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B. Korytowsky
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MINI 04 - Clinical Care of Lung Cancer (ID 102)
- Event: WCLC 2015
- Type: Mini Oral
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 2
- Moderators:L. Gaspar, V. Westeel
- Coordinates: 9/07/2015, 16:45 - 18:15, Mile High Ballroom 2c-3c
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MINI04.01 - Years of Life Lost and Lifetime Earnings Lost in Metastatic Lung Cancer: Potential Societal Benefits of Improved Survival by Age and Histology (ID 774)
16:45 - 18:15 | Author(s): B. Korytowsky
- Abstract
- Presentation
Background:
“Years of life lost” (YLL) and “lifetime earnings lost” (LEL) are used to describe the population burden of cancer. Lung cancer (LC) is one of the most common cancers in the US. While it affects older patients, the younger subgroups of LC are large. Approximately 57% of LC cases are metastatic at diagnosis, with a 5-year survival rate of approximately 5%. Nivolumab, a recently-approved fully human IgG4 programmed death-1 (PD-1) immune checkpoint inhibitor antibody, demonstrated a mortality risk reduction of 41% compared to docetaxel in patients previously treated with platinum-based therapy for metastatic squamous, non-small cell LC (NSCLC) (hazard ratio [HR]: 0.59; 95% CI: 0.44, 0.79). This analysis quantifies YLL and LEL prior to the introduction of LC immunotherapy in order to benchmark potential population-level effects of improved long-term survival.
Methods:
A simulation model was developed using real-world US patients with LC diagnosed 1/1/2000–12/31/2011 in the Surveillance, Epidemiology, and End Results Program, with follow-up through 12/31/2012. Age-, sex-, and race-specific life expectancy were estimated using flexible parametric survival models. Comparable life expectancy was projected for the general US population using US vital statistics data. Life expectancy was combined with US Bureau of Labor Statistics income data to derive lifetime earnings in 2014 US dollars. Earnings reflect 18 possible income sources, including salary, investments, social security, and other retirement income. Mean YLL and LEL were estimated as the differences between patients with LC and the general US population. Results were stratified by age (<65; ≥65) and histology subtype (small cell, non-squamous NSCLC; squamous NSCLC).
Results:
An estimated 1,223,031 patients in the US were diagnosed with metastatic LC from 2000–2011. Estimated patient counts, expected survival, and expected lifetime earnings within each age and histology subtype are provided (Table). For patients aged <65, YLL per patient due to LC varied from 22.8–23.7 years by histology subtype, while for patients aged ≥65, YLL varied from 9.9–11.3 years. LEL per patient ranged from $862,000–$887,000 for patients aged <65, and from $274,000–$313,000 for patients aged ≥65. Figure 1
Conclusion:
YLL and LEL values across LC histologies are substantial in both older and, perhaps even more noticeably, younger populations. Improvements in survival reported with promising new LC therapies have the potential to substantially decrease the societal burden caused by YLL and LEL.
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MINI04.02 - Value of Innovation in Systemic Therapy for US Patients with Advanced/Metastatic NSCLC (ID 783)
16:45 - 18:15 | Author(s): B. Korytowsky
- Abstract
- Presentation
Background:
Lung cancer remains the leading cause of cancer death in the US. Over the past 40 years, treatment approaches have evolved and new systemic anti-cancer therapies have been introduced to the standard of care. With few exceptions, the impact of these agents for patients with advanced/metastatic non-small cell lung cancer (NSCLC) has been arguably minimal, with overall survival (OS) still less than 1 year for most patients. This study analyzed the association of available new systemic therapies with median OS, 1-year OS, and 1-year conditional survival (CS: adjusted probability of survival, specifically probability of living to year 2, given survival at 1-year) in patients with advanced/metastatic NSCLC.
Methods:
This study enrolled adult patients with advanced/metastatic NSCLC diagnosed between 1973 and 2011 in the US Surveillance, Epidemiology, and End Results (SEER-Research) Program of the American National Cancer Institute. We report the data from 1973 to 2008 for this analysis. Thirty-eight cohorts of patients were defined by year of diagnosis. Survivor functions were estimated using Kaplan-Meier analysis, with death as the failure event. Median OS, 1-year OS, and 1-year CS were derived for each year and analyzed graphically. The innovation index was defined as the sum of all systemic anti-cancer treatments available in the US market within a given year between 1973 and 2011 (Lichtenberg; Econ Hum Biol 2003;1:259–266).
