OS. METHODS A comprehensive systematic literature review was conducted to identify neoadjuvant studies in resectable NSCLC. Analysis at patient-level using frequentist and Bayesian random-effects (HR for OS/EFS by pCR/MPR status, yes vs no) and at trial-level using weighted least-squares regressions (HR for OS/EFS vs pCR by treatment arm) were performed. RESULTS In both meta-analyses, pCR yielded favorable OS compared to no-pCR (frequentist, 20 studies and 6,530 patients: 0.49, 95% CI: 0.42, 0.57; Bayesian, 19 studies and 5,988 patients: 0.48, 95% PI: 0.43, 0.55) and similarly for MPR (frequentist, 12 studies and 1,193 patients: 0.36, 95% CI: 0.29, 0.44; Bayesian, 11 studies and 1,018 patients: 0.33, 95% PI: 0.26, 0.42). Across subgroups, estimates consistently showed better OS/EFS in pCR/MPR compared to no-pCR/no-MPR. Trial-level analyses showed a moderate to strong correlation between EFS and OS hazard ratios (R2 = 0.7159), but did not show a correlation between treatment effects on pCR and OS/EFS. CONCLUSION There was a strong and consistent association between pathologic response and survival and moderate to strong correlation between EFS and OS following neoadjuvant therapy for patients with resectable NSCLC.
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Affiliation(s)
- Nathalie A Waser
- Insights, Evidence and Value, ICON plc, Burlington, Ontario, Canada
| | | | | | - Jamie E Chaft
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Ahmed Adam
- Insights, Evidence and Value, ICON plc, Burlington, Ontario, Canada
| | - Lien Vo
- Health Economics and Outcomes Research, Bristol Myers Squibb, Lawrenceville, New Jersey, USA
| | - John R Penrod
- Health Economics and Outcomes Research, Bristol Myers Squibb, Lawrenceville, New Jersey, USA
| | - Joseph Fiore
- Health Economics and Outcomes Research, Bristol Myers Squibb, Lawrenceville, New Jersey, USA
| | | | - Sarah Goring
- Insights, Evidence and Value, ICON plc, Burlington, Ontario, Canada
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2
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Carbone DP, Ciuleanu TE, Schenker M, Cobo M, Bordenave S, Juan-Vidal O, Menezes J, Reinmuth N, Richardet E, Cheng Y, Mizutani H, Felip E, Zurawski B, Alexandru A, Paz-Ares L, Lu S, John T, Zhang X, Mahmood J, Hu N, De T, Santi I, Penrod JR, Yuan Y, Lee A, Reck M. Four-year clinical update and treatment switching-adjusted outcomes with first-line nivolumab plus ipilimumab with chemotherapy for metastatic non-small cell lung cancer in the CheckMate 9LA randomized trial. J Immunother Cancer 2024; 12:e008189. [PMID: 38346853 PMCID: PMC10862253 DOI: 10.1136/jitc-2023-008189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND In CheckMate 9LA, nivolumab plus ipilimumab with chemotherapy prolonged overall survival (OS) versus chemotherapy regardless of tumor PD-L1 expression or histology. We report updated efficacy and safety in all randomized patients with a minimum 4-year follow-up and an exploratory treatment-switching adjustment analysis in all treated patients who received chemotherapy and subsequent immunotherapy. METHODS Adults with stage IV/recurrent non-small cell lung cancer (NSCLC), no sensitizing EGFR/ALK alterations, and ECOG performance status ≤1 were randomized 1:1 to nivolumab 360 mg every 3 weeks plus ipilimumab 1 mg/kg every 6 weeks with chemotherapy (two cycles) or chemotherapy (four cycles, with optional maintenance pemetrexed for the nonsquamous population). Assessments included OS, progression-free survival, and objective response rate. Exploratory analyses included efficacy by tumor PD-L1 expression and histology and in patients who discontinued nivolumab plus ipilimumab with chemotherapy due to treatment-related adverse events (TRAEs), and a treatment-switching adjustment analysis using inverse probability of censoring weighting. RESULTS With a 47.9-month minimum follow-up for OS, nivolumab plus ipilimumab with chemotherapy continued to prolong OS over chemotherapy in all randomized patients (HR 0.74, 95% CI 0.63 to 0.87; 4-year OS rate: 21% versus 16%), regardless of tumor PD-L1 expression (HR (95% CI): PD-L1<1%, 0.66 (0.50 to 0.86) and ≥1%, 0.74 (0.60 to 0.92)) or histology (squamous, 0.64 (0.48 to 0.84) and non-squamous, 0.80 (0.66 to 0.97)). In patients who discontinued all components of nivolumab plus ipilimumab with chemotherapy due to TRAEs (n=61), the 4-year OS rate was 41%. With treatment-switching adjustment for the 36% of patients receiving subsequent immunotherapy in the chemotherapy arm, the estimated HR of nivolumab plus ipilimumab with chemotherapy versus chemotherapy was 0.66 (95% CI 0.55 to 0.80). No new safety signals were observed. CONCLUSIONS In this 4-year update, patients treated with nivolumab plus ipilimumab with chemotherapy continued to have long-term, durable efficacy benefit over chemotherapy regardless of tumor PD-L1 expression and/or histology. A greater estimated relative OS benefit was observed after adjustment for subsequent immunotherapy use in the chemotherapy arm. These results further support nivolumab plus ipilimumab with chemotherapy as a first-line treatment for patients with metastatic/recurrent NSCLC, including those with tumor PD-L1<1% or squamous histology, populations with high unmet needs.
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Affiliation(s)
- David P Carbone
- Division of Medical Oncology and the Pelotonia Institute for Immuno-Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Tudor-Eliade Ciuleanu
- Department of Medical Oncology, Institutul Oncologic Prof Dr Ion Chiricută and University of Medicine and Pharmacy Iuliu Haţieganu, Cluj-Napoca, Romania
| | - Michael Schenker
- Department of Medical Oncology, SF Nectarie Oncology Center, Craiova, Romania
| | - Manuel Cobo
- Department of Medical Oncology, Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Spain
| | | | - Oscar Juan-Vidal
- Department of Medical Oncology, Hospital Universitario La Fe, Valencia, Spain
| | - Juliana Menezes
- Department of Oncology, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | - Niels Reinmuth
- Department of Oncology, Asklepios Lung Clinic, German Center for Lung Research, Munich-Gauting, Germany
| | - Eduardo Richardet
- Department of Clinical Oncology, IONC Instituto Oncológico de Córdoba, Córdoba, Argentina
| | - Ying Cheng
- Department of Oncology, Jilin Cancer Hospital, Changchun, Jilin, China
| | - Hideaki Mizutani
- Department of Thoracic Oncology, Saitama Cancer Center, Saitama, Japan
| | - Enriqueta Felip
- Medical Oncology Service, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Bogdan Zurawski
- Chemotherapy Department, Ambulatorium Chemioterapii, Bydgoszcz, Poland
| | - Aurelia Alexandru
- Department of Oncology, Institute of Oncology Prof Dr Alexandru Trestioreanu Bucha, Bucharest, Romania
| | - Luis Paz-Ares
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Shun Lu
- Department of Medical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Thomas John
- Medical Oncology Department, Austin Hospital, Heidelberg, Victoria, Australia
| | - Xiaoqing Zhang
- Global Drug Development, Oncology Clinical Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Javed Mahmood
- Global Drug Development, Oncology Clinical Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Nan Hu
- Global Biometrics and Data Sciences, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Tuli De
- Parexel, Billerica, Massachusetts, USA
| | | | - John R Penrod
- Global Drug Development, Oncology Clinical Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Yong Yuan
- Global Drug Development, Oncology Clinical Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Adam Lee
- Global Drug Development, Oncology Clinical Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Martin Reck
- Department of Thoracic Oncology, Airway Research Center North, German Center for Lung Research, Lung Clinic, Grosshansdorf, Germany
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Hatswell AJ, Chaudhary MA, Monnickendam G, Moreno-Koehler A, Frampton K, Shaw JW, Penrod JR, Lawrance R. Modelling Health State Utilities as a Transformation of Time to Death in Patients with Non-Small Cell Lung Cancer. Pharmacoeconomics 2024; 42:109-116. [PMID: 37707719 DOI: 10.1007/s40273-023-01314-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND When utilities are analyzed by time to death (TTD), this has historically been implemented by 'grouping' observations as discrete time periods to create health state utilities. We extended the approach to use continuous functions, avoiding assumptions around groupings. The resulting models were used to test the concept with data from different regions and different country tariffs. METHODS Five-year follow-up in advanced non-small cell lung cancer (NSCLC) was used to fit six continuous TTD models using generalized estimating equations, which were compared with progression-based utilities and previously published TTD groupings. Sensitivity analyses were performed using only patients with a confirmed death, the last year of life only, and artificially censoring data at 24 months. The statistically best-fitting model was then applied to data subsets by region and different EQ-5D-3L country tariffs. RESULTS Continuous (natural) [Formula: see text] and [Formula: see text] models outperformed other continuous models, grouped TTD, and progression-based models in statistical fit (mean absolute error and Quasi Information Criterion). This held through sensitivity and scenario analyses. The pattern of reduced utility as a patient approaches death was consistent across regions and EQ-5D tariffs using the preferred [Formula: see text] model. CONCLUSIONS The use of continuous models provides a statistically better fit than TTD groupings, without the need for strong assumptions about the health states experienced by patients. Where a TTD approach is merited for use in modelling, continuous functions should be considered, with the scope for further improvements in statistical fit by both widening the number of candidate models tested and the therapeutic areas investigated.
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Affiliation(s)
- Anthony J Hatswell
- Delta Hat, Nottingham, UK.
- Department of Statistical Science, University College London, London, UK.
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Nadler E, Vasudevan A, Wentworth C, Robert N, Penrod JR, Fiore J, Vo L. Real-world relationship of early end points to survival end points in patients with resectable non-small-cell lung cancer. Future Oncol 2023; 19:1785-1800. [PMID: 37665271 DOI: 10.2217/fon-2023-0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Aim: Pathologic response has been shown to be a promising surrogate for survival in non-small-cell lung cancer. We examined the real-world relationship between these end points in patients with resectable stage IB-IIIA non-small-cell lung cancer receiving neoadjuvant chemotherapy/chemoradiotherapy (CT/CRT). Methods: Electronic health records/medical charts were analyzed. Overall and event-free survival (OS/EFS) were assessed by Kaplan-Meier stratified by pathologic response. Associations between the end points were assessed by Cox analyses. Results: A total of 425 patients were selected for the study; 147 and 278 received CT and CRT, respectively. Pathologic complete response (pCR) was associated with longer OS (adjusted HR = 0.50; 95% CI: 0.29-0.85) and EFS (adjusted HR = 0.44; 95% CI: 0.28-0.68) versus no pCR, and EFS was associated with OS (HR = 0.51, 95% CI: 0.38, 0.69). Conclusion: In patients receiving neoadjuvant CT/CRT, pCR and EFS were associated with improved survival in this real-world dataset.
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Affiliation(s)
- Eric Nadler
- Charles Sammons Cancer Center, Baylor University Medical Center, US Oncology Network, Dallas, TX 75246, USA
| | | | | | | | | | - Joseph Fiore
- Bristol Myers Squibb, Lawrenceville, NJ 08648, USA
| | - Lien Vo
- Bristol Myers Squibb, Lawrenceville, NJ 08648, USA
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5
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Mohindra NA, Peipert JD, Blum SI, Shaw JW, Penrod JR, Cella D. General population reference values for the Functional Assessment of Cancer Therapy-Lung and PROMIS-29. Cancer Med 2023. [PMID: 37148552 DOI: 10.1002/cam4.5920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/03/2023] [Accepted: 03/28/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Therapeutic advances in lung cancer have turned attention toward patient-reported outcome measures (PROMs) as important clinical outcomes. The Functional Assessment of Cancer Therapy-Lung (FACT-L) is a common endpoint in lung cancer trials. This study calculated FACT-L reference values for the United States (US) general population. METHODS Adults from the US general population (N = 2001) were surveyed between September 2020 and November 2020. Surveys contained 126 questions, including the FACT-L [36 items; FACT-G and four subscales (Physical Well-Being [PWB], Social Well-Being [SWB], Emotional Well-Being [EWB], and Functional Well-Being [FWB]) and the Lung Cancer Subscale (LCS), and a Trial Outcome Index (TOI)]. Reference values for each FACT-L scale were calculated with means for the total sample and separately for participants with: no comorbidities, COVID-19 as only comorbidity, no COVID-19. RESULTS In the total sample, the reference scores were as follows: PWB = 23.1; SWB = 16.8; EWB = 18.5; FWB = 17.6; FACT-G = 76.0; LCS = 23.0, TOI = 63.7, and FACT-L Total = 99.0. Scores were lower for those reporting a prior diagnosis of COVID-19, especially for SWB (15.7) and FWB (15.3). SWB scores were lower than previous references values. CONCLUSIONS These data provide US general adult population reference value set for FACT-L. While some of the subscale results were lower than those found in the reference data for other PROMs, these data were obtained in a more contemporaneous time frame juxtaposed with the COVID-19 pandemic and may represent a new peri-pandemic norm. Thus, these reference values will be useful for future clinical research.
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Affiliation(s)
- Nisha A Mohindra
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - James W Shaw
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | | | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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6
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Reck M, Ciuleanu TE, Cobo M, Schenker M, Zurawski B, Menezes J, Richardet E, Bennouna J, Felip E, Juan-Vidal O, Alexandru A, Cheng Y, Sakai H, Paz-Ares L, Lu S, John T, Sun X, Moisei A, Taylor F, Lawrance R, Zhang X, Sylvester J, Yuan Y, Blum SI, Penrod JR, Carbone DP. First-line nivolumab plus ipilimumab with two cycles of chemotherapy versus chemotherapy alone (four cycles) in metastatic non-small cell lung cancer: CheckMate 9LA 2-year patient-reported outcomes. Eur J Cancer 2023; 183:174-187. [PMID: 36871487 DOI: 10.1016/j.ejca.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND In CheckMate 9LA (NCT03215706), first-line nivolumab plus ipilimumab with chemotherapy (2 cycles) significantly improved overall survival versus chemotherapy (4 cycles) in patients with metastatic non-small cell lung cancer and no known sensitising epidermal growth factor receptor/anaplastic lymphoma kinase alterations. We present exploratory patient-reported outcomes (PROs; minimum follow-up, 2 years). METHODS In patients (N = 719) randomised 1:1 to nivolumab plus ipilimumab with chemotherapy or chemotherapy alone, disease-related symptom burden and health-related quality of life were assessed using the Lung Cancer Symptom Scale (LCSS) and 3-level EQ-5D (EQ-5D-3L). Treatment-phase changes in LCSS average symptom burden index (ASBI), LCSS three-item global index (3-IGI) and EQ-5D-3L visual analogue scale (VAS) and utility index (UI) over time were analysed descriptively and using mixed-effect model repeated measures. Time-to-deterioration/improvement analyses were conducted. RESULTS Treatment-phase PRO questionnaire completion rates were >80%. Mean treatment-phase changes showed no deterioration from baseline in both arms for LCSS ASBI/3-IGI and EQ-5D-3L VAS/UI; however, minimally important differences were not met. Mixed-effect model repeated measures analyses showed overall reduction in symptom burden from baseline for both arms; changes from baseline for LCSS 3-IGI and EQ-5D-3L VAS/UI were numerically improved with nivolumab plus ipilimumab with chemotherapy versus chemotherapy, but minimally important differences were not met. Nivolumab plus ipilimumab with chemotherapy delayed time-to-definitive-deterioration versus chemotherapy (LCSS ASBI: hazard ratio, 0.62 [95% confidence interval, 0.45-0.87]); results were similar across PRO measures. CONCLUSIONS At 2-year minimum follow-up, first-line nivolumab plus ipilimumab with chemotherapy reduced the risk of definitive deterioration in disease-related symptom burden and health-related quality of life versus chemotherapy and maintained QoL in patients with metastatic non-small cell lung cancer. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier, NCT03215706.
