1
|
Garon EB, Cho BC, Luft A, Alatorre-Alexander J, Geater SL, Kim SW, Ursol G, Hussein M, Lim FL, Yang CT, Araujo LH, Saito H, Reinmuth N, Medic N, Mann H, Shi X, Peters S, Mok T, Johnson M. Patient-reported outcomes with durvalumab, with or without tremelimumab, plus chemotherapy as first-line treatment for metastatic non-small-cell lung cancer (POSEIDON). Lung Cancer 2023; 186:107422. [PMID: 37992595 DOI: 10.1016/j.lungcan.2023.107422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES In the phase 3 POSEIDON study, first-line tremelimumab plus durvalumab and chemotherapy significantly improved overall survival and progression-free survival versus chemotherapy in metastatic non-small-cell lung cancer (NSCLC). We present patient-reported outcomes (PROs). PATIENTS AND METHODS Treatment-naïve patients were randomized 1:1:1 to tremelimumab plus durvalumab and chemotherapy, durvalumab plus chemotherapy, or chemotherapy. PROs (prespecified secondary endpoints) were assessed using the European Organisation for Research and Treatment of Cancer 30-item core quality of life questionnaire version 3 (QLQ-C30) and its 13-item lung cancer module (QLQ-LC13). We analyzed time to deterioration (TTD) of symptoms, functioning, and global health status/quality of life (QoL) from randomization by log-rank test and improvement rates by logistic regression. RESULTS 972/1013 (96 %) patients randomized completed baseline QLQ-C30 and QLQ-LC13 questionnaires, with scores comparable between treatment arms. Patients receiving tremelimumab plus durvalumab and chemotherapy versus chemotherapy had longer median TTD for all PRO items. Hazard ratios for TTD favored tremelimumab plus durvalumab and chemotherapy for all items except diarrhea; 95 % confidence intervals did not cross 1.0 for global health status/QoL, physical functioning, cognitive functioning, pain, nausea/vomiting, insomnia, constipation, hemoptysis, dyspnea, and pain in other parts. For durvalumab plus chemotherapy, median TTD was longer versus chemotherapy for all items except nausea/vomiting and diarrhea. Hazard ratios favored durvalumab plus chemotherapy for all items except appetite loss; 95 % confidence intervals did not cross 1.0 for global health status/QoL, physical functioning, role functioning, dyspnea, and pain in other parts. For both immunotherapy plus chemotherapy arms, improvement rates in all PRO items were numerically higher versus chemotherapy, with odds ratios > 1. CONCLUSIONS Tremelimumab plus durvalumab and chemotherapy delayed deterioration in symptoms, functioning, and global health status/QoL compared with chemotherapy. Together with significant improvements in survival, these results support tremelimumab plus durvalumab and chemotherapy as a first-line treatment option in metastatic NSCLC.
Collapse
Affiliation(s)
- Edward B Garon
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | | | - Alexander Luft
- Leningrad Regional Clinical Hospital, St Petersburg, Russia
| | | | | | - Sang-We Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Maen Hussein
- Florida Cancer Specialists - Sarah Cannon Research Institute, Leesburg, FL, USA
| | | | | | | | | | - Niels Reinmuth
- Asklepios Lung Clinic, member of the German Center for Lung Research (DZL), Munich-Gauting, Germany
| | | | | | | | - Solange Peters
- Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | - Tony Mok
- Chinese University of Hong Kong, Hong Kong, China
| | - Melissa Johnson
- Sarah Cannon Research Institute, Tennessee Oncology, PLLC, Nashville, TN, USA
| |
Collapse
|
2
|
Singh SA, McDermott DM, Mattes MD. Impact of Systemic Therapy Type and Timing on Intracranial Tumor Control in Patients with Brain Metastasis from Non-Small-Cell Lung Cancer Treated With Stereotactic Radiosurgery. World Neurosurg 2020; 144:e813-e823. [PMID: 32956881 DOI: 10.1016/j.wneu.2020.09.082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Stereotactic radiosurgery (SRS) can effectively control brain metastasis (BRM) from non-small-cell lung cancer (NSCLC), although intracranial recurrence from untreated micrometastatic tumor deposits is common without whole-brain radiotherapy. Our goal was to determine if immunotherapy improves distant intracranial progression-free survival (DI-PFS) compared with other systemic therapies in patients treated with SRS. METHODS All patients from 2011 to 2019 treated with SRS without previous whole-brain radiotherapy for NSCLC BRM were reviewed. DI-PFS for the entire cohort, and subgroups of patients, was estimated and compared using the Kaplan-Meier/log-rank method. RESULTS One hundred and thirty-six SRS sessions used to treat 99 patients were reviewed; 98 (72%) for previously untreated BRM and 38 (28%) for recurrent BRM. 35% received immunotherapy (77% concurrent with SRS), 46% received chemotherapy (75% concurrent), and 18% received epidermal growth factor receptor/anaplastic lymphoma kinase (ALK) targeted therapy (85% concurrent). At median follow-up of 13.7 months, 49% developed distant intracranial recurrence. One-year DI-PFS was improved with any use of immunotherapy (58% vs. 39%; P = 0.03) and concurrent immunotherapy versus chemotherapy or targeted therapy (67% vs. 37% vs. 39%, respectively; P = 0.01). In the immunotherapy cohort, 1-year DI-PFS was improved for programmed death-ligand 1 expression ≥50% versus 1%-49% versus 0% (80% vs. 49% vs. 19%, respectively; P < 0.01), and Lung Immune Prognostic Index 0-1 versus 2 (63% vs. 34%; P = 0.03). CONCLUSIONS Immunotherapy concurrent with SRS, particularly in patients with high programmed death-ligand 1 expression or low Lung Immune Prognostic Index, is associated with improved DI-PFS and no increased risk of radiation necrosis compared with other systemic therapies for NSCLC.
