Treatment, overall survival, and costs in patients with ALK-positive non-small-cell lung cancer after crizotinib monotherapy

Abstract

Background:

Limited post-crizotinib treatment options for ALK-positive non-small cell lung cancer (NSCLC) might lead to poor survival and high economic burden.

Objective:

To evaluate real-world treatment patterns, overall survival (OS), and costs following crizotinib discontinuation.

Methods:

This study used chart review and claims data. First, 27 participating US oncologists reviewed medical records of ALK-positive NSCLC patients who discontinued crizotinib monotherapy and reported patient demographic and clinical information, including post-crizotinib treatment and mortality. OS was estimated using Kaplan–Meier analyses. Second, three large administrative US claims databases were pooled. NSCLC patients were selected if they discontinued crizotinib monotherapy. Post-crizotinib costs were analyzed separately for patients who did or did not discontinue antineoplastic treatment after crizotinib monotherapy. All data were collected prior to ceritinib approval for this patient population.

Results:

A total of 119 ALK-positive NSCLC patients discontinued crizotinib monotherapy. Upon discontinuation, 42% had no additional antineoplastic treatment and 13% received radiation therapy only. The median OS post-crizotinib was 61 days; patients with brain metastases had shorter OS than those who did not (44 vs. 69 days, P = 0.018), and patients without further antineoplastic treatment had shorter OS than those who did (17 vs. 180 days, P < 0.001). From claims data, 305 ALK-positive NSCLC patients discontinued crizotinib monotherapy. After discontinuation, 72% had no additional antineoplastic treatment. Among patients who continued antineoplastic treatment, monthly healthcare costs averaged $22,160, driven by pharmacy ($9202), inpatient ($6419), and outpatient radiotherapy ($2888) and imaging ($1179) costs. Among patients who discontinued any antineoplastic treatment, monthly healthcare costs averaged $3423, mostly driven by inpatient costs ($2074).

Conclusions:

After crizotinib monotherapy, most patients either received radiotherapy only or discontinued antineoplastic treatment altogether. OS after discontinuing crizotinib was poor and shorter among those with brain metastases than without, and among those without subsequent antineoplastic treatment than with. Patients who continued antineoplastic treatment incurred substantial healthcare costs.

Keywords: :

• Anaplastic lymphoma kinase
• Carcinoma, non-small-cell lung
• Economic burden of disease
• Lung neoplasms
• Protein kinase inhibitor
• Survival

Transparency

Declaration of funding

This study was supported by Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.

Author contributions: All authors participated in the design of the study. A.G., K.D., R.N., P.G., and A.R.M. conducted analyses. A.G., M.S., H.W., J.Z., K.C., K.D., R.N., P.G., and A.R.M. have interpreted results. All authors contributed to manuscript development.

Declaration of financial/other relationships

A.G., K.D., R.N., P.G., and A.R.M. have disclosed that they are employees of Analysis Group Inc., a company that has received consulting fees from Novartis Pharmaceuticals Corporation. M.S., J.Z., and K.C. have disclosed that they are employees of Novartis Pharmaceuticals Corporation. H.W. has disclosed that she has received research support from Novartis Pharmaceuticals for the conduct of clinical trials but was not compensated for efforts on this project.

CMRO peer reviewers on this manuscript have no relevant financial relationships to disclose.

Acknowledgments

We would like to thank Ana Bozas and Junlong Li, employees of Analysis Group Inc., who contributed to the preparation and editing of the manuscript.