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Affiliation(s)
- Martin Reck
- Department of Thoracic Oncology, Airway Research Center North, German Center for Lung Research, LungClinic, Grosshansdorf, Germany.
| | - Tudor-Eliade Ciuleanu
- Department of Oncology, Institutul Oncologic Prof. Dr. Ion Chiricuta and UMF Iuliu Hatieganu, Cluj-Napoca, Romania.
| | - Manuel Cobo
- Department of Medical Oncology, Unidad de Gestión Clínica Intercentros de Oncología Médica, Hospitales Universitarios Regional y Virgen de la Victoria, IBIMA, Málaga, Spain.
| | - Michael Schenker
- Department of Oncology, SF Nectarie Oncology Center, Craiova, Romania.
| | - Bogdan Zurawski
- Department of Clinical Oncology, Ambulatorium Chemioterapii, Bydgoszcz, Poland.
| | - Juliana Menezes
- Department of Oncology, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil.
| | - Eduardo Richardet
- Department of Clinical Oncology, Instituto Oncológico de Córdoba, Córdoba, Argentina.
| | - Jaafar Bennouna
- Department of Thoracic Oncology, University Hospital of Nantes and INSERM, CRCINA, Nantes, France.
| | - Enriqueta Felip
- Department of Medical Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain.
| | - Oscar Juan-Vidal
- Department of Medical Oncology, Hospital Universitario La Fe, Valencia, Spain.
| | - Aurelia Alexandru
- Department of Oncology, Institute of Oncology Prof Dr Alexandru Trestioreanu Bucha, Bucharest, Romania.
| | - Ying Cheng
- Department of Medical Oncology, Jilin Cancer Hospital, Changchun, China.
| | - Hiroshi Sakai
- Department of Thoracic Oncology, Saitama Cancer Center, Saitama, Japan.
| | - Luis Paz-Ares
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, CNIO-H12o Lung Cancer Clinical Research Unit, Universidad Complutense & CiberOnc, Madrid, Spain.
| | - Shun Lu
- Department of Medical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Thomas John
- Department of Medical Oncology, Austin Hospital, Heidelberg, Australia.
| | | | | | | | - Rachael Lawrance
- Adelphi Values, Adelphi Mill, Grimshaw Ln, Bollington, Cheshire, UK.
| | | | | | - Yong Yuan
- Bristol Myers Squibb, Princeton, NJ, USA.
| | | | | | - David P Carbone
- Department of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
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7
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Zhang Y, Doran C, Le TK, Dreyfus B, Kola N, Sylvester BE, Lal L, Penrod JR, Meadows Shropshire S. Adverse events and clinical outcomes in patients treated with PD-(L)1 blockade for advanced non-small-cell lung cancer. Future Oncol 2023; 18:4509-4523. [PMID: 36942686 DOI: 10.2217/fon-2022-1117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Aims: To describe, in patients with advanced/metastatic non-small-cell lung cancer, the relationship between baseline immunosuppressive drug (ISD)/corticosteroid (CS) use, as well as the incidence of mild/moderate adverse events (AEs), and the clinical effectiveness of PD (L)-1 blockade. Patients & methods: This was a retrospective cohort study of patients with no evidence (n = 131) or positive evidence (n = 269) of ISD/CS use. Results: Duration of treatment, time to next treatment, progression-free survival and overall survival were significantly reduced for patients with evidence of prior ISD/CS use. Occurrence of mild/moderate AEs did not affect any clinical outcomes. Conclusion: Prior ISD/CS use was associated with a poorer prognosis in advanced/metastatic non-small-cell lung cancer patients treated with PD-(L)1 inhibitors, but the occurrence of AEs had no effect.
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Affiliation(s)
- Yan Zhang
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrence Township, NJ 08648, USA
| | | | - Trong Kim Le
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrence Township, NJ 08648, USA
| | - Brian Dreyfus
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrence Township, NJ 08648, USA
| | - Nina Kola
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrence Township, NJ 08648, USA
| | - Brooke E Sylvester
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrence Township, NJ 08648, USA
| | - Lincy Lal
- ConcertAI, 6555 Quince, Suite 400, Memphis, TN 38119, USA
| | - John R Penrod
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrence Township, NJ 08648, USA
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8
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Hu S, Tang Z, Harrison JP, Hertel N, Penrod JR, May JR, Juarez-Garcia A, Holdgate O. Economic Evaluation of Nivolumab Versus Docetaxel for the Treatment of Advanced Squamous and Non-squamous Non-small Cell Lung Cancer After Prior Chemotherapy in China. Pharmacoecon Open 2023; 7:273-284. [PMID: 36897427 PMCID: PMC10043099 DOI: 10.1007/s41669-022-00383-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/04/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To evaluate the economic value of nivolumab versus docetaxel for advanced non-small cell lung cancer (aNSCLC) treatment after platinum-based chemotherapy in adults without epidermal growth factor receptor/anaplastic lymphoma kinase aberrations in China. METHODS Partitioned survival models evaluated lifetime costs and benefits of nivolumab versus docetaxel by squamous and non-squamous histologies from a Chinese healthcare payer perspective. Progression-free disease, progressed disease, and death health states were considered over a 20-year time horizon. Clinical data were derived from the CheckMate pivotal Phase III trials (ClinicalTrials.gov identifiers: NCT01642004, NCT01673867, NCT02613507); patient-level survival data were extrapolated using parametric functions. China-specific health state utilities, healthcare resource utilisation, and unit costs were applied. Sensitivity analyses explored uncertainty. RESULTS Nivolumab resulted in extended survival (1.489 and 1.228 life-years [1.226 and 0.995 discounted]) and quality-adjusted survival benefits (1.034 and 0.833 quality-adjusted life-years) at additional costs of ¥214,353 (US$31,829) and ¥158,993 (US$23,608) versus docetaxel in squamous and non-squamous aNSCLC, respectively. Nivolumab was associated with higher acquisition costs, lower subsequent treatment costs, and lower adverse event management costs than docetaxel in both histologies. Drug acquisition costs, discount rate for outcomes, and average body weight were key model drivers. Stochastic results aligned with the deterministic results. CONCLUSIONS Nivolumab yielded survival and quality-adjusted survival benefits at incremental cost versus docetaxel in aNSCLC. As a traditional healthcare payer perspective was applied, the true economic benefit of nivolumab may be underestimated as not all treatment benefits and costs of relevance to society were considered.
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Affiliation(s)
- Shanlian Hu
- School of Public Health, Fudan University, Dong'an Rd, Xuhui Qu, Shanghai, 200333, China
| | - Zhiliu Tang
- Sino-American Shanghai Squibb Pharmaceuticals Ltd, 1315 Jianchuan Rd, Minhang Qu, Shanghai, 201401, China.
- GlaxoSmithKline China, 6/F The Headquarters Building, 168 Tibet Rd(M), Shanghai, 200001, China.
| | - James P Harrison
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ, USA
| | - Nadine Hertel
- Bristol Myers Squibb, Sanderson Rd, Uxbridge, UB8 1DH, UK
| | - John R Penrod
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ, USA
| | - Jessica R May
- Bristol Myers Squibb, Sanderson Rd, Uxbridge, UB8 1DH, UK
| | | | - Orban Holdgate
- Parexel International, Evergreen House North, Grafton Place, 160 Euston Road, London, NW1 2DX, UK
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9
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Chaudhary MA, Edmondson-Jones M, Baio G, Mackay E, Penrod JR, Sharpe DJ, Yates G, Rafiq S, Johannesen K, Siddiqui MK, Vanderpuye-Orgle J, Briggs A. Use of Advanced Flexible Modeling Approaches for Survival Extrapolation from Early Follow-up Data in two Nivolumab Trials in Advanced NSCLC with Extended Follow-up. Med Decis Making 2023; 43:91-109. [PMID: 36259353 DOI: 10.1177/0272989x221132257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Immuno-oncology (IO) therapies are often associated with delayed responses that are deep and durable, manifesting as long-term survival benefits in patients with metastatic cancer. Complex hazard functions arising from IO treatments may limit the accuracy of extrapolations from standard parametric models (SPMs). We evaluated the ability of flexible parametric models (FPMs) to improve survival extrapolations using data from 2 trials involving patients with non-small-cell lung cancer (NSCLC). METHODS Our analyses used consecutive database locks (DBLs) at 2-, 3-, and 5-y minimum follow-up from trials evaluating nivolumab versus docetaxel in patients with pretreated metastatic squamous (CheckMate-017) and nonsquamous (CheckMate-057) NSCLC. For each DBL, SPMs, as well as 3 FPMs-landmark response models (LRMs), mixture cure models (MCMs), and Bayesian multiparameter evidence synthesis (B-MPES)-were estimated on nivolumab overall survival (OS). The performance of each parametric model was assessed by comparing milestone restricted mean survival times (RMSTs) and survival probabilities with results obtained from externally validated SPMs. RESULTS For the 2- and 3-y DBLs of both trials, all models tended to underestimate 5-y OS. Predictions from nonvalidated SPMs fitted to the 2-y DBLs were highly unreliable, whereas extrapolations from FPMs were much more consistent between models fitted to successive DBLs. For CheckMate-017, in which an apparent survival plateau emerges in the 3-y DBL, MCMs fitted to this DBL estimated 5-y OS most accurately (11.6% v. 12.3% observed), and long-term predictions were similar to those from the 5-y validated SPM (20-y RMST: 30.2 v. 30.5 mo). For CheckMate-057, where there is no clear evidence of a survival plateau in the early DBLs, only B-MPES was able to accurately predict 5-y OS (14.1% v. 14.0% observed [3-y DBL]). CONCLUSIONS We demonstrate that the use of FPMs for modeling OS in NSCLC patients from early follow-up data can yield accurate estimates for RMST observed with longer follow-up and provide similar long-term extrapolations to externally validated SPMs based on later data cuts. B-MPES generated reasonable predictions even when fitted to the 2-y DBLs of the studies, whereas MCMs were more reliant on longer-term data to estimate a plateau and therefore performed better from 3 y. Generally, LRM extrapolations were less reliable than those from alternative FPMs and validated SPMs but remained superior to nonvalidated SPMs. Our work demonstrates the potential benefits of using advanced parametric models that incorporate external data sources, such as B-MPES and MCMs, to allow for accurate evaluation of treatment clinical and cost-effectiveness from trial data with limited follow-up. HIGHLIGHTS Flexible advanced parametric modeling methods can provide improved survival extrapolations for immuno-oncology cost-effectiveness in health technology assessments from early clinical trial data that better anticipate extended follow-up.Advantages include leveraging additional observable trial data, the systematic integration of external data, and more detailed modeling of underlying processes.Bayesian multiparameter evidence synthesis performed particularly well, with well-matched external data.Mixture cure models also performed well but may require relatively longer follow-up to identify an emergent plateau, depending on the specific setting.Landmark response models offered marginal benefits in this scenario and may require greater numbers in each response group and/or increased follow-up to support improved extrapolation within each subgroup.
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Affiliation(s)
| | | | - G Baio
- University College London, London, UK
| | | | - J R Penrod
- Bristol-Myers Squibb, Princeton, NJ, USA
| | | | - G Yates
- Parexel International Corp, London, UK
| | - S Rafiq
- Parexel International Corp, London, UK
| | | | | | | | - A Briggs
- London School of Hygiene and Tropical Medicine, London, UK
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10
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Goring S, Varol N, Waser N, Popoff E, Lozano-Ortega G, Lee A, Yuan Y, Eccles L, Tran P, Penrod JR. Correlations between objective response rate and survival-based endpoints in first-line advanced non-small cell lung Cancer: A systematic review and meta-analysis. Lung Cancer 2022; 170:122-132. [PMID: 35767923 DOI: 10.1016/j.lungcan.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The study objective was to estimate the relationship between objective response and survival-based endpoints by drug class, in first-line advanced non-small cell lung cancer (aNSCLC). MATERIALS AND METHODS A systematic literature review identified randomized controlled trials (RCTs) of first-line aNSCLC therapies reporting overall survival (OS), progression-free survival (PFS), and/or objective response rate (ORR). Trial-level and arm-level linear regression models were fit, accounting for inclusion of immunotherapy (IO)-based or chemotherapy-only RCT arms. Weighted least squares-based R2 were calculated along with 95% confidence intervals (CIs). For the main trial-level analysis of OS vs. ORR, the surrogate threshold effect was estimated. Exploratory analyses involved further stratification by: IO monotherapy vs. chemotherapy, dual-IO therapy vs. chemotherapy, and IO + chemotherapy vs. chemotherapy. RESULTS From 17,040 records, 57 RCTs were included. In the main analysis, trial-level associations between OS and ORR were statistically significant in both the IO-based and chemotherapy-only strata, with R2 estimates of 0.54 (95% CI: 0.26-0.81) and 0.34 (0.05-0.63), respectively. OS gains associated with a given ORR benefit were statistically significantly larger within IO vs. chemotherapy comparisons compared to chemotherapy vs. chemotherapy comparisons (p < 0.001). Exploratory analysis suggested a trend by IO type: for a given change in ORR, 'pure' IO (IO monotherapy and dual-IO) vs. chemotherapy RCTs tended to have a larger OS benefit than IO + chemotherapy vs. chemotherapy RCTs. For ORR vs. PFS, trial-level correlations were strong in the IO-based vs. chemotherapy (R2 = 0.84; 0.72-0.95), and chemotherapy vs. chemotherapy strata (R2 = 0.69; 0.49-0.88). For OS vs. PFS, correlations were moderate in both strata (R2 = 0.49; 0.20-0.78 and R2 = 0.49; 0.23-0.76). CONCLUSION The larger OS benefit per unit of ORR benefit in IO-based RCTs compared to chemotherapy-only RCTs provides an important addition to the established knowledge regarding the durability and depth of response in IO-based treatments.
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Affiliation(s)
- Sarah Goring
- Broadstreet HEOR, 201-343 Railway St, Vancouver, BC, Canada.
| | - Nebibe Varol
- Bristol Myers Squibb Pharmaceuticals Ltd, Sanderson Rd, Denham, Uxbridge, England, UK.
| | | | - Evan Popoff
- Broadstreet HEOR, 201-343 Railway St, Vancouver, BC, Canada.
| | | | - Adam Lee
- Bristol Myers Squibb Pharmaceuticals Ltd, Sanderson Rd, Denham, Uxbridge, England, UK.
| | - Yong Yuan
- Bristol Myers Squibb Pharmaceuticals Ltd, 3401 Princeton Pike, Lawrenceville, NJ, USA.
| | - Laura Eccles
- Bristol Myers Squibb Pharmaceuticals Ltd, 3401 Princeton Pike, Lawrenceville, NJ, USA.
| | - Phuong Tran
- Bristol Myers Squibb Pharmaceuticals Ltd, 3401 Princeton Pike, Lawrenceville, NJ, USA.
| | - John R Penrod
- Bristol Myers Squibb Pharmaceuticals Ltd, 3401 Princeton Pike, Lawrenceville, NJ, USA.