Results:
Of 347,709 patients, a clear correlation was observed between the innovation index and survival measures (median OS, 1-year OS, and 1-year CS), with correlation coefficients of 77%, 92%, and 97%, respectively. Median OS, 1-year OS, 1-year CS, and the innovation index are plotted against time (Figure), enabling a comparison of survival measures between 1973 and 2008. Any change in the innovation index is reflected as a change in the survival curves, most notably in the 1-year CS, displaying a 1- or 2-year delay. From 1973 to 2008, median life expectancy of patients increased from 4 to 6 months; 1-year OS and 1-year CS improved by 71% and 31%, respectively. Figure 1
Conclusion:
The availability of systemic anti-cancer treatments for advanced/metastatic NSCLC has resulted in an incremental survival benefit, albeit modest, for US patients diagnosed between 1973 and 2008. Despite progress in treatment, outcomes for this patient population are very poor. Further research is needed to explore these treatment-survival relationships, including the resulting benefit for all patients with advanced/metastatic NSCLC and select patient subgroups.
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P3.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 208)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.01-048 - Predictors of Subsequent Lines of Therapy (LOTs) in Non-Small Cell Lung Cancer (NSCLC) (ID 781)
09:30 - 17:00 | Author(s): B. Korytowsky
- Abstract
Background:
In recent years, the number of NSCLC treatment options has increased. The majority of patients receiving first-line therapy (1L) for locally advanced or metastatic NSCLC progress; however, fewer than half receive subsequent treatment. This analysis investigated which factors might be predictive of patients receiving subsequent LOTs within a US community network.
Methods:
A retrospective data analysis was conducted using electronic health records in the US Oncology Network for adult patients with advanced NSCLC receiving second-line therapy from 3/1/10 to 12/31/12, with follow-up through 10/31/14. Patients receiving 1L tyrosine kinase inhibitors (EGFR/ALK+), with concurrent cancer diagnoses, or in a clinical trial were excluded. Data on monotherapy/combination treatments, LOT, staging, histology, ECOG performance status (PS), metastases, comorbidities, age, gender, geography and practice size were collected. Chi-square tests examined patient and disease factors related to the receipt of subsequent treatments (2L–3L and 3L–4L). Logistic regression was used to predict the likelihood of receiving a subsequent LOT in multivariate models. Overall survival (OS) was estimated from diagnosis and from the initiation of each LOT.
Results:
Of 2,122 patients receiving 2L treatment, 963 (45%) advanced to receive 3L and 319 (15%) advanced to receive ≥4L treatment. Median age at 2L was 67 years (range, 34–94); 58% were male. PS at 2L was available for 80% of patients; 8%, 68%, and 24% were PS 0, 1, or 2+, respectively. The histology breakdown was 54% non-squamous, 25% squamous, and 21% not-specified. In univariate analysis, significance (P<0.05) for receiving a 3L/4L+ therapy was found for age, PS, histology, and treatment type. Multivariate analysis results are presented (Table). Figure 1 Of patients receiving 2+ LOTs, median OS from advanced NSCLC diagnosis was 22 months (95% CI: 20, 23). Median OS from the start of 2L, 3L, and 4L was 8.9, 7.0, and 7.2 months, respectively. In 2L, median OS for patients who received a 3L compared to those who did not was 13.4 vs 5.0 months (P<0.0001); median OS in 3L for patients who received a 4L compared to those who did not was 12.9 vs 4.9 months (P<0.0001).
Conclusion:
Receiving subsequent LOTs is associated with improved OS in advanced NSCLC. Whether this represents the efficacy of therapeutic agents or an enrichment for patients capable of receiving additional therapy is unclear. Nonetheless, these data on patient and treatment predictive factors may assist in understanding how future treatments might allow more patients to advance to later LOTs.
