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Herbert H Loong
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P1.01 - Advanced NSCLC (ID 757)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.01-050 - Cost-Effectiveness of PDL1 Based Test-And-Treat Strategy with Pembrolizumab as the 1st Line Treatment for NSCLC in Hong Kong (ID 8013)
09:30 - 09:30 | Presenting Author(s): Herbert H Loong
- Abstract
Background:
Pembrolizumab, a monoclonal antibody against PD-1, is approved by several regulatory agencies for first line treatment in metastatic NSCLC with a PD-L1 tumour proportion score (TPS) ≥50%. An economic model was developed to evaluate the cost-effectiveness of employing a biomarker (PD-L1) test-and-treat strategy (BTS), in which patients with TPS ≥50% are treated with pembrolizumab, and other patients receive standard-of-care (SoC) cytotoxic chemotherapies versus a non-BTS strategy with all patients receiving SoC. Patients with activating EGFR mutations and ALK translocations were excluded from the analysis.
Method:
The model was built with partitioned survival approach to estimate the incremental cost effectiveness ratio (ICER) expressed as cost per quality-adjusted life-year (QALY) gained. The clinical efficacy, utility and safety data used in this model were derived from the KN024 trial. The base case comparator in the model included five different platinum-based chemotherapy regimens used as SoC for advanced NSCLC in Hong Kong. The base-case time horizon for the model was 10 years with costs and health outcomes discounted at a rate of 3% per year. Utilities for the base case were based on utility data collected in KN024. Costs and disutility associated with grade 3-5 adverse effects of incidence rate 5%, including anaemia, neutropenia, pneumonia, thrombocytopenia and pneumonitis were considered in the model. Treatment was continued until disease progression or maximum 2 years for pembrolizumab. Local drug acquisition costs, PD-L1 testing costs, drug administration costs, disease management costs were applied. A series of sensitivity analyses were conducted to evaluate the uncertainty of cost-effectiveness results.
Result:
The BTS approach was projected to increase QALY by 0.29 with an additional total cost of HK$ 249,077 (USD 31,933) compared to non-BTS approach resulting in an incremental cost-effectiveness ratio (ICER) of HK$ 865,189 (USD 110,922) per QALY gained. This is lower than the World Health Organization (WHO) cost-effectiveness threshold of 3 times 2016 GDP per capita of Hong Kong, HK$ 1,017,819 (USD 130,490). Probabilistic sensitivity analysis showed 94.6% probability that the ICERs would be below this threshold. In a scenario analysis, a lower ICER of HK$ 859,284 (USD 110,165) was shown in comparison of pembrolizumab versus SoC among patients with TPS ≥50%.
Conclusion:
A BTS to identify a subset of NSCLC patients with PD-L1 TPS ≥50% to be treated with pembrolizumab in the first line setting can be considered cost-effective in Hong Kong.
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P3.14 - Radiotherapy (ID 730)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.14-017a - Extra-Cranial Oligo-Progression upon 1st Line EGFR TKI in Advanced Non-Small Cell Lung Cancer Patients: Outcomes of Local Ablative Radiotherapy (ID 10096)
09:30 - 09:30 | Author(s): Herbert H Loong
- Abstract
Background:
Continuation of Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors (EGFR TKI) in stage IV Non-small cell Lung cancer (NSCLC) patients harboring sensitive mutation (Exon 19 deletion /Exon 21 L858R mutation) upon first progression according to RECIST criteria were shown to be effective in ASPIRATION study and can prolong the use of EGFR TKI for 3 months till frank disease progression. Local ablative radiotherapy (LAR) on oligo-progression is increasingly advocated but the actual effect is to be determined.
Method:
Medical and radiotherapy records of patients given LAR from 2012-2017 were screened at a single centre. Patients with stage IV NSCLC harboring sensitive epidermal growth factor receptor (EGFR) activating mutations having extra-cranial oligo-progression and given LAR were included in the study. Patients’ demographics, site of oligo-progression, radiotherapy sites and dose/fractionation schedules were captured. Durations from starting of first line EGFR TKI to LAR was calculated (PFS1). Local progression free survival (L-PFS), overall progression free survival from LAR to further progression that led to stop of EGFR TKI (O-PFS) and overall survival (OS) were analyzed with Kaplan-Meier method.
Result:
There were 15 eligible patients with total 17 sites of oligo-progressive sites treated. There were 6 male and 9 female patients. The mean age was 59.6 years (36.5-82 years). All were treated with first-generation EGFR TKIs. The median duration PFS1 was 13.0 months (6.0-36.1 months). Treatment sites included 13 lung lesions and 4 bone lesions. The mean equivalent dose (2Gy) was 105Gy (64.5-122Gy). The median follow up time was 13.3 months. Ten out of 15 patients had CEA drop after treatment, with the median duration from treatment to first drop of CEA being 1.7 months. The median L-PFS and OS were not reached. The median PFS2 was 9.7 months (2.2-15.1 months). Eight out of 10 patients had second line/ third line treatment with either afatinib/ osimertinib chemotherapy or immunotherapy. Toxicities of radiotherapy were minimal and only grade 1 pneumonitis or pain flare documented. Duration of PFS1 was not found to affect duration of O-PFS.
Conclusion:
LAR appears to be a reasonable treatment approach in the event of oligo-progression in patients with advanced NSCLC harboring activating EGFR mutations. Longer follow-up and a larger cohort are underway to assess its impact on survival.
