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Phillips T, Lugtenburg P, Kalsekar A, Mutebi A, Wang A, Blaedel J, Kosa K, Martin S, Sacchi M, Kilavuz N, Thieblemont C. Improvements in Patient-Reported Outcomes in Relapsed or Refractory Large B-Cell Lymphoma Patients Treated With Epcoritamab. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:e78-e87.e2. [PMID: 38151388 DOI: 10.1016/j.clml.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/21/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Patient-reported outcomes were evaluated in EPCORE NHL-1 in patients with relapsed or refractory (R/R) large B-cell lymphoma (LBCL) treated with epcoritamab monotherapy (NCT03625037). MATERIALS AND METHODS Adults with R/R CD20+ LBCL and ≥2 prior systemic antilymphoma therapies, including anti-CD20, completed the Functional Assessment of Cancer Therapy-Lymphoma (FACT-Lym) and EQ-5D-3L. A subgroup of patients provided additional feedback in one-on-one qualitative interviews. FACT-Lym and EQ-5D-3L score changes from baseline (CFB) to cycle 9 or end of treatment were interpreted using published minimally important differences (MID). RESULTS In total, 157 patients (88.5% with diffuse LBCL) were treated (median age, 64 years). In total, 70.7% had ≥3 prior treatments, 61.1% had primary refractory disease, and 82.8% were refractory to last systemic therapy. FACT-Lym scores exceeded MID thresholds: mean (SD) CFB were 4.4 (15.2), MID 3.0 to 7.0 (FACT-General); 5.9 (7.6), MID 2.9 to 5.4 (FACT-Lymphoma subscale); 8.4 (15.2), MID 5.5 to 11.0 (FACT-Trial Outcome Index); 10.3 (20.2), MID 6.5 to 11.2 (FACT-Lym total score). EQ-5D-3L index scores, 0.09 (0.20), MID 0.08, and EQ-VAS scores, 16.6 (22.8), MID 7.0, improved. In 20 qualitative interviews, 88.2% reported symptom improvements; 80.0% were "very satisfied" or "satisfied" with epcoritamab. CONCLUSIONS R/R LBCL patients reported consistent, clinically meaningful improvements in symptoms and HRQoL and satisfaction with epcoritamab.
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Affiliation(s)
- Tycel Phillips
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI.
| | - Pieternella Lugtenburg
- On behalf of the Lunenburg Lymphoma Phase I/II Consortium-HOVON/LLPC, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | | - Catherine Thieblemont
- Assistance Publique & Hôpitaux de Paris (APHP), Hôpital Saint-Louis, Hémato-Oncologie, Université de Paris, Paris, France
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Liu FF, Bartlett M, Craigie S. A Systematic Literature Review of Health-Related Quality of Life Outcomes and Associated Utility Values in Relapsed and/or Refractory Large B Cell Lymphoma. PHARMACOECONOMICS - OPEN 2024; 8:171-190. [PMID: 38198111 PMCID: PMC10883903 DOI: 10.1007/s41669-023-00464-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND In this ever-expanding treatment landscape, there is a lack of consolidated health-related quality of life (HRQOL) outcomes and utility reports in relapsed or refractory (R/R) large B cell lymphoma (LBCL) to inform health care policy and decision-maker assessments for both old and new products. These assessments can have a direct effect on what treatment options are available to patients and physicians. OBJECTIVE A systematic literature review (SLR) was performed to understand the HRQOL evidence for treatments in R/R LBCL and identify associated health utility values. METHODS The SLR searched and screened literature published from 1 January 2003 to 2 May 2022. Studies were screened based on Population, Intervention, Comparator, Outcome, Study design criteria established a priori and were assessed by two independent reviewers; quality assessments of the evidence were performed in accordance with health technology assessment recommendations from the National Institute for Health and Care Excellence. Several types of therapies were included, such as chimeric antigen receptor (CAR) T cell products (lisocabtagene maraleucel, axicabtagene ciloleucel, tisagenlecleucel), novel therapies (selinexor, nivolumab, polatuzumab vedotin, and bendamustine), salvage therapies, and rituximab. RESULTS The review identified 33 unique studies reporting HRQOL, including 15 economic studies that reported health state utility values, 9 clinical trials, 7 health technology assessment reports, and 1 each of a vignette-based study and a point-in-time survey. Improvements in general and/or lymphoma-specific HRQOL measures were observed with CAR T cell therapy in both the second-line and third-line or later settings. On-treatment utility values for CAR T cell therapies ranged from 0.50 to 0.74. Values for remission/progression-free survival (0.70-0.90) and for disease progression (0.39-0.59) were similar across studies. For novel therapies, utility values were 0.83 for progression-free survival and ranged from 0.39 to 0.71 for disease progression. On-treatment utility values for salvage chemotherapy ranged from 0.63 to 0.67. CONCLUSIONS Overall, the evidence synthesized in this SLR provides a comprehensive understanding of the HRQOL evidence in R/R LBCL. This article identified several sources for utility values in the published literature showing variation in the HRQOL outcomes for patients across a variety of therapeutics. Treatment of R/R LBCL with CAR T cell therapies was associated with improvement in health utility values. Mixed results were found for novel therapies and salvage therapies. More data are needed as new therapies are used in this patient population to inform treatment decision-making.
