PD-1 Treatment in Progressed NSCLC Associated With Cost Increase, Limited Benefit
Immunotherapy treatment past progression for patients with advanced lung cancer may account for 29% of total treatment costs, without clear value for most patients, according to a presentation at the ASCO-SITC Clinical Immuno-Oncology Symposium (January 25-27, 2018; San Francisco, CA).
PD-1 inhibitors have become standard of care in the treatment of patients with advanced non-small cell lung cancer (NSCLC). Prior research has shown immunotherapy agents to improve survival with less toxicity compared with chemotherapy agents. However, response patterns to PD-1 inhibitors may be unconventional and identifying disease progression using RECIST has been challenging.
Mor T Moskovitz, MD, and colleagues conducted a study to explore treatment past progression with PD-1 inhibitors and its impact on patient symptoms and costs. The retrospective analysis included 89 patients with advanced NSCLC who received single agent PD-1 inhibitors at the Princess Margaret Cancer Center (Toronto, Canada) between 2013 and 2017.
Patient symptom burden was evaluated by Edmonton Symptom Assessment Scale (ESAS) at outpatient clinics. Drug acquisition costs were calculated using hospital-based costs for the agents used and both actual and fixed dosing recommendations.
Researchers noted that approximately 70% of patients developed disease progression during treatment while 19% stopped due to toxicity. A total of 21 patients received treatment past progression (23% of entire cohort, 34% of those with progression). Patients more likely to receive treatment past progression were younger patients (P = .046), those with lower symptom burden upon RECIST progression (mean ESAS, 14.7 vs 27.2 for patients not receiving treatment past progression; P = .013), and greater symptom improvement from baseline (mean ESAS change, -11.7 vs -2.3, respectively; P = .11). Only one patient receiving treatment past progression achieved tumor response, researchers noted.
Importantly, researchers acknowledged that treatment past progression represented 29% of the total treatment costs and did not vary significantly between weight-based and fixed dosing. Cost of treatment of the entire cohort was 23% higher using fixed dosing compared with weight-based.
Dr Moskovitz and colleagues concluded that while treatment with immunotherapy beyond progression is common in advanced NSCLC, patient benefit is rare and can lead to substantial expenditure without clear value for most patients. “Better methods for detecting early failure of immunotherapy in advanced NSCLC are needed, to allow patients to switch to more active treatment,” they wrote.—Zachary Bessette