Costs and hazard ratios of commonly used drugs in advanced/metastatic lung cancer at Cancer Free Foundation, Dana Point, California.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20508-e20508
Author(s):  
Helmy M. Guirgis
Keyword(s):  
Lung Cancer ◽  
Death Receptor ◽  
Metastatic Lung Cancer ◽  
Net Benefit ◽  
Cancer Society ◽  
Flat Dose ◽  
Hazard Ratios ◽  
Metastatic Lung ◽  
Death Receptor Ligand ◽  
One Year

e20508 Background: The American Cancer Society of Clinical Oncology used hazard ratios (HR) in its value framework as indicators of clinical response. Bevacizumab (Bev) and Pemetrexed (Peme) were introduced for non-squamous metastatic lung cancer prior to epidermal growth factor recognition. Objective: Analyze drug costs and HR in 1st-line advanced/metastatic lung cancer. Methods: Costs of Bev, Peme, Pembrolizumab (Pembro) and Atezolizumab (Atezo) were calculated x one year. Protocols and HR at 95% confidence intervals were quoted. Results: Median drug HR was 0.73. Bev costs were $132,314 and HR 0.79 (A. Sandler, 2006). Peme costs were $97,947, HR 0.63 (M. Zuchin, 2013) and 0.78 (PARAMOUNT). Costs of Pembro 2mg/Kg x 80 Kg were $125,770 compared with $157,313, the currently used 200 mg flat dose. Proportionate savings were noted over the 90-50 Kg weight. Pembro costs x 35 cycles increased to $317,450. In tumor progression score (TPS) > 50% (KEYNOTR-24), Pembro HR was 0.60. In KEYNOTE-042, HR in > 1.0% was 0.81 and improved to 0.69 in 50% with a net benefit of 14%. In squamous cell (KEYNOTE-407), Pembro+chemo HR was 0.64. Pembro+Peme+chemo costs were $255,160. In KEYNOTE-189, irrespective of program death receptor-ligand-1 (PD-L1), HR was 0.49, < 1.0% 0.59 and > 50% 0.42. The net benefit was 28%. Atezo+Bev combination costs were $287,314 and HR 0.78 (IMPOWER 150). In extensive small-cell, Atezo+chemo costs were $150,604 and HR 0.70 (IMPOWER 133). Conclusions: Pembro weight-adjusted dose resulted in significant cost saving over the fit-all 200mg. In 1st-line advanced/metastatic lung cancer, Pembro-Peme, irrespective of PD-L1, offered incomparable 0.49 HR at yearly costs of $255,160.

Costs of extended immune check point inhibitors treatment in advanced/metastatic lung cancer: Bundling of costs proposal.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e21738-e21738
Author(s):  
Helmy M. Guirgis
Keyword(s):  
Lung Cancer ◽  
Check Point ◽  
Metastatic Lung Cancer ◽  
Probability Of Survival ◽  
Hazard Ratios ◽  
Metastatic Lung ◽  
Check Point Inhibitors ◽  
One Year ◽  
The One ◽  
The Cost

e21738 Background: Pembrolizumab (Pembro) demonstrated remarkable 5-year overall survival (OS) and hazard ratios (HR) in 1st-line advanced/metastatic lung cancer (amLC) lacking EGFR and ALK alterations. After 35 cycles or 2 years, there is no consensus on whether to continue or stop the immune check point inhibitors (ICI). In contrast to ICI receiving no cost adjustment, CAR T-cell were contained at $375,000-$400,000. Probability of survival (PoS) was previously expressed as (1.0- HR) and used as surrogates of outcome. Our objective was to weigh ICI costs at one year and beyond vs PoS. Methods: Costs of Durvalumab (Durv) 10mg/Kg iv were calculated in US dollars q2 weeks. Pemetrexed (Peme) 500 mg/m2, Atezolizumab (Atezo) 1200 mg and Pembro 200 mg were computed q3 weeks. HR at the 95% confidence levels were quoted and PoS calculated. Results: The average ICI yearly-costs were $153,053, increasing annually by 2-4%. Peme were $108.108 and PoS 0.22. One-year adjuvant Durv in unresectable stage III were $145,808 at PoS 0.47. Pembro were $157,213 and PoS 0.40 in PD-L1 > 50%. Pembro costs beyond 5-years exceeded $786,065. Pembro- Peme-carboplatin in non-squamous histology were $265,321. PoS was 0.41 in PD-L1 < 1% and 0.58 in > 50%. Atezo+Bev 4-drug-costs were higher at $389,134 with modest 0.22 PoS. Setting mono-theray ICI yearly-costs at $160,000, one patient treated for 3 years would pay $480,000. Bundling costs at $400,000-$450,00 would save $30,000-$80,000. Savings would multiply with further years of extension. Conclusions: At 0.47 PoS, the one-year cost of adjuvant Durv was worth the dollars spent. The runaway ICI costs beyond 2 years would support the cost bundling proposal.