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Affiliation(s)
- Fei Fei Liu
- Bristol Myers Squibb, 3401 Princeton Pike, Lawrence Township, Princeton, NJ, 08648, USA.
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Lin Z, Zuo C, Jiang Y, Su W, Yao X, Man Y, Wu Q, Xuan J. Cost-Effectiveness Analysis of Relmacabtagene Autoleucel for Relapsed or Refractory Large B-Cell Lymphoma in China. Value Health Reg Issues 2023; 37:41-48. [PMID: 37209540 DOI: 10.1016/j.vhri.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/07/2023] [Accepted: 03/29/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Relmacabtagene autoleucel (relma-cel) was recently approved in China for treating relapsed or refractory large B-cell lymphoma (r/r LBCL). We conducted a cost-effectiveness analysis from the perspective of Chinese healthcare system. METHODS A mixture-cure model was developed to project life-years (LYs), quality-adjusted LYs (QALYs), and overall direct cost with a lifetime horizon for patients with r/r LBCL treated with relma-cel versus salvage chemotherapy. Patient-level data from RELIANCE trial and published data from Collaborative Trial in Relapsed Aggressive Lymphoma extension study were used to inform the model. The incremental cost-effectiveness ratio (ICER) was estimated and cost-effectiveness was evaluated at the willingness-to-pay threshold of 3 times the national gross domestic product per capita. RESULTS The model projected that treatment with relma-cel was associated with incremental gains of 5.11 LYs and 5.26 QALYs compared with salvage chemotherapy at an increased cost of ¥1 067 430 (∼$154 152), resulting in an ICER of ¥203 137 (∼$29 435) per QALY. The model was most sensitive to the uncertainty around the estimated cure rate. The ICER of relma-cel was within the willingness-to-pay threshold in the base case and the probability of relma-cel treatment being considered cost-effective was approximately 74%. CONCLUSIONS Compared with salvage chemotherapy, treatment with relma-cel for r/r LBCL in patients who have failed at least 2 lines of systemic therapy is within the cost-effective range from the perspective of Chinese healthcare system and represents a good use of healthcare resources.
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Affiliation(s)
- Ziyi Lin
- School of Pharmacy, Health Economic Research Institute, Sun Yat-sen University, Guangzhou, China
| | - Chenyu Zuo
- Shanghai Centennial Scientific Co. Ltd., Shanghai, China
| | - Yifan Jiang
- School of Pharmacy, Southern Medical University, Guangzhou, China
| | - Wen Su
- Shanghai Centennial Scientific Co. Ltd., Shanghai, China
| | - Xing Yao
- JW Therapeutics (Shanghai) Co. Ltd, Shanghai, China
| | - Yu Man
- JW Therapeutics (Shanghai) Co. Ltd, Shanghai, China
| | - Qiong Wu
- JW Therapeutics (Shanghai) Co. Ltd, Shanghai, China
| | - Jianwei Xuan
- School of Pharmacy, Health Economic Research Institute, Sun Yat-sen University, Guangzhou, China.
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Elsawy M, Chavez JC, Avivi I, Larouche JF, Wannesson L, Cwynarski K, Osman K, Davison K, Rudzki JD, Dahiya S, Dorritie K, Jaglowski S, Radford J, Morschhauser F, Cunningham D, Martin Garcia-Sancho A, Tzachanis D, Ulrickson ML, Karmali R, Kekre N, Thieblemont C, Enblad G, Dreger P, Malladi R, Joshi N, Wang WJ, Solem CT, Snider JT, Cheng P, To C, Kersten MJ. Patient-reported outcomes in ZUMA-7, a phase 3 study of axicabtagene ciloleucel in second-line large B-cell lymphoma. Blood 2022; 140:2248-2260. [PMID: 35839452 PMCID: PMC10653042 DOI: 10.1182/blood.2022015478] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/23/2022] [Indexed: 12/30/2022] Open
Abstract
Here, we report the first comparative analysis of patient-reported outcomes (PROs) with chimeric antigen receptor T-cell therapy vs standard-of-care (SOC) therapy in second-line relapsed/refractory large B-cell lymphoma (R/R LBCL) from the pivotal randomized phase 3 ZUMA-7 study of axicabtagene ciloleucel (axi-cel) vs SOC. PRO instruments were administered at baseline, day 50, day 100, day 150, month 9, and every 3 months from randomization until 24 months or an event-free survival event. The quality of life (QoL) analysis set comprised patients with a baseline and ≥1 follow-up PRO completion. Prespecified hypotheses for Quality of Life Questionnaire-Core 30 (QLQ-C30) physical functioning, global health status/QoL, and EQ-5D-5L visual analog scale (VAS) were tested using mixed-effects models with repeated measures. Clinically meaningful changes were defined as 10 points for QLQ-C30 and 7 for EQ-5D-5L VAS. Among 359 patients, 296 (165 axi-cel, 131 SOC) met inclusion criteria for QoL analysis. At day 100, statistically significant and clinically meaningful differences in mean change of scores from baseline were observed favoring axi-cel over SOC for QLQ-C30 global health status/QoL (estimated difference 18.1 [95% confidence interval (CI), 12.3-23.9]), physical functioning (13.1 [95% CI, 8.0-18.2]), and EQ-5D-5L VAS (13.7 [95% CI, 8.5-18.8]; P < .0001 for all). At day 150, scores significantly favored axi-cel vs SOC for global health status/QoL (9.8 [95% CI, 2.6-17.0]; P = .0124) and EQ-5D-5L VAS (11.3 [95% CI, 5.4-17.1]; P = .0004). Axi-cel showed clinically meaningful improvements in QoL over SOC. Superior clinical outcomes and favorable patient experience with axi-cel should help inform treatment choices in second-line R/R LBCL. This trial was registered at www.clinicaltrials.gov as #NCT03391466.
