Abstract 1601P
Background
Pembrolizumab, a monoclonal antibody anti-programmed death ligand 1 (PD-1), was approved in October 2017 by National Health Surveillance Agency (ANVISA) for first-line treatment of metastatic Non-Small Cell Lung Cancer (NSCLC) with a PD-L1 tumor proportion score (TPS) ≥50% based on the KEYNOTE 024 (KN24). In our public health system (SUS), however, it is not approved. Considering that Lung Cancer (LC) is the major cause of cancer mortality in our country, and NSCLC represents more than 85% of the patients (pts), it is notable its huge impact in terms of lives lost, economic and social burden of this disease, and so an estimation of the Years of Potential Life Lost (YPLL) would be an helpful tool to address this topic in oncology medical societies.
Methods
The Number of Eligible Patients (NEP) with NSCLC was taken from our National Cancer Institute (INCA). Pts with life insurance and other histologies, not NSCLC, were disregarded. For the YPLL calculation purpose the NEP between the years 2017 & 2019 was multiply by the difference of the documented improvement in the median overall survival of the therapeutic regimen, 30 months and 14,2 months - KN24 for pembrolizumab and chemotherapy regime respectively. For a conservative calculation, we assume that all eligible pts would have had access at the time of first approval in the country.
Results
INCA estimates 4,703 (October and November 2017); 62,540 (2018 and 2019) new cases of LC/year in Brazil. Of these, 76.3% are treated by SUS, upon which 89% are NSCLC. Of these 44% have metastasis at diagnosis, and 43%, 7%, 6% are diagnosed in stages III, II and I, respectively. It was used a recurrences rate of 53.79% in stage III, 46.49% in II and 26% in I in 5 years from diagnosis, and considering as 17,38% as PD-L1 ≥ 50% (Gelatti et, 2020): resulted in 5,858 NEP from 2017 until 2019, resulting in a loss of approximately 7,713 YPLL in 26 months.
Conclusions
Pembrolizumab improves overall survival outcome compared to chemotherapy in PD-L1 positive (TPS≥50%) naive stage IV NSCLC patients and this represents a substantial gain YPLL. Collaborative initiatives are needed to address this major barrier to access to treatment and relive the economic and social burden of NSCLC.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.