Costs comparison of the immune check point inhibitors versus survival ratio in first-line non-small lung cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21050-e21050
Author(s):  
Helmy M. Guirgis
Keyword(s):  
Lung Cancer ◽  
Death Receptor ◽  
Survival Ratio ◽  
Check Point ◽  
First Line ◽  
Unresectable Stage ◽  
Programmed Death ◽  
Check Point Inhibitors ◽  
Death Receptor Ligand ◽  
One Year

e21050 Background: Five-year overall survival (OS) was reported in 20% of patients treated by Pembrolizumab (Pembro) in 1st-line advanced/metastatic (a/m)-non-small lung cancer (nsLC). Costs of the immune check point inhibitors (ICI) are relatively high and bound to increase with extended use. We purposed to weigh and compare costs of ICI vs outcome. Methods: OS, hazard ratio (HR) and survival ratio (SR) defined as (1.0-HR) were used. Chemo-drug excluded; costs were calculated in US$. Results: Adjuvant Durv one-year costs in unresectable stage III were $130,956, OS gain 363 days and SR 0.47. Pembro one-year costs were $134,778. OS were 474 and SR 0.37 in programmed death receptor-ligand-1 > 50%. At 5 years, costs were $673,890. Costs of 35-cycle Pembro combination were $336,945, OS 339 and SR 0.51. Costs increased with extended use. Atezolizumab/Bevacizumab-combination (Atezo/Bev) costs x 2-years were $492,114, OS 135 and SR 0.22. Using Biosimilar Bev costs dropped to $429,744. Ipilimumab/Nivolumab (Ipi/Nivo) costs x 2 were $544,696, OS 141 and SR 0.34. Costs of both Atezo/Bev and Ipi/Nivo increased by 50% with one year of extended use. Costs of Pembro-combination were 0.78 lower than Atezo/Bev and 0.62 than Ipi/Nivo. Pembro SR were 2.32 higher than Atezo/Bev and 1.65 than Ipi/Nivo. Absence of direct comparison, however, cast doubts on Pembro advantage. Conclusions: Costs of one-year adjuvant Durv, 3-year Pembro and 35-cycle Pembro-combination were considered fair and equitable with their corresponding SR. Pembro-combination costs were cheaper than Atezo/Bev and Nivo/Ipi. Costs of all drugs and combinations multiplied with extended use.

Sleep Disturbances in Metastatic Lung Cancer

2019 ◽  
Author(s):  
M. Kaous ◽  
D.D. Balachandran ◽  
G. Pacheco ◽  
S.A. Mahoney ◽  
J.N.T. Po ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Sleep Disturbances ◽  
Metastatic Lung Cancer ◽  
Metastatic Lung

scholarly journals Patients with Metastatic Lung Cancer and Oncologists’ Views on Achievement of Treatment Goals and Making the Right Treatment Decision: A Prospective Multicenter Study

2021 ◽  
pp. 0272989X2199895
Author(s):  
Adinda Mieras ◽  
Annemarie Becker-Commissaris ◽  
Hanna T. Klop ◽  
H. Roeline W. Pasman ◽  
Denise de Jong ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Multicenter Study ◽  
Systemic Treatment ◽  
Treatment Decision ◽  
Treatment Goals ◽  
Metastatic Lung Cancer ◽  
Prospective Multicenter Study ◽  
Cancer Data ◽  
Metastatic Lung ◽  
The Right

Background Previous studies have investigated patients’ treatment goals before starting a treatment for metastatic lung cancer. Data on the evaluation of treatment goals are lacking. Aim To determine if patients with metastatic lung cancer and their oncologists perceive the treatment goals they defined at the start of systemic treatment as achieved after treatment and if in hindsight they believe it was the right decision to start systemic therapy. Design and Participants A prospective multicenter study in 6 hospitals across the Netherlands between 2016 and 2018. Following systemic treatment, 146 patients with metastatic lung cancer and 23 oncologists completed a questionnaire on the achievement of their treatment goals and whether they made the right treatment decision. Additional interviews with 15 patients and 5 oncologists were conducted. Results According to patients and oncologists, treatment goals were achieved in 30% and 37% for ‘quality of life,’ 49% and 41% for ‘life prolongation,’ 26% and 44% for ‘decrease in tumor size,’ and 44% for ‘cure’, respectively. Most patients and oncologists, in hindsight, felt they had made the right decision to start treatment and also if they had not achieved their goals (72% and 93%). This was related to the feeling that they had to do ‘something.’ Conclusions Before deciding on treatment, the treatment options, including their benefits and side effects, and the goals patients have should be discussed. It is key that these discussions include not only systemic treatment but also palliative care as effective options for doing ‘something.’

Surgical treatment of cerebral metastases from lung cancer

1971 ◽  
Vol 35 (4) ◽  
pp. 416-420 ◽  
Author(s):  
Edwin E. MacGee
Keyword(s):  
Lung Cancer ◽  
Surgical Treatment ◽  
Operative Mortality ◽  
Cerebral Metastases ◽  
Cerebral Metastasis ◽  
Metastatic Lung Cancer ◽  
Content Type ◽  
Intracranial Surgery ◽  
Metastatic Lung ◽  
Fine Print

✓ Results in 27 cases of intracranial surgery for metastatic lung cancer are evaluated with regard to both the quality and duration of survival; 56% of the patients lived more than 1 year, with the longest survivor still living 32 months after operation. The operative mortality was 26%. These data suggest that intracranial surgery is worthwhile in patients with lung cancer when the cerebral metastasis is either solitary or single.

Nanomedicine as an emerging platform for metastatic lung cancer therapy

2015 ◽  
Vol 34 (2) ◽  
pp. 291-301 ◽  
Author(s):  
Dalit Landesman-Milo ◽  
Srinivas Ramishetti ◽  
Dan Peer
Keyword(s):  
Lung Cancer ◽  
Cancer Therapy ◽  
Metastatic Lung Cancer ◽  
Metastatic Lung ◽  
Lung Cancer Therapy
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