Abstract 5405
Background
Novel therapies are replacing established treatment options for patients with advanced non-small cell lung cancer (aNSCLC), which poses a challenge to healthcare budgets. The impact of Treatment Evolution in NSCLC (iTEN) model is a validated discrete event patient simulation designed to estimate the impact of treatment sequencing in aNSCLC. The impact of five novel therapies (osimertinib, alectinib, brigatinib, dabrafenib and trametinib, and pembrolizumab combination therapy) changing aNSCLC management in Canada was modelled.
Methods
Current Canadian treatment practices were established via a modified Delphi process with Canadian clinical experts. The table presents potential treatment sequences for biomarker positive aNSCLC with the novel therapies. Clinical efficacy of treatments was estimated from Kaplan–Meier progression-free and overall survival data, as previously described (Moldaver et al. 2018). Modelled costs (2018 CDN $) included drug acquisition and administration costs and the costs of ongoing monitoring, imaging, physician visits, end-of-life, best supportive care, and adverse event management. A treatment rate of 100% in the first-line and 60% thereafter was modelled.Table:
1582P Biomarker positive aNSCLC therapy
EGFR | ALK | BRAF | PD-L1 ≥ 50% | PD-L1 <50% | |
---|---|---|---|---|---|
1L | Osimertinib* | Alectinib* | Dabrafenib plus trametinib* | Pembrolizumab | Pembrolizumab plus chemotherapy* |
2L | PD | Brigatinib* | IO for those PD-L1 ≥ 50% PD for remainder | PD | Docetaxel |
3L | I-O | PD | Switch (PD to I-O and I-O to PD) | Docetaxel | Erlotinib |
4L | Docetaxel/BSC | I-O | Docetaxel | Erlotinib/BSC | BSC |
Therapies with an asterisk (*) are new to Canada BSC, best supportive care; I-O, immuno-oncology agent; PD, platinum doublet chemotherapy
Results
Introduction of these five therapies was estimated to increase the average 1- and 3-year survival of Canadian aNSCLC patients from 69% and 14% to 73% and 21%, respectively. Estimated average lifetime cost per treated patient rose from $159,764 to $269,056. ALK positive patients were estimated to have the largest increase in 3-year survival, from 35% to 64%, and cost of treatment, from $315,333 to $747,859.
Conclusions
New therapies for aNSCLC are likely to increase the survival and average cost of treatment in Canada.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
AstraZeneca Canada.
Disclosure
P.K. Cheema: Honoraria (self), Advisory / Consultancy: AstraZeneca Canada, BI, BMS, Roche, Pfizer, Novartis, Takeda and Merck,. W.K. Evans: Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony: AstraZeneca Canada, AbbVie, Astellas, BMS, Eisai, Lilly, Janssen, Gilead, Takeda, Boehringer Ingelheim, Roche and Celgene. R. Burkes: Honoraria (self), Advisory / Consultancy: AstraZeneca Canada. R. Sangha: Honoraria (self), Advisory / Consultancy: Pfizer, BI, AZ, Roche/Genentech, Lundbeck, BMS, Merck, AbbVie and Takeda, Lilly, BMS, Novartis. C. Ho: Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony: AstraZeneca Canada, Boehringer Ingelheim, Pfizer, BMS, Roche, Lilly, Genzyme, Eisai, Merck and Bayer. P. Wheatley-Price: Honoraria (self), Advisory / Consultancy, Leadership role: Novartis, BMS, Merck, AZ, Takeda, Roche and AbbVie. D. Boehm: Honoraria (self): AstraZeneca Canada, Baxter and Genomic Health. J. Venkatesh: Honoraria (self): AstraZeneca Canada, Takeda. S. Walisser: Honoraria (self), Advisory / Consultancy: stellas Pharma Canada, AstraZeneca Canada, Gilead Sciences Canada, Pfizer, and Janssen Inc. D. Grima: Shareholder / Stockholder / Stock options, Full / Part-time employment, Officer / Board of Directors: Cornerstone Research Group. D. Moldaver: Full / Part-time employment: Cornerstone Research Group. M. Hurry: Full / Part-time employment: AstraZeneca Canada.
Resources from the same session
3409 - Effect and safety of immune checkpoint inhibitors for brain metastases from non-small cell lung cancer
Presenter: Toshihiko Iuchi
Session: Poster Display session 1
Resources:
Abstract
3683 - Impact of Radiotherapy on efficacy of anti-programmed death 1 (PD-1) antibodies in metastatic NSCLC
Presenter: Evangeline Samuel
Session: Poster Display session 1
Resources:
Abstract
3924 - Pembrolizumab frontline monotherapy in patients with NSCLC and high PD-L1 expression: Real World Data from a European Cohort with focus on subgroups of interest
Presenter: Giannis Mountzios
Session: Poster Display session 1
Resources:
Abstract
3970 - Patients with metastatic non-small cell lung cancer and PD-L1 expression in Germany. Treatment and first outcome from the prospective German Registry Platform CRISP (AIO-TRK-0315)
Presenter: Martin Sebastian
Session: Poster Display session 1
Resources:
Abstract
5350 - The efficacy and safety of pembrolizumab as a first-line therapy in PD-L1 50% positive advanced NSCLC (HOPE-001)
Presenter: Motohiro Tamiya
Session: Poster Display session 1
Resources:
Abstract
3832 - Osimertinib in epidermal growth factor receptor (EGFR) T790M advanced non-small cell lung cancer (NSCLC): analysis of patients with central nervous system (CNS) metastases in a real-world study (ASTRIS)
Presenter: Giulio Metro
Session: Poster Display session 1
Resources:
Abstract
4082 - Real-world (RW) treatment patterns and outcomes for second-line (2L) therapy and beyond in patients (pts) with epidermal growth factor receptor-mutated (EGFRm) advanced NSCLC receiving a first-line (1L) first- or second-generation (1G/2G) EGFR tyrosine kinase inhibitor (TKI)
Presenter: Riyaz Shah
Session: Poster Display session 1
Resources:
Abstract
2855 - Impact of ramucirumab (RAM) + erlotinib (ERL) on EGFR mutations in circulating tumor DNA – The 1st report of a biomarker study in Japanese patients from RELAY: Global Ph3 study of ERL + RAM or placebo (PL) in 1L metastatic NSCLC with EGFR activating mutations
Presenter: Kazuto Nishio
Session: Poster Display session 1
Resources:
Abstract
2911 - Apatinib combined with EGFR - TKI in treating advanced non-small cell lung cancer with EGFR - TKI resistance
Presenter: Ruifen Tian
Session: Poster Display session 1
Resources:
Abstract
2100 - Updated analysis of a phase I trial of afatinib (Afa) and bevacizumab (Bev) in chemo-naïve patients (pts) with advanced non-small-cell lung cancer (NSCLC) harboring EGFR-mutations: OLCSG1404
Presenter: Takashi Ninomiya
Session: Poster Display session 1
Resources:
Abstract