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Y. Wang



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    P1.10 - Poster Session 1 - Chemotherapy (ID 204)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P1.10-048 - Real-world evidence for clinical effectiveness, toxicity, and hospitalization costs associated with second-line chemotherapy in Chinese patients with advanced non-squamous non-small cell lung cancer (ID 3101)

      09:30 - 09:30  |  Author(s): Y. Wang

      • Abstract

      Background
      Real world evidence for clinical effectiveness, toxicity, and hospitalization costs associated with second-line chemotherapy in patients with advanced non-squamous non-small cell lung cancer (NSCLC) is needed to guide clinical practice and reimbursement decision making in China.

      Methods
      This study retrospectively identified advanced non-squamous NSCLC patients treated with second-line chemotherapy between 2007 and 2012 in four triple-A hospitals. Patients’ baseline characteristics, chemotherapy, clinical response, adverse events, and hospitalization costs were extracted from medical and financial records associated with hospitalizations during second-line chemotherapy. They were compared by treatment using descriptive statistical methods. Kaplan-Meier (KM) survival analysis was conducted to explore the differences in time to progression (TTP) between the treatments. Hospitalization costs were stratified into non-drug costs and non-chemotherapy drug costs, and chemotherapy drug costs. Propensity score methods were used to create matched patients with balanced baseline characteristics to confirm the findings in the unadjusted analyses.

      Results
      414 patients received pemetrexed singlet (n=57), docetaxel singlet (n=64), docetaxel-platinum doublet (n=119), and pemetrexed-platinum doublet (n=174) as second-line chemotherapy in the four hospitals. The identified patients had similar baseline characteristics except that patients receiving docetaxel-platinum doublet (53.2 years vs. 58.5 years, p = 0.003) or pemetrexed-platinum doublet (54.3 years vs. 58.5 years, p = 0.010) were younger than those treated by pemetrexed singlet. KM survival analysis indicated a non-significant trend suggesting longer mean TTP for pemetrexed singlet than that for docetaxel singlet (95.6 days vs. 53.4 days; p = 0.139), for docetaxel-platinum doublet (95.6 days vs. 52.4 days; p = 0.139), and for pemetrexed-platinum doublet (95.6 days vs. 76.3 days; p = 0.716). The adverse event comparisons demonstrated that pemetrexed singlet had lower incidence rates for neutropenia (8.8% vs. 25.0%, p = 0.035 for docetaxel singlet; 21.9%, p = 0.055 for docetaxel-platinum doublet; 23.0%, p = 0.031 for pemetrexed-platinum doublet) and leukopenia (10.5% vs. 21.9%, p = 0.152 for docetaxel singlet; 28.6%, p = 0.013 for docetaxel-platinum doublet; 26.4%, p = 0.021 for pemetrexed-platinum doublet) and had lower incidence rates for vomiting (35.1% vs. 62.6%, p < 0.001) and nausea (43.9% vs. 69.0%, p < 0.001) than pemetrexed-platinum doublet. Pemetrexed singlet was associated with the lowest hospitalization costs per treatment cycle (3 weeks) for non-drug expenses (RMB 3,949 vs. RMB 5,154 for docetaxel singlet, p = 0.043; RMB 6,067 for docetaxel-platinum doublet, p = 0.002; RMB 5,045 for pemetrexed-platinum doublet, p = 0.029; 1 RMB = 0.16 US$) and non-chemotherapy drugs (RMB 5,471 vs. RMB 8,421 for docetaxel singlet, p = 0.006; RMB 7,874 for docetaxel-platinum doublet, p = 0.015; RMB 7,665 for pemetrexed-platinum doublet, p = 0.009). Similar trends were observed in the comparisons between the treatments in propensity score matched patients.

      Conclusion
      Advanced non-squamous NSCLC patients treated with pemetrexed singlet for second-line therapy had less toxicity and lower hospitalization costs for non-drug expenses and non-chemotherapy drugs in this Chinese cohort. When compared to pemetrexed singlet, pemetrexed-platinum doublet as second-line chemotherapy was associated with greater occurrence of adverse events and higher hospitalization costs without giving any additional survival benefits.

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    P3.11 - Poster Session 3 - NSCLC Novel Therapies (ID 211)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Medical Oncology
    • Presentations: 1
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      P3.11-043 - Survival of patients with advanced lung adenocarcinoma before and after approved use of Gefitinib in China: a comparative clinical study in a single center (ID 2973)

      09:30 - 09:30  |  Author(s): Y. Wang

      • Abstract

      Background
      Since approved use of Gefitinib in March 2005 in China, more patients with lung cancer, especially those with lung adenocarcinoma, have chosen it for treatment. It is of clinical significance to compare survival of lung adenocarcinoma patients who received Gefitinib treatment after March 2005 and that of those who did not receive it so as to provide clinical clues for selection of Gefitinib in Chinese lung adenocarcinoma patients.

      Methods
      Clinical data of 558 patients with advanced lung adenocarcinoma who received palliative chemotherapy from January 2002 throughout December 2010 were reviewed retrospectively. According to the matched-pair case-control study design, 255 patients who only received palliative chemotherapyand 255 patients who received Gefitinib treatment after approved use of Gefitinib were stringently matched by age, sex and smoking history and finally enrolled in this study. Clinical factors including age, sex, smoking history, Eastern Cooperative Oncology Group performance status (ECOG PS), tumor stage, organ metastasis and the number of prior cytotoxic chemotherapies were analyzed to determine their correlations with OS.

      Results
      The median survival time (MST) of the 510 enrolled patients with advanced lung adenocarcinoma was 22.8 months. MST of the patients who received Gefitinib treatment was significantly longer than that of the patients without (33.5 months vs. 14.1 months, p<0.001). OS in patients who received Gefitinib treatment was significantly longer than that in patients without receiving Gefitinib treatment in almost all clinical factor-based subgroups, including age, sex ,smoking history, ECOG PS 0-1, tumor stage, the presence or absence of lung, pleural, bone, brain, adrenal gland and liver metastasis, and the number of prior cytotoxic chemotherapies (all p<0.001), except in ECOG PS ≥2 subgroup.

      Conclusion
      Gefitinib treatment significantly improved the survival of patients with advanced lung adenocarcinoma in China.