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11
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Carroll R, Bortolini M, Calleja A, Munro R, Kong S, Daumont MJ, Penrod JR, Lakhdari K, Lacoin L, Cheung WY. Trends in treatment patterns and survival outcomes in advanced non-small cell lung cancer: a Canadian population-based real-world analysis. BMC Cancer 2022; 22:255. [PMID: 35264135 PMCID: PMC8908553 DOI: 10.1186/s12885-022-09342-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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] [Received: 06/28/2021] [Accepted: 02/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND As part of the multi-country I-O Optimise research initiative, this population-based study evaluated real-world treatment patterns and overall survival (OS) in patients treated for advanced non-small cell lung cancer (NSCLC) before and after public reimbursement of immuno-oncology (I-O) therapies in Alberta province, Canada. METHODS This study used data from the Oncology Outcomes (O2) database, which holds information for ~ 4.5 million residents of Alberta. Eligible patients were adults newly diagnosed with NSCLC between January 2010 and December 2017 and receiving first-line therapy for advanced NSCLC (stage IIIB or IV) either in January 2010-March 2016 (pre-I-O period) or April 2016-June 2019 (post-I-O period). Time periods were based on the first public reimbursement of I-O therapy in Alberta (April 2017), with a built-in 1-year lag time before this date to allow progression to second-line therapy, for which the I-O therapy was indicated. Kaplan-Meier methods were used to estimate OS. RESULTS Of 2244 analyzed patients, 1501 (66.9%) and 743 (33.1%) received first-line treatment in the pre-I-O and post-I-O periods, respectively. Between the pre-I-O and post-I-O periods, proportions of patients receiving chemotherapy decreased, with parallel increases in proportions receiving I-O therapies in both the first-line (from < 0.5% to 17%) and second-line (from 8% to 47%) settings. Increased use of I-O therapies in the post-I-O period was observed in subgroups with non-squamous (first line, 15%; second line, 39%) and squamous (first line, 25%; second line, 65%) histology. First-line use of tyrosine kinase inhibitors also increased among patients with non-squamous histology (from 26% to 30%). In parallel with these evolving treatment patterns, median OS increased from 10.2 to 12.1 months for all patients (P < 0.001), from 11.8 to 13.7 months for patients with non-squamous histology (P = 0.022) and from 7.8 to 9.4 months for patients with squamous histology (P = 0.215). CONCLUSIONS Following public reimbursement, there was a rapid and profound adoption of I-O therapies for advanced NSCLC in Alberta, Canada. In addition, OS outcomes were significantly improved for patients treated in the post-I-O versus pre-I-O periods. These data lend support to the emerging body of evidence for the potential real-world benefits of I-O therapies for treatment of patients with advanced NSCLC.
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Affiliation(s)
- Robert Carroll
- Centre for Observational Research & Data Sciences, Bristol Myers Squibb, Uxbridge, UK
| | | | | | | | - Shiying Kong
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Melinda J Daumont
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Braine-l'Alleud, Belgium
| | - John R Penrod
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
| | - Khalid Lakhdari
- Health Economics and Market Access Oncology, Bristol Myers Squibb, Saint-Laurent, QC, Canada
| | | | - Winson Y Cheung
- Department of Medical Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.
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12
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Chang J, Wu YL, Lu S, Wang J, Mok T, Zhang L, Feng J, Wu L, Tu HY, Zhang Y, Luft A, Zhou JY, Ma Z, Lu Y, Hu C, Shi Y, Poddubskaya E, Soo RA, Chia YH, Penrod JR, Taylor F, Lawrance R, Blum SI, Sun X, Juarez-Garcia A, Moreno-Koehler A, Li A, Li A, Cheng Y. Three-year follow-up and patient-reported outcomes from CheckMate 078: Nivolumab versus docetaxel in a predominantly Chinese patient population with previously treated advanced non-small cell lung cancer. Lung Cancer 2022; 165:71-81. [PMID: 35093625 DOI: 10.1016/j.lungcan.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES In the phase 3 CheckMate 078 study, nivolumab prolonged overall survival (OS) and showed a favorable safety profile versus docetaxel in a predominantly Chinese patient population with previously treated advanced non-small cell lung cancer (aNSCLC). However, long-term efficacy, safety, and health-related quality of life findings with second-line nivolumab are very limited in Asian patients with previously treated aNSCLC. Here, we report updated clinical data and patient-reported outcomes (PROs) from the phase 3 CheckMate 078 trial with a 3-year minimum follow-up. MATERIALS AND METHODS Patients with aNSCLC and disease progression after platinum-doublet chemotherapy were randomized 2:1 to nivolumab (3 mg/kg every 2 weeks) or docetaxel (75 mg/m2 every 3 weeks) until progression or unacceptable toxicity. The primary endpoint was OS; secondary endpoints included objective response rate, progression-free survival, safety, and disease-related symptom deterioration assessed using the Lung Cancer Symptom Scale (LCSS) by Week 12. Additional PRO assessments were exploratory endpoints. RESULTS At ≥ 37.3 months follow-up, 3-year OS rates were 19% with nivolumab and 12% with docetaxel; 30% and 0% of responders remained in response for ≥ 3 years, respectively. Incidence of treatment-related adverse events occurring after 2 years was lower than during the first 2 years. No new treatment-related deaths were reported. By Week 12 of treatment, rates of disease-related symptom deterioration were 32% with nivolumab and 47% with docetaxel. Completion rates for PRO questionnaires were ≥ 80% in both arms. Clinically meaningful and sustained improvements in LCSS Average Symptom Burden Index scores and delayed time to first symptom deterioration were observed with nivolumab against docetaxel. CONCLUSIONS At 3 years, nivolumab continued to demonstrate survival benefit versus docetaxel, exhibiting improvements in disease-related symptoms and overall health status in a predominantly Chinese patient population with previously treated aNSCLC. No new safety signals were observed. These findings are similar to the global population.
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Affiliation(s)
- Jianhua Chang
- Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai 200032, China.
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshan Second Road, Guangzhou 510080, China.
| | - Shun Lu
- Shanghai Chest Hospital, 241 Huaihai West Road, Shanghai 200030, China.
| | - Jie Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China.
| | - Tony Mok
- State Laboratory of Translational Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Hong Kong, China.
| | - Li Zhang
- Sun Yat-Sen University Cancer Center, 651 Dong Feng East Road, Guangzhou 510060, China.
| | - Jifeng Feng
- Jiangsu Cancer Hospital, 42 Bai Zi Ting, Nanjing 210000, China.
| | - Lin Wu
- Hunan Cancer Hospital, 283 Tongzipo Road, Changsha 410013, China.
| | - Hai-Yan Tu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshan Second Road, Guangzhou 510080, China.
| | - Yiping Zhang
- Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou 310022, China.
| | - Alexander Luft
- Leningrad Regional Clinical Hospital, 45-49 Lunacharskogo Avenue, St. Petersburg 194291, Russian Federation.
| | - Jian-Ying Zhou
- The First Affiliated Hospital of College of Medicine, 79 Qingchun Road, Hangzhou 310003, China.
| | - Zhiyong Ma
- The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, 127 Dongming Road, Zhengzhou 450008, China.
| | - You Lu
- West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu 610041, China.
| | - Chengping Hu
- Xiangya Hospital of Central South University, 87 Xiangya Road, Changsha 410008, China.
| | - Yuankai Shi
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China.
| | - Elena Poddubskaya
- Clinical Center VitaMed, 10 Seslavinskaya Street, Moscow, Russian Federation.
| | - Ross A Soo
- National University Hospital, 1E Kent Ridge Road, 119228 Singapore, Singapore.
| | - Yee Hong Chia
- Johns Hopkins Singapore Pte Ltd, 11 Jalan Tan Tock Seng, 308433 Singapore, Singapore.
| | | | | | | | | | | | | | | | - Ang Li
- Bristol Myers Squibb, Princeton, NJ 08540, USA.
| | - Amy Li
- Bristol Myers Squibb, Princeton, NJ 08540, USA.
| | - Ying Cheng
- Jilin Cancer Hospital, 1018 Huguang Road, Changchun 130012, China.
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13
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Waser N, Vo L, McKenna M, Penrod JR, Goring S. Real-world treatment patterns in resectable (stages I-III) non-small-cell lung cancer: a systematic literature review. Future Oncol 2022; 18:1519-1530. [PMID: 35073732 DOI: 10.2217/fon-2021-1417] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The aim of this systematic literature review was to describe treatment patterns in non-metastatic non-small-cell lung cancer. Methods: A search was conducted in MEDLINE and EMBASE. Eligible studies were multicentered (>50 patients) and conducted after 2000 in North America, Europe and Asia. Results: Twenty studies met the eligibility criteria. Based on US and Canadian studies in the resectable population, the proportion of patients who received neoadjuvant chemotherapy/chemoradiotherapy and adjuvant chemotherapy/chemoradiotherapy increased with increasing stage (i.e., from <3% in stage I to about 40% in stage III and from 15% in stage I to 30% in stage III, respectively). Within the resectable population, the breakdown between bimodal and trimodal therapy was variable, suggesting that clinical practice is not uniform. Conclusion: Overall, studies were heterogeneous, precluding data extrapolation across regions. Despite heterogeneity and limited evidence, this review suggested an increase in neoadjuvant and adjuvant chemotherapy with increasing stage, generally in line with treatment guidelines.
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Affiliation(s)
| | - Lien Vo
- Bristol Myers Squibb, Lawrenceville, NJ, USA
| | | | - J R Penrod
- Bristol Myers Squibb, Lawrenceville, NJ, USA
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14
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Polyzoi M, Sandhu H, Maervoet J, Yuan Y, Chaudhary MA, Varol N, Lee A, Dale P, Jones C, Lubinga SJ, Penrod JR. Cost-effectiveness analysis of nivolumab plus ipilimumab plus two cycles of platinum-doublet chemotherapy versus platinum-doublet chemotherapy alone for first-line treatment of stage IV or recurrent non-small cell lung cancer in the United States. J Med Econ 2022; 25:660-668. [PMID: 35658806 DOI: 10.1080/13696998.2022.2048573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/18/2022]
Abstract
AIM This economic analysis evaluated the cost-effectiveness of nivolumab (NIVO) plus ipilimumab (IPI) plus two cycles of platinum-doublet chemotherapy (PDC) compared with four cycles of PDC as first-line treatment for patients with advanced NSCLC in the United States (US). METHODS A partitioned survival model was constructed with three mutually exclusive health states: progression free, progressed disease, and death. The analysis was conducted from a US healthcare payer perspective, using a time horizon of 25 years. Costs and outcomes were discounted at 3% annually. Survival outcomes from CheckMate 9LA were extrapolated with longer follow-up data from CheckMate 227 Part 1 (NIVO + IPI) and validated against data from other relevant clinical trials and real-world registries. Health-related quality of life utility values were derived from EQ-5D-3L data collected in CheckMate 9LA. US-specific costs (2020 dollars) were used for disease management; drug acquisition, administration, and monitoring; end-of-life care; adverse events; and subsequent treatments. Model outcomes included life years (LYs) gained, quality-adjusted LYs (QALYs) gained, and incremental cost-effectiveness ratio (ICER) for NIVO + IPI + PDC versus PDC. Sensitivity and scenario analyses were conducted. RESULTS NIVO + IPI + PDC was associated with higher projected health benefits than PDC, including gains in LYs (3.71 vs 1.89) and QALYs (2.86 vs 1.37), and higher costs ($317,581 vs $119,909). The ICER was $132,960/QALY gained. NIVO + IPI + PDC had a 78-100% probability of being cost-effective at a willingness-to-pay threshold of $150,000-$250,000/QALY. Sensitivity and scenario analyses indicated that the results were robust to changes in key parameters. LIMITATIONS The inherent limitation in extrapolating clinical trial data was mitigated using data from the more mature CheckMate 227 Part 1 trial and validating the outcomes against data from other relevant trials and real-world registries. CONCLUSION NIVO + IPI + PDC (two cycles) provides a new first-line treatment option for patients with advanced NSCLC that is cost-effective within a range considered acceptable in the US.
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Affiliation(s)
| | | | | | - Yong Yuan
- Bristol Myers Squibb, Princeton, NJ, USA
| | | | | | - Adam Lee
- Bristol Myers Squibb, Uxbridge, UK
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15
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Berling M, Chaudhary MA, Yuan Y, Varol N, Dale P, Testa E, Klint J, Lee A, Lubinga SJ, Penrod JR. Cost-effectiveness analysis of nivolumab plus ipilimumab versus platinum-doublet chemotherapy for first-line treatment of stage IV or recurrent non-small cell lung cancer in the United States. J Med Econ 2022; 25:703-711. [PMID: 35659172 DOI: 10.1080/13696998.2022.2077549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/18/2022]
Abstract
AIM We evaluated the cost-effectiveness of nivolumab in combination with ipilimumab (NIVO + IPI) versus platinum-doublet chemotherapy (PDC) for the first-line treatment of stage IV or recurrent non-small cell lung cancer (NSCLC) from a third-party payer perspective in the United States (US). METHODS A partitioned survival model was developed using efficacy, safety, and utility inputs derived from Part 1 of the phase 3 CheckMate 227 trial (NCT02477826) with 37.7-month minimum follow-up for overall survival (OS). OS and progression-free (PF) survival were extrapolated over a 20-year time-horizon using parametric spline-based models selected based on goodness of fit and validated with data from external sources. Duration of treatment Kaplan-Meier curves were used for treatment cost calculations. US-specific costs (2021 dollars) for drug acquisition, administration, and monitoring; disease management (PF and progressed disease health states); end-of-life care; adverse events; and subsequent treatments were derived from publicly available sources. Time-to-death utilities were applied in the base case, whereas treatment-specific progression-based utilities were tested in a scenario analysis. Main outcomes included incremental cost per life-year gained (LYG) and quality-adjusted life-year (QALY). Model uncertainty was assessed through deterministic and probabilistic sensitivity analyses. RESULTS NIVO + IPI resulted in 1.53 additional life-years, 1.33 additional QALYs, and $142 088 in additional costs compared with PDC. The incremental cost per LYG was $92 651, whereas incremental cost per QALY gained was $106 553. The application of treatment-specific progression-based utilities yielded an incremental cost per QALY gained of $117 076. Probabilistic sensitivity analysis revealed a 98% probability that NIVO + IPI was cost-effective versus PDC at a willingness-to-pay threshold of $150 000 per QALY. CONCLUSIONS NIVO + IPI was estimated to be cost-effective as a first-line treatment for stage IV or recurrent NSCLC in the US, with increased survival and higher cost compared with PDC.
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Affiliation(s)
| | | | - Yong Yuan
- Bristol Myers Squibb, Princeton, NJ, USA
| | | | | | | | | | - Adam Lee
- Bristol Myers Squibb, Uxbridge, UK
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16
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Sørensen JB, Horvat P, Rosenlund M, Kejs AM, Patel D, Juarez-Garcia A, Lacoin L, Daumont MJ, Penrod JR, O'Donnell JC, Brustugun OT, Ekman S. Initial treatment and survival in Danish patients diagnosed with non-small-cell lung cancer (2005-2015): SCAN-LEAF study. Future Oncol 2021; 18:205-214. [PMID: 34784783 DOI: 10.2217/fon-2021-0746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To describe initial treatment patterns and survival of patients diagnosed with non-small-cell lung cancer (NSCLC) in Denmark, before immune checkpoint inhibitor and later-generation tyrosine kinase inhibitor use. Patients & methods: Adults diagnosed with incident NSCLC (2005-2015; follow-up: 2016). Initial treatments and overall survival (OS) are reported. Results: 31,939 NSCLC patients (51.6% stage IV) were included. Increasing use of curative radiotherapy/chemoradiation for stage I, II/IIIA and IIIB NSCLC coincided with improved 2-year OS. Systemic anticancer therapy use increased for patients with stage IV non-squamous NSCLC (53.0-60.6%) but not squamous NSCLC (44.9-47.3%). 1-year OS improved in patients with stage IV non-squamous NSCLC (23-31%) but not squamous NSCLC (22-25%). Conclusion: Trends indicated improved OS as treatments evolved between 2005 and 2015, but the effect was limited to 1-year OS in stage IV disease.
