Author of

• 10743

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

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Medical Oncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10791

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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): J. Chen
    • 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.