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Zhang PF, Xie D, Wen F, Li Q. Lenalidomide plus rituximab Vs rituximab alone in relapsed or refractory indolent lymphoma: A cost-effectiveness analysis. Cancer Med 2020; 9:5312-5319. [PMID: 32489014 PMCID: PMC7402838 DOI: 10.1002/cam4.3121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/23/2020] [Accepted: 04/21/2020] [Indexed: 02/05/2023] Open
Abstract
Background The aim of the study was to evaluate the cost‐effectiveness of lenalidomide plus rituximab vs rituximab alone in patients with relapsed or refractory indolent lymphoma. Methods A Markov decision model was established to carry out the cost‐effectiveness analysis. Three discrete health states, progression‐free survival (PFS), progressive disease (PD), and death, were included. Cycle length was set at 1 month, and utility scores were derived from previously published literature. The incremental cost‐effectiveness ratio (ICER) was defined as the primary endpoint, and the willingness‐to‐pay (WTP) threshold was set at $29,306.43 per quality‐adjusted life year (QALY). Both cost and effectiveness were determined using a 3% annual discount rate. Furthermore, one‐way and probabilistic sensitivity analyses were performed to check the robustness of the model. Results Lenalidomide plus rituximab gained 6.08 QALYs at a cost of $120,979.62 while rituximab alone gained 4.84 QALYs at a cost of $48,052.11. The ICER of lenalidomide plus rituximab vs rituximab alone was $58,812.51/QALY. The parameters most significantly influenced the model were the utility values for the PFS state, the duration of the PFS state in the lenalidomide plus rituximab group, and the cost of lenalidomide. The probability of lenalidomide plus rituximab or rituximab alone being the most cost‐effective option was 0% and 100%, respectively, at a WTP threshold of $29,306.43/QALY. Conclusions Lenalidomide plus rituximab is not a cost‐effective strategy compared with rituximab monotherapy for relapsed or refractory indolent lymphoma from a Chinese societal perspective.
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Affiliation(s)
- Peng-Fei Zhang
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Dan Xie
- Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Feng Wen
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Qiu Li
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
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Leonard JP, Trneny M, Izutsu K, Fowler NH, Hong X, Zhu J, Zhang H, Offner F, Scheliga A, Nowakowski GS, Pinto A, Re F, Fogliatto LM, Scheinberg P, Flinn IW, Moreira C, Cabeçadas J, Liu D, Kalambakas S, Fustier P, Wu C, Gribben JG. AUGMENT: A Phase III Study of Lenalidomide Plus Rituximab Versus Placebo Plus Rituximab in Relapsed or Refractory Indolent Lymphoma. J Clin Oncol 2019; 37:1188-1199. [PMID: 30897038 PMCID: PMC7035866 DOI: 10.1200/jco.19.00010] [Citation(s) in RCA: 243] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Patients with indolent non-Hodgkin lymphoma typically respond well to first-line immunochemotherapy. At relapse, single-agent rituximab is commonly administered. Data suggest the immunomodulatory agent lenalidomide could increase the activity of rituximab. METHODS A phase III, multicenter, randomized trial of lenalidomide plus rituximab versus placebo plus rituximab was conducted in patients with relapsed and/or refractory follicular or marginal zone lymphoma. Patients received lenalidomide or placebo for 12 cycles plus rituximab once per week for 4 weeks in cycle 1 and day 1 of cycles 2 through 5. The primary end point was progression-free survival per independent radiology review. RESULTS A total of 358 patients were randomly assigned to lenalidomide plus rituximab (n = 178) or placebo plus rituximab (n = 180). Infections (63% v 49%), neutropenia (58% v 23%), and cutaneous reactions (32% v 12%) were more common with lenalidomide plus rituximab. Grade 3 or 4 neutropenia (50% v 13%) and leukopenia (7% v 2%) were higher with lenalidomide plus rituximab; no other grade 3 or 4 adverse event differed by 5% or more between groups. Progression-free survival was significantly improved for lenalidomide plus rituximab versus placebo plus rituximab, with a hazard ratio of 0.46 (95% CI, 0.34 to 0.62; P < .001) and median duration of 39.4 months (95% CI, 22.9 months to not reached) versus 14.1 months (95% CI, 11.4 to 16.7 months), respectively. CONCLUSION Lenalidomide improved efficacy of rituximab in patients with recurrent indolent lymphoma, with an acceptable safety profile.
