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Justin Kelly



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    EP1.06 - Mesothelioma (ID 196)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Mesothelioma
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.06-04 - Differences in Health State Preference Values for Malignant Pleural Mesothelioma and Glioblastoma Multiforme (Now Available) (ID 2707)

      08:00 - 18:00  |  Author(s): Justin Kelly

      • Abstract
      • Slides

      Background

      Malignant pleural mesothelioma (MPM) is an invasive and generally fatal malignancy of the pleura mainly caused by exposure to asbestos fibers. Glioblastoma (GBM) is the most aggressive and similarly fatal form of primary brain cancer in adults. It was recently shown, that both rare cancers are treateable with tumor treating fields (TTFields). Novel cancer treatment modalities are subject to comparative economic evaluation using health state preference values or heath utilities, in addition to clinical trial endpoint data. Utilities have a value range between 0 and 1, with "1" representing a state of perfect health and "0" death. Clinical results of TTFields treatment show a comparable effect on median overall survival (OS) for both MPM and GBM. The EF-23 STELLAR trial in MPM demonstrated a median OS increase of 6.1 months for TTFields treatment compared to historical control. The EF-14 trial showed a median OS increase of 4.9 months in GBM. Differences in health state preference values however, could significantly influence the adoption of a treatment independent of its clinical efficacy and safety in the respective indication.

      Method

      We reviewed the structure and results of the trials using TTFields treatment in GBM and MPM from a health economic standpoint. Three health states (stable disease, progressed disease and death) were determined appropriate for both, the EF-14 trial in GBM and for the EF-23 STELLAR trial in MPM. A comprehensive review of the published literature adressing health state preference values or health utilities was performed using a boolean search of the PubMed database. The results were compiled separately for both diseases and then compared to each other.

      Result

      Estimates of health states preference values or utilities in GBM all refer to one single publication. Healthy members of the NHS Value of Health Panel (VoHP) rated a total of nine descriptive health state scenarios using the standard gamble method for preference elicitation. There are no published preference values for descriptive health states scenarios or disease states in mesothelioma. Uilities published for MPM were elicited at individual patient level as derived from the EQ-5 questionnaire data collected during the trial. Other publications do not use specific mesothelioma heath state preference values but assume applicability of utilities derived from a non small cell lung cancer (NSCLC) population.

      Conclusion

      Although both are rare cancers, health state preference values for GBM and MPM are different. GBM health state preference values are elicited from a single source, while utilities used in MPM are more diverse. Published utilities for GBM allow for use in a health state disease model, while there are no similar published values for MPM. MPM utilities derived from the EQ-5 questionnaire however describe more adequatly the individual utilities and their change during the course of the disease. This difference in structure, elicitation methods and sources of health state preference values in GBM and MPM could lead to disparities in the assessment of cost effectiveness of new treatments like TTFields in different indications, despite similar costs and clinical efficacy.

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    P2.06 - Mesothelioma (ID 170)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Mesothelioma
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.06-15 - Clinical Value Scores of TTFields Treatment of Unresectable Malignant Pleural Mesothelioma Using the ASCO and ESMO Framework (ID 2828)

      10:15 - 18:15  |  Author(s): Justin Kelly

      • Abstract
      • Slides

      Background

      The effectiveness and safety of TTFields in addition to pemetrexed and cisplatin or carboplatin in unresectable malignant pleural mesothelioma (MPM) was recently shown through the analysis of the phase II single arm EF-23 STELLAR trial. The American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO) have both developed frameworks accounting for the need of physicians and policymakers to objectively and comparably capture the clinical value of new cancer treatments. We quantified the clinical value of the TTFields treatment in MPM by applying ASCO and ESMO frameworks to the comparison of the STELLAR data to historical controls.

      Method

      The EF-23 STELLAR trial (n=80) demonstrated that adding TTFields to pemetrexed and cisplatin or carboplatin for malignant pleural mesothelioma patients resulted in overall survival of 18.2 months (95% CI 12.1-25.8) and progression free survival of 7.6 months (95% CI 6.7-8.6). The median time to deterioration in ECOG performance status was 13.1 months. Average pain score was lower compared to baseline during the first 7 months of treatment. The ESMO Magnitude of Clinical Benefit Scale (MCBS) and the ASCO Net Health Benefit (NHB) frameworks were applied to the EF-23 trial data using a historical control as comparator.

      Result

      The application of the ASCO framework to the EF-23 data resulted in a NHB score of 52, the first such score reported for MPM. This result is at the higher end of the score range of novel cancer treatments and compares well to the results for nivolumab in NSCLC as reference point. Applying the ESMO framework resulted in MCBS scores of A/5 (adjuvant/advanced) which is also the first MCBS score reported for MPM. The MCBS scores of A/5 are the highest scores achievable in the ESMO framework, and higher then most ESMO MCBS scores reported in the literature for NSCLC treatments.

      Conclusion

      Despite differences in their respective concepts, both the ASCO and ESMO frameworks suggest that adding TTFields to Pemetrexed and Cisplatin or Carboplatin in malignant pleural mesothelioma patients may provide a significant clinical benefit. The high scores underline that treatment with TTFields may extended time to deterioration of performance status, progression free and overall survival without additional systemic toxicities.

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