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Gehan Khedr



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    P3.01 - Advanced NSCLC (Not CME Accredited Session) (ID 967)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.01-03 - The Cost Benefit from Second Line Immunotherapy in Metastatic NSCLC: ASCO Value Framework Prospective (ID 14338)

      12:00 - 13:30  |  Author(s): Gehan Khedr

      • Abstract

      Background

      In recent years there has been a major paradigm shift in the management of advanced stage NSCLC with uses of novel immunotherapy. Three immune check point inhibitors were approved as second line in advanced stage NSCLC namely nivolumab, pembrolizumab and atezolizumab. The high cost of these drug making decision for both physicians and patients challenging. ASCO developed a tool for help in decision making based on data obtained from clinical trial

      a9ded1e5ce5d75814730bb4caaf49419 Method

      In this study we used ASCO Value Framework to compare the net health benefit (NHB) of second line immune check point inhibitors approved in metastatic NSCLC

      4c3880bb027f159e801041b1021e88e8 Result

      Nivolumab was approved based on Check mate 17 and check mate 057 which compare nivolumab vs docetaxel in both squamous cell carcinoma and non-squamous NSCLC respectively with statistically significant improvement in overall survival with hazard ratio(0.59; 95% CI, 0.44 to 0.79; P<0.00) and ( 0.73; 96% CI, 0.59 to 0.89; P = 0.002) for both squamous cell carcinoma and non-squamous respectively. The calculated NHB for nivolumab vs docetaxel were 62.8 and 49.8 in both squamous cell carcinoma and non-squamous NSCLC respectively.

      Pembrolizumab was approved based on Keynote 010 which compare pembrolizumab vs docetaxel in metastatic NSCLC with statistically significant improvement in overall survival with hazard ratio 0·71, 95% CI 0·58–0·88; p=0·0008.The calculated NHB for pembrolizumab vs docetaxel was 46.1

      Atezolizumab was approved based on OAK trial which compare atezolizumab vs docetaxel for metastatic NSCLC with statistically significant improvement in overall survival with hazard ratio 0·73, 95% CI 0·62–0·87, p=0·0003. The calculated NHB for atezolizumab vs docetaxel was 49.8

      CheckMate 017

      CheckMate 057

      KEYNOTE-010

      OAK

      Clinical Benefit

      HR 0.59, P<0.001

      HR 0.73; P = 0.002

      HR 0·71; p=0·0008

      HR 0·73 ; P = 0·0003

      (HR death)

      9.2 vs. 6.0 months

      12.2 vs. 9.4 months

      12.7 vs. 8.5 months

      13.8 vs. 9.6 months

      +41 points

      +27 points

      +29 points

      +27 points

      Toxicity

      7% versus 55%, -87%

      10% vs. 54%, -79%,

      13% vs. 35%, -60%,

      15% vs. 43%, -63%,

      +7.2 Ponts

      +6.8 Points

      -2.9 Points

      +6.8 Points

      Bonus Points

      20 Points

      16 Points

      20 Points

      16 Points

      NHB

      68.2

      49.8

      46.1

      49.8

      Cost

      $39,300

      $39,300

      $39,000

      $37,500

      8eea62084ca7e541d918e823422bd82e Conclusion

      For second line immunotherapy for metastatic NSCLC calculated NHB is comparable for both three Immune check points inhibitors with nivolumab has best calculated NBH for metastatic squamous cell carcinoma NSCLC patients.

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