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Affiliation(s)
| | - Pia Horvat
- Real-World Evidence Solutions, IQVIA, London, N1 9JY, UK
| | - Mats Rosenlund
- Real-World & Analytics Solutions, IQVIA, 169 56 Solna, Sweden.,Department of Learning, Informatics, Management & Ethics (LIME), Karolinska Institutet, Stockholm, 171 65, Sweden
| | - Anne Mette Kejs
- Real-World & Analytics Solutions, IQVIA, Copenhagen, 2100, Denmark
| | - Dony Patel
- Real-World Evidence Solutions, IQVIA, London, N1 9JY, UK
| | - Ariadna Juarez-Garcia
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Uxbridge, UB8 1DH, UK
| | - Laure Lacoin
- Epi-Fit, Bordeaux, Nouvelle-Aquitaine 33000, France
| | - Melinda J Daumont
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, 1420 Braine-L'Alleud, Belgium
| | - John R Penrod
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, NJ 08540, USA
| | - John C O'Donnell
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, NJ 08540, USA
| | - Odd Terje Brustugun
- Section of Oncology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, 3019, Norway
| | - Simon Ekman
- Thoracic Oncology Center, Karolinska University Hospital/Department of Oncology-Pathology, Karolinska Institutet, Stockholm, 171 64, Sweden
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17
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Danese MD, Daumont M, Nwokeji E, Gleeson M, Penrod JR, Lubeck D. Treatment patterns and outcomes in older patients with advanced malignant pleural mesothelioma: Analyses of Surveillance, Epidemiology, and End Results-Medicare data. Cancer Rep (Hoboken) 2021; 5:e1568. [PMID: 34698447 PMCID: PMC9458508 DOI: 10.1002/cnr2.1568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 04/01/2021] [Revised: 08/30/2021] [Accepted: 09/21/2021] [Indexed: 11/09/2022] Open
Abstract
Background Malignant mesothelioma is a rare neoplasm associated with asbestos exposure. Characterizing treatment patterns and outcomes of older patients with advanced malignant pleural mesothelioma (MPM) is important to understand the unmet needs of this population. Aim To evaluate the demographic and clinical characteristics, treatment patterns, and outcomes among older patients diagnosed with advanced MPM in the United States between 2007 and 2013. Methods This was a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) data linked with Medicare claims. We included patients who were age 66 or older at the time of their primary MPM diagnosis between 2007 and 2013 and followed them through 2014. Treated patients who received first‐line chemotherapy with pemetrexed and platinum within 90 days of diagnosis, second‐line, or third‐line therapy were identified for evaluation of outcomes. Results There were 666 older patients with advanced MPM, of whom 82% were male, 87% White, 78% stage IV, and 70% had no mobility limitation indicators at diagnosis. There were 262 patients who received first‐line chemotherapy for advanced MPM, most of whom (80%; n = 209) received pemetrexed‐platinum. Of these 209 patients, 41% (n = 86) initiated second‐line therapy, and 26% (n = 22) initiated third‐line therapy. Median overall survival for the cohort of 209 patients was 7.2 months. Patients with epithelioid histology had better median overall survival (12.2 months) compared with other histologies (4.4–5.6 months). Within 90 days of diagnosis of advanced MPM, 78% of patients were hospitalized, 52% visited an emergency department, and 21% had hospice care. The 2‐year cost of care was over $100 000 for all patients with advanced MPM treated with first‐line pemetrexed‐platinum. Conclusions Although first‐line systemic anticancer treatment was generally consistent with guidelines (e.g., pemetrexed‐platinum), poor patient outcomes highlight the need for effective treatment options for older patients with advanced MPM.
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Affiliation(s)
- Mark D Danese
- Outcomes Insights, Inc., Agoura Hills, California, USA
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18
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Ekman S, Horvat P, Rosenlund M, Kejs AM, Patel D, Juarez-Garcia A, Lacoin L, Daumont MJ, Penrod JR, Brustugun OT, Sørensen JB. Epidemiology and Survival Outcomes for Patients With NSCLC in Scandinavia in the Preimmunotherapy Era: A SCAN-LEAF Retrospective Analysis From the I-O Optimise Initiative. JTO Clin Res Rep 2021; 2:100165. [PMID: 34590017 PMCID: PMC8474201 DOI: 10.1016/j.jtocrr.2021.100165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 08/17/2020] [Revised: 02/18/2021] [Accepted: 03/05/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction SCAN-LEAF, part of the I-O Optimise initiative, is a retrospective, longitudinal study investigating the epidemiology, clinical care, and outcomes for patients with NSCLC in Scandinavia. We report overall survival (OS) trends for patients diagnosed with NSCLC in Sweden and Denmark between 2005 and 2015. Methods Swedish and Danish cohorts were established by linking national registries. Data on all adults diagnosed with incident NSCLC from January 1, 2005, to December 31, 2015, were included. For temporal analyses of OS trends, patients were stratified by TNM stage and histology. Results Between 2005 and 2015, a total of 30,067 and 31,939 patients from Sweden and Denmark, respectively, were diagnosed with NSCLC; the most common histological subtype was nonsquamous cell carcinoma (56.9% and 53.0%) and 48.4% and 51.6% were diagnosed at stage IV. Over the study period, significant improvements in short-term survival (1 y) were observed for patients with nonsquamous cell carcinoma in both countries, regardless of disease stage at diagnosis; however, improvements in longer-term survival (5 y) were limited to patients with stage I and II disease only. Conversely, among patients with squamous cell histology, improvements in short-term survival were only observed for stage I disease in Sweden and stage IIIA disease in Denmark, while significant improvements in longer-term survival were seen only for stage IIIA NSCLC in both countries. Conclusions Despite some survival improvements between 2005 and 2015, an unmet need remains for patients with advanced NSCLC, particularly those with squamous cell histology. Future analyses will evaluate the impact of newer treatments on OS in NSCLC.
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Affiliation(s)
- Simon Ekman
- Thoracic Oncology Center, Department of Oncology-Pathology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Pia Horvat
- Real-World Evidence Solutions, IQVIA, London, United Kingdom
| | - Mats Rosenlund
- Real-World & Analytics Solutions, IQVIA, Solna, Sweden.,Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Anne Mette Kejs
- Real-World & Analytics Solutions, IQVIA, Copenhagen, Denmark
| | - Dony Patel
- Real-World Evidence Solutions, IQVIA, London, United Kingdom
| | - Ariadna Juarez-Garcia
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Uxbridge, United Kingdom
| | | | - Melinda J Daumont
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Braine-L'Alleud, Belgium
| | - John R Penrod
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, New Jersey
| | - Odd Terje Brustugun
- Section of Oncology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
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19
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Snee M, Cheeseman S, Thompson M, Riaz M, Sopwith W, Lacoin L, Chaib C, Daumont MJ, Penrod JR, Hall G. Treatment patterns and survival outcomes for patients with non-small cell lung cancer in the UK in the preimmunology era: a REAL-Oncology database analysis from the I-O Optimise initiative. BMJ Open 2021; 11:e046396. [PMID: 34526333 PMCID: PMC8444261 DOI: 10.1136/bmjopen-2020-046396] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 07/15/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To report characteristics, treatment and overall survival (OS) trends, by stage and pathology, of patients diagnosed with non-small cell lung cancer (NSCLC) at Leeds Teaching Hospital NHS Trust in 2007-2018. DESIGN Retrospective cohort study based on electronic medical records. SETTING Large NHS university hospital in Leeds. PARTICIPANTS 3739 adult patients diagnosed with incident NSCLC from January 2007 to August 2017, followed up until March 2018. MAIN OUTCOME MEASURES Patient characteristics at diagnosis, treatment patterns and OS. RESULTS 34.3% of patients with NSCLC were clinically diagnosed (without pathological confirmation). Among patients with known pathology, 45.2% had non-squamous cell carcinoma (NSQ) and 33.3% had squamous cell carcinoma (SQ). The proportion of patients diagnosed at stage I increased (16.4%-27.7% in 2010-2017); those diagnosed at stage IV decreased (57.0%-39.1%). Surgery was the most common initial treatment for patients with pathologically confirmed stage I NSCLC. Use of radiotherapy alone increased over time in patients with clinically diagnosed stage I NSCLC (39.1%-60.3%); chemoradiation increased in patients with stage IIIA NSQ (21.6%-33.3%) and SQ (24.2%-31.9%). Initial treatment with systemic anticancer therapy (SACT) increased in patients with stages IIIB-IV NSQ (49.0%-67.5%); the proportion of untreated patients decreased (30.6%-15.0%). Median OS improved for patients diagnosed with stage I NSQ and SQ and stage IIIA NSQ over time. Median OS for patients with stages IIIB-IV NSQ and SQ remained stable, <10% patients were alive 3 years after diagnosis. Median OS for clinically diagnosed stages IIIB-IV patients was 1.2 months in both periods. CONCLUSIONS OS for stage I and IIIA patients improved over time, likely due to increased use of stereotactic ablative radiation, surgery (stage I) and chemoradiation (stage IIIA). Conversely, OS outcomes remained poor for stage IIIB-IV patients despite increasing use of SACT for NSQ. Many patients with advanced-stage disease remained untreated.
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Affiliation(s)
- Michael Snee
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sue Cheeseman
- REAL Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Majid Riaz
- REAL Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Will Sopwith
- REAL Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Carlos Chaib
- Research & Development Medical Affairs, Bristol Myers Squibb, Madrid, Spain
| | - Melinda J Daumont
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Braine-l'Alleud, Belgium
| | - John R Penrod
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Geoff Hall
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
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20
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Chaudhary MA, Lubinga SJ, Smare C, Hertel N, Penrod JR. Cost-effectiveness of nivolumab in patients with NSCLC in the United States. Am J Manag Care 2021; 27:e254-e260. [PMID: 34460179 DOI: 10.37765/ajmc.2021.88726] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To determine the lifetime cost-effectiveness of nivolumab vs docetaxel in advanced squamous and nonsquamous non-small cell lung cancer (NSCLC) following platinum-based chemotherapy from a US payer perspective. STUDY DESIGN Trial- and cohort-based cost-effectiveness analyses. METHODS The analyses used partitioned survival models with 3 mutually exclusive health states: progression free, progressed disease, and death. The mean starting age was 61 years. Clinical parameters were derived from the 2 registrational, randomized, phase 3 trials with a minimum follow-up of 5 years. Costs were derived from published literature. The primary outcomes were quality-adjusted life-years (QALYs), life-years gained (LYG), and incremental cost-effectiveness ratios (ICERs). Costs and outcomes were discounted at 3% per annum. Uncertainty was examined using univariate and probabilistic sensitivity analyses. RESULTS In patients with squamous NSCLC, the use of nivolumab improved life-years (LYs) and QALYs by 1.23 and 0.99, respectively, compared with docetaxel. Costs were increased by $99,677, resulting in ICERs of $100,776 per QALY and $81,294 per LYG. In patients with nonsquamous NSCLC, nivolumab increased LYs and QALYs by 0.99 and 0.80, respectively. Costs were increased by $94,174, resulting in ICERs of $117,739 per QALY and $94,849 per LYG. ICERs were most sensitive to the discount rates applied to costs and outcomes. At a willingness-to-pay threshold of $150,000, nivolumab had probabilities of 91% and 99% of being cost-effective in patients with squamous and nonsquamous NSCLC, respectively. CONCLUSIONS Nivolumab is likely to be cost-effective for the treatment of patients with advanced NSCLC following platinum-based chemotherapy in the United States.
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Affiliation(s)
| | - Solomon J Lubinga
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrence Township, NJ 08648.
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21
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Soares M, Antunes L, Redondo P, Borges M, Grimson F, Hermans R, Chaib C, Lacoin L, Juarez-Garcia A, Daumont MJ, Penrod JR, Bento MJ, Gonçalves FR. Small cell lung cancer treatment and survival in Portugal: A retrospective analysis from the I-O Optimise initiative. Eur J Cancer Care (Engl) 2021; 30:e13496. [PMID: 34288191 PMCID: PMC9285943 DOI: 10.1111/ecc.13496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 11/05/2020] [Revised: 05/11/2021] [Accepted: 07/08/2021] [Indexed: 02/03/2023]
Abstract
Objective We aim to describe treatment patterns and overall survival (OS) among a Portuguese cohort of patients with small cell lung cancer (SCLC). Methods This study utilised a database held by IPO‐Porto, Portugal's largest oncology hospital. Adult patients diagnosed with SCLC at IPO‐Porto between January 2012 and June 2017, with follow‐up to December 2017, were included. Patients were stratified into subgroups with limited disease (LD) or extensive disease (ED). Treatment analyses were performed from 2015 onwards. Results Overall, 227 patients diagnosed with SCLC (37 LD; 190 ED) were analysed. Median OS (interquartile range [IQR]) was 15.0 months (3.8–39.3) for LD‐SCLC and 5.0 months (1.7–10.3) for ED‐SCLC. Among 19 patients diagnosed with LD‐SCLC from 2015 onwards, 12 (63.2%) received initial treatment with systemic anticancer therapy (SACT) ± radiotherapy; 6 (31.6%) received best supportive care (BSC). Among 89 patients with ED‐SCLC, 57 (68.5%) received SACT ± palliative radiotherapy; 28 (31.5%) received BSC. For patients receiving platinum doublet chemotherapy (±radiotherapy), median OS (IQR) was not reached for LD‐SCLC and 5.4 months (2.3–10.9) for ED‐SCLC. Conclusion This real‐world data analysis from a large Portuguese oncology hospital demonstrates a high disease burden for patients diagnosed with SCLC, particularly those with ED, and highlights a need for more effective therapies.
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Affiliation(s)
- Marta Soares
- Department of Medical Oncology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Luís Antunes
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Patrícia Redondo
- Outcomes Research Laboratory, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Marina Borges
- Outcomes Research Laboratory, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | | | | | - Carlos Chaib
- Research & Development Medical Affairs, Bristol Myers Squibb, Madrid, Spain
| | | | | | - Melinda J Daumont
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Braine-l'Alleud, Belgium
| | - John R Penrod
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Maria José Bento
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal.,Department of Population Studies, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
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Shafrin J, May SG, Zhao LM, Bognar K, Yuan Y, Penrod JR, Romley JA. Measuring the Value Healthy Individuals Place on Generous Insurance Coverage of Severe Diseases: A Stated Preference Survey of Adults Diagnosed With and Without Lung Cancer. Value Health 2021; 24:855-861. [PMID: 34119084 DOI: 10.1016/j.jval.2020.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/27/2020] [Accepted: 06/03/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To compare the ex ante willingness to pay (WTP) of healthy individuals for generous insurance coverage of novel lung cancer treatments to the WTP for coverage of such treatment among individuals with lung cancer. METHODS A survey was administered to 2 cohorts of US adults: (1) healthy individuals without cancer and (2) individuals diagnosed with lung cancer. A multiple random staircase survey design was used to elicit respondent WTP for coverage of novel lung cancer therapy associated with survival gains. RESULTS Of the 84 937 healthy individuals invited, 300 completed the survey. Of the 36 249 in the lung cancer cohort invited, 250 completed the survey. Mean age by cohort was 50.0 (SD 14.6) and 48.4 (SD 16.8) years, and 55.2% and 47.2% were female, respectively. Respondents in the healthy and lung cancer cohorts were willing to pay $97.52 (95% confidence interval (CI) $89.89-$105.15) and $22 304 (95% CI $20 194-$24 414) per month, respectively, for coverage of a novel therapy providing 5-year survival of 15% versus standard-of-care therapy with a 5-year survival of 4%. After accounting for the likelihood that healthy individuals are diagnosed with lung cancer in the future, we estimated that 89.8% of the total value of new lung cancer treatments comes from the WTP healthy individuals place on generous insurance coverage. CONCLUSIONS Total societal willingness to pay for lung cancer is much higher than conventionally thought, as most healthy individuals are risk-averse and highly value having lung cancer treatments available to them in the future.
