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Díaz MA, Fusco M, Benítez CA, Gayet F, García L, Victoria L, Jaramillo S, Bayo J, Zubieta MR, Rizzo MM, Piccioni F, Malvicini M. Targeting hyaluronan metabolism-related molecules associated with resistant tumor-initiating cells potentiates chemotherapy efficacy in lung cancer. Sci Rep 2024; 14:16803. [PMID: 39039104 PMCID: PMC11263553 DOI: 10.1038/s41598-024-66914-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/05/2024] [Indexed: 07/24/2024] Open
Abstract
The success of chemotherapy regimens in patients with non-small cell lung cancer (NSCLC) could be restricted at least in part by cancer stem cells (CSC) niches within the tumor microenvironment (TME). CSC express CD133, CD44, CD47, and SOX2, among other markers and factors. Analysis of public data revealed that high expression of hyaluronan (HA), the main glycosaminoglycan of TME, correlated positively with CSC phenotype and decreased disease-free interval in NSCLC patients. We aimed to cross-validate these findings on human and murine lung cancer cells and observed that CD133 + CSC differentially expressed higher levels of HA, HAS3, ABCC5, SOX2, and CD47 (p < 0.01). We modulated HA expression with 4-methylumbelliferone (4Mu) and detected an increase in sensitivity to paclitaxel (Pa). We evaluated the effect of 4Mu + chemotherapy on survival, HA metabolism, and CSC profile. The combination of 4Mu with Pa reduced the clonogenic and tumor-forming ability of CSC. Pa-induced HAS3, ABCC5, SOX2, and CD47 expression was mitigated by 4Mu. Pa + 4Mu combination significantly reduced in vivo tumor growth, enhancing animal survival and restoring the CSC profile in the TME to basal levels. Our results suggest that HA is involved in lung CSC phenotype and chemosensitivity, and its modulation by 4Mu improves treatment efficacy to inhibit tumor progression.
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Affiliation(s)
- Marco Aurelio Díaz
- Cancer Immunobiology Laboratory, Instituto de Investigaciones en Medicina Traslacional, Universidad Austral-Consejo Nacional de Investigaciones Científicas y Técnicas, Pilar, Argentina
| | - Mariel Fusco
- Cancer Immunobiology Laboratory, Instituto de Investigaciones en Medicina Traslacional, Universidad Austral-Consejo Nacional de Investigaciones Científicas y Técnicas, Pilar, Argentina
| | - Constanza Arriola Benítez
- Cancer Immunobiology Laboratory, Instituto de Investigaciones en Medicina Traslacional, Universidad Austral-Consejo Nacional de Investigaciones Científicas y Técnicas, Pilar, Argentina
| | - Fernando Gayet
- Servicio de Oncología, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Ludmila García
- Laboratorio Central, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Lucia Victoria
- Cancer Immunobiology Laboratory, Instituto de Investigaciones en Medicina Traslacional, Universidad Austral-Consejo Nacional de Investigaciones Científicas y Técnicas, Pilar, Argentina
| | - Sebastián Jaramillo
- Cancer Immunobiology Laboratory, Instituto de Investigaciones en Medicina Traslacional, Universidad Austral-Consejo Nacional de Investigaciones Científicas y Técnicas, Pilar, Argentina
| | - Juan Bayo
- Programa de Hepatología Experimental y Terapia Génica, Instituto de Investigaciones en Medicina Traslacional, Universidad Austral-Consejo Nacional de Investigaciones Científicas y Tecnicas, Pilar, Argentina
| | | | - Manglio M Rizzo
- Cancer Immunobiology Laboratory, Instituto de Investigaciones en Medicina Traslacional, Universidad Austral-Consejo Nacional de Investigaciones Científicas y Técnicas, Pilar, Argentina
- Servicio de Oncología, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Flavia Piccioni
- Cancer Immunobiology Laboratory, Instituto de Investigaciones en Medicina Traslacional, Universidad Austral-Consejo Nacional de Investigaciones Científicas y Técnicas, Pilar, Argentina.
| | - Mariana Malvicini
- Cancer Immunobiology Laboratory, Instituto de Investigaciones en Medicina Traslacional, Universidad Austral-Consejo Nacional de Investigaciones Científicas y Técnicas, Pilar, Argentina.
