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A. Velastegui



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    P1.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 206)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      P1.01-048 - Cost-Effectiveness of Pemetrexed for Advanced Non-Squamous Non-Small Cell Lung Cancer (nsNSCLC) in Patients Treated in a Spanish Institution (ID 2777)

      09:30 - 17:00  |  Author(s): A. Velastegui

      • Abstract
      • Slides

      Background:
      Pemetrexed (Pem) is a widespread used drug as standard treatment option in patients diagnosed of nsNSCLC in different settings: first line combined with platinum, maintenance or second line treatment. The aim of this study is to assess the cost-effectiveness of Pem-based chemotherapy in routine clinical practice from the perspective of the Spanish National Health System.

      Methods:
      We evaluated retrospectively clinical outcomes, in terms of overall survival (OS) and progression free survival (PFS), in patients diagnosed of advanced nsNSCLC from 2005 to 2014 who were treated with Pem-based chemotherapy, and we performed a cost-effectiveness analysis. We assessed the cost-effectivenss of the use of Pem-based treatment in routine clinical practice calculating the cost per life years gained (LYG) from the first time the patient received Pem, based on the price established in Spain and the number of cycles received. We calculated OS from the start date of Pem to the death or last contact with the patient, and PFS from the start date of Pem to first tumor progression after Pem.

      Results:
      114 patients treated with Pem-based chemotherapy were reviewed, 78.9% men and 21.1% women. Mean age at diagnosis was 64 (range 36-81). 80.7% were smokers or former smokers. 90.4% were stage IV and 9.6% IIIB. The predominant histology was adenocarcinoma (69.3%), followed by large cell carcinoma (22.8%), NSCLC-NOS (7%) and pleomorphic carcinoma (0.9%). 59.6% of patients received Pem in first-line and/or maintenance (1L - Maint.), and 40.3% in second or successive lines. The majority of them had a good functional status; ECOG 0 25,4% and 1 59,6%. Median number of received Pem cycles was 5 (range 1-39). Median number of treatment lines was 3 (range 1-8). Clinical outcomes: 68.6% obtained clinical benefit (46.1% stable disease, 21.5% partial response, and 1% complete response). Median progression free survival (PFS) was 5.16 months in 1L- Maint., and 4.55 months in second or successive lines (p = 0,278). Median OS was significantly better in 1L – Maint. setting than in second or successive lines (17.8 vs 9.8 months (p = 0,033)). The mean cost of Pem-based chemotherapy per LYG was 18988 euros in 1L-Maint. setting and 17095 euros in second or successive lines.

      Conclusion:
      From the perspective of the Spanish National Health System, Pem-based chemotherapy was cost-effective in both first line and/or maintenance setting, and second or successive treatment lines in our patients. The cost per life year gained (LYG) from treatment with Pem was below the standard threshold of 30000 euros.

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    P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Advanced Diseases - NSCLC
    • Presentations: 1
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      P2.01-056 - Thyroid Transcription Factor 1 (TTF1) as a Possible Predictive Biomarker for Pemetrexed-Based Chemotherapy in Non-Squamous NSCLC (ID 1740)

      09:30 - 17:00  |  Author(s): A. Velastegui

      • Abstract
      • Slides

      Background:
      There are no demonstrated predictive molecular markers for pemetrexed. The aim of this study is to explore and evaluate whether thyroid transcription factor 1 (TTF1) protein expression can be a predictive biomarker of clinical activity for pemetrexed-based chemotherapy in patients with nonsquamous non-small cell lung cancer (NSCLC).

      Methods:
      123 patients with advanced nonsquamous NSCLC treated with pemetrexed-based chemotherapy as first-line, maintenance, second or later-line therapy were retrospectively reviewed. Then we chosen patients who had undergone assay of immunohistochemical expression of TTF1 in their tumor tissue sample, and we analyzed for their clinicopathological features, expression of TTF1 and clinical outcomes. Analysis of TTF1 expression was done according to the routine clinical practice of our center.

      Results:
      Immunohistochemical analysis of TTF1 expression was only performed in 51 of the 123 patients reviewed. Of these 51 patients, 36 were men and 15 women, 7 (13,7%) had never smoked and 44 (86,3%) were former or current smokers. Median age was 65 (range 39-79). Performance status (PS) distribution: 0 (25,4%), 1 (62,7%), 2 (7,8%), 3 (3,9%). Predominant histology type was adenocarcinoma (78,4%), followed by large cell carcinoma (13,7%) and not otherwhise specified-NOS (7,8%). 36 patientes had TTF1-positive tumors (70,5%), and 15 TTF1-negative ones (29,5%). The types of tumor tissue sample in which TTF1 assay was undergone were the following: endobronquial biopsy (43,1%), percutaneous biopsy (33,3%), fine needle aspiration puncture (17,6%), citology (0,5%). TTF1 positive tumors shown a higher disease control rate (DCR) for pemetrexed-based chemotherapy (60,5% vs 39,5%, p=0,05). Median progresión free survival (PFS) and overall survival (OS) in the whole group was 5,55 and 23,95 months respectively. TTF1-positive tumors had significant longer PFS (6,96 vs 3,64 months; p=0,0156) and a nonsignificant trend of longer OS (24,27 vs 13,66 months; p=0,581) to pemetrexed-based chemotherapy than patients with TTF1-negative tumors.

      Conclusion:
      TTF1 protein expression was associated with better clinical outcomes. TTF1 positive tumors shown a significant association with better PFS and a nonsignificant trend of better DCR and OS in nonsquamous NSCLC patients who were treated with pemetrexed-based chemotherapy. The predictive role of TTF1 expression should be further studied.

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