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Affiliation(s)
- Jason Shafrin
- Precision Health Economics and Outcomes Research, Los Angeles, CA, USA.
| | - Suepattra G May
- Precision Health Economics and Outcomes Research, Los Angeles, CA, USA
| | - Lauren M Zhao
- Precision Health Economics and Outcomes Research, New York, NY, USA
| | - Katalin Bognar
- Precision Health Economics and Outcomes Research, Los Angeles, CA, USA
| | - Yong Yuan
- Bristol-Myers Squibb, Princeton, NJ, USA
| | | | - John A Romley
- University of Southern California, Los Angeles, CA, USA
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23
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Snee M, Cheeseman S, Thompson M, Riaz M, Sopwith W, Lacoin L, Chaib C, Manley Daumont M, Penrod JR, O'Donnell JC, Hall G. Trends in the prescription of systemic anticancer therapy and mortality among patients with advanced non-small cell lung cancer: a real-world retrospective observational cohort study from the I-O optimise initiative. BMJ Open 2021; 11:e043442. [PMID: 33941627 PMCID: PMC8098989 DOI: 10.1136/bmjopen-2020-043442] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To assess how a decade of developments in systematic anticancer therapy (SACT) for advanced non-small cell lung cancer (NSCLC) affected overall survival (OS) in a large UK University Hospital. DESIGN Real-world retrospective observational cohort study using existing data recorded in electronic medical records. SETTING A large National Health Service (NHS) university teaching hospital serving 800 000 people living in a diverse metropolitan area of the UK. PARTICIPANTS 2119 adults diagnosed with advanced NSCLC (tumour, node, metastasis stage IIIB or IV) between 2007 and 2017 at Leeds Teaching Hospitals NHS Trust. MAIN OUTCOMES AND MEASURES OS following diagnosis and the analysis of factors associated with receiving SACT. RESULTS Median OS for all participants was 2.9 months, increasing for the SACT-treated subcohort from 8.4 months (2007-2012) to 9.1 months (2013-2017) (p=0.02); 1-year OS increased from 33% to 39% over the same period for the SACT-treated group. Median OS for the untreated subcohort was 1.6 months in both time periods. Overall, 30.6% (648/2119) patients received SACT; treatment rates increased from 28.6% (338/1181) in 2007-2012 to 33.0% (310/938) in 2013-2017 (p=0.03). Age and performance status were independent predictors for SACT treatment; advanced age and higher performance status were associated with lower SACT treatment rates. CONCLUSION Although developments in SACT during 2007-2017 correspond to some changes in survival for treated patients with advanced NSCLC, treatment rates remain low and the prognosis for all patients remains poor.
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Affiliation(s)
| | | | - Matthew Thompson
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Real-World Insights, IQVIA, London, UK
| | - Majid Riaz
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Real-World Insights, IQVIA, London, UK
| | - Will Sopwith
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Real-World Insights, IQVIA, London, UK
| | | | - Carlos Chaib
- R&D Medical Affairs, Bristol Myers Squibb, Madrid, Spain
| | - Melinda Manley Daumont
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Braine-l'Alleud, Belgium
| | - John R Penrod
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - John C O'Donnell
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Geoff Hall
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
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24
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Debieuvre D, Juergens RA, Asselain B, Audigier-Valette C, Auliac JB, Barlesi F, Benoit N, Bombaron P, Butts CA, Dixmier A, Gröschel A, Gutz S, Labbé C, Moro-Sibilot D, Pérol M, Raspaud C, Schumann C, Juarez-Garcia A, Lakhdari K, Pettersson F, Penrod JR, Reynaud D, Waldenberger D, Allan V, Sebastian M. Two-year survival with nivolumab in previously treated advanced non-small-cell lung cancer: A real-world pooled analysis of patients from France, Germany, and Canada. Lung Cancer 2021; 157:40-47. [PMID: 33980420 DOI: 10.1016/j.lungcan.2021.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Immune checkpoint inhibitors have become the standard of care for metastatic non-small-cell lung cancer (NSCLC) progressing during or after platinum-based chemotherapy. Real-world clinical practice tends to represent more diverse patient characteristics than randomized clinical trials. We sought to evaluate overall survival (OS) outcomes in the total study population and in key subsets of patients who received nivolumab for previously treated advanced NSCLC in real-world settings in France, Germany, or Canada. MATERIALS AND METHODS Data were pooled from two prospective observational cohort studies, EVIDENS and ENLARGE, and a retrospective registry in Canada. Patients included in this analysis were aged ≥18 years, had stage IIIB/IV NSCLC, and received nivolumab after at least one prior line of systemic therapy. OS was estimated in the pooled population and in various subgroups using the Kaplan-Meier method. Timing of data collection varied across cohorts (2015-2019). RESULTS Of the 2585 patients included in this analyses, 1235 (47.8 %) were treated in France, 881 (34.1 %) in Germany, and 469 (18.1 %) in Canada. Median OS for the total study population was 11.3 months (95 % CI: 10.5-12.2); this was similar across France, Germany, and Canada. The OS rate was 49 % at 1 year and 28 % at 2 years for the total study population. In univariable Cox analyses, the presence of epidermal growth factor receptor mutations in nonsquamous disease, liver, or bone metastases were associated with significantly shorter OS, whereas tumor programmed death ligand 1 expression and Eastern Cooperative Oncology Group performance status 0-1 were associated with significantly prolonged OS. Similar OS was noted across subgroups of age and prior lines of therapy. CONCLUSION OS rates in patients receiving nivolumab for previously treated advanced NSCLC in real-world clinical practice closely mirrored those in phase 3 studies, suggesting similar effectiveness of nivolumab in clinical trials and clinical practice.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Sylvia Gutz
- Ev. Diakonissenkrankenhaus, Leipzig, Germany
| | - Catherine Labbé
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, QC, Canada
| | - Denis Moro-Sibilot
- Thoracic Oncology Unit, SHUPP, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | | | | | - Christian Schumann
- Klinikverbund Allgäu, Klinik für Pneumologie, Thoraxonkologie, Schlaf- und Beatmungsmedizin, Kempten Und Immenstadt, Germany
| | | | | | | | | | | | | | | | - Martin Sebastian
- University Hospital, Goethe-University Frankfurt, Department of Hematology and Medical Oncology, Frankfurt, Germany.
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25
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Waterhouse DM, Nwokeji ED, Boyd M, Penrod JR, Espirito JL, Robert NJ, Daumont MJ. Treatment patterns and outcomes of patients with advanced malignant pleural mesothelioma in a community practice setting. Future Oncol 2021; 17:2439-2448. [PMID: 33769073 DOI: 10.2217/fon-2021-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To assess real-world treatment patterns and outcomes among patients with advanced malignant pleural mesothelioma. Patients & methods: Retrospective database analysis. Results: In all, 469 patients received first-line systemic anticancer therapy (SACT) at community centers. Median follow-up from diagnosis was 11.6 months. Pemetrexed + platinum was the most common first-line SACT; similar proportions of patients received cisplatin or carboplatin with pemetrexed. Only a small proportion of patients received second- and third-line therapies. Median overall survival for first-line SACT was 12.0 months (95% CI: 10.7-14.2). Results were similar with pemetrexed + cisplatin and pemetrexed + carboplatin. Median overall survival with second-line SACT was 6.4 months (95% CI: 5.1-7.6). Conclusion: There is a need for more effective SACTs for advanced malignant pleural mesothelioma.
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Affiliation(s)
| | | | - Marley Boyd
- McKesson Life Sciences, The Woodlands, TX 77380, USA
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26
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Soares M, Antunes L, Redondo P, Borges M, Hermans R, Patel D, Grimson F, Munro R, Chaib C, Lacoin L, Daumont M, Penrod JR, O'Donnell JC, Bento MJ, Gonçalves FR. Treatment and outcomes for early non-small-cell lung cancer: a retrospective analysis of a Portuguese hospital database. Lung Cancer Manag 2021; 10:LMT46. [PMID: 34084212 PMCID: PMC8162184 DOI: 10.2217/lmt-2020-0028] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: This observational study evaluated treatment patterns and survival for patients with stage I–IIIA non-small-cell lung cancer (NSCLC). Materials & methods: Adults newly diagnosed with NSCLC in 2012–2016 at IPO-Porto hospital were included. Treatment data were available for patients diagnosed in 2015–2016. Results: 495 patients were included (median age: 67 years). The most common treatments were surgery alone or with another therapy (stage I: 66%) and systemic anticancer therapy plus radiotherapy (stage II: 54%; stage IIIA: 59%). One-year OS (95% CI) for patients with stage I, II and IIIA NSCLC (diagnosed 2012–2016) were 92% (88–96), 71% (62–82) and 69% (63–75), respectively; one-year OS (95% CI) for treated patients with stage I–II or stage IIIA NSCLC (diagnosed 2015–2016) were 89% (81–97) and 86% (75–98) for non-squamous cell and 76% (60–95) and 49% (34–70) for squamous cell NSCLC. Conclusion: Treatment advances are strongly needed for stage I–IIIA NSCLC, especially for patients with squamous cell histology.
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Affiliation(s)
- Marta Soares
- Department of Medical Oncology, Portuguese Oncology Institute of Porto (IPO-Porto), 4200-072 Porto, Portugal
| | - Luís Antunes
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), 4200-072 Porto, Portugal
| | - Patrícia Redondo
- Outcomes Research Lab, Portuguese Oncology Institute of Porto (IPO-Porto), 4200-072 Porto, Portugal
| | - Marina Borges
- Outcomes Research Lab, Portuguese Oncology Institute of Porto (IPO-Porto), 4200-072 Porto, Portugal
| | | | - Dony Patel
- Real World Solutions, IQVIA, London, N1 9JY, UK
| | | | - Robin Munro
- Real World Solutions, IQVIA, London, N1 9JY, UK
| | - Carlos Chaib
- R&D Medical Affairs, Bristol Myers Squibb, 28050 Madrid, Spain
| | - Laure Lacoin
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, 1420 Braine-l'Alleud, Belgium.,Epi-Fit, Bordeaux, Nouvelle-Aquitaine 33000, France
| | - Melinda Daumont
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, 1420 Braine-l'Alleud, Belgium
| | - John R Penrod
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, NJ 08540, USA
| | - John C O'Donnell
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, NJ 08540, USA
| | - Maria José Bento
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), 4200-072 Porto, Portugal.,Department of Population Studies, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), 4050-313 Porto, Portugal
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Reck M, Ciuleanu TE, Lee JS, Schenker M, Audigier-Valette C, Zurawski B, Linardou H, Otterson GA, Salman P, Nishio M, de la Mora Jimenez E, Lesniewski-Kmak K, Albert I, Ahmed S, Syrigos K, Penrod JR, Yuan Y, Blum SI, Nathan FE, Sun X, Moreno-Koehler A, Taylor F, O'Byrne KJ. First-Line Nivolumab Plus Ipilimumab Versus Chemotherapy in Advanced NSCLC With 1% or Greater Tumor PD-L1 Expression: Patient-Reported Outcomes From CheckMate 227 Part 1. J Thorac Oncol 2021; 16:665-676. [PMID: 33485960 DOI: 10.1016/j.jtho.2020.12.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In CheckMate 227 (NCT02477826), patients with treatment-naive stage IV or recurrent NSCLC and 1% or greater tumor programmed death ligand 1 expression had significantly improved overall survival with nivolumab plus ipilimumab versus chemotherapy. We present the patient-reported outcomes (PROs). METHODS Patients (N = 1189) were randomized to nivolumab plus ipilimumab, nivolumab, or chemotherapy. PROs were exploratory. Changes in Lung Cancer Symptom Scale (LCSS) average symptom burden index, LCSS 3-item global index, EQ-5D visual analog scale (VAS), and EQ-5D utility index were analyzed descriptively. Mixed-effect model repeated measures and time-to-first deterioration and improvement analyses were conducted. RESULTS PRO completion rates were generally greater than 80%. On-treatment improvements from baseline in LCSS measures of symptom burden and global health status with nivolumab plus ipilimumab generally met or exceeded the minimal important difference (smallest clinically meaningful change) from weeks 24 and 30, respectively; improvements with chemotherapy generally remained below the minimal important difference. Mean on-treatment EQ-5D VAS scores for both treatments approached the U.K. population norm at week 24, remaining so throughout the treatment period. Mixed-effect model repeated measures analyses revealed numerically greater improvements from baseline with nivolumab plus ipilimumab versus chemotherapy across LCSS average symptom burden index and 3-item global index, and EQ-5D VAS and utility index. Nivolumab plus ipilimumab had delayed time-to-first deterioration (hazard ratio [95% confidence interval] 0.74 [0.56 to 0.98]) and a trend for more rapid time-to-first improvement (1.24 [0.98 to 1.59]) versus chemotherapy. CONCLUSIONS Nivolumab plus ipilimumab revealed delayed deterioration and numerical improvement in symptoms and health-related quality of life versus chemotherapy in patients with advanced NSCLC and 1% or greater programmed death ligand 1 expression.
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Affiliation(s)
- Martin Reck
- LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research, Grosshansdorf, Germany.
| | - Tudor-Eliade Ciuleanu
- Institutul Oncologic Prof. Dr. Ion Chiricuta and UNF Iulia Hatieganu, Cluj-Napoca, Romania
| | - Jong-Seok Lee
- Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | | | | | | | | | | | | | - Makoto Nishio
- The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | | | - Samreen Ahmed
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Konstantinos Syrigos
- Sotiria General Hospital, National and Kaposistrian University of Athens, Athens, Greece
| | | | - Yong Yuan
- Bristol Myers Squibb, Princeton, New Jersey
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Roth JA, Yuan Y, Othus M, Danese M, Wagner S, Penrod JR, Ramsey SD. A comparison of mixture cure fraction models to traditional parametric survival models in estimation of the cost-effectiveness of nivolumab for relapsed small cell lung cancer. J Med Econ 2021; 24:79-86. [PMID: 33334176 DOI: 10.1080/13696998.2020.1857960] [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: 10/22/2022]
Abstract
BACKGROUND In August 2018, the US FDA granted accelerated approval for nivolumab in small cell lung cancer (SCLC) that has progressed after platinum-based chemotherapy and at least one other line of therapy. The objective of this study was to evaluate the cost-effectiveness of nivolumab vs. usual care as third-line (3 L) therapy for patients with recurrent SCLC (rSCLC) from the health payer perspective. Given the potential for a meaningful fraction of treated patients to achieve long-term response to nivolumab, we also assessed the impact of using mixture cure modeling (MCM) vs. parametric survival modeling on survival estimates and cost-effectiveness from the US Medicare payer perspective. METHODS We created a partitioned survival decision model to assess the cost-effectiveness of 3 L nivolumab vs. usual care in rSCLC, based on observed US treatment patterns. Using this approach, we assessed the impact of extrapolating long-term survival from the CheckMate 032 trial, using both MCM and standard parametric curve fits. Nivolumab survival, resource use, and Grade 3/4 adverse event rates were derived from CheckMate 032. Usual care survival, resource use, and costs were derived from an analysis of patients receiving 3 L treatment for rSCLC in the SEER-Medicare registry. We applied 2020 Wholesale Acquisition Cost for drugs and 2020 CMS reimbursement for procedures. Utilities were derived from the literature. We estimated life years (LY), quality-adjusted life years (QALYs), and costs over a lifetime horizon. RESULTS MCM and parametric survival model extrapolations resulted in 0.43 versus 0.38 more LYs, 0.34 versus 0.30 more QALYs, and $69,308 versus $61,336 more expenditure for nivolumab vs. usual care, respectively. The costs per QALY gained using mixture cure versus parametric survival modeling were $204,386 and $207,431, respectively. CONCLUSIONS Mixture cure modeling was equivalent compared to parametric modeling in estimating the cost-effectiveness of nivolumab-based therapy due to the small fraction of patients achieving a long-term response with nivolumab (12.9%).
