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Poster Discussion – NETs and endocrine tumours

3665 - Prescription and Treatment Patterns of Lenvatinib (L) in Patients with Radioactive Iodine-Refractory Differentiated Thyroid Cancer (rDTC): A Retrospective Analysis of the Canadian Patient Support Program (PSP)

Date

30 Sep 2019

Session

Poster Discussion – NETs and endocrine tumours

Presenters

Sebastien Hotte

Citation

Annals of Oncology (2019) 30 (suppl_5): v756-v759. 10.1093/annonc/mdz267

Authors

S.J. Hotte1, E. Winquist2, B. Lemieux3, S.A. Laurie4, N. Bouganim5, N. Chua6, M. Brassard7, J..D. Ruether8, N. Lamond9, S. Ezzat10, P. Klimo11, H. Lim12, M. Massicotte13, R. Wong14, P. Lam15, B. Yap16, M.K. Krzyzanowska17

Author affiliations

  • 1 Oncology, Juravinski Cancer Centre, L8V 5C2 - Hamilton/CA
  • 2 Medical Oncology, London Regional Cancer Program (LRCP) - London Health Science Center (LHSC), N6A 4L6 - London/CA
  • 3 Hematology-oncology, Centre Hospitalier Universite de Montreal (CHUM), Montreal/CA
  • 4 Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa/CA
  • 5 Medical Oncology, McGill University Health Centre, H4A3J1 - Montreal/CA
  • 6 Oncology, Cross Cancer Institute, Edmonton/CA
  • 7 Medicine, Centre Hospitalier Universite Laval (CHUL), Quebec/CA
  • 8 Medical Oncology, Tom Baker Cancer Centre, T2N 4N2 - Calgary/CA
  • 9 Medicine, Nova Scotia Health Authority, Halifax/CA
  • 10 Medicine, University Health Network, Toronto/CA
  • 11 Oncology, Continuum Medical Care Clinic, V7V 3S8 - West Vancouver/CA
  • 12 Oncology, BC Cancer Agency - Vancouver, V5Z 4E6 - Vancouver/CA
  • 13 Medicine, Centre Hospitalier Universite de Sherbrooke (CHUS), Sherbrooke/CA
  • 14 Medical Oncology, St. Boniface General Hospital Cancercare Manitoba, R2H 2A6 - Winnipeg/CA
  • 15 N/a, Eisai Ltd., L5N7K2 - Mississauga/CA
  • 16 Health Economics And Outcomes Research, Innomar Strategies Inc., Okville/CA
  • 17 Oncology, Princess Margaret Cancer Centre, Toronto/CA

Resources

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Abstract 3665

Background

L provided a 19.4 month (mo) median PFS in the phase 3 Study of Lenvatinib in Differentiated Cancer of the Thyroid (SELECT) and an objective response rate of 60.2%; however, all patients (pts) experienced some toxicity. In Canada, a PSP was created to offer L to pts with rDTC prior to public funding. We report the prescription practices and treatment patterns of these pts.

Methods

Between August 2015 and January 2019, 223 pts with rDTC started L as part of the PSP. Prescriber information, patient demographics, start and discontinuation dates, starting doses and dose modifications and reasons for discontinuation were ascertained whenever possible. Pt and prescriber demographic and clinical characteristics were described using summary statistics. Kaplan-Meyer method was used to estimate persistency on L, defined as time from first prescription to discontinuation.

Results

Two-hundred twenty-three rDTC pts were analyzed (42% female, mean age 63.4 years). Median study follow-up was 15.8 mo. Mean starting dose was 21.2mg and was 24 mg for 158 pts (66%), 20mg for 35 pts (15%) and lower for 47 pts. Median KM estimate of persistency on L was 15.8 mo and was similar for pts starting full or reduced dose. Treatment persistency was similar between all provinces but there was a trend favouring prescribers with more than one patient in the PSP versus those with only one patient (18.0 mo vs 10.2 mo, p = 0.0922) and for pts treated by endocrinologists compared to other specialties. There was also a trend for longer persistency in pts who had dose modifications compared to pts treated with constant doses (19.0 mo vs 9.8 mo, p = 0.0577). One hundred and twelve pts have discontinued L (39 deaths from disease, 23 progressive disease/palliation, 15 for medical reasons other than toxicity (including decision to pursue alternative therapy), 14 from toxicity and 21 undisclosed/other reasons).

Conclusions

To date, this is the largest presented real-world analysis of the treatment patterns of L in pts with rDTC and our estimates of treatment duration as proxy for effectiveness are comparable to the phase 3 SELECT trial. Toxicity led to a minor proportion of discontinuations.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Eisai Supported the Patient Support Program, hosted by Innomar Strategies, Inc.

Disclosure

S.J. Hotte: Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Eisai. E. Winquist: Honoraria (self), Advisory / Consultancy, Research grant / Funding (institution): Eisai. N. Chua: Honoraria (self), Advisory / Consultancy: Eisai. J..D. Ruether: Honoraria (self), Advisory / Consultancy: Eisai. N. Lamond: Honoraria (self), Advisory / Consultancy, Travel / Accommodation / Expenses: Eisai. S. Ezzat: Advisory / Consultancy: Eisai. M. Massicotte: Honoraria (self), Advisory / Consultancy: Eisai. R. Wong: Advisory / Consultancy: Eisai. P. Lam: Full / Part-time employment: Eisai. B. Yap: Full / Part-time employment: Eisai. M.K. Krzyzanowska: Honoraria (self), Research grant / Funding (institution): Eisai; Research grant / Funding (institution): Exilixis. All other authors have declared no conflicts of interest.

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