Abstract 1605P
Background
In Brazil, lung cancer (LC) is the leading cause of cancer deaths, with the non-small cell (NSCLC) subtype being the most common (85%). While the European Medicines Agency (EMA) approved crizotinib as an anaplastic lymphoma kinase (ALK) inhibitor for treatment of ALK- positive advanced NSCLC in 2012, the National Sanitary Surveillance Agency (ANVISA) in Brazil did not approve it until 2016. More than 75% of advanced NSCLC patients (pts) depend exclusively on the Brazilian public health system (SUS). However, in this setting, pts are still treated with chemotherapy and not with crizotinib. Our aim was to estimate the number of premature deaths in ALK+ NSCLC pts dated from EMA approval to the present day.
Methods
The annual number of LC pts was taken from our National Cancer Institute (INCA) and for the purposes of calculations we assume constant incidence. Pts with private health insurance were excluded. Only NSCLC adenocarcinoma histology was considered. INCA database, a cohort (Wong, 2016) and PROFILE 1014 trial were used to estimate stage distribution at diagnosis, recurrence rates and overall survival. Candidates for an ALK inhibitor are 4% of the sum of patients who have advanced disease at diagnosis and those who have recurrence in the last 5 years.
Results
INCA estimates 31,270 new cases of LC per year in Brazil. Of these, 76.3% are supposed to be treated in SUS, totalling 23,859. These include 21,235 (89%) NSCLC cases and 15,225 (71.7%) have adenocarcinoma histology. Of these, 6,699 (44%) have metastasis at diagnosis, and 6,547 (43%), 1,066 (7%), 914 (6%) are diagnosed in stages III, II and I, respectively. We used a recurrences rate of 53.79% in stage III (3,522), 46.49% in II (495) and 26% in I (238) in 5 years from diagnosis. 438 (4%) pts in 1 year are candidates to receive an ALK-inhibitor. With a hazard ratio of 0.346, we estimated that 1,175 patients died prematurely due to the lack of access to crizotinib from 2012 to 2020.
Conclusions
In low- and middle-income countries, there are access problems that limit the availability of cancer therapies. From 2012 to 2020, we estimate that 1,175 pts with NSCLC died prematurely due to lack of access to crizotinib in the Brazilian public health system. Studies with real life data and including the cost-effectiveness of this targeted therapy for Brazilian pts with NSCLC are urgently necessary.
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.