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B. Haaland
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P2.07 - Immunology and Immunotherapy (ID 708)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Immunology and Immunotherapy
- Presentations: 2
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.07-054 - Cost-Effectiveness of Pembrolizumab as First-Line Therapy for Advanced Non-Small Cell Lung Cancer (ID 7510)
09:30 - 09:30 | Author(s): B. Haaland
- Abstract
Background:
Immunotherapy is changing the therapeutic perspective and expectations for solid tumors and constitutes a major therapeutic advance for advanced non-small cell lung cancer (NSCLC). We assessed the cost-effectiveness of pembrolizumab (anti-PD-1 antibody) as compared to platinum-doublet chemotherapy as first-line therapy for advanced NSCLC.
Method:
We developed a Bayesian Markov model of disease states with a 5-year horizon. We retrieved survival, progression, and safety data comparing pembrolizumab to contemporaneous platinum-doublet chemotherapy as first-line therapy for PD-L1 expression equal to or greater than 50%, EGFR non-mutated, ALK non-translocated lung carcinoma patients. Published estimated US and UK costs were applied to inform the incremental cost-effectiveness ratio (ICER). We estimated costs in USD and summarized effectiveness as discounted quality-adjusted life-years (QALYs).
Result:
Patients treated with pembrolizumab accumulated 0.65 QALYs (95% credible interval [95% CrI] 0.5-0.91) as compared to 0.19 QALYs (95% CrI 0.16-0.22) to 0.32 QALYs (95% CrI 0.27-0.37) for those treated with platinum-doublet chemotherapy. From a current US cost perspective, ICERs varied from $173,000 (95% CrI $163,000-$183,000) to $201,000 (95% CrI $182,000-232,000) for one end-of-life (EoL) adjusted QALY, while from a British National Health System (NHS) perspective, ICERs varied from $154,000 (95% CrI $144,000-$166,000) to $193,000 (95% CrI $165,000-$248,000) per EoL adjusted QALY gained.
Conclusion:
At current price, pembrolizumab is not cost effective considering the usual NICE threshold in the UK. In the US, these numbers would be considered cost-effective according to the WHO definition.
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P2.07-055 - Indirect Comparison between Immune-Checkpoint Inhibitors for 2nd Line Non-Small Cell Lung Cancer – a Network Meta-Analysis (ID 7513)
09:30 - 09:30 | Author(s): B. Haaland
- Abstract
Background:
Treatment with immune checkpoint inhibitors (ICIs) improves overall survival with lower toxicity when compared to classic chemotherapy in the management of advanced non-small cell lung cancer (NSCLC). While emerging, the role of PD-L1 expression as a biomarker remains controversial. In addition, all clinical trials that included previously treated patients compared ICIs with docetaxel and there is a lack of data comparing each agent against each other. This network meta-analysis aims to (i) compare overall survival (OS) with nivolumab, pembrolizumab, and atezolizumab against docetaxel in previously treated advanced non-small cell lung cancer (NSCLC) patients and (ii) to perform indirect comparisons between ICIs in the PD-L1 unselected population and by PD-L1 expression levels.
Method:
We searched Pubmed for randomized controlled trials comparing the ICIs nivolumab, pembrolizumab and atezolizumab in the treatment of patients with previously treated advanced NSCLC. Two independent reviewers screened each study. We performed network meta-analyses of survival outcomes in the PD-L1 unselected population and by PD-L1 expression levels <1%, ≥1%, ≥5%, ≥10%, and ≥50%. Head-to-head indirect comparisons of nivolumab, pembrolizumab and atezolizumab were constructed and treatment rankings provided in terms of SUCRA and probability that a treatment is best. We also assessed the potential survival benefits of selecting patients by PD-L1 expression level as compared to a PD-L1 unselected population.
Result:
Five trials with 3,024 total patients were included in the meta-analysis. ICIs improved OS in previously treated advanced NSCLC patients across PD-L1 expression levels compared to docetaxel with HRs of 0.70 (95% CrI 0.61-0.81), 0.79 (0.65-0.97), 0.67 (0.57-0.77), 0.55 (0.44-0.69), 0.43 (0.30-0.63), and 0.49 (0.37-0.63) for PD-L1 expression levels as follows: unselected, <1%, ≥1%, ≥5%, ≥10%, and ≥50%. However, for individual ICIs nivolumab and atezolizumab in PD-L1<1%, there was only weak evidence of benefit with HR of 0.77 (0.57-1.04) and 0.81 (0.62-1.08) respectively compared to docetaxel. Nivolumab, pembrolizumab and atezolizumab showed little survival differences between each other (nivolumab vs pembrolizumab HR 0.94 (0.63-1.39), nivolumab vs atezolizumab 0.91 (0.62-1.35), and pembrolizumab vs atezolizumab 0.97 (0.68-1.41) in PD-L1 ≥1%). When interpreting these data, it is important to note that while nivolumab and pembrolizumab trials used tumor cells for PD-L1 cutoffs, atezolizumab used both tumor and/or immune cell cut-offs and PD-L1≥50% in atezolizumab trials comprised patients with tumor cell PD-L1≥50% or immune cell PD-L1≥10%.
Conclusion:
ICIs improve survival across PD-L1 expression levels compared to docetaxel. None of the available ICIs, nivolumab, pembrolizumab and atezolizumab, seem to be better than the others.