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Hu X, Chirovsky D, Walker MS, Wang Y, Kaushiva A, Tepsick J, Samkari A. A retrospective analysis of treatment patterns, overall survival, and real-world disease-free survival in early-stage non-small cell lung cancer following complete resection. BMC Pulm Med 2024; 24:332. [PMID: 38987763 PMCID: PMC11234548 DOI: 10.1186/s12890-024-03138-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/30/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Real-world data regarding patient characteristics, adjuvant treatment patterns, and long-term survival outcomes are needed to better understand unmet needs among patients with completely resected early-stage non-small cell lung cancer (NSCLC). METHODS Electronic medical records from the U.S.-based ConcertAI Patient360™ database were analyzed in patients with stage IB-IIIA NSCLC who underwent complete resection prior to March 1, 2016. Patients were followed until death or July 1, 2021. This study evaluated adjuvant chemotherapy use, and overall survival (OS) and real-world disease-free survival (rwDFS) outcomes using the Kaplan-Meier method. The correlation between OS and rwDFS was assessed using the Kendall rank test. Among patients who did not recur 5 years following surgery, landmark analyses of OS and rwDFS were conducted to understand the subsequent survival impact of remaining disease-free for at least 5 years. RESULTS Data from 441 patients with completely resected stage IB-IIIA NSCLC were included. About 35% of patients received adjuvant chemotherapy post-resection. Median OS and rwDFS from resection were 83.1 months and 42.4 months, respectively. The 5-year OS and rwDFS rates were 65.7% and 42.1%, respectively. OS and rwDFS were positively correlated (Kendall rank correlation coefficient = 0.67; p < 0.0001). Among patients without recurrence within 5 years after resection, the subsequent 5-year OS and rwDFS survival rates were 52.9% and 36.6%, respectively. CONCLUSIONS Use of adjuvant chemotherapy was low, and the overall 5-year OS rate remained low despite all patients having undergone complete resection. Patients who remained non-recurrent over time had favorable subsequent long-term survival.
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Affiliation(s)
- Xiaohan Hu
- Merck & Co., Inc., P.O. Box 2000, 126 East Lincoln Avenue, Rahway, NJ, 07065, USA.
| | - Diana Chirovsky
- Merck & Co., Inc., P.O. Box 2000, 126 East Lincoln Avenue, Rahway, NJ, 07065, USA
| | - Mark S Walker
- ConcertAI, LLC, 1120 Massachusetts Ave., Cambridge, MA, 02138, USA
| | - Yuexi Wang
- ConcertAI, LLC, 1120 Massachusetts Ave., Cambridge, MA, 02138, USA
| | - Alpana Kaushiva
- ConcertAI, LLC, 1120 Massachusetts Ave., Cambridge, MA, 02138, USA
| | - Jon Tepsick
- ConcertAI, LLC, 1120 Massachusetts Ave., Cambridge, MA, 02138, USA
| | - Ayman Samkari
- Merck & Co., Inc., P.O. Box 2000, 126 East Lincoln Avenue, Rahway, NJ, 07065, USA
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Apple J, DerSarkissian M, Shah A, Chang R, Chen Y, He X, Chun J. Economic burden of early-stage non-small-cell lung cancer: an assessment of healthcare resource utilization and medical costs. J Comp Eff Res 2023; 12:e230107. [PMID: 37655686 PMCID: PMC10690396 DOI: 10.57264/cer-2023-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023] Open
Abstract
Aim: To quantify the economic burden of early-stage non-small-cell lung cancer (NSCLC) among patients with and without adjuvant therapy. Methods: All-cause and NSCLC-related healthcare resource utilization and medical costs were assessed among patients with resected stage IB-IIIA NSCLC in the SEER-Medicare database (1 January 2011-31 December 2019), from NSCLC diagnosis to death, end of continuous enrollment, or end of data availability (whichever occurred first). Results: Patients receiving adjuvant therapy had the lowest mean NSCLC-related medical costs (adjuvant [n = 1776]: $3738; neoadjuvant [n = 56]: $5793; both [n = 47]: $4818; surgery alone [n = 3478]: $4892, per-person-per-month), driven by lower NSCLC-related hospitalization rates. Conclusion: Post-surgical management of early-stage NSCLC was associated with high economic burden. Adjuvant therapy was associated with numerically lower medical costs over surgical resection alone.