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Affiliation(s)
- Joshua A Roth
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Yong Yuan
- Global Health Outcomes, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Megan Othus
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mark Danese
- HEOR, Outcomes Insights, Westlake Village, CA, USA
| | - Samuel Wagner
- Global Health Outcomes, Bristol-Myers Squibb, Princeton, NJ, USA
| | - John R Penrod
- Global Health Outcomes, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Scott D Ramsey
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Chaudhary MA, Holmberg C, Lakhdari K, Smare C, Theriou C, Dale P, Penrod JR. Cost-effectiveness of nivolumab in squamous and non-squamous non-small cell lung cancer in Canada and Sweden: an update with 5-year data. J Med Econ 2021; 24:607-619. [PMID: 33870833 DOI: 10.1080/13696998.2021.1917139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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 Nivolumab has been approved for advanced squamous and non-squamous non-small cell lung cancer (NSCLC) following platinum-based chemotherapy in both Canada and Sweden. We aimed to determine the value-for-money of nivolumab versus docetaxel in a Canadian and Swedish setting based on 5-year data. METHODS These cost effectiveness analyses used partitioned survival models with three mutually exclusive health states: progression-free, progressed disease, and death. All clinical parameters were derived from two registration phase 3 randomized trials, CheckMate 017 and CheckMate 057, with a minimum follow-up of 5 years. Treatment duration was based on time-on-treatment data from the clinical trials. Costs were derived from published sources. The primary outcomes of the analyses were quality-adjusted life-years (QALYs), life-years gained, and incremental cost-effectiveness ratios (ICERs). The model input parameters for each analysis were chosen in line with guidance from the respective HTA authorities. RESULTS From a Canadian payer perspective, the ICERs were CAN$140,753 per QALY in the squamous population, and CAN$173,804 per QALY in the non-squamous population, assuming a 10-year time horizon and a 5% discount rate for both costs and outcomes. Sensitivity analyses demonstrated that changes to the discount rates for outcomes had the highest impact on the ICERs. In the Swedish analysis, the ICERs were SEK568,895 per QALY in the squamous population and SEK662,991 per QALY in the non-squamous population, assuming a 15-year time horizon, a 3% discount rate, and a 2-year maximum treatment duration for nivolumab. Sensitivity analyses demonstrated that the ICERs were most sensitive to changes in the discount rate for outcomes. CONCLUSION These updated analyses, based on more mature trial data with a minimum follow-up of 5 years, generate more favorable ICERs versus the previously submitted HTA assessments that resulted in approval of nivolumab for patients with previously treated NSCLC in Canada and Sweden.
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Affiliation(s)
- Mohammad A Chaudhary
- Worldwide Health Economics and Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
| | - Christoffer Holmberg
- Value & Health Economics and Outcomes Research, Bristol Myers Squibb, Solna, Sweden
| | - Khalid Lakhdari
- Market Access & HTA, Bristol Myers Squibb Canada, St. Laurent, QC, Canada
| | | | | | | | - John R Penrod
- Worldwide Health Economics and Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
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Smare C, Dave K, Juarez-Garcia A, Abraham P, Penrod JR, Camidge DR, Yuan Y. Cost-effectiveness of nivolumab monotherapy in the third-line treatment of small cell lung cancer. J Med Econ 2021; 24:1124-1133. [PMID: 34465261 DOI: 10.1080/13696998.2021.1974763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/20/2022]
Abstract
AIMS Present cost-effectiveness analysis of nivolumab monotherapy vs. commonly prescribed third-line (3 L+) treatment in small cell lung cancer (SCLC). MATERIALS AND METHODS A three health states partitioned survival model (progression-free, progressed disease, and death; US payer perspective) was developed. The systematic literature review identified no randomized controlled or single-arm trials with separate outcomes for 3 L + SCLC patients. Topotecan was chosen as a comparator because it is frequently prescribed in real-world practice for 3 L SCLC. Clinical inputs for topotecan were derived from the Flatiron database with inclusion/exclusion criteria matched to patients treated with 3 L + nivolumab in CheckMate 032. Intravenous (IV) and oral topotecan clinical efficacy were assumed equivalent. Base-case analysis used a 20-year lifetime horizon. An annual discount rate of 3.0% for costs and outcomes was applied. Uncertainty was assessed using sensitivity analyses adjusted for key parameters. RESULTS Incremental cost per quality-adjusted life-year (QALY) gained with nivolumab was US$153,312 vs. IV topotecan and US$123,003 vs. oral topotecan, respectively. When results were disaggregated, nivolumab-related costs were mainly driven by drug acquisition costs, and topotecan-related costs were primarily due to adverse event treatment. Mean overall survival (OS) was 21.69 months with nivolumab and 5.80 months with IV or oral topotecan. More favorable outcomes were found by the landmark response analyses. Deterministic sensitivity analyses showed that changes to the discount rate for costs and outcomes and body weight had the greatest impacts on results. LIMITATIONS Included use of real-world data for OS outcomes associated with 3 L topotecan, use of second-line topotecan data for progression-free survival, and no indirect costs. CONCLUSIONS Based on the literature on willingness-to-pay for a QALY in metastatic cancer, nivolumab monotherapy might represent a cost-effective option for 3 L + treatment of SCLC compared with IV and oral topotecan. Sensitivity analysis using response-based methods yielded further favorable cost-effectiveness estimates.
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Affiliation(s)
| | | | | | - Pranav Abraham
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
| | - John R Penrod
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
| | - D Ross Camidge
- Division of Medical Oncology, University of Colorado Denver School of Medicine, Denver, CO, USA
| | - Yong Yuan
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
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Keeping ST, Cope S, Chan K, Wilson FR, Jansen JP, Penrod JR, Abraham P, Camidge DR, Korytowsky B, Gu T, Garcia AJ, Le TK, Yuan Y. Comparative effectiveness of nivolumab versus standard of care for third-line patients with small-cell lung cancer. J Comp Eff Res 2020; 9:1275-1284. [PMID: 33140652 DOI: 10.2217/cer-2020-0134] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To estimate the comparative effectiveness of nivolumab versus standard of care (SOC) in terms of overall survival (OS) for small-cell lung cancer patients treated with two prior lines of chemotherapy, in other words, third line in the USA. Materials & methods: Data were from CheckMate 032, a single-arm trial of nivolumab, and real-world electronic patient records. Comparisons of OS were conducted using three different methods to adjust for differences (regression, weighting and doubly robust) between the populations. Results: Nivolumab was associated with longer survival compared with SOC (hazard ratio for OS: 0.58-0.70) across all methods for adjustment. Conclusion: Nivolumab was more efficacious in terms of OS as third-line treatment for small-cell lung cancer compared with current SOC in the USA.
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Affiliation(s)
| | | | - Keith Chan
- Precision HEOR, Vancouver, BC V6H 3Y4, Canada
| | | | | | - John R Penrod
- Bristol Myers Squibb, Princeton Pike, Lawrenceville, NJ 08648, USA
| | - Pranav Abraham
- Bristol Myers Squibb, Princeton Pike, Lawrenceville, NJ 08648, USA
| | - D Ross Camidge
- Division of Medical Oncology, University of Colorado School of Medicine, Denver, CO 80045, USA
| | - Beata Korytowsky
- Bristol Myers Squibb, Princeton Pike, Lawrenceville, NJ 08648, USA
| | - Tao Gu
- Bristol Myers Squibb, Princeton Pike, Lawrenceville, NJ 08648, USA
| | | | - Trong K Le
- Bristol Myers Squibb, Princeton Pike, Lawrenceville, NJ 08648, USA
| | - Yong Yuan
- Bristol Myers Squibb, Princeton Pike, Lawrenceville, NJ 08648, USA
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Soares M, Antunes L, Redondo P, Borges M, Hermans R, Patel D, Grimson F, Munro R, Chaib C, Lacoin L, Daumont M, Penrod JR, O'Donnell JC, Bento MJ, Rocha Gonçalves F. Real-world treatment patterns and survival outcomes for advanced non-small cell lung cancer in the pre-immunotherapy era in Portugal: a retrospective analysis from the I-O Optimise initiative. BMC Pulm Med 2020; 20:240. [PMID: 32912174 PMCID: PMC7488009 DOI: 10.1186/s12890-020-01270-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Received: 04/30/2020] [Accepted: 08/19/2020] [Indexed: 12/14/2022] Open
Abstract
Background As part of the multinational I-O Optimise research initiative, this retrospective cohort study of patients with advanced non-small cell lung cancer (NSCLC) evaluated real-world treatment patterns and survival prior to immunotherapy reimbursement in Portugal. Methods This study utilized a database held by IPO-Porto, Portugal’s largest oncology hospital. Adult patients diagnosed with stage IIIB or IV NSCLC from January 2012 to December 2016 at IPO-Porto, with follow-up to June 2017, were included. Treatment analyses were performed from 2015 onwards. Kaplan–Meier methods were used for overall survival (OS). Factors associated with OS and systemic anti-cancer therapy (SACT) treatment were assessed using multivariate statistical models. Results Of 1524 patients diagnosed with NSCLC at IPO-Porto, 1008 patients had advanced disease (stage IIIB: 10.1%, 154/1524, stage IV: 56.0%, 854/1524). For those with advanced disease, median age was 65 years (range: 21–92) and 75.6% (762/1008) were male. Median OS (interquartile range [IQR]) was 11.4 (5.2–26.9) months for stage IIIB and 6.3 (2.4–15.0) months for stage IV. Factors associated with decreased risk of death included female sex and epidermal growth factor receptor gene (EGFR)/anaplastic lymphoma kinase gene (ALK) mutations/rearrangements; factors associated with increased risk of death included older age and stage IV disease. Among patients diagnosed in 2015 or 2016, 75.8% (297/392) received ≥1 line of SACT. Platinum-based chemotherapy was the most common first-line therapy (non-squamous cell carcinoma [NSQ]: 72.9%; squamous cell carcinoma [SQ] 87.3%, 55/63; patients with EGFR/ALK mutations/rearrangements primarily received tyrosine kinase inhibitors). The likelihood of receiving SACT was lower in older patients and those diagnosed with stage IV disease. Patients not receiving SACT had poor survival outcomes (median OS [IQR]: NSQ, 1.8 [1.1–3.1] months; SQ, 2.3 (1.3–3.4) months), while median OS (IQR) in SACT-treated patients was 12.6 (6.1–24.5) months for NSQ and 10.3 (5.7–15.9) months for SQ. Conclusions This real-world data analysis from a large Portuguese oncology hospital demonstrates a high disease burden for advanced NSCLC in the pre-immunotherapy era, with nearly one-quarter of patients not receiving SACT. Even in patients receiving SACT, median survival was only about 1 year.
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Affiliation(s)
- Marta Soares
- Department of Medical Oncology, Portuguese Oncology Institute of Porto (IPO-Porto), Rua Dr. Antonio Bernardino de Almeida, 4200-072, Porto, Portugal.
| | - Luís Antunes
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Patrícia Redondo
- Outcomes Research Lab, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Marina Borges
- Outcomes Research Lab, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | | | | | | | | | - Carlos Chaib
- R&D Medical Affairs, Bristol Myers Squibb, Madrid, Spain
| | | | - Melinda Daumont
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Braine-l'Alleud, Belgium
| | - John R Penrod
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
| | - John C O'Donnell
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA
| | - Maria José Bento
- Cancer Epidemiology Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal.,Department of Population Studies, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Porto, Portugal
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Sebastian M, Audigier-Valette C, Butts CA, Debieuvre D, Dixmier A, Gröschel A, Gutz S, Juergens RA, Labbe C, Moro-Sibilot D, Perol M, Schumann C, Juarez-Garcia A, Lakhdari K, Penrod JR, Pettersson F, Reynaud D, Waldenberger D, Allan V, Barlesi F. Two-year survival with nivolumab in previously treated, advanced non-small cell lung cancer: A pooled analysis of real-world patients from France, Germany and Canada. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e21714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21714 Background: Data from clinical studies demonstrate a long-term survival benefit of nivolumab in previously treated advanced non-small cell lung cancer (NSCLC) patients with overall survival (OS) at two-years of 27%, however real-world data are limited. We report OS in patients pooled from two prospective multi-centre observational cohort studies in France (EVIDENS, NCT03382496) and Germany (ENLARGE, NCT02910999) and a third retrospective registry of patients treated through expanded access to nivolumab in Canada. Methods: Individual patient data from each cohort were pooled and harmonised in eligibility criteria and variable definitions. Included patients had locally advanced or metastatic (stage IIIB/IV) NSCLC, received nivolumab after at least one prior systemic therapy and had no other concurrent primary cancers. OS was estimated from nivolumab initiation until death or censoring using Kaplan-Meier method. Equality of survival distributions across cohorts was measured using log-rank test. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated from unstratified Cox proportional hazards regression models to explore survival among subgroups. Data on bone and liver metastases, PD-L1 and safety were available and analysed for France and Germany only. Results: Data from 2582 patients (48% France; 34% Germany; 18% Canada) were pooled. Baseline characteristics were: median age 66 years, 64% male, 82% ECOG 0-1, 69% 1 prior line of therapy, 68% non-squamous histology, and 18% with brain metastases (treated or untreated). Median follow-up was 8 months. No difference in OS was observed between countries. The 2-year OS was 28% (95%CI 25-31) for all patients, 26% (95%CI 21-31) for squamous histology and 29% (95%CI 26-33) for non-squamous histology. Bone metastases (HR 1.42; 95%CI 1.26-1.60; P= < .0001) and liver metastases (HR 1.60; 95%CI 1.39-1.85; P= < .0001) were associated with shorter survival, while ECOG PS 0-1 (HR 0.61; 95%CI 0.52-0.71; P= < .0001) and PD-L1 positivity (HR 0.75; 95%CI 0.60-0.93; P= < .0001) were associated with prolonged survival. Rates of any grade and grade 3/4 treatment-related adverse events (TRAE) were 32% and 7% respectively. Conclusions: In this three-country pooled analysis of nivolumab in previously treated advanced NSCLC, real-world overall survival at 2-years was consistent with pivotal nivolumab trials overall and in subgroups. Rates of grade 3/4 TRAEs were comparable, but events of lower grade may be underreported in the real world.
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Affiliation(s)
- Martin Sebastian
- University Hospital, Goethe-University Frankfurt, Department of Hematology and Medical Oncology, Frankfurt, Germany
| | | | | | | | | | - Andreas Gröschel
- Dept. of Pulmonary and Critical Care Medicine, Clemenshospital, Münster, Germany
| | - Sylvia Gutz
- Ev. Diakonissenkrankenhaus, Leipzig, Germany
| | | | - Catherine Labbe
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, QC, Canada
| | - Denis Moro-Sibilot
- Thoracic Oncology unit, SHUPP, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | | | - Christian Schumann
- Klinikverbund Allgäu, Klinik für Pneumologie, Thoraxonkologie, Schlaf- und Beatmungsmedizin, Kempten Und Immenstadt, Germany
| | | | | | | | | | | | | | - Victoria Allan
- Centre for Observational Research and Data Science, Bristol-Myers Squibb, Uxbridge, United Kingdom
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Verleger K, Penrod JR, Manley Daumont M, Solem C, Luo L, Macahilig C, Hertel N. Costs and Cost Drivers Associated with Non-Small-Cell Lung Cancer Patients Who Received Two or More Lines of Therapy in Europe. Clinicoecon Outcomes Res 2020; 12:23-33. [PMID: 32021337 PMCID: PMC6970261 DOI: 10.2147/ceor.s223760] [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] [Received: 07/18/2019] [Accepted: 12/10/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Advanced non-small-cell lung cancer (aNSCLC; stage IIIB/IV) presents a substantial clinical burden to society; reliable estimates of its economic burden are lacking. Therefore, this study aimed to quantify real-world health care resource utilization (HCRU) and costs of patients with squamous (SQ) and non-SQ (NSQ) aNSCLC who received two or more lines of treatment (2L+) in Europe, and to describe cost-predictors. Methods The LENS (Leading the Evaluation of Non-squamous and Squamous NSCLC) retrospective chart review study collected data from 2L+ patients with aNSCLC diagnosed between 07/2009 and 08/2011 (wave 1) or 07/2010 and 09/2012 (wave 2) in France, Germany, Italy, Spain, England, the Netherlands, and Sweden. Patients were followed from diagnosis through most recent visit/death. A weighted average of country-specific unit costs (2018 Euro) was applied to systemic anti-cancer therapy usage and HCRU (hospital/emergency department visit, surgery, radiotherapy, ancillary care, biomarker testing) to determine the total cost from aNSCLC diagnosis to death. Generalized linear models (gamma distribution, log link) were used to assess clinical and demographic predictors. Results Of 973 2L+ aNSCLC patients, median overall survival (OS) was 1.5 years from advanced diagnosis (range: 0.2-5.3; median OS: 1.4 [SQ], 1.6 [NSQ]), 79.0% died during follow-up. Weighted mean total per-patient costs were €21,273, ranging from €17,761 (England) to €30,854 (Sweden), and €15,446 (SQ) to €26,477 (NSQ). Systemic drug costs comprised 77.4% of total costs. Insurance status, presence of epidermal growth factor receptor (EGFR) mutation, SQ histology, age, alcohol abuse, and year of diagnosis were significant predictors for lower total costs per patient-month, Eastern Cooperative Oncology Group performance status (ECOG PS) ≥1 and country for higher costs. Conclusion In the era pre-immunotherapy, HCRU and costs were substantial in aNSCLC 2L+ patients, with most of the costs accrued prior to start of 2L. NSQ patients incurred significantly higher total costs than SQ patients in all participating countries.
