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Parneet Kaur Cheema



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    EX04 - Mini Oral Abstract Session - MA08.06, MA18.02, MA19.02, MA20.11 (ID 1006)

    • Event: WCLC 2018
    • Type: Exhibit Showcase
    • Track: Advanced NSCLC
    • Presentations: 1
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      EX04.02 - The Impact of Treatment Evolution in NSCLC (iTEN) Model: Development and Validation (ID 13468)

      10:00 - 10:05  |  Author(s): Parneet Kaur Cheema

      • Abstract
      • Slides

      Background

      Background: The iTEN model was developed to estimate the survival impact of new treatments for advanced NSCLC (aNSCLC) patients. The structure and key assumptions of the iTEN model and outputs validated against published real-world survival data are presented.

      Method

      Methods: The iTEN model is a discrete event simulation of aNSCLC patients’ treatment plans. Individual patient characteristics (histology, molecular subtypes (EGFR, ALK, ROS1, BRAF, PD-L1), and performance status) are generated by random sampling from Canadian prevalence estimates. All Health Canada approved agents for treatment of aNSCLC are included. Simulated patients start on first-line therapy and move to subsequent lines of therapy in modelled progression events. Up to six-lines of therapy can be included. Time-of-event for progression or death for each patient is calculated based on random probabilities and progression-free survival (PFS) and overall survival (OS) curves modelled from published clinical trials. For example, a simulated ALK+ patient might receive first-line crizotinib, followed by second-line ceritinib and BSC, based on PFS/OS data from PROFILE 1014 and ASCEND-5. Predicted OS is calculated as the cumulative time spent on active therapy and BSC. PFS/OS data were extrapolated using best practices. Treatment on previous therapies was assumed to have no impact on the efficacy of subsequent therapies. Model survival predictions were validated against published real-world estimates from the Ontario Cancer and Austrian (TYROL) registries, by reproducing the same treatment mix in the simulated patients as in the publications.

      Result

      Results: iTEN estimated two- to five-year survival rates were similar to those reported by the Ontario Cancer and TYROL registries.

      abstract1 image.png

      Conclusion

      Conclusions: While further analyses are required, the iTEN model produces survival estimates comparable to published real-world data; therefore, the iTEN model may be a valid tool to estimate aNSCLC patient survival.

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    P2.13 - Targeted Therapy (Not CME Accredited Session) (ID 962)

    • 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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      P2.13-13 - Real-World Study of Osimertinib in EGFR T790M-Mutated Non-Small Cell Lung Cancer (NSCLC): ASTRIS Canadian Cohort Analysis (ID 12986)

      16:45 - 18:00  |  Presenting Author(s): Parneet Kaur Cheema

      • Abstract
      • Slides

      Background

      ASTRIS is an open-label, single-arm, multinational, real world study of osimertinib for patients with advanced/metastatic epidermal growth factor receptor-mutated (EGFRm) T790M-positive non-small cell lung cancer (NSCLC) who previously received therapy with an EGFR tyrosine kinase inhibitor (EGFR-TKI) (NCT02474355). Data cut-off (DCO) for the second interim analysis was 20 October 2017, with 3014 patients enrolled (full analysis set), including 99 patients in Canada.

      Method

      Adult patients with locally advanced/metastatic EGFRm NSCLC, not amenable to curative surgery/radiotherapy, with confirmation of T790M and prior EGFR-TKI therapy were enrolled. Patients were included with World Health Organization performance status of 0 to 2, as well as those with asymptomatic stable central nervous system (CNS) metastases. Patients received osimertinib 80 mg once daily until loss of clinical benefit. The primary efficacy outcome was overall survival (OS), with secondary outcomes of investigator-assessed response rate (RR), progression-free survival (PFS), and time to treatment discontinuation (TTD).

