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Ying Wang
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P2.09 - Pathology (Not CME Accredited Session) (ID 958)
- 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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P2.09-08 - Clinical Outcomes of Histology Versus Cytology PD-L1 22C3 Antibody Testing in Advanced Non-Small Cell Lung Cancer (ID 13490)
16:45 - 18:00 | Presenting Author(s): Ying Wang
- Abstract
Background
Immune checkpoint inhibitors (CPIs) are now an accepted standard of care along the treatment algorithm for advanced non-small cell lung cancer (NSCLC). PD-L1 expression using 22C3 immunohistochemistry (IHC) help determine the line of therapy in which CPI are used. Previous studies demonstrated that PD-L1 expression is comparable on cytology versus solid biopsy/histology specimens. We assess the clinical outcomes between patients with PD-L1 expression ≥50% (high positive) tested using cytology versus histology specimens.
a9ded1e5ce5d75814730bb4caaf49419 Method
This retrospective cohort study includes specimens processed between January 2015 to June 2017 on samples dating back to March 2014. Patients were included in the study if they were seen by a medical oncologist for consideration of systemic treatment for advanced NSCLC. Clinical characteristics were extracted from electronic medical records. Overall survival (OS) was defined as time from diagnosis of advanced NSCLC to death and compared by method of PD-L1 analysis (cytology versus histology), adjusting for age, ECOG, weight loss, and receipt of palliative intent radiotherapy, targeted therapy, and CPI.
4c3880bb027f159e801041b1021e88e8 Result
148 (30.8%) of 481 samples tested ≥50% for PD-L1 expression. Amongst those, 32 and 37 patients fulfilled eligibility criteria with cytology and histology samples respectively. Baseline characteristics of the two groups are comparable in age, gender, ECOG, histological subtype, and receipt of CPIs. The cytology group had a significantly higher number of patients with baseline pleural effusion (10 vs 4 patients, p=0.035) and receipt of any systemic therapy (28 vs 22 patients, p=0.009). The histology group received more palliative intent radiation (24 vs 13, p=0.044).
There was no difference in OS between the cytology and histology groups. Median OS in the cytology group was 11.9 versus 8.0 months in the histology group; adjusted HR 0.98 (95% CI 0.43-2.26). Amongst patients who received systemic therapy, survival was longer if patients were exposed to CPI during their course of treatment regardless of cytology or histology groups; adjusted HR 0.45 (95% CI 0.22 – 0.90).
8eea62084ca7e541d918e823422bd82e Conclusion
In advanced NSCLC, CPI treatment guided by specimens analyzed by cytology versus histology were equivalent in survival. Regardless of sample source, patients exposed to CPI in any line of therapy had significantly longer survival than patients without exposure to CPI amongst patients testing high positive for PD-L1. Ongoing analyses are comparing clinical outcomes in patients with other expressions of PD-L1.
6f8b794f3246b0c1e1780bb4d4d5dc53
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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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P2.15-31 - The Evolution of Costs in the Treatment of Advanced Non-Small Cell Lung Cancer (NSCLC) in Ontario, Canada Between 1999 to 2014 (ID 13480)
16:45 - 18:00 | Presenting Author(s): Ying Wang
- Abstract
Background
Treatment options for patients with advanced non-small cell lung cancer (NSCLC) have evolved substantially since the 1990s. Newer agents are more expensive to acquire and administer and the perception is the cost of lung cancer care has increased considerably in the last two decades. We conducted a cost analysis study to evaluate changes in the total cost of NSCLC care over time.
a9ded1e5ce5d75814730bb4caaf49419 Method
We conducted a retrospective cohort study of all NSCLC patients diagnosed in Ontario from Apr 1, 1999 to Mar 30, 2014, who received palliative chemotherapy for advanced disease. Variables of interest were extracted from provincial registry data electronically linked by the Institute for Clinical Evaluative Sciences (ICES). The use of oral systemic therapy is not universally captured in these databases. The mean total cost of care including, systemic therapy, and supportive care (hospitalizations, physician billings, lab tests, out-patient visits, emergency visits, home care, and most prescription medications), was calculated in 2015 CAD dollars by fiscal year of diagnosis. Regression analysis was used to project costs in years with missing supportive care costs.
4c3880bb027f159e801041b1021e88e8 Result
Of all NSCLC cases diagnosed in Ontario (n=89,936), 21.6% (n=19,447) received any chemotherapy for advanced disease. In this population, median age ranged from 65 to 69 years, 54.9% were male, 15.4% resided rurally, 45.0% were adenocarcinoma, 58.6% with de novo stage IV disease, and 25.8% received second line chemotherapy. At the time of the data analysis, 6.8% of patients are presumed to be alive.
The average cost of care per patient treated rose from $85,339 to $102,026. The cost of systemic therapy rose from $3,856 to $12,554. During the same time period, average supportive care costs changed from $84,732 to $93,495. The proportion of total costs of systemic therapy changed from 4.5% to 12.3%. Utilization of palliative chemotherapy in only those with de novo stage IV disease remained stable over time (29.8%).
Patients who received second line chemotherapy cost 5.9 times that of patients who did not ($11,342 and $1,924 respectively). Costs in the final year of life increased from 61.9% to 68.0% of total lifetime costs from 2003 to 2014.
8eea62084ca7e541d918e823422bd82e Conclusion
The cost of systemic therapy for lung cancer patients is rising disproportionately to that of supportive care. Ongoing analyses are assessing the main drivers of cost of care and model the impact of oral targeted therapies and immunotherapies on the cost of lung cancer care.
6f8b794f3246b0c1e1780bb4d4d5dc53