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Affiliation(s)
| | | | | | | | - Linlin Luo
- Pharmerit International, Bethesda, MD, USA
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Hauber B, Penrod JR, Gebben D, Musallam L. The Value of Hope: Patients' and Physicians' Preferences for Survival in Advanced Non-Small Cell Lung Cancer. Patient Prefer Adherence 2020; 14:2093-2104. [PMID: 33154633 PMCID: PMC7608144 DOI: 10.2147/ppa.s248295] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 09/19/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Immuno-oncology treatments offer patients with advanced non-small cell lung cancer (NSCLC) treatment options with greater probability of durable survival and a different toxicity profile compared with traditional chemotherapy. The objective of this study was to explore the importance of increases in the probability of long-term survival versus changes in expected (median) survival and treatment toxicities among patients with advanced NSCLC and physicians. PATIENTS AND METHODS In a discrete-choice experiment, oncologists and patients diagnosed with NSCLC chose between profiles of treatments for advanced NSCLC offering different combinations of benefits (expected, best-case, and worst-case survival) and risks. We analyzed preference data from each sample using a random-parameters logit model that controls for preference heterogeneity and the panel nature of the data. RESULTS Both patients and physicians expressed a strong preference for improving the probability of best-case survival; however, patients viewed increases in the probability of long-term survival as more important than increases in expected survival, while the opposite was true for physicians. Both patients and physicians weighted survival to be more important than toxicities. CONCLUSION This study identified a potentially important divergence between physician and patient perspectives on survival statistics. Physicians placed more importance on increases in expected survival than did patients with NSCLC. The importance patients placed on long-term survival reinforce previous research identifying the primacy of hope as a value among seriously ill patients. The findings underscore the importance of considering patients' priorities and in shared decision-making when choosing treatment.
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Affiliation(s)
- Brett Hauber
- RTI Health Solutions, Research Triangle Park, NC, USA
- Correspondence: Brett Hauber Email
| | | | - David Gebben
- RTI Health Solutions, Research Triangle Park, NC, USA
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Antonia SJ, Borghaei H, Ramalingam SS, Horn L, De Castro Carpeño J, Pluzanski A, Burgio MA, Garassino M, Chow LQM, Gettinger S, Crinò L, Planchard D, Butts C, Drilon A, Wojcik-Tomaszewska J, Otterson GA, Agrawal S, Li A, Penrod JR, Brahmer J. Four-year survival with nivolumab in patients with previously treated advanced non-small-cell lung cancer: a pooled analysis. Lancet Oncol 2019; 20:1395-1408. [PMID: 31422028 PMCID: PMC7193685 DOI: 10.1016/s1470-2045(19)30407-3] [Citation(s) in RCA: 208] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Phase 3 clinical data has shown higher proportions of patients with objective response, longer response duration, and longer overall survival with nivolumab versus docetaxel in patients with previously treated advanced non-small-cell lung cancer (NSCLC). We aimed to evaluate the long-term benefit of nivolumab and the effect of response and disease control on subsequent survival. METHODS We pooled data from four clinical studies of nivolumab in patients with previously treated NSCLC (CheckMate 017, 057, 063, and 003) to evaluate survival outcomes. Trials of nivolumab in the second-line or later setting with at least 4 years follow-up were included. Comparisons of nivolumab versus docetaxel included all randomised patients from the phase 3 CheckMate 017 and 057 studies. We did landmark analyses by response status at 6 months to determine post-landmark survival outcomes. We excluded patients who did not have a radiographic tumour assessment at 6 months. Safety analyses included all patients who received at least one dose of nivolumab. FINDINGS Across all four studies, 4-year overall survival with nivolumab was 14% (95% CI 11-17) for all patients (n=664), 19% (15-24) for those with at least 1% PD-L1 expression, and 11% (7-16) for those with less than 1% PD-L1 expression. In CheckMate 017 and 057, 4-year overall survival was 14% (95% CI 11-18) in patients treated with nivolumab, compared with 5% (3-7) in patients treated with docetaxel. Survival subsequent to response at 6 months on nivolumab or docetaxel was longer than after progressive disease at 6 months, with hazard ratios for overall survival of 0·18 (95% 0·12-0·27) for nivolumab and 0·43 (0·29-0·65) for docetaxel; for stable disease versus progressive disease, hazard ratios were 0·52 (0·37-0·71) for nivolumab and 0·80 (0·61-1·04) for docetaxel. Long-term data did not show any new safety signals. INTERPRETATION Patients with advanced NSCLC treated with nivolumab achieved a greater duration of response compared with patients treated with docetaxel, which was associated with a long-term survival advantage. FUNDING Bristol-Myers Squibb.
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Affiliation(s)
- Scott J Antonia
- H Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
| | | | | | - Leora Horn
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Adam Pluzanski
- Klinika Nowotworow Pluca i Klatki Piersiowej, Centrum Onkologii-Instytut Im Marii Sklodowskiej-Curie, Warsaw, Poland
| | - Marco A Burgio
- Medical Oncology Unit, Istituto Scientifico Romagnolo Per lo Studio e la Cura dei Tumori (IRST) IRCSS, Meldola, Italy
| | - Marina Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Q M Chow
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Lucio Crinò
- Medical Oncology Unit, Istituto Scientifico Romagnolo Per lo Studio e la Cura dei Tumori (IRST) IRCSS, Meldola, Italy
| | - David Planchard
- Institut Gustave Roussy, Department of Medical Oncology, Thoracic Group, Villejuif, France
| | - Charles Butts
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada
| | | | | | | | | | - Ang Li
- Bristol-Myers Squibb, Princeton, NJ, USA
| | | | - Julie Brahmer
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
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Povsic M, Enstone A, Wyn R, Kornalska K, Penrod JR, Yuan Y. Real-world effectiveness and tolerability of small-cell lung cancer (SCLC) treatments: A systematic literature review (SLR). PLoS One 2019; 14:e0219622. [PMID: 31318909 PMCID: PMC6638917 DOI: 10.1371/journal.pone.0219622] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/27/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES SCLC makes up approximately 15% of all lung carcinomas and is characterized by relatively aggressive spread and poorer prognosis compared to other lung cancers. Treatment options are limited, and their efficacy in randomized trials is poor, whilst outcomes in clinical practice remain unclear. The aim of this study was to assess the real-world effectiveness and tolerability of SCLC treatments. METHODS An SLR was conducted across nine databases accessed through OVID, capturing observational, non-randomized studies published between 01/2006-11/2018. In total, 554 abstracts were retrieved and systematically screened for eligibility. The eligible publications included effectiveness and tolerability data from adult SCLC patients (at any line of therapy). Additional grey literature searches were conducted. RESULTS Forty-three publications were included in this review-data from first-line therapies were captured most often (n = 32), while data from second (n = 14) and third line (n = 7) and beyond (n = 7) were less frequent. The publications reported primarily on chemotherapy/radiotherapy. The majority of publications lacked robustness and only 14/43 conducted statistical analyses or controlled for bias. Median OS for the largest SCLC populations were 9.6 months at first line (n = 23,535) and 4.9 months at second line (n = 254) for treatment with chemotherapy, and 4.7 months at third line (n = 120) for predominantly platinum-based chemotherapy or cyclophosphamide/adriamycin/vincristine. Hematologic toxicities (such as neutropenia, thrombocytopenia and anemia) were the most frequently reported TRAEs (n = 9). CONCLUSIONS Real-world treatment effectiveness and tolerability data were fragmented and inconsistently reported, and available publications were primarily of poor quality and lacked statistical analyses. This SLR showed limited treatment options and poor OS in SCLC, with no treatment option being clearly superior. TRAEs additionally increased the burden of this already challenging disease. Recent data suggest real-world outcomes are even poorer that those reported in clinical trials, and that novel therapies are needed to offer new treatment options for patients.
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Affiliation(s)
- Manca Povsic
- Adelphi Values, Bollington, Cheshire, United Kingdom
| | | | - Robin Wyn
- Adelphi Values, Bollington, Cheshire, United Kingdom
| | | | - John R. Penrod
- Bristol-Myers Squibb, Princeton, NJ, United States of America
| | - Yong Yuan
- Bristol-Myers Squibb, Princeton, NJ, United States of America
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Reck M, Schenker M, Lee KH, Provencio M, Nishio M, Lesniewski-Kmak K, Sangha R, Ahmed S, Raimbourg J, Feeney K, Corre R, Franke FA, Richardet E, Penrod JR, Yuan Y, Nathan FE, Bhagavatheeswaran P, DeRosa M, Taylor F, Lawrance R, Brahmer J. Nivolumab plus ipilimumab versus chemotherapy as first-line treatment in advanced non–small-cell lung cancer with high tumour mutational burden: patient-reported outcomes results from the randomised, open-label, phase III CheckMate 227 trial. Eur J Cancer 2019; 116:137-147. [DOI: 10.1016/j.ejca.2019.05.008] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/23/2019] [Accepted: 05/07/2019] [Indexed: 11/28/2022]
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Brahmer J, Borghaei H, Ramalingam SS, Horn L, Holgado E, Pluzanski A, Burgio MA, Garassino M, Chow LQ, Gettinger S, Crino L, Planchard D, Butts C, Drilon A, Wojcik-Tomaszewska J, Otterson G, Hayreh V, Li A, Penrod JR, Antonia SJ. Abstract CT195: Long-term survival outcomes with nivolumab (NIVO) in pts with previously treated advanced non-small cell lung cancer (NSCLC): Impact of early disease control and response. Clin Trials 2019. [DOI: 10.1158/1538-7445.am2019-ct195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cope S, Keeping ST, Goldgrub R, Ayers D, Jansen JP, Penrod JR, Korytowsky B, Juarez-Garcia A, Yuan Y. Indirect comparison of nivolumab ± ipilimumab (CheckMate 032) versus other treatments for recurrent small-cell lung cancer. J Comp Eff Res 2019; 8:733-751. [PMID: 31237143 DOI: 10.2217/cer-2018-0130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Aim: To estimate the comparative efficacy of nivolumab ± ipilimumab versus alternative treatments for small-cell lung cancer after at least one prior line of chemotherapy. Materials & m ethods: A systematic literature review identified six randomized controlled trials (RCTs) that could be connected in a network. The Kaplan-Meier survival curves from these RCTs were synthesized using network meta-analysis models. Aggregate-level matching was used to connect CheckMate 032 to the RCTs. Results: CheckMate 032 was connected to the network by Amrubicin Clinical Trial-1. Nivolumab ± ipilimumab had a more durable tumor response and more favorable long-term survival versus topotecan via intravenous and versus amrubicin. Conclusion: Compared with chemotherapies for recurrent small-cell lung cancer, nivolumab ± ipilimumab improves response duration, which may translate to long-term survival benefits.
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Affiliation(s)
- Shannon Cope
- Precision Xtract, Vancouver, BC, V6H 3Y4, Canada
| | | | | | - Dieter Ayers
- Precision Xtract, Vancouver, BC, V6H 3Y4, Canada
| | | | - John R Penrod
- Bristol-Myers Squibb, Princeton Pike, Lawrence Township, NJ 08648, USA
| | - Beata Korytowsky
- Bristol-Myers Squibb, Princeton Pike, Lawrence Township, NJ 08648, USA
| | | | - Yong Yuan
- Bristol-Myers Squibb, Princeton Pike, Lawrence Township, NJ 08648, USA
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41
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Ekman S, Griesinger F, Baas P, Chao D, Chouaid C, O'Donnell JC, Penrod JR, Daumont M, Lacoin L, McKenney A, Khovratovich M, Munro REJ, Durand-Zaleski I, Johnsen SP. I-O Optimise: a novel multinational real-world research platform in thoracic malignancies. Future Oncol 2019; 15:1551-1563. [DOI: 10.2217/fon-2019-0025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Aim: To describe I-O Optimise, a multinational program providing real-world insights into lung cancer management. Materials & methods: Real-world data source selection for I-O Optimise followed a structured approach focused on population coverage, key variable capture, continuous/consistent data availability, record duration and data latency, and database expertise. Results: As of 31 October 2018, seven real-world data sources were included in I-O Optimise, providing data on characteristics, treatment patterns and clinical outcomes from more than 45,000 patients/year with non-small-cell lung cancer, small-cell lung cancer and mesothelioma across Denmark, Norway, Portugal, Spain, Sweden and the UK. Conclusion: The ongoing I-O Optimise initiative has the potential to provide a broad, robust and dynamic research platform to continually address numerous research objectives in the lung cancer arena.
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Affiliation(s)
- Simon Ekman
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Frank Griesinger
- Department of Haematology & Oncology, University Department Internal Medicine-Oncology, Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Paul Baas
- Department of Thoracic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - David Chao
- Department of Oncology, Royal Free Hospital, London, UK
| | - Christos Chouaid
- Pneumology Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - John C O'Donnell
- Worldwide Health Economics & Outcomes Research, Bristol-Myers Squibb, Princeton, NJ, USA
| | - John R Penrod
- Worldwide Health Economics & Outcomes Research, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Melinda Daumont
- Worldwide Health Economics & Outcomes Research, Bristol-Myers Squibb, Braine-l'Alleud, Belgium
| | - Laure Lacoin
- Worldwide Health Economics & Outcomes Research, Bristol-Myers Squibb, Braine-l'Alleud, Belgium
| | | | | | | | - Isabelle Durand-Zaleski
- URC Eco IdF, Unité de Recherche Clinique en Économie de la Santé d'Ile de France, AP-HP Paris, Paris, France
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
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Schwartzberg L, Korytowsky B, Penrod JR, Zhang Y, Le TK, Batenchuk C, Krug L. Real-World Clinical Impact of Immune Checkpoint Inhibitors in Patients With Advanced/Metastatic Non-Small Cell Lung Cancer After Platinum Chemotherapy. Clin Lung Cancer 2019; 20:287-296.e4. [PMID: 31130450 DOI: 10.1016/j.cllc.2019.04.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/05/2019] [Accepted: 04/12/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The real-world effect of anti-programmed death ligand 1 (PD-L1) therapies is unclear. We compared US patients who received second-line therapy for non-small-cell lung cancer (NSCLC) before and shortly after US Food and Drug Administration (FDA) approval of PD-L1 inhibitors. PATIENTS AND METHODS Patients in the Flatiron Health database (≥18 years; received first-line platinum therapy for advanced/metastatic NSCLC; ≥6 months of follow-up) were assessed before ("historical": January 1, 2011 to December 31, 2013) and after ("current": January 1, 2015 to May 31, 2017) FDA approval of anti-PD-L1 therapies for NSCLC. Index was start of second-line therapy. Baseline variables, treatment patterns, and overall survival (OS) were reported. RESULTS A greater proportion of patients in the current cohort received second-line treatment than in the historical cohort (n = 4240 [57.0%] vs. n = 2357 [37.4%]); 48.8% [n = 2071] of the current second-line patients received anti-PD-L1 therapy. Current patients were more likely to receive second-line anti-PD-L1 therapy if they had poorer Eastern Cooperative Oncology Group (ECOG) performance status (≥2), had squamous histology, or had no epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), or ROS proto-oncogene 1 mutations. Median OS from index was higher in the current cohort (9.4 [95% confidence interval (CI), 8.9-9.9] months) than the historical cohort (7.3 [95% CI, 6.9-7.8] months). Adjusted for sex, race, ECOG performance status, disease stage, and Kirsten rat sarcoma viral oncogene homolog, EGFR, and ALK status, OS was improved by 15% in the current cohort. CONCLUSION Contemporary patients are more likely to receive second-line therapy and have longer OS than patients who received care before approval of anti-PD-L1 therapies.
