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Grainne M O'Kane
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MA18 - Modelling, Decision-Making and Population-Based Outcomes (ID 920)
- 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, 13:30 - 15:00, Room 201 F
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MA18.09 - Predictors of Health Utility Scores (HUS) in Advanced EGFR-Mutated NSCLC. (ID 13087)
14:25 - 14:30 | Author(s): Grainne M O'Kane
- Abstract
- Presentation
Background
Advanced NSCLC patients with EGFR mutations (EGFRm) are currently treated with first - to third-generation tyrosine kinase inhibitors (TKIs). In the advanced setting, quality of life is an important goal; we therefore evaluated determinants of HUS in this population.
a9ded1e5ce5d75814730bb4caaf49419 Method
In a prospective, observational study, patients with advanced EGFRm NSCLC completed EQ-5D surveys at outpatient visits generating HUS (range 0-1). Patients were allowed to enrol at any point in their disease course. Baseline clinical characteristics and outcome data were extracted from chart review. Patient imaging was reviewed and health states (stable/progressing) at each encounter recorded. Univariable analyses conducted using ANOVA and multivariable regression analyses with generalized estimating equations identified factors associated with HUS.
4c3880bb027f159e801041b1021e88e8 Result
From November 2014 to July 2017, 782 encounters (follow-up visits) were collected for 244 patients. Median age at first encounter was 64 years (range:29-96); 54% were female and 54% Asian. Median time from diagnosis of stage IV NSCLC to first encounter was 23 months (range:0-67). The median number of HUS collected per patient was 2 (range:1-14). For patients with multiple visits the median time between completed questionnaires was 1.8 months (1-18). 105 patients (43%) presented with or developed brain metastases during the study period. In a univariable analysis, regardless of treatment line, mean HUS (mHUS) on osimertinib was 0.85 (standard deviation (SD):0.15) (n=33 patients; 114 encounters) compared to mHUS=0.80 (SD:0.17) on gefitinib (n=147, 351 encounters); mHUS=0.72 (SD:0.16) on chemotherapy (n=32, 76 encounters); and mHUS=0.79 (SD=0.15) on other TKIs (n=49, 133 encounters); p<0.001. In a multivariable analysis, disease progression (p=0.04) and ECOG performance status >0 (p<0.001) were associated with lower HUS. In contrast, treatment with osimertinib (when compared to a reference group of first-generation TKIs, gefitinib/erlotinib) was associated with improved HUS (p=0.01), while line of therapy and number of metastatic sites of disease were not associated with HUS. In addition, brain metastases had no significant impact on HUS (p=0.33).
8eea62084ca7e541d918e823422bd82e Conclusion
Progressive disease and worse performance status associate with lower HUS in patients with EGFRm NSCLC. Patients treated with osimertinib had the highest HUS when compared with a reference group of first-generation EGFR TKIs regardless of line of therapy. These results may help in the choice of EGFR-TKI, especially in patients with a poor performance status.
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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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P2.15-10 - Determinants of Health Utility Scores (HUS) in Patients with ALK Rearranged Non-Small Cell Lung Cancer. (ID 14025)
16:45 - 18:00 | Author(s): Grainne M O'Kane
- Abstract
Background
Despite an increasing number of available treatment options for patients with advanced ALK-rearranged (ALKr) NSCLC, the goals of care remain to improve survival whilst maintaining quality of life. With rapidly changing management and prognosis, understanding the impact of treatments on quality of life becomes important. We evaluated factors affecting health utility scores (HUS) in this generally younger cohort of patients with NSCLC.
a9ded1e5ce5d75814730bb4caaf49419 Method
An ongoing prospective observational/real-world cohort study at the Princess Margaret Cancer Centre is enrolling patients with advanced NSCLC. Patients are asked to complete the EQ5D questionnaire at each outpatient visit. During the period from November, 2014 to March, 2018, patients with ALKr who participated were analyzed. Baseline clinical characteristics, oncological treatment, and outcomes were extracted from chart review. Factors associated with HUS were identified using ANOVA.
4c3880bb027f159e801041b1021e88e8 Result
272 encounters (follow-up visits) in 43 ALK+ patients were analysed. The median age at diagnosis was 56 years (range: 31-79 years). Half the patients in our sample were female (49%), and the majority were never-smokers (84%); 44% of the cohort were Asian. During the study period, 24 patients (56%) presented with or developed brain metastases. The median number of HUS collected per person was 4 (range: 1-20). Among patients who were stable on treatment, there were no statistically significant differences in mean HUS (mHUS) between different ALK inhibitors: mHUS [SD, standard deviation] were: mHUS of crizotinib=0.82 [0.08] (n=25, 92 encounters); mHUS of ceritinib=0.79 [0.14] (n=17, 102 encounters); and mHUS of other ALK inhibitors=0.80 [0.17] (n=12, 25 encounters), which included mHUS of alectinib=0.79 [0.20] (n=8, 10 encounters). The number of previous lines of treatment did not impact HUS (p=0.85). Patients stable on treatment who received prior whole brain radiation (n=14) had lower mHUS compared to those who never had WBRT (mHUS=0.78 [0.14] vs. 0.84 [0.10]; p=0.05), which may partly explain differences in mHUS by sex (64% of patients who had received WBRT were female vs 41% who did not receive WBRT): males=0.84 [0.10] vs females=0.78 [0.14], p=0.04. In 11 stable patients who had received radiation to bone metastases mHUS was 0.75 [0.16] vs. 0.84 [0.09] in those who did not (p=0.006).
8eea62084ca7e541d918e823422bd82e Conclusion
In this study, mean HUS were similar across different ALK inhibitors. Female patients and those receiving whole brain radiation or radiation to bone had lower HUS. This highlights specific factors that influence health-related quality of life in this subset of patients with advanced NSCLC
6f8b794f3246b0c1e1780bb4d4d5dc53
