Extra cost of brain metastases (BM) in patients with non-squamous non-small cell lung cancer (NSCLC): a French national hospital database analysis

Girard, Nicolas; Cozzone, D.; Léotoing, Lucie de; Tournier, Charlène; Vainchtock, Alexandre; Téhard, B; Cortot, A.

doi:10.1136/esmoopen-2018-000414

Cited by 17 publications

(13 citation statements)

References 21 publications

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“…The analysis was limited to a set of six comorbidities of specific interest, namely hypertension, diabetes, renal failure, chronic obstructive pulmonary disease (COPD), pulmonary insufficiency and other chronic pulmonary disease. The presence of cerebral metastases at the index hospitalisation or any previous hospitalisation was documented as previously described [32].…”

Section: Data Extractionmentioning

confidence: 99%

Immunotherapy rechallenge after nivolumab treatment in advanced non-small cell lung cancer in the real-world setting: A national data base analysis

Levra¹,

Cotté²,

Corre³

et al. 2020

Lung Cancer

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Nivolumab is now a reference treatment for patients with advanced non-small cell lung cancer (NSCLC) after failure of prior platinum-based chemotherapy. Little data are available on treatment approaches following discontinuation of nivolumab and on the interest of a second course of immunotherapy after nivolumab discontinuation. The aims of this study were to describe treatment pathways following nivolumab discontinuation and to describe survival following retreatment with immunotherapy. Materials and methods: The analysis includes all patients with NSCLC recorded in a national hospital database, starting nivolumab in 2015-2016. Nivolumab treatment was considered discontinued if ≥3 infusions were missed. Patients starting a second course of PD-1 inhibitor following nivolumab discontinuation were analysed according to the duration of their initial nivolumab treatment course. Results: 10,452 patients were included (71 % men; mean age: 63.8 ± 9.6 years; squamous histology: 44 %). Median nivolumab treatment duration was 2.8 months [IQR :1.4-6.9]. Median OS was 11.5 months [95 %CI: 11.1-11.9]; 5118 (53.4 %) patients received post nivolumab therapy lines: 1517 (29.6 %) of these received a second course of PD-1 inhibitor, either after a treatment-free interval (resumption: n = 1127) or after intervening chemotherapy (rechallenge: n = 390). Median OS after nivolumab discontinuation was 15.0 months [13.9-16.7] in the resumption group and 18.4 months [14.8-21.9] in the rechallenge group. Median OS was significantly longer in patients with an initial nivolumab treatment duration ≥3 months. Conclusion: In this real-world setting, outcome after retreatment with a PD-1 inhibitor following a first course of nivolumab was significantly better in patients with a longer duration of initial nivolumab treatment.

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Section: Data Extractionmentioning

confidence: 99%

Immunotherapy rechallenge after nivolumab treatment in advanced non-small cell lung cancer in the real-world setting: A national data base analysis

Levra¹,

Cotté²,

Corre³

et al. 2020

Lung Cancer

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“…A specificity of the present modelling study was to include the impact on clinical and cost outcomes of the occurrence or progression of brain metastases using data from the ALEX study [13] to model the evolution of brain metastases over time and data from a recent hospital database analysis [26] to model costs. This is of particular relevance given that management of these metastases in NSCLC is a major unmet medical need [11], where alectinib can bring an important clinical benefit [12].…”

Section: Discussionmentioning

confidence: 99%

“…The modelling study indicates that use of alectinib in first-line Cost-effectiveness of alectinib in non-squamous NSCLC in France treatment can result in significant cost savings compared to crizotinib in the context of the French health care system. In addition, it is possible that the cost of brain metastases included in the model are underestimated, since, as pointed out in the source publication [26], only hospital costs and consultation by neuro-oncologist are considered and costs incurred in the community or in nursing homes, which may be considerable [31], are not taken into account.…”

Section: Discussionmentioning

confidence: 99%

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Cost-effectiveness of alectinib compared to crizotinib for the treatment of first-line ALK+ advanced non-small-cell lung cancer in France

