380P - Survival outcome and cost-effectiveness of tyrosine kinase inhibitor in EGFR sensitive mutation advanced-stage NSCLC in Thammasat university hospital

Background

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) is the first-line treatment of advanced-stage NSCLC with EGFR-sensitive mutation. We aimed to determine the efficacy and cost-effectiveness of each EGFR-TKI.

Methods

The retrospective study was conducted by reviewing medical records of advanced-stage NSCLC patients treated with EGFR-TKI at Thammasat hospital, from 1^st January 2015 to 31^st December 2020. The primary endpoint was to determine the overall survival (OS) and progression-free survival (PFS) of EGFR-TKI. The Secondary endpoint was objective response rate (ORR) and cost-effectiveness ratio (CER).

Results

A total of 76 patients who primarily had sensitive EGFR mutations were included. For OS, there was no statistical difference between gefitinib, original erlotinib, and generic erlotinib (20.8 months vs 16.2 months vs 26.9 months). The median PFS of gefitinib, original erlotinib, and generic erlotinib was 9.2 months, 11.1 months, and 13.3 months, respectively. The median OS and PFS of original erlotinib and generic erlotinib were not significant (p=0.07 and p=0.450). Additionally, the median OS of patients with acquired T790M mutation who were treated with osimertinib for the second line after first-generation EGFR TKI was significantly longer than those without acquired T790M compared with gefitinib (36.5 months vs 20.8 months; HR 0.685, 95% CI 0.53-0.90, p=0.007) and erlotinib (36.5 months vs 19.1 months; HR 0.529, 95%CI 0.41-0.97, p=0.037). ORR of gefitinib, erlotinib, and second-line osimertinib was 56.8%, 65.0%, and 44.4%, respectively. CER of gefitinib, original erlotinib, and generic erlotinib was 3,873.39 USD/Lys, 5403.02 USD/Lys, and 1966.92 USD/Lys respectively. Thailand’s GDP was 4462.79 USD/Lys, thus, only gefitinib and generic erlotinib achieved the cost-effectiveness goal.

Conclusions

In patients with advanced-stage NSCLC, there was no statistical difference between gefitinib, original erlotinib, and generic erlotinib. According to Thailand’s GDP, only gefitinib and generic erlotinib could reach cost-effectiveness in resource-limited countries.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The author.

Funding

Has not received any funding.

Disclosure

The author has declared no conflicts of interest.