Collapse
Affiliation(s)
- Sarah A Singh
- Department of Radiation Oncology, West Virginia University Cancer Institute, West Virginia University, Morgantown, West Virginia, USA
| | - David M McDermott
- Department of Radiation Oncology, West Virginia University Cancer Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Malcolm D Mattes
- Department of Radiation Oncology, West Virginia University Cancer Institute, West Virginia University, Morgantown, West Virginia, USA.
| |
Collapse
|
3
|
Zheng H, Xie L, Zhan M, Wen F, Xu T, Li Q. Cost-effectiveness analysis of the addition of bevacizumab to chemotherapy as induction and maintenance therapy for metastatic non-squamous non-small-cell lung cancer. Clin Transl Oncol 2017; 20:286-293. [PMID: 28785913 DOI: 10.1007/s12094-017-1715-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 07/08/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND The BEYOND trial found that the addition of bevacizumab (B) to paclitaxel-carboplatin (PC) chemotherapy provided a significant clinical benefit to Chinese patients with metastatic non-squamous non-small-cell lung cancer (NSCLC). This study aimed to evaluate the cost-effectiveness of adding B to first-line PC induction and continuation maintenance therapy from a Chinese perspective. METHODS A Markov model was developed to estimate the cost and effectiveness of B + PC in the induction and maintenance therapy of patients with metastatic non-squamous NSCLC. Costs were calculated in the Chinese setting, and health outcomes derived from the BEYOND trial were measured as quality-adjusted life years (QALYs). A one-way sensitivity analysis was conducted to explore the impact of various parameters in the study. RESULTS The B + PC treatment was more costly ($112,943.40 versus $32,171.43) and more effective (1.07 QALYs versus 0.80 QALYs) compared with the PC treatment. Adding B to the PC regimen for non-squamous NSCLC results in an incremental cost-effectiveness ratio of $299,155.44 per QALY, which exceeded the accepted societal willingness-to-pay threshold ($23,970.00) for China. In the sensitivity analysis, the duration of progression-free survival (PFS) for the B + PC group, the cost of the PFS state for B + PC group and the price of B were considered the most sensitive factors in the model. CONCLUSIONS The addition of B to first-line PC induction and maintenance therapy was not determined to be a cost-effective strategy for metastatic non-squamous NSCLC in China, even when an assistance program was provided.
Collapse
Affiliation(s)
- H Zheng
- Department of Clinical Pharmacy, West China Hospital, Sichuan University, Chengdu, China.,West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, China
| | - L Xie
- Department of the Infrastructure, West China Hospital, Sichuan University, Chengdu, China
| | - M Zhan
- Department of Clinical Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - F Wen
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - T Xu
- Department of Clinical Pharmacy, West China Hospital, Sichuan University, Chengdu, China.
| | - Q Li
- West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, China. .,Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
4
|
Abstract
Metastatic non-small-cell lung cancer (nsclc) is the leading cause of cancer mortality in Canada. Although treatment outcomes in advanced disease remain modest, with paradigm shifts in the approach to treatment, they are steadily improving. Customizing treatment based on histology and molecular typing has become the standard of care. EGFR genotyping and pathology subtyping should be considered routine in new diagnoses of metastatic nsclc. Treatment options for those with somatic EGFR activating mutations include gefitinib until progression, followed by standard chemotherapy. For patients with wild-type EGFR, or in patients whose EGFR genotype is unknown, platinum-based chemotherapy remains the first-line standard, with single-agent chemotherapy as an option for older patients and those who are unfit for platinum-doublet therapy. Patients with nonsquamous histology may receive treatment regimens incorporating pemetrexed or bevacizumab. In patients with squamous cell carcinoma, the latter agents should be avoided because of concerns about enhanced toxicity or decreased efficacy. Second-line chemotherapy is offered to a selected subgroup of patients upon progression and may include pemetrexed in non-squamous histology and docetaxel or erlotinib (or both) in all histologies. Currently, only erlotinib is offered as a third-line option in unselected nsclc patients after failure of first- and second-line chemotherapy. Maintenance therapy is emerging as a new option for patients, as are targeted therapies for particular molecular subtypes of nsclc, such as crizotinib in tumours harbouring the EML4-ALK gene rearrangement.
Collapse
Affiliation(s)
- N.B. Leighl
- Correspondence to: Natasha B. Leighl, Department of Medicine, University of Toronto, and Division of Medical Oncology, Princess Margaret Hospital, Toronto, Ontario M5G 2M9. E-mail:
| |
Collapse
|