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Affiliation(s)
- Jon Apple
- AstraZeneca Pharmaceuticals, One MedImmune Way, Gaithersburg, MD 20878, USA
| | - Maral DerSarkissian
- Analysis Group, 333 South Hope Street, 27th Floor, Los Angeles, CA 90071, USA
| | - Anne Shah
- AstraZeneca Pharmaceuticals, One MedImmune Way, Gaithersburg, MD 20878, USA
| | - Rose Chang
- Analysis Group, 111 Huntington Avenue, 14th Floor, Boston, MA 02199, USA
| | - Yan Chen
- Analysis Group, 333 South Hope Street, 27th Floor, Los Angeles, CA 90071, USA
| | - Xuanhao He
- Analysis Group, 333 South Hope Street, 27th Floor, Los Angeles, CA 90071, USA
| | - Justin Chun
- Analysis Group, 333 South Hope Street, 27th Floor, Los Angeles, CA 90071, USA
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Jovanoski N, Abogunrin S, Di Maio D, Belleli R, Hudson P, Bhadti S, Jones LG. Systematic Literature Review to Identify Cost and Resource Use Data in Patients with Early-Stage Non-small Cell Lung Cancer (NSCLC). PHARMACOECONOMICS 2023; 41:1437-1452. [PMID: 37389802 PMCID: PMC10570243 DOI: 10.1007/s40273-023-01295-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Approximately 2 million new cases and 1.76 million deaths occur annually due to lung cancer, with the main histological subtype being non-small cell lung cancer (NSCLC). The costs and resource use associated with NSCLC are important considerations to understand the economic impact imposed by the disease on patients, caregivers and healthcare services. OBJECTIVE The objective of this systematic literature review (SLR) is to provide a comprehensive overview of the available direct medical costs, direct non-medical costs, indirect costs, cost drivers and resource use data available for patients with early-stage NSCLC. METHODS Electronic searches were conducted via the Ovid platform in March 2021 and June 2022 and were supplemented by grey literature searches. Eligible patients had early-stage (stage I-III) resectable NSCLC and received treatment in the neoadjuvant or adjuvant setting. There was no restriction on intervention or comparators. Publication date was restricted to 2011 onwards, and English language publications or non-English language publications with an English abstract were of primary interest. Due to the anticipation of many studies meeting the inclusion criteria, analyses were restricted to full publications from countries of primary interest (Australia, Brazil, Canada, China, France, Germany, Italy, Japan, South Korea, Spain, UK and the US) and those with > 200 patients. The Molinier checklist was applied to conduct quality assessment. RESULTS Forty-two full publications met the eligibility criteria and were included in this SLR. Early-stage NSCLC was associated with significant direct medical costs and healthcare utilisation, and the economic burden of the disease increased with its progression. Surgery was the primary cost driver in stage I patients, but as patients progressed to stage II and III, treatments such as chemotherapy and radiotherapy, and inpatient care became the main cost drivers. There was no significant difference in resource use between patients with early-stage disease. However, these data were heavily US-centric and there was a paucity of data relating to direct non-medical and indirect costs associated with early-stage NSCLC. CONCLUSIONS Preventing disease progression for patients with NSCLC could reduce the economic burden of NSCLC on patients, caregivers and healthcare systems. This review provides a comprehensive overview of the available cost and resource use data in this indication, which is important in guiding the decisions of policy makers regarding the allocation of resources. However, it also indicates a need for more studies comparing the economic impact of NSCLC in markets in addition to the US.