Marine¹,

Monnier²,

Téhard

et al. 2020

PLoS ONE

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The aim of the study is to evaluate the cost-effectiveness of alectinib for first-line treatment of ALK+ advanced non-small-cell lung cancer compared to crizotinib in the French setting. This study used a partitioned survival model, with three discrete health states (progressionfree survival, post-progression survival and death). Survival probabilities were derived from a randomised Phase III clinical trial comparing alectinib to crizotinib (ALEX). Beyond the length of the trial (18 months), the efficacy of both treatments was considered equivalent. Occurrence of adverse events or brain metastases were considered as inter-current events. Utilities (and disutilities for intercurrent adverse events) derived from the EQ-5D were applied. Costs were attributed using standard French national public health tariffs. Projected mean overall survival was 4.62 years for alectinib and 4.18 years for crizotinib. Projected mean progression-free survival was 30.30 months for alectinib and 16.13 months for crizotinib. The total number of quality-adjusted life years projected was 3.40 for alectinib and 2.84 for crizotinib. The projected total cost of treatment over the lifetime of the model was € 246,022 for alectinib and € 195,486 for crizotinib. This extra cost was principally attributable to treatment acquisition costs and management before progression. Alectinib was associated with lower costs related to brain metastases and to management post-progression. The incremental cost per life year gained was 115,334 €/year and the incremental costeffectiveness ratio was 90,232 €/QALY. First-line treatment of ALK+ NSCLC with alectinib provides superior clinical outcomes to crizotinib and is cost-effective in the French context. OPEN ACCESS Citation: Sivignon M, Monnier R, Tehard B, Roze S (2020) Cost-effectiveness of alectinib compared to crizotinib for the treatment of first-line ALK+ advanced non-small-cell lung cancer in France. PLoS ONE 15(1): e0226196. https://doi.org/ 10.patients who develop cancers bearing these fingerprints [3]. In particular, inhibitors of the epidermal growth factor receptor (EGFR), such as gefitinib and erlotinib, or anaplastic lymphoma kinase (ALK), such as crizotinib and alectinib, have been developed. Mutations in the Erb-1 gene encoding EGFR are present in 10-20% of patients developing squamous cell lung cancer and rearrangements of the ALK gene are present in around 3.2% of patients developing nonsmall cell lung cancer (NSCLC) [3,4].Crizotinib, the first ALK inhibitor to be introduced for the treatment of lung cancer in 2011, has rapidly become the gold standard for this type of cancer [5,6]. However, its longterm effectiveness is compromised by the development of resistance and progression of central nervous system (CNS) disease [7]. Alectinib is an orally-administered inhibitor of ALK which has been demonstrated to be effective in the treatment of ALK+ NSCLC [8]. Since this molecule is lipophilic and is not a substrate for p-glycoprotein, it penetrates the CNS effectively and can prevent the growth o...

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“…Whilst the true figure will lie between the two, elective admissions in our review were limited only to elective surgical admissions with the remainder relating to unplanned emergency admissions. In France, a recent analysis of the cost of brain metastases in non‐small‐cell lung cancer demonstrated that the cost to health services of managing these patients was €533 per patient per month more than managing those with metastases elsewhere‐ a 22% difference (Girard et al, ).…”

Section: Discussionmentioning

confidence: 99%

Defining patterns of care in the management of patients with brain metastases in a large oncology centre: A single‐centre retrospective audit of 236 cases

et al. 2019

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Aims The role of selected treatments for brain metastases (BM) is well documented; however, the prevalence of these is not. We report on the patterns of care in the management of BM in a large oncology centre. Materials and methods We retrospectively audited 236 cases of newly diagnosed BM from January 2016 to December 2017 by looking at 2 years of radiology reports and gathered data on primary site, survival, treatment received, palliative care input and brain metastases‐related admissions. Results Eighty‐two per cent of cases were related to lung, breast and melanoma primaries. Half of patients received a form of treatment with the other half receiving best supportive care. Of these, whole‐brain radiotherapy (39%) and stereotactic radiosurgery (40%) were the most common treatment modalities. Most common reasons for admissions were headaches, seizures, weakness and confusion. Conclusion This is the first study in the UK that gives an in‐depth overview of the real‐world management of brain metastases. We have demonstrated the prevalence of treatment across the spectrum of brain metastases patients. Radiotherapy is the mainstay of treatment in nearly 80% of cases; however, care needs to be taken in ensuring that SRS is offered to those who are suitable.

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Extra cost of brain metastases (BM) in patients with non-squamous non-small cell lung cancer (NSCLC): a French national hospital database analysis

Cited by 17 publications

References 21 publications

Immunotherapy rechallenge after nivolumab treatment in advanced non-small cell lung cancer in the real-world setting: A national data base analysis

Immunotherapy rechallenge after nivolumab treatment in advanced non-small cell lung cancer in the real-world setting: A national data base analysis

Cost-effectiveness of alectinib compared to crizotinib for the treatment of first-line ALK+ advanced non-small-cell lung cancer in France

Defining patterns of care in the management of patients with brain metastases in a large oncology centre: A single‐centre retrospective audit of 236 cases

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