P2.07-054 Cost-Effectiveness of Pembrolizumab as First-Line Therapy for Advanced Non-Small Cell Lung Cancer

Abstract

returning of cardiac functions to baseline he was re-challenged with second dose of nivolumab. Patient again developed decomensated CHF with ejection fraction of 30-40%. Subsequent therapy was aborted. Patient continues to have stable disease off therapy for the past 8 months. Our second patient developed moderate to severe pericardial effusion after fifth dose of nivolumab. Pericardial fluid cytology was negative for malignancy and CT scans showed stable visceral metastatic disease. He is currently off therapy and will get a prolonged 8 week steroid taper. Our literature review revealed only nineteen documented cases of immune checkpoint mediated cardiotoxicity. Seventeen of the 19 patients had metastatic melanoma; the remaining two had non-small cell lung cancer (one adenocarcinoma and one squamous cell). Six of the 19 patients developed cardiotoxicity within five weeks of treatment initiation. One of the patients developed biopsy confirmed immune mediated cardiotoxicity 31 weeks after initiation of treatment. Seven patients were treated with ipilimumab alone, four with nivolumab, one with pembrolizumab and the remaining seven patients received a combination of PD1/PDL-1 and CTLA-4 antibody either sequentially or concurrently. Six out of 19 patients died from toxicity of the respective drugs. Conclusion: Immune checkpoint associated cardiotoxicity is rare but well defined in literature. Patients can present with decompensated heart failure, arrhythmia or pericardial effusions. Early recognition, prolonged steroid taper and optimization of cardiac function with diuretics, ACE inhibitors and beta blockade are critical steps for the successful management.

Modeling Challenges in Cost-Effectiveness Analysis of First-Line Immuno-Oncology Therapies in Non-small Cell Lung Cancer: A Systematic Literature Review

“…Upon full-text screening, 27 articles identified through database searches ultimately met the inclusion criteria, with an additional 19 records (three conference abstracts, one full-text publication, and 15 TAs) identified through other sources or bibliography checks. In total, 46 records on economic models (18 full texts [9][10][11][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], 13 conference abstracts [28][29][30][31][32][33][34][35][36][37][38][39][40], and 15 TAs [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55]) met eligibility criteria and were ultimately included in the review (see Fig. 1).…”

“…When summarizing our findings, we covered 26 publications comprising 38 unique models (15 full texts [10, 11, 13-15, 17-20, 22-27], 11 conference abstracts [28][29][30][31][32][35][36][37][38][39][40], and 12 TAs [41-45, 48-51, 53-55]) and discussed adaptations only when explicitly mentioned.…”

“…Of the unique models, most were of a European (including the UK) perspective. Model populations were similar across CEAs; almost two-thirds of models were in patients with metastatic NSCLC only [ 10 , 11 , 14 , 17 – 19 , 23 , 24 , 26 , 28 – 30 , 35 – 38 , 40 ], whereas more than one-third included patients with advanced or metastatic disease [ 13 , 15 , 20 , 22 , 25 , 27 , 31 , 32 , 39 ]. All 38 models compared the cost effectiveness of IOs (atezolizumab, nivolumab, and pembrolizumab, alone or in combination with other treatments) against standard chemotherapy; eight models [ 11 , 14 , 18 , 19 , 29 , 41 , 43 , 49 ] included more than one IO strategy, of which three [ 11 , 14 , 29 ] concerned different IOs (Fig.…”

“…However, only one of the three studies also directly compared IOs that had corresponding PD-L1 assays with each other [ 11 ], whereas the remaining two compared IOs versus chemotherapy only [ 14 , 29 ]. Most studies were Markov cohort models [ 15 , 20 , 22 – 27 , 31 , 35 , 36 , 45 ] or PS models [ 10 , 17 – 19 , 28 – 30 , 37 – 44 , 48 – 51 , 53 – 55 ], with two patient simulation models [ 11 , 13 ] and one analysis comparing pharmacological costs and overall survival (OS) gains across treatment options [ 14 ]. One study from the USA did not report the type of model used [ 32 ].…”