Virtual Library
Start Your Search
Diana Flores-Estrada
Author of
-
+
MA07 - Clinical Questions and Potential Blood Markers for Immunotherapy (ID 125)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Immuno-oncology
- Presentations: 1
- Now Available
- Moderators:David R Spigel, Roberto Ferrara
- Coordinates: 9/08/2019, 13:30 - 15:00, Vancouver (2003)
-
+
MA07.08 - The Role of a Cachexia Grading System in Patients with NSCLC Treated with Immunotherapy: Implications for Response and Survival (Now Available) (ID 2046)
13:30 - 15:00 | Author(s): Diana Flores-Estrada
- Abstract
- Presentation
Background
The association between cancer-induced weight-loss (CIWL) and poor clinical outcomes is well established. However, many of these studies were performed in the chemotherapy era. Meanwhile, current standard of care for NSCLC patients has shifted towards the more efficacious immunotherapy agents (IO). IO has improved survival outcomes, nonetheless clinicians face the challenge of identifying who will derive substantial clinical benefit from these more costly agents. Response to IO is influenced by several patient-related factors, including microbiome, medications, and nutritional status.
Method
In this study we sought to evaluate the effect of cachexia in survival of NSCLC patients undergoing treatment with IO. Included patients had advanced NSCLC (IIIB, IV), who received IO agents in any line of therapy, and had a good performance status. All the patients were evaluated by the nutritionist specialist and were graded according to a previously documented cachexia scale which takes into consideration body mass index (BMI) and weight loss in order to stratify patients into 5 risk categories (0 [pre-cachexia] - 4 [refractory cachexia]). Primary endpoint was overall survival (OS), secondary endpoints included objective response rate (ORR) and progression-free survival.
Result
A total of 181 patients met the inclusion criteria and were included in the analysis. Among these 82 (45%) were classified in the first category (risk grade 0-1 [low risk]), 83 (46%) were classified in the second category (risk grade 2-3[intermediate risk]) and 9% were in the third category (risk grade 4 [high risk]). Patients classified as low-risk had a significantly longer OS compared to those with intermediate or high risk (22.4 months [95%CI: 18.7-26.1] vs. 15.7 [95%CI: 10.8-20.7] vs. 3.9 [0.0-7.8]; p<0.001; Hazard ratio: 1.81 [1.29-2.53]; p<0.001). In the multivariate analysis ORR, hemoglobin and risk category were independent factors associated with OS. Grade of cachexia was also significantly associated with ORR, with low-risk patients having a significantly higher ORR compared to intermediate and high-risk patients (36.6% vs. 17.3% vs. 25%; p=0.021). PFS was also influenced by risk category, with low risk patients having a longer PFS compared with intermediate and high-risk patients.
Conclusion
Cachexia is independently associated with worse OS in NSCLC patients who receive IO, while better nutritional status is related to higher ORR, highlighting a potential role for nutritional assessment in the selection of patients who are candidates for IO. Early assessment of nutritional status in these patients is imperative in order to timely diagnose and treat anorexia-cachexia and improve outcomes.
Only 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.
-
+
P2.14 - Targeted Therapy (ID 183)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Targeted Therapy
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
-
+
P2.14-43 - Cost-Effectiveness of 1st-Line Treatment EGFR-TKIs for Advanced NSCLC Patients Harboring EGFR Mutation in Mexico (Now Available) (ID 1146)
10:15 - 18:15 | Author(s): Diana Flores-Estrada
- Abstract
Background
As cancer care costs are rising at an unprecedented rate, it is crucial to provide evidence-based justification for promising but expensive therapeutic approaches such as Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs). EGFR-TKIs such as gefitinib, erlotinib and afatinib had become the standard first-line treatment for EGFR gene mutation-positive non-small cell lung cancer (NSCLC) improving progression-free survival (PFS) and overall survival (OS) of these patients. However, the economic impact of them remain unclear. Hence, we aimed to assess healthcare costs during and after progression to treatment and to compare the cost-effectivess and safety of the 1st-line treatment with EGFR-TKIs in patients with advanced non-small cell lung cancer (NSCLC) in Mexico.
Method
The health and economic outcomes of three first-line strategies (gefitinib, erlotinib, and afatinib) among NSCLC patients harboring EGFRmutations were estimated and assessed. Costs in the Mexican setting were obtained from local hospital data and public national purchasing sources. The structure used in this analysis was a Markov model with three possible health states: free of progression, progression and death considering a time horizon of 3 and 5 years. The probabilities of transition and the use of resources used to feed the model were retrospectively collected by reviewing medical records of patients who were treated at the Instituto Nacional de Cancerologia (INCan) of Mexico between April 2013 and June 2017. Probabilistic sensitivity analysis (PSA) was conducted with a Monte Carlo simulation.
Result
Similar hazards of progression and death were obtained when constrasting afatinib vs. erlotinib, [HR:0.91 (95% CI: 0.59 -2.07) and 0.82 (95% CI: 0.56-2.65), respectively] as well as when contrasting the hazards of progression and death of afatinib vs. gefininib [HR:0.87 (95% CI: 0.87-1.53) and 0.94 (95% CI: 0.74-1.55), respectively]. However, statistically significant differences were identified between the costs of the treatment both the total cost (p<.001) and the daily cost (p <0.001) of treatment. The most expensive treatment was with afatinib, followed by erlotinib and gefitinib. In addition, treatment with afatinib showed the highest cost associated with adverse events. PSA with Monte Carlo simulations showed robustness of estimations.
Conclusion
Although equivalent effectiveness and safety of the three arms of the study was found, substantial differences in treatment costs were observed. Nonetheless, we should highlight that patient selection is absolutely critical for cost-efectiveness analyses; as well as longer follow-up of existing data could substantially alter the conclusions of this analysis.