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Affiliation(s)
- Lee Schwartzberg
- The University of Tennessee Health Science Center, and West Cancer Center, Memphis, TN.
| | | | | | | | - T Kim Le
- Bristol-Myers Squibb, Lawrenceville, NJ
| | | | - Lee Krug
- Bristol-Myers Squibb, Lawrenceville, NJ
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Stenehjem DD, Santi I, Gupte-Singh K, Penrod JR, Venkatachalam M. Estimated costs of grade 3–4 all-cause and treatment-related adverse events for stage IV or recurrent non-small cell lung cancer (NSCLC) in the CheckMate 227 (CM-227) trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.8_suppl.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
120 Background: In the ongoing phase 3 CM-227 trial, nivolumab + ipilimumab (N+I) showed significantly longer progression-free survival compared to chemotherapy (C) among patients with NSCLC and tumor mutational burden (TMB) ≥10 mutations/megabase (high) by Foundation One CDx. The frequencies of all-cause (AC) and treatment-related (TR) adverse events (AEs) including grade 3–4 AEs were similar between the N+I and C arms, although the types of AEs differed. This study estimated the costs of managing grade 3–4 ACAEs and TRAEs in the first year after treatment initiation in CM-227 patients with high TMB. Methods: The frequency, grade, and attribution of AEs were extracted from CM-227 patient-level data. Costs of managing each grade 3–4 ACAE and grade 3–4 TRAE were estimated using related codes of the International Classification of Disease, 10th Revision, as well as cost information from the Healthcare Cost and Utilization Project National Inpatient Sample data (2015). A sensitivity analysis accounting for treatment duration and a temporal trends analysis were conducted. Results: In patients treated with N+I (n = 135), 157 grade 3–4 ACAEs and 70 grade 3–4 TRAEs were observed compared to 153 and 74 respectively among the patients treated with C (n = 159). The cost of managing grade 3–4 ACAEs per treated patient for N+I was $19,602 and for C was $16,353 (difference $3,249; 95% CI $1,774–$4,723), while the cost of managing grade 3–4 TRAEs per treated patient was $6,921 and $8,925 for N+I and C, respectively (difference $2,004; 95% CI $878–$3,131). An analysis adjusting for treatment duration yielded lower cost per person-month for N+I compared to C for both grade 3–4 ACAEs ($2,886 and $3,521; difference $634; 95% CI $379–$889) and grade 3–4 TRAEs ($1,019 and $1,921, difference $902; 95% CI $696–$1,109). For both N+I and C, the cost of managing grade 3–4 ACAEs and grade 3–4 TRAEs per person-month was highest in the first 3 months and declined thereafter. Conclusions: The cost of ACAEs was somewhat higher for N+I than for C, while the cost of TRAEs was somewhat lower for N+I than for C. Adjusting for treatment duration, N+I had lower costs for both ACAEs and TRAEs compared to C. Clinical trial information: NCT02477826.
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Affiliation(s)
- David D. Stenehjem
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, Duluth, MN
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DiBonaventura MD, Shah-Manek B, Higginbottom K, Penrod JR, Yuan Y. Adherence to recommended clinical guidelines in extensive disease small-cell lung cancer across the US, Europe, and Japan. Ther Clin Risk Manag 2019; 15:355-366. [PMID: 30881001 PMCID: PMC6400139 DOI: 10.2147/tcrm.s183216] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 12/15/2022] Open
Abstract
Purpose This study compared real-world treatment patterns of patients with extensive disease small-cell lung cancer (ED-SCLC) across regions and by platinum resistance/platinum sensitivity (PR/PS) and established if these patterns were in line with published guidelines. Patients and methods The data source was the Oncology Monitor, a global database using retrospective medical chart reviews of oncology patients treated with anticancer drugs. All patients diagnosed with ED-SCLC from January 2014 through December 2016 in the US, and in France, Germany, Italy, Spain, and the UK (European Union; EU5), and Japan were included. Results Of 5,849 treated patients, 73.4%, 19.8% and 6.8% received first, second, or third/later lines (1L, 2L, 3L) of therapy, respectively. The most frequent 1L treatment, platinum + etoposide, was significantly more common in the US (87.0%) than in the EU5 (82.1%) or Japan (73.3%) (P<0.05). Platinum + irinotecan was a common 1L treatment in Japan (22.7%) but not in the US (2.0%) or EU5 (0.5%, P<0.0001). Topotecan was the most common 2L treatment in the US and EU5, but amrubicin was the most common in Japan. Among PR patients, 27.3%, 10.8%, and 36.4% received a platinum-based 2L therapy in the US, EU5, and Japan, respectively. Among PS patients, approximately half were not re-challenged with a 2L platinum-based therapy across all regions. Conclusion In contrast to treatment guidelines, a significant proportion of real-world PR patients were re-challenged with a 2L platinum-based therapy, while conversely, many PS patients did not receive platinum-based therapies in 2L. This study highlights a lack of a consistent paradigm for 2L ED-SCLC treatment, limited therapeutic options, and an unmet need among SCLC patients.
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Affiliation(s)
| | - Bijal Shah-Manek
- Global Evidence Value and Access (GEVA), Ipsos Healthcare, San Francisco, CA, USA,
| | - Karen Higginbottom
- Global Evidence Value and Access (GEVA), Ipsos Healthcare, Mahwah, NJ, USA
| | - John R Penrod
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb, Princeton, NJ, USA
| | - Yong Yuan
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb, Princeton, NJ, USA
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Campbell D, O'Day K, Hertel N, Penrod JR, Manley Daumont M, Lees M. The present and future burden of previously treated advanced non-small cell lung cancer (NSCLC) by histology and line of therapy in France, Germany, Italy, and Spain: model-based predictions. Popul Health Metr 2018; 16:17. [PMID: 30477516 PMCID: PMC6257974 DOI: 10.1186/s12963-018-0174-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 09/12/2017] [Accepted: 11/07/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The burden of advanced non-small cell lung cancer (NSCLC) is not well understood, and the number of patients likely to receive treatment in Europe has not been quantified. The aim of this study was to forecast the annual number of patients with squamous and non-squamous advanced NSCLC likely to receive second and third lines of therapy (LOT) from 2016 to 2020 in France, Germany, Italy, and Spain. METHODS A patient count model (PCM) was developed in Microsoft Excel to estimate the number of patients with refractory advanced NSCLC eligible to receive systemic treatment. Using historical population-based cancer registry data, segmented linear regression ("Joinpoint") was used to forecast age- and sex-stratified lung cancer incidence rates in each country through 2020. Yearly incident case count totals by country were apportioned according to NSCLC histology and stage at diagnosis. Country-specific treatment rates came from a recent medical chart review study, and early- to advanced-stage disease progression rates were estimated over a 10-year interval. A probabilistic sensitivity analysis (PSA) was performed to estimate variability in the patient counts. RESULTS The combined number of squamous and non-squamous advanced NSCLC patients estimated to receive second and third LOT, respectively, in 2016 were France = 11,600 and 3500; Germany = 15,100 and 4900; Italy = 13,500 and 2500; Spain = 9400 and 2100. The forecasted numbers of patients receiving second and third LOT, respectively, in 2020 were France = 13,900 and 4200; Germany = 16,200 and 5200; Italy = 15,100 and 2600; Spain = 11,000 and 2500. CONCLUSIONS Driven by growth in the incidence of NSCLC among women, the model forecasts an overall increase in the number of patients with advanced-stage squamous and non-squamous NSCLC likely to receive systemic treatment in the year 2020. The results highlight the significant burden of refractory advanced NSCLC and the need for more robust surveillance data to accurately quantify the burden of disease.
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Affiliation(s)
| | - Ken O'Day
- Xcenda LLC, Palm Harbor, Florida, USA
| | - Nadine Hertel
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Pharmaceuticals Ltd, Uxbridge, UK
| | - John R Penrod
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Pharmaceuticals Ltd, Princeton, NJ, USA
| | - Melinda Manley Daumont
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Pharmaceuticals Ltd, Rueil-Malmaison, France
| | - Michael Lees
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Pharmaceuticals Ltd, Rueil-Malmaison, France
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Reck M, Brahmer J, Bennett B, Taylor F, Penrod JR, DeRosa M, Dastani H, Spigel DR, Gralla RJ. Evaluation of health-related quality of life and symptoms in patients with advanced non-squamous non-small cell lung cancer treated with nivolumab or docetaxel in CheckMate 057. Eur J Cancer 2018; 102:23-30. [PMID: 30103096 DOI: 10.1016/j.ejca.2018.05.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/07/2018] [Accepted: 05/13/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Nivolumab, a programmed death-1 inhibitor, prolonged overall survival and had a favourable safety profile versus docetaxel in previously treated patients with advanced non-squamous non-small cell lung cancer (NSCLC) in the phase III CheckMate 057 trial. AIM To evaluate health-related quality of life (HRQoL) using patient-reported outcomes. METHODS Disease-related symptoms and general health status were assessed using two validated patient-reported instruments, the Lung Cancer Symptom Scale (LCSS) and the European Quality of Life Five Dimensions (EQ-5D), respectively. The proportion of patients with disease-related symptom improvement at 12 weeks on the LCSS average symptom burden index (ASBI) was a secondary end-point. LCSS 3-item global index (3-IGI), EQ-5D utility index and EQ-5D visual analogue scale (VAS) scores were also determined. Mixed-effects model repeated measures (MMRM) and time to first deterioration analyses assessed longitudinal changes. RESULTS Mean baseline LCSS ASBI scores were similar in both arms. By week 12, rates of disease-related improvement (95% confidence interval) were similar between nivolumab (17.8% [13.6-22.7]) and docetaxel (19.7% [15.2-24.7]); however, numerical differences in LCSS ASBI mean change from baseline favoured nivolumab. Subsequently, LCSS ASBI scores improved with nivolumab and worsened with docetaxel, with statistically significant between-arm differences at weeks 12, 24, 30 and 42. HRQoL improvements with nivolumab versus docetaxel were also supported by the LCSS 3-IGI, EQ-5D VAS and MMRM analysis. Time to first HRQoL deterioration was longer with nivolumab than with docetaxel. CONCLUSION Nivolumab improved disease-related symptoms and overall health status versus docetaxel for second-line treatment of advanced non-squamous NSCLC. CLINICAL TRIAL REGISTRATION NCT01673867.
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Affiliation(s)
- Martin Reck
- Thoracic Oncology, Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Grosshansdorf, Germany.
| | - Julie Brahmer
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1650 Orleans St, CRB 440, Baltimore, MD, 21231, USA
| | - Bryan Bennett
- Adelphi Values, Adelphi Mill, Grimshaw Ln, Bollington, Cheshire, SK10 5JB, UK
| | - Fiona Taylor
- Adelphi Values, 290 Congress Street 7th Floor, Boston, MA, 02210, USA
| | - John R Penrod
- Bristol-Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ, 08648, USA
| | - Michael DeRosa
- Adelphi Values, 290 Congress Street 7th Floor, Boston, MA, 02210, USA
| | - Homa Dastani
- Bristol-Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ, 08648, USA
| | - David R Spigel
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, 250 25th Ave North, Suite 100, Nashville, TN, 37203, USA
| | - Richard J Gralla
- Albert Einstein College of Medicine, 1400 Pelham Parkway South Building 1, Room 3N20, Bronx, NY, 10461, USA
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47
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Enstone A, Greaney M, Povsic M, Wyn R, Penrod JR, Yuan Y. The Economic Burden of Small Cell Lung Cancer: A Systematic Review of the Literature. Pharmacoecon Open 2018; 2:125-139. [PMID: 29623624 PMCID: PMC5972116 DOI: 10.1007/s41669-017-0045-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Small cell lung cancer (SCLC), the most aggressive form of lung carcinoma, represents approximately 15% of all lung cancers; however, the economic and healthcare burden of SCLC is not well-defined. OBJECTIVE The aim of this study was to explore the impact of SCLC on healthcare costs through a systematic literature review (SLR). METHODS Using the OVID search engine, the SLR was conducted in PubMed, MEDLINE In-Process, EMBASE, EconLIT and the National Health Service Economic Evaluation Database (NHS EED). Searches were limited to studies published between January 2005 and 24 February 2016, and excluded preclinical studies. Additional internet-based searches were conducted. In total, 229 abstracts were retrieved and systematically screened for eligibility, with 17 publications retained. RESULTS The majority of publications provided data on limited and extensive disease of SCLC. The reported burden was categorised as direct costs and indirect costs, with the majority of the publications (n = 16) reporting on direct costs and one reporting on both direct and indirect costs. The only indirect costs reported for SCLC were lost productivity (premature mortality costs) and caregiver burden. Chemotherapy, diagnostic costs and treatment costs were identified as significant costs when managing SCLC patients, including the associated treatment costs such as hospitalisation, nurse visits, emergency room visits, follow-up appointments and outpatient care. CONCLUSIONS SCLC and its treatment have a substantial impact on costs. The scarcity and heterogeneity of economic cost data negated meaningful cost comparison, highlighting the need for further research. Capturing the economic burden of SCLC may help patients and clinicians make informed treatment choices and improve SCLC management.
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Affiliation(s)
| | - Maire Greaney
- Adelphi Values, Adelphi Mill, Bollington, Cheshire UK
| | - Manca Povsic
- Adelphi Values, Adelphi Mill, Bollington, Cheshire UK
| | - Robin Wyn
- Adelphi Values, Adelphi Mill, Bollington, Cheshire UK
| | | | - Yong Yuan
- Bristol-Myers Squibb, Princeton, NJ USA
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Shafrin J, Skornicki M, Brauer M, Villeneuve J, Lees M, Hertel N, Penrod JR, Jansen J. An exploratory case study of the impact of expanding cost-effectiveness analysis for second-line nivolumab for patients with squamous non-small cell lung cancer in Canada: Does it make a difference? Health Policy 2018; 122:607-613. [DOI: 10.1016/j.healthpol.2018.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 04/05/2018] [Accepted: 04/19/2018] [Indexed: 12/31/2022]
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49
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Richards DA, Hussein MA, McCune SL, Ulrich BK, Telivala BP, Monte M, Danese MD, Gleeson ML, Lubeck DP, Sanzari J, Penrod JR, Yuan Y, Abraham P, Korytowsky B, Schwartzberg LS. What is the benefit from second- and third-line (2L and 3L) therapy for extensive disease small cell lung cancer (ED-SCLC)? A prospective study of patterns, discontinuation, and survival in US community practices. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e20567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Marc Monte
- St. Bernards Medical Group, Jonesboro, AR
| | | | | | | | | | | | | | | | | | - Lee Steven Schwartzberg
- Division of Hematology/Oncology, the University of Tennessee Health Science Center, West Cancer Center, Memphis, TN
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50
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Atmaca A, Ardizzoni A, Farago AF, Calvo E, Taylor F, Bennett B, Selvaggi G, Pieters A, Penrod JR, Yuan Y, Camidge DR. Health Status in Patients With Small Cell Lung Cancer (SCLC) Treated With Nivolumab Alone or Combined With Ipilimumab: CheckMate 032. Pneumologie 2018. [DOI: 10.1055/s-0037-1619269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A Atmaca
- Institut für Klinisch-onkologische Forschung (IKF), Klinik, Frankfurt
| | - A Ardizzoni
- S.Orsola-Malpighi University Hospital, Bologna
| | - AF Farago
- Massachusetts General Hospital, Boston, Massachusetts
| | - E Calvo
- Centro Integral Oncológico Clara Campal, START Madrid,
| | - F Taylor
- Adelphi Values, Boston, Massachusetts
| | - B Bennett
- Adelphi Values, Boston, Massachusetts
| | - G Selvaggi
- Bristol-Myers Squibb, Princeton, New Jersey
| | - A Pieters
- Bristol-Myers Squibb, Princeton, New Jersey
| | - JR Penrod
- Bristol-Myers Squibb, Princeton, New Jersey
| | - Y Yuan
- Bristol-Myers Squibb, Princeton, New Jersey
| | - DR Camidge
- University of Colorado, Denver, Colorado
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