scholarly journals Is Initial Dasatinib-Blinatumomab Therapy for Ph-Positive ALL in Adults Cost Effective?

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4962-4962
Author(s):  
Jacob D. Bitran ◽  
Edward Nabrinsky ◽  
Shams Bufalino ◽  
Phillip Knouse ◽  
Angel G. Galvez
Keyword(s):  
Conflicts Of Interest ◽  
Lymphoblastic Leukemia ◽  
Disease Free Survival ◽  
Cost Effective ◽  
Free Survival ◽  
New Therapy ◽  
The Cost ◽  
Disease Free ◽  
Yearly Cost

Abstract Adult, Philadelphia chromosome-positive, Acute Lymphoblastic Leukemia (Ph-positive ALL) had a poor prognosis, but with the use of an initial BCR/ABL tyrosine kinase inhibitor such as Dasatinib in conjunction with chemotherapy such as hyper-CVAD, the projected 24 month disease free survival is 64%. More recently Foa et al. on behalf of the GIMEMA investigators published a phase II trial of Dasatinib and Blinatumomab as initial therapy for adults with ALL. The complete remission rate was 98%, and the projected disease-free survival at 24 months is 88%. We wished to analyze the incremental cost-effectiveness ratio (ICER) of the Dasatinib and Blinatumomab therapy as compared to Dasatinib and hyper-CVAD. The comparison is based on retail costs of chemotherapy for Dasatinib, Blinatumomab and hyperCVAD and excluded hospital and outpatient charges. The cost of hyperCVAD is based on treatment of a person with a BSA I.8m2. The retail cost of therapy is shown below. Drug Dose Cost Dasatinib 100 mg $505.67 Blinatumomab 1 mg $126.81 Cyclophosphamide 1,000 mg $231.00 Mesna 1,000 mg $42.89 Vincristine 2 mg $18.52 Dexamethasone 40 mg $4.12 Cytarabine 100 mg $22.88 Leucovorin 25 mg $7.48 The ICER formula is the cost of new therapy minus (-) the cost of standard therapy/quality of adjusted life new therapy - the quality of adjusted life standard (QALY). The yearly cost of Hyper-CVAD and Dasatinib is $147,288.48 per QALY, whereas, the yearly cost of Dasatinib-Blinatumomab is $187,940.46 per QALY. The difference is $42,451.98 which is less than the 50,000-threshold using cost-effective analysis. In conclusion, the combination of Dasatinib-Blinatumomab appears to be cost effective. Disclosures No relevant conflicts of interest to declare.

scholarly journals Cost analysis of two follow-up strategies for localized kidney cancer: a Canadian cohort comparison

2013 ◽  
Vol 4 (5) ◽  
pp. 322
Author(s):  
Marie Dion ◽  
Carlos H. Martínez ◽  
Andrew K. Williams ◽  
Venu Chalasani ◽  
Linda Nott ◽  
...  
Keyword(s):  
Disease Free Survival ◽  
Cost Effective ◽  
Metastatic Renal Cancer ◽  
Free Survival ◽  
Primary Renal Cell Carcinoma ◽  
Survival Endpoints ◽  
The Cost ◽  
Theoretical Cost ◽  
Disease Free