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Affiliation(s)
- John P Leonard
- 1 Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY
| | - Marek Trneny
- 2 Charles University, General Hospital, Prague, Czech Republic
| | - Koji Izutsu
- 3 National Cancer Center Hospital, Tokyo, Japan
| | - Nathan H Fowler
- 4 The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xiaonan Hong
- 5 Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Jun Zhu
- 6 Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Huilai Zhang
- 7 Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | | | | | | | - Antonio Pinto
- 11 Istituto Nazionale Tumori IRCCS - Fondazione Pascale, Naples, Italy
| | - Francesca Re
- 12 Azienda Ospedaliero Universitaria di Parma, Parma, Italy
| | | | | | - Ian W Flinn
- 15 Sarah Cannon Research Institute, Nashville, TN
| | - Claudia Moreira
- 16 Instituto Português de Oncologia do Porto Francisco Gentil Epe, Porto, Portugal
| | - José Cabeçadas
- 17 Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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Sorigue M, Mercadal S, Alonso S, Fernández-Álvarez R, García O, Moreno M, Pomares H, Alcoceba M, González-García E, Motlló C, González-Barca E, Martin A, Sureda A, Caballero D, Ribera JM, Sancho JM. Refractoriness to immunochemotherapy in follicular lymphoma: Predictive factors and outcome. Hematol Oncol 2017; 35:520-527. [PMID: 28156010 DOI: 10.1002/hon.2378] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/17/2016] [Accepted: 11/28/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Marc Sorigue
- Department of Hematology. ICO-Badalona, Hospital Germans Trias i Pujol, Institut de Recerce Josep Carreras; Universitat Autònoma de Barcelona; Badalona Spain
| | - Santiago Mercadal
- Department of Hematology. ICO-Duran y Reynals; Hospitalet de Llobregat; Bacelona Spain
| | - Sara Alonso
- Department of Hematology; Hospital Universitario de Salamanca; Salamanca Spain
| | | | - Olga García
- Department of Clinical Hematology. ICO-Badalona, Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras; Universitat Autònoma de Barcelona; Badalona Spain
| | - Miriam Moreno
- Department of Clinical Hematology. ICO-Badalona, Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras; Universitat Autònoma de Barcelona; Badalona Spain
| | - Helena Pomares
- Department of Hematology. ICO-Duran y Reynals; Hospitalet de Llobregat; Bacelona Spain
| | - Miguel Alcoceba
- Department of Hematology; Hospital Universitario de Salamanca; Salamanca Spain
| | | | - Cristina Motlló
- Department of Clinical Hematology. ICO-Badalona, Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras; Universitat Autònoma de Barcelona; Badalona Spain
| | - Eva González-Barca
- Department of Hematology. ICO-Duran y Reynals; Hospitalet de Llobregat; Bacelona Spain
| | - Alejandro Martin
- Department of Hematology; Hospital Universitario de Salamanca; Salamanca Spain
| | - Anna Sureda
- Department of Hematology. ICO-Duran y Reynals; Hospitalet de Llobregat; Bacelona Spain
| | - Dolores Caballero
- Department of Hematology; Hospital Universitario de Salamanca; Salamanca Spain
| | - Josep-María Ribera
- Department of Clinical Hematology. ICO-Badalona, Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras; Universitat Autònoma de Barcelona; Badalona Spain
| | - Juan-Manuel Sancho
- Department of Clinical Hematology. ICO-Badalona, Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras; Universitat Autònoma de Barcelona; Badalona Spain
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