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Affiliation(s)
- Mahmoud Elsawy
- Queen Elizabeth II Health Sciences Centre and Division of Hematology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Irit Avivi
- Hematology Institute, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jean-François Larouche
- Centre Hospitalier Universitaire (CHU) de Québec, Hôpital de l'Enfant-Jésus, Québec, QC, Canada
| | - Luciano Wannesson
- Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - Kate Cwynarski
- Department of Haematology, University College London Hospitals National Health Services (NHS) Foundation Trust, London, United Kingdom
| | - Keren Osman
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kelly Davison
- Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Jakob D. Rudzki
- Department of Hematology & Oncology, The Medical University of Innsbruck, University Clinic for Internal Medicine, Innsbruck, Austria
| | - Saurabh Dahiya
- Greenebaum Comprehensive Cancer Center, Transplant and Cellular Therapy Program, University of Maryland Medical Center, Baltimore, MD
| | - Kathleen Dorritie
- University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, Pittsburgh, PA
| | - Samantha Jaglowski
- Comprehensive Cancer Center, Blood and Marrow Transplant Program, The Ohio State University, Columbus, OH
| | - John Radford
- Division of Cancer Sciences, The Christie NHS Foundation Trust and the University of Manchester, Manchester, United Kingdom
| | - Franck Morschhauser
- Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, CHU Lille, Lille, France
| | | | - Alejandro Martin Garcia-Sancho
- Hematology Department, Salamanca University Hospital, Institute of Biomedical Research of Salamanca (IBSAL), Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Salamanca, Spain
| | | | | | - Reem Karmali
- Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | | | | | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Peter Dreger
- Department of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Ram Malladi
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Cambridge, United Kingdom
| | | | | | | | | | - Paul Cheng
- Kite, a Gilead Company, Santa Monica, CA
| | | | - Marie José Kersten
- Cancer Center Amsterdam, Department of Hematology, Amsterdam UMC on behalf of Stichting Hemato-Oncologie voor Volwassenen Nederland (HOVON)/ Lunenburg Lymphoma Phase 1 / II Consortium (LLPC), University of Amsterdam, Amsterdam, Netherlands
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Sylvain C. A drug profile on selinexor for the treatment of refractory diffuse large B-cell lymphoma. Expert Rev Hematol 2022; 15:195-201. [PMID: 35318887 DOI: 10.1080/17474086.2022.2057295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The efficacy of selinexor, the first commercially available exportin inhibitor, has been evaluated in patients with diffuse large B-cell lymphoma (DLBCL) who have received at least 2 lines of therapy. Its role in treatment of DLBCL requires a review of current evidence. AREAS COVERED This review describes the pharmacology of selinexor and the clinical trials of the medication for the treatment of patients with DLBCL. To clarify the role of selinexor in the treatment of DLBCL, a PubMed search was performed for articles on currently available treatments for relapsed/refractory (R/R) DLBCL. EXPERT OPINION Selinexor, which is administered orally, benefits from an advantageous pharmacokinetic profile with toxicity limited to hematological and digestive side effects. It has little or no interaction with other medications and no dose adjustment is required for patients with renal or hepatic impairment. Selinexor has been assessed for treatment of R/R DLBCL in one phase I and one phase II trial. Those studies found a 28% overall response rate, including 12% complete remission, with a median duration of response of 9.3 months. If selinexor's effectiveness as monotherapy is limited, it remains an option when there are no other therapeutic possibilities and can then give long-lasting responses.
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Affiliation(s)
- Choquet Sylvain
- Service d'hématologie Clinique, Hôpital de la Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
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