Introduction: The cost of surveillance strategies in patients afterradical nephrectomy for localized primary renal cell carcinoma(RCC) has not been evaluated. We compared the costs of 2 differentsurveillance strategies, the new Canadian Urological Association(CUA) guidelines and the old strategy implemented in our institution. Methods: Seventy-five patients who underwent radical nephrectomyfor primary non-metastatic renal cancer were retrospectivelyreviewed. The direct cost of surveillance was determined and comparedwith the theoretical cost which would have been accruedusing the CUA guidelines. Results: Our mean follow-up was 31.1 (SD ± 20.4) months. Theoverall and disease-free survival endpoints were 87.7% and 85.2%,respectively. Total medical costs were higher for our old institutionalsurveillance strategy than the CUA guidelines ($181 861vs. $135 054). For the complete follow-up of 75 patients, a costsavingsof $46 806 could have been achieved following the CUAguidelines (p = 0.002). Of recurrences, 7 of 8 were detected by routinescreening, only 1 recurrence was identified by symptoms. Thecost per recurrence detected in our old protocol was $9 812.92.The increased cost of our institution was due to more visits withbasic testing, symptomatic investigation, and follow-up of imagingtests. The median percent cost attributable to these extra tests was15% (range 0 to 59). Conclusion: Based on our results, we endorse the new CUA surveillancestrategy in RCC follow-up as appropriate and cost effective incomparison with previous follow-up strategies used at our institution.Can Urol Assoc J 2010;4(5):322-326Introduction : Le coût associé aux stratégies de surveillance despatients ayant subi une néphrectomie radicale en raison d’un hypernéphromeprimitif localisé n’a jamais été évalué. Nous avons comparéles coûts de deux stratégies de surveillance différentes, soitles nouvelles lignes directrices de l’Association des urologues duCanada (AUC) et l’ancienne stratégie utilisée à notre établissement. Méthodologie : Soixante-quinze patients qui ont subi une néphrectomieradicale en raison d’un néphrome primitif non métastatiqueont été passés en revue de façon rétrospective. Les coûts directs dela surveillance ont été déterminés et comparés avec le coût théoriquequi aurait été comptabilisé en suivant les lignes directrices de l’AUC. Résultats : La durée moyenne du suivi était de 31,1 mois (ÉT ± 20,4).La survie globale et la survie sans maladie étaient de 87,7 % et 85,2%, respectivement. Les coûts médicaux totaux étaient plus élevés avecl’ancienne stratégie de surveillance de notre établissement par rapportaux lignes directrices de l’AUC (181 861 $ contre 135 054 $). Deséconomies de 46 806 $ auraient pu être réalisées en suivant leslignes directrices de l’AUC pour le suivi complet des 75 patients(p = 0,002). Quant aux récurrences, 7 sur 8 ont été décelées lorsde tests de routine, et une seule a été décelée par la présence desymptômes. Le coût d’une récurrence décelée selon notre ancienprotocole était de 9 812,92 $. Le coût plus élevé lié au protocole denotre établissement est attribuable à un nombre plus élevé de visitesavec épreuves de routine, vérification des symptômes et suivi desépreuves d’imagerie. Le pourcentage médian du coût attribuable àces épreuves supplémentaires était de 15 % (0 à 59 %). Conclusion : En fonction de nos résultats, nous appuyons la nouvellestratégie de surveillance de l’AUC pour le suivi des casd’hypernéphrome; cette stratégie nous semble approprié et rentableen comparaison avec les stratégies auparavant utilisées à notre

scholarly journals EPEN-49. RESPONSE OF RECURRENT EPENDYMOMA TO MEMMAT BASED METRONOMIC ANTIANGIOGENIC COMBINATION THERAPY UTILIZING TAPERED BEVACIZUMAB AND MAINTENANCE THERAPY WITH CELECOXIB AND FENOFIBRATE

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii317-iii317
Author(s):  
Eileen Gillan
Keyword(s):  
Combination Therapy ◽  
Maintenance Therapy ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Time To Progression ◽  
Free Survival ◽  
Dismal Prognosis ◽  
Recurrent Ependymoma ◽  
Disease Free

Abstract Recurrent ependymomas have a dismal prognosis (2 year survival rates 29% OS and 23% EFS) and are relatively resistant to conventional chemotherapy. We previously reported five relapsed ependymoma patients treated with a MEMMAT based metronomic antiangiogenic combination therapy. All patients are currently alive, including four patients who were multiply relapsed with at least three recurrences. These four patients received between 44–52 weeks of therapy with minimal toxicity. Three had recurrent disease within an average of 44 months (median 42 months) after discontinuation of therapy. One patient who received the following tapering bevacizumab schedule: q3 weeks x 3, q4 weeks x 4 and q5 weeks x 5 followed by maintenance therapy with fenofibrate and celecoxib is in complete remission 12 months post treatment. This regimen was well tolerated with good quality of life in this patient population. Our results suggest that the chosen anti-angiogenic drug combination prolonged the time to progression in these multiply relapsed patients and thus may be particularly beneficial for patients with recurrent ependymoma. Tapered bevacizumab and maintenance therapy with celecoxib and fenofibrate may be modifications worth further investigation for prolonged disease free survival in relapsed ependymoma patients.

scholarly journals Treatment of adult acute lymphoblastic leukemia with intensive cyclical chemotherapy: a follow-up report

