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Carmelia Maria Noia Barreto
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P1.11 - Patient Advocacy (ID 697)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Patient Advocacy
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.11-001 - Economic Impact of Immune Checkpoint Inhibitor Therapy in Brazil and Strategies to Improve Access (ID 7516)
09:30 - 09:30 | Author(s): Carmelia Maria Noia Barreto
- Abstract
Background:
Immunotherapy was elected by ASCO as the most important advance in Oncology in the last 2 consecutive years. Harnessing the immune system to fight cancer cells has already changed clinical practice. Nevertheless, the cost of immune checkpoint inhibitors is a limitation to their incorporation in several countries, including Brazil. The objective of this study was to estimate the economic impact of immunotherapy and make suggestions in order to improve access for patients who benefit the most from treatment.
Method:
We assessed Brazilian cancer epidemiology data and the international literature to estimate the number of eligible patients each year. The authors estimated the economic impact according to the local medication acquisition costs converted to US dollars. The median duration of the treatment was based upon the randomized clinical trials.
Result:
We assessed 3 different agents (and one combo) for 4 indications in the treatment of lung cancer. The results are summarized in the table below.Drug NSCLC 1L NSCLC 2L TOTAL Number of Eligible Patients (% of all cancer patients) Increase in Cancer Drug Total Expenditure Cost in the Public Health System Additional Cost Per Citizen LYG Cost per LYG Nivo NA 173.0 mi All Comers 173.0 mi -10%: 154.1 -20%: 135.1 4,733 (1.0) +21.6% +19.3% +16.9% $0.90 $0.77 $0.68 0.57 $99,467 Pembro 354.0 mi PD-L1>50% (monoTx) 898.5 mi PD-L1<50% (+chemo) 100.0 mi PD-L1>1% 1,352 mi -10%: 1,211 -20%: 1,070 16,362 (3.5) +169% +151% +134% $6.76 $6.06 $5.35 Mono 0.73 +chemo 0.55 2L 0.69 $156,164 $200,684 $49,007 Atezo NA 255.6 mi All Comers 255.6 mi -10%: 228.4 -20%: 201.2 4,733 (1.0) +32.0% +28.6% +25.2% $1.28 $1.14 $1.01 0.74 $103,095
Conclusion:
The current cost of immune checkpoint inhibitors is prohibitive in the public health system in Brazil. While the country’s GDP per capita is 78% lower than that of the US, immune checkpoint inhibitors have similar prices in both. Biomarker selection, posology and lower cost drugs help decrease the total economic impact of therapy. Price discrimination and volume discounts would help improve access. Further studies and discussion with all stakeholders is needed to identify patients who would benefit the most and to implement strategies to increase access to these potentially life-saving therapies.
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P3.03 - Chemotherapy/Targeted Therapy (ID 719)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Chemotherapy/Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.03-019 - Activity of PARP Inhibitor in NSCLC with Germline and Somatic Mutation and in Silico Chemotherapy Lethality (ID 9740)
09:30 - 09:30 | Presenting Author(s): Carmelia Maria Noia Barreto
- Abstract
Background:
Challenges in Precision and Personalized Medicine with interpatient variation needs individualized protocols. PARP Inhibition may be one modality of treatment of NSCLC, as coadjutant to chemotherapy.
Method:
A 66 years old male has been diagnosed with lung adenocarcinoma since 02-06-2016, c T4 c N1 c M1a (pleura and pericardium), had been exposed to carboplatin and pemetrexed for 6 cycles (January to March 2016) with disease progression, and peripheral neuropathy. He didn’t have EGFR mutation, ALK translocation, MET/RET or ROS-1 FISH alterations. He had been treated with radiation therapy from September to November 2016 with 60 Gy, IMRT, and after he received Nivolumab, from November 2016 to Abril 2017 with radiological progression. He had been tested by RCGG in May 2017 looking for circulating tumor cells in vitro (the culture contains all substances measured to apoptotic ability using oncogene apoptosis kit; the result is confirmed by cultures of the tumor or circulating tumor cells), Idengen (inherited hot-spot mutations), and Guardiant 360 by liquid biopsy (circulating DNA sequencing somatic mutations).
Result:
With the Idengene test, he has had PALB2 inherited mutation germline with possible pathogenic significance, BRCA1 and BRCA2 with unknown pathogenic significance. Also, he had NBN, PTCH2, and PTEN as possible pathogenic significance. With the Guardiant 360 test, he had BRCA1, C24Y, NF1, R416Q somatic mutations. With the RGCC test, the specific tumor appears to have resisting populations because of the MDR1 overexpression that can be reversed using inhibitors of ABCG2 pumps. Also, the neoplastic cells have the greatest sensitivity in the alkylating agent (cisplatin, mitomycin), in the tubulin dimmer polymerization inhibitors (Vinorelbine). Inhibitor of Akt/mTOR pathway can be used, as Everolimus, temsirolimus. He has partial sensibility to nucleus spindle stabilizer I (paclitaxel, docetaxel), II (vincristine, vinblastine), and nucleoside analogues (methotrexate, gemcitabine, pemetrexed). Therefore he has been exposed to oral Olaparib 300 mg BID, intravenous Gemcitabine 600 mg/m2, and oral vinorelbine 60mg/m2 weekly both., with good tolerability, and improvement of Performance Status.
Conclusion:
PARP Inhibitor can be a target therapy in personalized medicine, guided by PALB2 / BRCA 1 / 2 mutations in codons inherited and / or somatic mutations, in addition to gemcitabine and vinorelbine in lung adenocarcinoma resistant to platinum/pemetrexed. The addition of Olaparib was possible in this patient, and feasible with a good tolerability, maybe impacting the outcome. More studies related to PARP inhibitor and NSCLC need to be developed.