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Lee JM, McNamee CJ, Toloza E, Negrao MV, Lin J, Shum E, Cummings AL, Kris MG, Sepesi B, Bara I, Kurtsikidze N, Schulze K, Ngiam C, Chaft JE. Neoadjuvant Targeted Therapy in Resectable NSCLC: Current and Future Perspectives. J Thorac Oncol 2023; 18:1458-1477. [PMID: 37451404 PMCID: PMC11040203 DOI: 10.1016/j.jtho.2023.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/20/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
The standard of care (SoC) for medically operable patients with early-stage (stages I-IIIB) NSCLC is surgery combined with (neo)adjuvant systemic therapy for patients with stages II to IIIB disease and some stage IB or, rarely, chemoradiation (stage III disease with mediastinal lymph node metastases). Despite these treatments, metastatic recurrence is common and associated with poor survival, highlighting the need for systemic therapies that are more effective than the current SoC. After the success of targeted therapy (TT) in patients with advanced NSCLC harboring oncogenic drivers, these agents are being investigated for the perioperative (neoadjuvant and adjuvant) treatment of patients with early-stage NSCLC. Adjuvant osimertinib is the only TT approved for use in the early-stage setting, and there are no approved neoadjuvant TTs. We discuss the importance of comprehensive biomarker testing at diagnosis to identify individuals who may benefit from neoadjuvant targeted treatments and review emerging data from neoadjuvant TT trials. We also address the potential challenges for establishing neoadjuvant TTs as SoC in the early-stage setting, including the identification and validation of early response markers to guide care and accelerate drug development, and discuss safety considerations in the perioperative setting. Initial data indicate that neoadjuvant TTs are effective and well tolerated in patients with EGFR- or ALK-positive early-stage NSCLC. Data from ongoing trials will determine whether neoadjuvant targeted agents will become a new SoC for individuals with oncogene-addicted resectable NSCLC.
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Affiliation(s)
- Jay M Lee
- Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
| | - Ciaran J McNamee
- Department of Surgery, Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eric Toloza
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida; Department of Surgery and Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, Florida
| | - Marcelo V Negrao
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jules Lin
- Section of Thoracic Surgery, University of Michigan Rogel Cancer Center, Ann Arbor, Michigan
| | - Elaine Shum
- Division of Hematology and Medical Oncology, Department of Medicine, Perlmutter Cancer Center at NYU Langone Health, New York, New York
| | - Amy L Cummings
- Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Mark G Kris
- Thoracic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, New York
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ilze Bara
- US Medical Affairs, Genentech, Inc., South San Francisco, California
| | - Nino Kurtsikidze
- Global Product Development and Medical Affairs Oncology, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Katja Schulze
- Translational Medicine, Oncology Biomarker Development, Genentech, Inc., South San Francisco, California
| | - Celina Ngiam
- US Medical Affairs, Genentech, Inc., South San Francisco, California
| | - Jamie E Chaft
- Thoracic Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, New York
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Uldbjerg EM, Ringgaard L, Andersen KK, Frederiksen LE, Jovanovic A, Meldgaard P. Diagnostic Workup, Treatment Patterns, and Clinical Outcomes in Early-Stage IB-IIIA Non-Small-Cell Lung Cancer Patients in Denmark. Cancers (Basel) 2023; 15:5130. [PMID: 37958305 PMCID: PMC10647574 DOI: 10.3390/cancers15215130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
Despite recent improvements in early-stage non-small-cell lung cancer (NSCLC), disease relapse remains challenging. Moreover, real-world evidence on long-term follow-up of disease-free survival (DFS) and recurrence patterns in a large, unselected cohort of early-stage NSCLC patients is lacking. This cohort study aimed to assess clinical characteristics, diagnostic workup, treatment, survival, and risk of disease relapse among early-stage NSCLC patients. Adult patients with stage IB, II, or IIIA NSCLC diagnosed and/or treated at Aarhus University Hospital in Denmark from January 2010 to December 2020 were included and followed-up until May 2021. Comprehensive clinical data were collected from electronic medical records of eligible patients and linked to Danish register data. The study population comprised 1341 early-stage NSCLC patients: 22%, 40%, and 38% were diagnosed with stage IB, II, and IIIA disease, respectively. In total, 42% of patients were tested for epidermal growth factor receptor (EGFR), of whom 10% were EGFR-mutation-positive (EGFRm+). Half of all patients received surgery, and nine percent of patients received stereotactic body radiation therapy (SBRT). Disease-free survival 5 years post-diagnosis was 49%, 42%, and 22% for stage IB, II, and stage IIIA patients, respectively. DFS improved over time both for patients treated with surgery and SBRT. However, disease relapse remained a challenge, with approximately 40% of stage IIIA having relapsed 3 years post-diagnosis. This study contributes important knowledge that puts clinical trials on new perioperative treatment modalities for early-stage NSCLC patients into perspective. Our findings cover an essential evidence gap on real-world DFS and recurrence dynamics, confirming that despite an improvement in DFS over time and across different treatment modalities, disease relapse remains a monumental challenge. Therefore, better treatment strategies are needed.