Blood ◽  
1991 ◽  
Vol 78 (11) ◽  
pp. 2814-2822 ◽  
Author(s):  
CA Linker ◽  
LJ Levitt ◽  
M O'Donnell ◽  
SJ Forman ◽  
CA Ries
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Disease Free Survival ◽  
Remission Induction ◽  
Cell Phenotype ◽  
Free Survival ◽  
Prognostic Features ◽  
Adult Acute Lymphoblastic Leukemia ◽  
Disease Free

Abstract We treated 109 patients with adult acute lymphoblastic leukemia (ALL) diagnosed by histochemical and immunologic techniques. Patients were excluded only for age greater than 50 years and Burkitt's leukemia. Treatment included a four-drug remission induction phase followed by alternating cycles of noncrossresistant chemotherapy and prolonged oral maintenance therapy. Eighty-eight percent of patients entered complete remission. With a median follow-up of 77 months (range, 48 to 111 months), 42% +/- 6% (SEM) of patients achieving remission are projected to remain disease-free at 5 years, and disease-free survival for all patients entered on study is 35% +/- 5%. Failure to achieve remission within the first 4 weeks of therapy and the presence of the Philadelphia chromosome are associated with a 100% risk of relapse. Remission patients with neither of these adverse features have a 48% +/- 6% probability of remaining in continuous remission for 5 years. Patients with T-cell phenotype have a favorable prognosis with 59% +/- 13% of patients achieving remission remaining disease-free compared with 31% +/- 7% of CALLA-positive patients. Intensive chemotherapy may produce prolonged disease-free survival in a sizable fraction of adults with ALL. Improved therapy is needed, especially for patients with adverse prognostic features.

scholarly journals 306. Role of adjunct Ayurvedic treatment in increasing disease free survival and improving quality of life in cancer patients

2018 ◽  
Vol 9 (2) ◽  
pp. S13
Author(s):  
Shrinivas Datar ◽  
Swapna Kulkarni ◽  
Nilambari Patil ◽  
Amruta Salunkhe ◽  
Suchita Vaidya ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cancer Patients ◽  
Disease Free Survival ◽  
Free Survival ◽  
Ayurvedic Treatment ◽  
Disease Free

Allogeneic bone marrow transplantation for children with acute lymphoblastic leukemia in first remission: a cooperative study of the Groupe d'Etude de la Greffe de Moelle Osseuse.

1989 ◽  
Vol 7 (6) ◽  
pp. 747-753 ◽  
Author(s):  
P Bordigoni ◽  
J P Vernant ◽  
G Souillet ◽  
E Gluckman ◽  
D Marininchi ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Lymphoblastic Leukemia ◽  
Bone Marrow Transplantation ◽  
Lymphoblastic Leukemia ◽  
Allogeneic Bone Marrow Transplantation ◽  
Disease Free Survival ◽  
Allogeneic Bone ◽  
Free Survival ◽  
Disease Free

Thirty-two children ranging in age from 1.5 to 16 years with poor-prognosis acute lymphoblastic leukemia (ALL) were treated with myeloablative immunosuppressive therapy consisting of cyclophosphamide (CPM) and total body irradiation (TBI) followed by allogeneic bone marrow transplantation (BMT) while in first complete remission (CR). The main reasons for assignment to BMT were WBC count greater than 100,000/microL, structural chromosomal abnormalities, and resistance to initial induction therapy. All children were transplanted with marrow from histocompatible siblings. Twenty-seven patients are alive in first CR for 7 to 82 months post-transplantation (median, 30 months). The actuarial disease-free survival rate is 84.4% (confidence interval, 7.2% to 29%) and the actuarial relapse rate is 3.5% (confidence interval, 0.9% to 13%). Four patients died of transplant-related complications, 16 developed low-grade acute graft-v-host disease (GVHD), and six developed chronic GVHD. The very low incidence of relapse (one of 28 long-term survivors) precluded the determination of the prognostic significance of the different poor-outcome features. Moreover, two infants treated with busulfan, CPM, and cytarabine (Ara-C) relapsed promptly in the marrow. In summary, as a means of providing long-term disease-free survival and possible cure, BMT should be considered for children with ALL presenting poor-prognostic features, particularly certain chromosomal translocations [t(4;11), t(9;22)], very high WBC counts, notably if associated with a non-T immunophenotype, and, perhaps, a poor response to initial therapy with corticosteroids (CS), or infants less than 6 months of age.

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