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Doreen Anuli Ezeife
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MA02 - Improving Outcomes for Patients with Lung Cancer (ID 895)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Advanced NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 10:30 - 12:00, Room 201 BD
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MA02.11 - Achieving Value in Cancer Diagnostics: Blood Versus Tissue Molecular Profiling - A Prospective Canadian Study (VALUE) (ID 13611)
11:40 - 11:45 | Presenting Author(s): Doreen Anuli Ezeife
- Abstract
- Presentation
Background
Cell-free DNA (cfDNA) next-generation sequencing (NGS) has emerged as an effective molecular profiling technique that is potentially faster and cost-saving in comparison to standard-of-care (SOC) tumour biopsy and tissue-based profiling. In a public payer system, the added value of cfDNA blood-based profiling compared to SOC remains unknown. This study will determine the incremental clinical utility and cost of cfDNA NGS versus SOC genotyping in patients with advanced non-squamous non-small cell lung cancer (NSCLC).
a9ded1e5ce5d75814730bb4caaf49419 Method
This multicentre, non-randomized, longitudinal study will be conducted at 6 sites across Canada (BC, Alberta, Ontario, Quebec). The Guardant360® assay will be used to perform plasma-based cfDNA testing, and includes mutations, rearrangements and copy number variations in 73 known cancer associated genes. Two patient cohorts will be recruited: (1) treatment naïve patients with ≤10 pack year smoking history; and (2) patients with known abnormalities of EGFR, ALK, ROS-1 or BRAF after disease progression on all standard targeted therapies. SOC tissue profiling will be performed for all patients per institutional standards. The study will begin recruiting in May 2018, with estimated completion in 12 months. The primary endpoints are comparison of response rate (RR), progression-free survival (PFS) and time-to-treatment failure (TTF) using cfDNA versus tissue genomic testing. Secondary endpoints include time to treatment initiation, number of actionable genomic abnormalities identified, result turnaround time, potentially avoidable repeat tissue biopsies, costs, patient-reported quality of life (EQ-5D) and willingness-to-pay. Exploratory analyses of treatment outcomes in selected molecular subgroups will also be undertaken, including response to immunotherapy in those with KRAS/STK11 co-mutations. A decision-analytic model will be developed to perform cost-consequence analyses using a cfDNA versus tissue-based approach.
4c3880bb027f159e801041b1021e88e8 Result
A total of 210 patients will be recruited across Canada, (Cohort 1 N=150, Cohort 2 N=60). Based on testing with either blood-based GUARDANT360TM or tissue-based profiling, the costs and benefits of blood-based profiling either at initial diagnosis or upon TKI progression will be determined versus initial or repeat tumour biopsy and tissue-based profiling. Data from patients accrued until 08/2018 will be presented at the meeting.
8eea62084ca7e541d918e823422bd82e Conclusion
This study will determine the added value of cfDNA blood-based genotyping compared to SOC from the perspective of a public payer system (Canada).
6f8b794f3246b0c1e1780bb4d4d5dc53Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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MA14 - Survivorship, Socioeconomic and End-of-Life Considerations (ID 915)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 10:30 - 12:00, Room 205 BD
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MA14.06 - Predictors of Financial Toxicity, an Under-Recognized Patient-Reported Outcome (ID 13571)
11:05 - 11:10 | Presenting Author(s): Doreen Anuli Ezeife
- Abstract
- Presentation
Background
In contemporary cancer care, financial distress has been established as a clinically relevant patient-reported outcome (PRO) associated with worse mortality and quality of life, but remains under-recognized by health care providers. Our goal was to define predictors of patient financial toxicity (FT) in a public healthcare system.
a9ded1e5ce5d75814730bb4caaf49419 Method
Patients with advanced lung cancer were recruited from outpatient clinics at the Princess Margaret Cancer Centre (Toronto, Canada). FT was measured with the validated Comprehensive Score for Financial Toxicity (COST) instrument, an 11-item survey scored from 0-44 with lower scores reflecting worse financial well-being. Data on patient and treatment characteristics, total out-of-pocket costs (OOP) and extended insurance coverage (EIC) were collected. Associations between variables and COST score were evaluated using multivariable regression analyses.
4c3880bb027f159e801041b1021e88e8 Result
Of 249 patients approached, 200 (80%) participated. Median age of the cohort was 65 years; 44% were male, 36% immigrants, 67% employed or on pension, with median OOP between $1000-5000 CAD. Median COST score was 21 (range 0-44). FT was associated with age, with patients <65 years reporting greater FT than older patients (COST 18 vs. 25; P<0.0001). Employed patients or those receiving pension income reported less FT than unemployed patients (22 vs. 19; P=0.01). Less FT occurred in patients with EIC compared to those without (23 vs. 19; P=0.03). Patients with higher OOP reported more FT (P<0.0001). Patients on clinical trials reported less FT than others (25 vs. 20; P=0.04). In multivariable linear regression, younger age was a predictor of higher FT, when adjusting for income, employment status, OOP and EIC (P<0.0001).
8eea62084ca7e541d918e823422bd82e Conclusion
Age is a predictor of FT in the Canadian (Ontario) public healthcare system, with younger lung cancer patients reporting greater financial distress. This study highlights priority patient populations where FT should be routinely assessed and appropriate resources for support offered.
6f8b794f3246b0c1e1780bb4d4d5dc53Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P2.01 - Advanced NSCLC (Not CME Accredited Session) (ID 950)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.01-29 - <sub>Economic Analysis of Osimertinib in Previously Untreated EGFR-Positive Advanced Non-Small Cell Lung Cancer</sub> (ID 13592)
16:45 - 18:00 | Presenting Author(s): Doreen Anuli Ezeife
- Abstract
Background
Osimertinib doubles progression-free survival (PFS) in previously untreated EGFR-positive advanced non-small cell lung cancer (NSCLC) patients, with remarkable intracranial response rates. However, its cost-effectiveness has not been established. We assessed the cost-effectiveness of first-line osimertinib from the perspective of the Canadian public health care payer.
a9ded1e5ce5d75814730bb4caaf49419 Method
A remaining lifetime Markov model was used to project the outcomes and costs of 2 treatment pathways, osimertinib or current standard-of-care (SoC) first-line EGFR TKI gefinitib or afatinib, in previously untreated EGFR-mutant advanced NSCLC patients from the health care system perspective. Clinical, health preference and cost input estimates were informed from the available literature, including second-line osimertinib after SoC failure in those with EGFR T790M mutant cancer. Model outcomes included costs (in 2017 Canadian dollars), quality-adjusted life-years (QALYs), and the incremental cost per QALY gained. The model was fully probabilistic to assess parameter uncertainty.
4c3880bb027f159e801041b1021e88e8 Result
Osimertinib was associated with a gain of 0.70 quality-adjusted life-years (QALYs) at an incremental cost of $58,619 vs SoC (incremental cost-effectiveness ratio [ICER]: $83,164/QALY gained). Unadjusted LY gain was 0.95. Osimertinib had a 7% probability of being cost-effective at a willingness-to-pay threshold of $50,000/QALY, and a 77% probability at a threshold of $100,000/QALY. Deterministic sensitivity analysis showed that health utilities and cost of osimertinib had the largest impact on ICER results.
8eea62084ca7e541d918e823422bd82e Conclusion
First-line osimertinib use in patients with advanced EGFR mutant lung cancer was found to involve a trade-off between improved PFS, QALYs and LYs versus increased cost.
6f8b794f3246b0c1e1780bb4d4d5dc53