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Affiliation(s)
| | | | | | | | - Aleksandar Jovanovic
- Department of Experimental Oncology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Peter Meldgaard
- Department of Oncology, Aarhus University Hospital, 8200 Aarhus, Denmark
- Institute for Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 35, 8200 Aarhus, Denmark
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Felip E, Altorki N, Zhou C, Vallières E, Martínez-Martí A, Rittmeyer A, Chella A, Reck M, Goloborodko O, Huang M, Belleli R, McNally V, Srivastava MK, Bennett E, Gitlitz BJ, Wakelee HA. Overall survival with adjuvant atezolizumab after chemotherapy in resected stage II-IIIA non-small-cell lung cancer (IMpower010): a randomised, multicentre, open-label, phase III trial. Ann Oncol 2023; 34:907-919. [PMID: 37467930 DOI: 10.1016/j.annonc.2023.07.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND IMpower010 (NCT02486718) demonstrated significantly improved disease-free survival (DFS) with adjuvant atezolizumab versus best supportive care (BSC) following platinum-based chemotherapy in the programmed death-ligand 1 (PD-L1)-positive and all stage II-IIIA non-small-cell lung cancer (NSCLC) populations, at the DFS interim analysis. Results of the first interim analysis of overall survival (OS) are reported here. PATIENT AND METHODS The design, participants, and primary-endpoint DFS outcomes have been reported for this phase III, open-label, 1 : 1 randomised study of atezolizumab (1200 mg q3w; 16 cycles) versus BSC after adjuvant platinum-based chemotherapy (1-4 cycles) in adults with completely resected stage IB (≥4 cm)-IIIA NSCLC (per the Union Internationale Contre le Cancer and American Joint Committee on Cancer staging system, 7th edition). Key secondary endpoints included OS in the stage IB-IIIA intent-to-treat (ITT) population and safety in randomised treated patients. The first pre-specified interim analysis of OS was conducted after 251 deaths in the ITT population. Exploratory analyses included OS by baseline PD-L1 expression level (SP263 assay). RESULTS At a median of 45.3 months' follow-up on 18 April 2022, 127 of 507 patients (25%) in the atezolizumab arm and 124 of 498 (24.9%) in the BSC arm had died. The median OS in the ITT population was not estimable; the stratified hazard ratio (HR) was 0.995 [95% confidence interval (CI) 0.78-1.28]. The stratified OS HRs (95% CI) were 0.95 (0.74-1.24) in the stage II-IIIA (n = 882), 0.71 (0.49-1.03) in the stage II-IIIA PD-L1 tumour cell (TC) ≥1% (n = 476), and 0.43 (95% CI 0.24-0.78) in the stage II-IIIA PD-L1 TC ≥50% (n = 229) populations. Atezolizumab-related adverse event incidences remained unchanged since the previous analysis [grade 3/4 in 53 (10.7%) and grade 5 in 4 (0.8%) of 495 patients, respectively]. CONCLUSIONS Although OS remains immature for the ITT population, these data indicate a positive trend favouring atezolizumab in PD-L1 subgroup analyses, primarily driven by the PD-L1 TC ≥50% stage II-IIIA subgroup. No new safety signals were observed after 13 months' additional follow-up. Together, these findings support the positive benefit-risk profile of adjuvant atezolizumab in this setting.
