Estimating quality adjusted progression free survival of first-line treatments for EGFR mutation positive non small cell lung cancer patients in The Netherlands

Health and Quality of Life Outcomes

Research

Merel K Langenfeld¹  Feike W van der Scheer¹  Bonne Biesma²  Anne-Marie C Dingemans³  Franz MNH Schramel⁴  S Cora Verduyn⁵  Maria A de Peuter⁵ 

[1] AstraZeneca NL, Zoetermeer, The Netherlands;Department of Pulmonology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands;Department of Pulmonology, Maastricht University Medical Center, Maastricht, The Netherlands;Department of Pulmonology, Sint Antonius Hospital, Nieuwegein, The Netherlands;Mapi Consultancy, Houten, The Netherlands;

关键词: Advanced non-small cell lung cancer;    Tyrosine kinase inhibitors;    EGFR mutation;    Gefitinib;    Quality of life;    Progression free survival;   

DOI  :  10.1186/1477-7525-10-108

 received in 2012-03-02, accepted in 2012-08-31,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundGefitinib, a tyrosine kinase inhibitor, is an effective treatment in advanced non-small cell lung cancer (NSCLC) patients with an activating mutation in the epidermal growth factor receptor (EGFR). Randomised clinical trials showed a benefit in progression free survival for gefitinib versus doublet chemotherapy regimens in patients with an activated EGFR mutation (EGFR M+). From a patient perspective, progression free survival is important, but so is health-related quality of life. Therefore, this analysis evaluates the Quality Adjusted progression free survival of gefitinib versus three relevant doublet chemotherapies (gemcitabine/cisplatin (Gem/Cis); pemetrexed/cisplatin (Pem/Cis); paclitaxel/carboplatin (Pac/Carb)) in a Dutch health care setting in patients with EGFR M+ stage IIIB/IV NSCLC. This study uses progression free survival rather than overall survival for its time frame in order to better compare the treatments and to account for the influence that subsequent treatment lines would have on overall survival analysis.MethodsMean progression free survival for Pac/Carb was obtained by extrapolating the median progression free survival as reported in the Iressa-Pan-Asia Study (IPASS). Data from a network meta-analysis was used to estimate the mean progression free survival for therapies of interest relative to Pac/Carb. Adjustment for health-related quality of life was done by incorporating utilities for the Dutch population, obtained by converting FACT-L data (from IPASS) to utility values and multiplying these with the mean progression free survival for each treatment arm to determine the Quality Adjusted progression free survival. Probabilistic sensitivity analysis was carried out to determine 95% credibility intervals.ResultsThe Quality Adjusted progression free survival (PFS) (mean, (95% credibility interval)) was 5.2 months (4.5; 5.8) for Gem/Cis, 5.3 months (4.6; 6.1) for Pem/Cis; 4.9 months (4.4; 5.5) for Pac/Carb and 8.3 (7.0; 9.9) for gefitinib.ConclusionsIn the Dutch health care setting, the previously established progression free survival benefit of first-line gefitinib in advanced NSCLC EGFR M+ patients in comparison to standard doublet chemotherapy is further supported by the Quality Adjusted PFS, which takes into account the additional health-related quality of life benefits of gefitinib over doublet chemotherapy.

【 授权许可】

Unknown   
© Verduyn et al.; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.