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
2041 - Efficacy results of selective AXL inhibitor bemcentinib with pembrolizumab following chemo in patients with NSCLC
Presenter: Jose Trigo Perez
Session: Poster Display session 1
Resources:
Abstract
5444 - Analysis of the tumor microenvironment and tumor genotype through different stages of lung adenocarcinoma
Presenter: Peter Zink
Session: Poster Display session 1
Resources:
Abstract
3124 - Does Progress achieved in the Treatment of Patients with Metastatic Non-Small-Cell Lung Cancer (NSCLC) reach the Elderly Population?
Presenter: Jorune Suipyte
Session: Poster Display session 1
Resources:
Abstract
5142 - Prognostic factors for non-small cell lung cancer patients with driver mutation negative and brain metastases (HOT 1701)
Presenter: Yoshihito Ohhara
Session: Poster Display session 1
Resources:
Abstract
1580 - A novel risk classification system based on nomogram scores to predict survival of patients presenting with brain metastases at the first diagnosis of NSCLC
Presenter: Pengfei Cui
Session: Poster Display session 1
Resources:
Abstract
4442 - Comparison of real-world response rate (rwRR) to RECIST-based response rate in patients with advanced non-small cell lung cancer (aNSCLC)
Presenter: Xinran Ma
Session: Poster Display session 1
Resources:
Abstract
1893 - SMARCA4 Deficient Non-Small Cell Lung Cancer (NSCLC): A Comprehensive Genomic Profiling (CGP) Study
Presenter: Stephen Graziano
Session: Poster Display session 1
Resources:
Abstract
5582 - Exploring Resistance to Nivolumab [NIV] applying an Immune Genomic Signature (IGS) in advanced pretreated NSCLC [PRINCiPe study]
Presenter: Sara Pilotto
Session: Poster Display session 1
Resources:
Abstract
1408 - DNA damage repair deficiency is associated with early resistance to crizotinib: whole-genome analysis in non-small cell lung cancer patients with ALK-fusion
Presenter: Dongyun He
Session: Poster Display session 1
Resources:
Abstract
5751 - Phase 3 ALTA-3 study of brigatinib (BRG) vs alectinib (ALC) in patients (pts) with advanced anaplastic lymphoma kinase (ALK)−positive non–small cell lung cancer (NSCLC) that progressed on crizotinib (CRZ)
Presenter: Sanjay Popat
Session: Poster Display session 1
Resources:
Abstract