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Affiliation(s)
- E Felip
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.
| | - N Altorki
- NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, USA
| | - C Zhou
- Department of Oncology, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | | | - A Martínez-Martí
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - A Rittmeyer
- LKI Lungenfachklinik Immenhausen, Immenhausen, Germany
| | - A Chella
- Cardiac and Thoracic Department, Pneumo-Oncology Day Hospital, Pisa, Italy
| | - M Reck
- Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany
| | - O Goloborodko
- Zaporizhzhia Regional Clinical Oncological Dispensary, Zaporizhzhia SMU Ch of Oncology, Zaporizhzhya, Ukraine
| | - M Huang
- Genentech Inc, South San Francisco, USA
| | - R Belleli
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - V McNally
- Roche Products Ltd, Welwyn Garden City, UK
| | | | - E Bennett
- Genentech Inc, South San Francisco, USA
| | | | - H A Wakelee
- Stanford University School of Medicine/Stanford Cancer Institute, Stanford, USA
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8
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West H, Hu X, Chirovsky D, Walker MS, Wang Y, Kaushiva A, Tepsick J, Samkari A. Clinical and economic impact of recurrence in early-stage non-small-cell lung cancer following complete resection. Future Oncol 2023; 19:1415-1427. [PMID: 37218514 DOI: 10.2217/fon-2023-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Aim: Real-world data on outcomes for early-stage non-small-cell lung cancer (NSCLC) are needed to better understand the benefits of new therapies. Methods: In this retrospective study using the ConcertAI Patient360™ database, overall survival and healthcare resource utilization were compared among patients with recurrent and non-recurrent completely resected stage IB-IIIA NSCLC. Results: Recurrence was associated with a shorter median overall survival compared with non-recurrence (31.5 months vs 75.6 months, respectively), lower survival probability 5-years post-resection, and higher healthcare resource utilization. Patients with late recurrence had a longer restricted mean survival time versus patients with early recurrence. Conclusion: Results from this real-world study highlight the potential value of preventing or delaying recurrence in patients with early-stage NSCLC.
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Affiliation(s)
- Howard West
- City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Xiaohan Hu
- Merck & Co., Inc., 126 East Lincoln Avenue, P.O. Box 2000, Rahway, NJ 07065, USA
| | - Diana Chirovsky
- Merck & Co., Inc., 126 East Lincoln Avenue, P.O. Box 2000, Rahway, NJ 07065, USA
| | - Mark S Walker
- ConcertAI, 1120 Massachusetts Ave., Cambridge, MA 02138, USA
| | - Yuexi Wang
- ConcertAI, 1120 Massachusetts Ave., Cambridge, MA 02138, USA
| | - Alpana Kaushiva
- ConcertAI, 1120 Massachusetts Ave., Cambridge, MA 02138, USA
| | - Jon Tepsick
- ConcertAI, 1120 Massachusetts Ave., Cambridge, MA 02138, USA
| | - Ayman Samkari
- Merck & Co., Inc., 126 East Lincoln Avenue, P.O. Box 2000, Rahway, NJ 07065, USA
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9
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West H, Hu X, Zhang S, Song Y, Chirovsky D, Gao C, Lerner A, Jiang A, Signorovitch J, Samkari A. Treatment Patterns and Outcomes in Resected Early-stage Non-small Cell Lung Cancer: An Analysis of the SEER-Medicare Data. Clin Lung Cancer 2022; 24:260-268. [PMID: 36641325 DOI: 10.1016/j.cllc.2022.