      Result

      From study start (14 January 2016) to DCO (20 October 2017), 99 patients were enrolled at 12 Canadian centres. Median age was 64 years (30-89 years). Patients were 68% female, 57% Asian, and had ECOG 0/1/2 of 22%/65%/13%. Twenty-five patients had CNS metastases at screening. Gefitinib was the most commonly used previous EGFR-TKI (gefitinib, erlotinib and afatinib were 80%, 14%, and 14%, respectively). Thirty-nine percent had previous chemotherapy; 6% previous immunotherapy; 46% previous radiotherapy. All patients had T790M: 75% tissue, 7% blood and 18% cytology. Biomarker testing methods varied, with the majority (61%) identified by Entrogen EGFR kit. At DCO, 45 patients had discontinued treatment. OS data were immature. Median PFS was 11.0 months (95% CI, 8.9-13.3). Median TTD was 14.9 months (95% CI, 11.2-not calculated). RR was 67.0% (95% CI, 56.7-76.2); sub-analyses showed RR of 69.9% (58.0-80.1), 66.7% (22.3, 95.7) and 55.6% (30.8, 78.5) for patients with T790M by tissue, blood and cytology, respectively. Serious adverse events (AEs) were reported for 18% of patients. AEs leading to dose modifications and discontinuations were reported for 12% and 5% of patients, respectively.

      Conclusion

      The Canadian results from this real world study of osimertinib in advanced/metastatic EGFRm T790M-positive NSCLC, which includes heavily pretreated patients and various approaches to biomarker testing, were comparable to outcomes reported in the phase III study AURA3 (NCT02151981). These findings provide further support for osimertinib as standard of care for EGFRm T790M-positive NSCLC.

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    P2.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 964)

    • 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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      P2.15-09 - The Impact of Treatment Evolution in NSCLC (iTEN) Model: Survival and Cost of Treating Patients with Advanced NSCLC in 2017 (ID 13477)

      16:45 - 18:00  |  Author(s): Parneet Kaur Cheema

      • Abstract
      • Slides

      Background

      Background: The life expectancy and healthcare costs of treating advanced NSCLC (aNSCLC) patients are expected to rise as new targeted and immuno-oncology (IO) therapies are approved for clinical practice. Here, we have used the iTEN model to estimate the cost of managing aNSCLC patients in Canada in 2017.

      Method

      Methods: The iTEN model development and validation are presented in an accompanying abstract (“The iTEN model: Development and Validation”). A treatment algorithm for EGFRm, T790m, ALK re-arrangement and PD-L1+ aNSCLC patients in 2017 was generated through a modified Delphi process based on anonymous responses from Canadian clinical experts. The generated treatment algorithm was used to estimate the survival and life-time costs of managing patients. Health resource use and cost estimates included drug acquisition and administration, adverse events, laboratory and radiologic monitoring, physician visits and end of life costs (2018 costs). Cost estimates were based on published literature, Ontario formulary listings, Cancer Care Ontario recommendations and the Ontario Case Costing Initiative. The estimation of survival is described in the companion abstract.

      Result

      Results: Survey responses indicated that first-line therapy is consistent with current guideline recommended practice, but that care beyond the second-line is variable, particularly with respect to IO usage. Modelled life expectancy varied based on the molecular subtype of aNSCLC. Costs over the span of an average aNSCLC patient’s life-time were estimated to be $89,899 (range: $61,134-$194,158). In comparison, the life-time cost of treating a Canadian lung cancer patient in 2007 (ie, prior to the introduction of IOs and ALK TKIs), inflated to 2018 dollars, was an estimated $60,678 (de Oliveira et al., 2016).

      abstract2 image - corrected.png

      Conclusion

      Conclusions: Results suggest that aNSCLC patient survival increases in conjunction with increased expenditure. The iTEN model may be used to assess the impacts of evolving treatment paradigms in aNSCLC.

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    YI01 - Young Investigators Session (ID 988)

    • Event: WCLC 2018
    • Type: Young Investigator Session
    • Track:
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/23/2018, 08:00 - 11:30, Room 106
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      YI01.06 - Community Oncology (Now Available) (ID 14675)

      08:50 - 09:00  |  Presenting Author(s): Parneet Kaur Cheema

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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