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A. Sexton Ward

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    MA14 - Immunotherapy in Advanced NSCLC: Biomarkers and Costs (ID 394)

    • Event: WCLC 2016
    • Type: Mini Oral Session
    • Track: Advanced NSCLC
    • Presentations: 1
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      MA14.09 - Demonstrating Life Expectancy Gains with Immuno-Oncology (IO) Therapies (ID 4634)

      16:00 - 17:30  |  Author(s): A. Sexton Ward

      • Abstract
      • Presentation
      • Slides

      Immuno-oncology (IO) therapies offer the possibility of long-term survival to metastatic cancer patients. Prior analyses have shown that lung cancer reduces life expectancy by an average of 11.8 years (Burnet NG, et al. Br J Cancer. 2005;92:241‒245.). We aimed to investigate the impact of IO therapies on life extension of patients with non-small cell lung cancer (NSCLC).

      We used The Health Economics Medical Innovation Simulation (THEMIS) alongside available clinical trial data to estimate the anticipated increase in NSCLC patient survival post-diagnosis resulting from the introduction of IO therapy. THEMIS is an established microsimulation with a 50-year time horizon that tracks a representative sample of patients aged ≥51 years to project longevity. These outcomes were estimated for metastatic NSCLC patients under a pre-IO scenario and compared to a post-IO scenario where IO is available for either first- or second-line treatment. Patients were classified as either heavy, medium, or light responders, corresponding to reductions in mortality hazards of 96.5%, 64.4%, and 0%, respectively, based on extrapolations of clinical trial results for nivolumab (see table). Health state transitions probabilities and medical expenditures were estimated from nationally representative datasets. Mortality and disease stage were estimated using the Surveillance and Epidemiology End Results (SEER) database.

      In the pre-IO simulation, metastatic NSCLC patients lose 11.3 years of life (comparable with the published 11.8 years). The results from the post-IO scenarios are shown in the table. For comparison, SEER data suggest that survival in metastatic NSCLC patients has only increased by 0.3 years since 1998.

      Population Heavy Responder Prevalence Medium Responder Prevalence Heavy Responder Hazard Reduction Medium Responder Hazard Reduction Light Responder Hazard Reduction Additional Life Years
      Second-line monotherapy, All patients 20% 30% 96.5% 64.4% 0% 2.1
      First-line monotherapy, PD-L1 >1% 30% 40% 96.5% 64.4% 0% 3.25
      First-line monotherapy, PD-L1 >50% 50% 40% 96.5% 64.4% 0% 4.72
      First-line combination therapy, PD-L1 >1% 60% 30% 96.5% 64.4% 0% 4.22
      First-line combination therapy, PD-L1 >50% 100% 0% 96.5% N/A N/A 7.06

      Current IO therapies represent a significant step towards extending life expectancy for metastatic NSCLC patients.

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