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND As the non-small cell lung cancer (NSCLC) adjuvant treatment landscape evolves, an evaluation of treatment patterns and outcomes of patients with early-stage, resected NSCLC eligible for adjuvant treatment in routine clinical practice is needed to better understand the unmet needs in this patient population. MATERIALS AND METHODS Data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2007-2019) were used to identify patients with newly diagnosed stage IB (tumor size ≥4cm)-IIIA (AJCC 7th edition) NSCLC who received primary surgery (index date). We assessed adjuvant treatment patterns, real-world disease-free survival (rwDFS; time from index date to first recurrence or death) and overall survival (OS; time from index date to death), and loco-regional recurrence pattern and treatment distribution. RESULTS Among 1761 patients with primary surgery, mean age was 73.8 years; 47.9% were male; and 83.9% were white. Approximately 41% of patients received adjuvant chemotherapy; median time from surgery to adjuvant chemotherapy initiation was 48 days, and the most frequently observed adjuvant chemotherapy regimen was carboplatin+paclitaxel (24.5%). In the overall population, median rwDFS was 24.8 months and OS was 76.7 months; 5-year rwDFS and OS rates were 29.3% and 57.5%, respectively. Among 392 patients with loco-regional recurrence, the most frequently observed treatment was curative radiation monotherapy (28.2%). CONCLUSION Despite clinical guideline recommendations, rate of adjuvant chemotherapy among patients with resected early-stage NSCLC was low in clinical practice. Overall, among patients with early-stage NSCLC treated with conventional primary surgery, poor survival outcomes were observed, highlighting the need for and importance of more effective adjuvant treatments.
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Affiliation(s)
- Howard West
- Department of Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA.
| | | | - Su Zhang
- Analysis Group, Inc., Boston, MA
| | - Yan Song
- Analysis Group, Inc., Boston, MA
| | | | - Chi Gao
- Analysis Group, Inc., Boston, MA
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10
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Sharma R, Ogale S, Smith NJ, Lee JS. Estimating recurrences prevented and costs avoided with atezolizumab in early non‐small cell lung cancer in the United States. Cancer Med 2022; 12:7450-7458. [PMID: 36420712 PMCID: PMC10067035 DOI: 10.1002/cam4.5462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/12/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Recurrence of early-stage non-small cell lung cancer (eNSCLC) is associated with significant mortality and costs. Atezolizumab (ATZ) was recently approved as adjuvant treatment following resection and platinum-based chemotherapy for adults with stage II-IIIA NSCLC with PD-L1 expression ≥1% after demonstrating significant improvement in disease-free survival (DFS) relative to best supportive care (BSC) in the IMpower010 trial (NCT02486718). This study evaluated the population-level impact of ATZ as adjuvant treatment for eNSCLC in the United States by estimating the number and costs of recurrences avoided. METHODS A Monte Carlo simulation model estimated the cumulative number of recurrences and deaths prevented, along with direct, indirect, and terminal care costs, by treating eNSCLC patients with ATZ compared to BSC. The model included eligible patients treated in any given year and followed over a 5-year period. Recurrence and mortality rates and costs were based on the IMpower010 data and supplemented by estimates from published literature. RESULTS An estimated 4400 eNSCLC patients in the United States were eligible for adjuvant ATZ in any given year, of whom 2387 would experience recurrence within 5 years with BSC. Following the introduction of ATZ, 1030 (95% confidence interval [CI]: 1023, 1036) recurrences and 369 (95% CI: 362, 376) deaths would be avoided with estimated reductions in cumulative recurrence-related direct, indirect, and terminal care costs of $785 million, $15 million, and $32 million, respectively, over a 5-year time horizon. CONCLUSIONS Adjuvant ATZ is estimated to prevent a significant number of recurrences and reduce the economic burden of eNSCLC.
