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Chih-Yen Tu
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P1.03 - Chemotherapy/Targeted Therapy (ID 689)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Chemotherapy/Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.03-053 - Taiwan Real Word Efficacy of 1st Line EGFR TKIs Treatment in EGFR Mutation Positive Advanced Non Small Cell Lung Cancer (ID 9995)
09:30 - 16:00 | Presenting Author(s): Chih-Yen Tu
- Abstract
Background:
Previous studies have shown EGFR TKIs provided superior 1[st] line efficacy to chemotherapy for advanced non-small cell lung cancer (NSCLC) patients harboring activating EGFR mutation. LUX-Lung7, a phase IIB randomized head-to-head study, showed afatinib significantly improved PFS, TTF, and ORR compared with gefitinib. However, it is still unclear how to choose among these three EGFR TKIs in clinical setting, especially for uncommon mutation, which was excluded in most studies. This retrospective study is aimed to evaluate the treatment pattern in our hospital and efficacy of three EGFR TKI for patients with common mutations and uncommon mutations.
Method:
Patients with advanced NSCLC were retrospectively reviewed in a university hospital in central Taiwan from Jan 2013 to Mar 2017. In this population, patients with EGFR mutations and have to be taking EGFR TKIs as 1[st] line treatment more than 30 days were recorded for analysis.
Result:
1,951 patients with advanced lung cancer were reviewed. About 75% of lung cancer were adenocarcinomas and 55% were EGFR mutation rate. Clinical data of 467 patients with advanced EGFR mutation lung adenocarcinomas were extracted, 95.7% of them used EGFR TKI as 1[st] line therapy including gefitinib (n=210), erlotinib (n=147), and afatinib (n=110). The median age was 64 years old. More female was included in the gefitinib cohort and afatinib cohort tended to have higher component of uncommon mutations. The TTF among gefitinib (G), erlotinib (E) and afatinib (A) were 9.8 vs 11.4 vs 12.2 months (p = 0.094). Patients treated with afatinib had improved TTF compared with gefitinib (HR= 0.72, 95% CI: 0.54-0.97, p = 0.035) and showed a trend compared with erlotinib without significantly difference. In del 19, TTF among G, E and A were 9.4 vs 12.0 vs 12.2 months ( p = 0.074). In L858R, TTF among G, E and A were 10.4 vs 10.9 vs 11.7 months ( p = 0.721). Intriguingly, afatinib showed excellent TTF in uncommon mutations (median TTF G vs E vs A: 7.5 vs 7.0 vs 19.7 months, p = 0.506). Afatinib dose reduction didn’t have impact TTF (median TTF 30 mg vs 40 mg: 16.1 vs 10.3 months. p = 0.923)
Conclusion:
Consistently, our findings supported improved efficacy as observed from LUX-Lung7. In more resistance mutation type such as uncommon mutation, afatinib tended to have better efficacies. Due to insufficient sample size and the retrospective study design, further confirmatory study is warranted.
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P2.03 - Chemotherapy/Targeted Therapy (ID 704)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Chemotherapy/Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.03-003 - Cost Effectiveness of Gefitinib for Lung Adenocarcinoma Patients with Mutant Epidermal Growth Factor Receptor (ID 7382)
09:30 - 16:00 | Author(s): Chih-Yen Tu
- Abstract
Background:
Tyrosine kinase inhibitor such as Gefitinib rather than conventional chemotherapy is the standard of care for advanced lung adenocarcinoma (LA) with mutant epidermal growth factor receptor (mEGFR). However, its cost-effectiveness is less clear. The aim of our study is to compare the cost and effectiveness of 1[st] line gefitinib vs platinum-based chemotherapy for clinical stage IV LA via this population-based propensity score (PS) matched analysis.
Method:
We identified eligible patients diagnosed within 2011 through a comprehensive population-based database containing cancer and death registries, and reimbursement data in Taiwan. The primary duration of interest (DOI) was two years within diagnosis. Effectiveness was measured as survival whereas direct medical cost was measured from the health care sector’s perspective. In supplementary analysis (SA), we estimated the cost-effectiveness under potential unmeasured confounder(s) and the cost-effectiveness if the DOI was three years.
Result:
Our study population constituted 240 patients [Table 1]. Within 2 years, gefitinib was both more effective [mean overall survival 1.48 vs 1.47 life-year] and cost-saving [mean 78770 vs 82684, 2015 US dollars] when compared to chemotherapy. In SA, our results was sensitive to potential unmeasured confounder(s) but remained cost-effective when DOI was 3 years.Table 1. Patient characteristics of the propensity-score matched final study population
Gefitinib Platinum-based chemotherapy standardized difference (rounded) number (%) number (%) age <65 76 (63.33) 75 (62.5) 0.017 >=65 44 (36.67) 45 (37.5) gender female 60 (50) 60 (50) 0 male 60 (50) 60 (50) residency non-north 55 (45.83) 56 (46.67) 0.017 north 65 (54.17) 64 (53.33) comorbidity without 62 (51.67) 64 (53.33) 0.033 with 58 (48.33) 56 (46.67) smoking history no 79 (65.83) 79 (65.83) 0 yes 41 (34.17) 41 (34.17) performance status 0-1 113 (94.17) 113 (94.17) 0 2 7 (5.83) 7 (5.83)
Conclusion:
1[st] line gefitinib was cost-effective for clinically stage IV LA with mEGFR from health care sector’s perspective when compared to platinum-based chemotherapy.
