P79.02 Updated OS and Time to Second Progression with First-Line Camrelizumab Plus Chemo vs Chemo for Advanced Non-Squamous NSCLC

Abstract

median age was 63 years old (range 31w91). Nearly one third (56, 30.6%) of the patients had received at least three lines of prior therapies. The majority of the patients (148, 80.9%) were diagnosed as stage IV lung cancer, among them, 40 (21.9%) underwent prior surgery and 136 (74.3%) received prior chemotherapy. Of all the patients, the majority had an ECOG PS of 1 and 79 (69.4%) were histologically classified as adenocarcinoma. Overall, 127 patients were eligible for effectiveness evaluation, and of them, no patient achieved CR, 26 achieved PR, 84 achieved SD, and 17 showed PD, resulting in an ORR of 20.5% and a DCR of 86.7%. The primary study endpoint (PFS) and secondary endpoint (OS) has not been reached. Subgroup analysis revealed that the ORR and DCR values were slightly higher in patients received less than three lines of prior therapies than those in patients received at least three lines of prior therapies (ORR: 21.6% vs 18.8%; DCR: 87.8% vs 84.9%) The incidence of treatment-related AEs was 53.0% and grade 3-4 AEs were not observed. The most common AE caused by camrelizumab was reactive cutaneous capillary endothelial proliferation (REECP) (24.4%). Conclusion: In the real-world setting, advanced NSCLC patients with an older age, stage IV disease, cancer type of adenocarcinoma or ECOG PS 1 were more likely to be treated with camrelizumab. Camrelizumab monotherapy or in combination with chemotherapy and/or antiangiogenic agent were proved to be effective and safe in advanced NSCLC patients. Further study with a larger sample size is needed to explore the most potential camrelizumab-based therapeutic regimen for NSCLC patients.

Economic Evaluation of First-Line Camrelizumab for Advanced Non-small-cell Lung Cancer in China

“…In addition, the present study found that a high level of within-trial crossover underestimated the cost-effectiveness of this new regimen. The high proportion of within-trial crossover prolonged the median OS of chemotherapy, with 20.5 months compared to 15.2 months if OS data were adjusted by the RPSFT model (7,8). Following adjustment for crossover, the OS HR associated with camrelizumab combination therapy compared to chemotherapy alone was 0.56 compared to 0.73 when unadjusted, implying that an analysis using the adjusted survival data would accord a substantial clinical value to camrelizumab.…”

“…All patients who began in PFS state received first-line treatment, camrelizumab combination therapy or chemotherapy alone, respectively. Given a substantive number of early treatment discontinuations in the CameL trial, the model adjusted downward the PFS curve by applying the ratio of median time on treatment to median PFS at each week (8). After progression, the patients were assumed to receive second-line therapy.…”

“…In total, 79 patients (46%) who showed radiological disease progression could crossover from chemotherapy to camrelizumab monotherapy. In order to remove the effects of within-trial crossover, the conversion of chemotherapy group was adjusted by Rank-Preserving Structural Failure Time (RPSFT) Model when extrapolating the OS curve (8).…”

“…To minimize potential bias and assess the OS accurately, the present study used adjusted OS conducted by the RPSFT model from the recent update analysis of the CameL trial (8). In the scenario with crossover-adjusted OS, camrelizumab combination therapy had an incremental cost of $10,508 and an incremental QALY of 0.34, for an improved ICER of $30,591 per QALY compared to chemotherapy (Table 2).…”

“…Additionally, the CameL trial (ClinicalTrials.gov identifier NCT03134872), a multicentre randomized phase 3 trial, evaluated the combination of camrelizumab and pemetrexedplatinum chemotherapy (camrelizumab combination therapy) for previously untreated patients with advanced, non-squamous NSCLC without Alk or Egfr genomic aberrations. In this trial, camrelizumab significantly prolonged median progression-free survival (PFS) by 3 months [11.3 vs. 8.3 months, hazard ratio (HR), 0.60; 95% confidence interval (CI), 0.45-0.79] and the median overall survival (OS) by 7.4 months (27.9 vs. 20.5 months, HR, 0.73, IC, 0.55-0.96) for patients receiving camrelizumab in comparison to placebo (7,8). Owing to the synergistic effect and improved efficacy, in 2020, the National Medical Products Administration (NMPA) approved the incorporation of camrelizumab to pemetrexed-platinum chemotherapy as first-line treatment for patients with advanced, non-squamous NSCLC without Alk or Egfr tumor alterations in China (9).…”