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Affiliation(s)
| | - Sarika Ogale
- Genentech Inc. South San Francisco California USA
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Real-life long-term outcomes of upfront surgery in patients with resectable stage I-IIIA non-small cell lung cancer. Radiol Oncol 2022; 56:346-354. [PMID: 35962955 PMCID: PMC9400448 DOI: 10.2478/raon-2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/10/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Treatment of early-stage non-small cell lung cancer (NSCLC) is rapidly evolving. When introducing novelties, real-life data on effectiveness of currently used treatment strategies are needed. The present study evaluated outcomes of stage I-IIIA NSCLC patients treated with upfront radical surgery in everyday clinical practice, between 2010-2017. PATIENTS AND METHODS Data of 539 consecutive patients were retrieved from a prospective hospital-based registry. All diagnostic, treatment and follow-up procedures were performed at the same thoracic oncology centre according to the valid guidelines. The primary outcome was overall survival (OS) analysed by clinical(c) and pathological(p) TNM (tumour, node, metastases) stage. The impact of clinicopathological characteristics on OS was evaluated using univariable (UVA) and multivariable regression analysis (MVA). RESULTS With a median follow-up of 53.9 months, median OS and 5-year OS rate in the overall population were 90.4 months and 64.4%. Five-year OS rates by pTNM stage I, II and IIIA were 70.2%, 60.21%, and 49.9%, respectively. Both cTNM and pTNM stages were associated with OS; but only pTNM retained its independent prognostic value (p = 0.003) in MVA. Agreement between cTNM and pTNM was 69.0%. Next to pTNM, age (p = 0.001) and gender (p = 0.004) retained their independent prognostic value for OS. CONCLUSIONS The study showed favourable outcomes of resectable stage I-IIIA NSCLC treated with upfront surgery in real-life. Relatively low agreement between cTNM and pTNM stages and independent prognostic value of only pTNM, observed in real-life data, suggest that surgery remains the most accurate provider of the anatomical stage of disease and important upfront therapy.
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Cai B, Fulcher N, Boyd M, Spira A. Clinical outcomes and resource utilization after surgical resection with curative intent among patients with non-small cell lung cancer treated with adjuvant therapies in a community oncology setting: A real-world retrospective observational study. Thorac Cancer 2021; 12:2055-2064. [PMID: 34028984 PMCID: PMC8287010 DOI: 10.1111/1759-7714.14007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022] Open
Abstract
Aims Adjuvant chemotherapy has been shown to improve survival in patients with completely resected early‐stage non‐small cell lung cancer (NSCLC). This study evaluated real‐world relapse rates and healthcare resource utilization in patients with stage II–IIIB NSCLC receiving adjuvant therapy in a community oncology setting after complete resection. Patients and Methods The study included patients with stage II–IIIB NSCLC and complete resection receiving any adjuvant therapy during 06/2008–04/2017 at US Oncology Network clinics, with follow‐up through 04/2019. Primary endpoints were rate of relapse, time to relapse (TTR), disease‐free survival (DFS), overall survival (OS), and monthly emergency department (ED) visits and hospitalizations before and after relapse. Results The study identified 456 patients; median age was 66 years, 50% were male. In patients with relapse (45.2%), median follow‐up was 31.7 months and median TTR was 13.7 months. Median DFS in the overall population was 42.9 months. Median OS was 82.4 months in the overall population and shorter in patients with relapse than without relapse (41.6 months vs. not reached, p < 0.0001). Patients with relapse had significantly more monthly ED visits (mean [SD] 0.10 [0.24] vs. 0.03 [0.08], p < 0.0001) and hospitalizations (mean [SD] 0.20 [0.43] vs. 0.05 [0.10], p < 0.0001) following relapse than before relapse. Conclusions Patients with stage II–IIIB NSCLC treated with adjuvant therapy after complete resection had high relapse rates, reduced survival, and significantly increased healthcare resource use when relapse occurred. New therapeutic options to reduce relapse rates in patients with early‐stage NSCLC could reduce healthcare utilization and costs.
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Affiliation(s)
- Beilei Cai
- Novartis Pharmaceuticals, East Hanover, New Jersey, USA
| | | | | | - Alexander Spira
- Virginia Cancer Specialists/The US Oncology Network, Fairfax, Virginia, USA
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