Real-World EQ5D Health Utility Scores for Patients With Metastatic Lung Cancer by Molecular Alteration and Response to Therapy
Real-World EQ5D Health Utility Scores for Patients With Metastatic Lung Cancer by Molecular Alteration and Response to Therapy
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DOI：
10.1016/j.cllc.2016.12.015
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发表时间：
2017-07-01
影响因子：
3.6
通讯作者：
Howell, Doris
中科院分区：
文献类型：
--
作者：
Labbe, Catherine;Leung, Yvonne;Howell, Doris
转移性肺癌患者健康效用评分的临床试验以外数据有限。这项纵向队列研究在475名门诊患者中评估了EQ 5D-3L衍生的健康效用评分。携带靶向治疗稳定的驱动突变的患者的平均评分高于化疗稳定的无改变的患者。这种差异应考虑在经济分析即将到来的treatment.Introduction：经济分析即将到来的治疗肺癌受益于现实世界的健康效用评分（HUSs）在靶向治疗的时代。研究方法：玛格丽特公主癌症中心的一项纵向队列研究评估了475例不同疾病状态的转移性肺癌门诊患者中的1571例EQ 5D-3L衍生HUS。通过靶向入组，富集了表皮生长因子受体（EGFR）（n = 183）和间变性淋巴瘤激酶（ALK）（n = 38）驱动改变的患者;随机抽取了野生型非小细胞肺癌（WT NSCLC）（n = 224）和小细胞肺癌（SCLC）（n = 30）患者。结果如下：对于接受最适当治疗后病情稳定的患者，接受EGFR和ALK酪氨酸激酶抑制剂（TKI）治疗的患者的平均HUS分别为0.81和0.82（不同药物的HUS相似），高于接受化疗的WT NSCLC（0.78; P = 0.04）和SCLC（0.72; P = 0.06）患者。在突变特异性比较中，适当治疗后疾病稳定导致的平均HUS（P <0.002 - 0.02）显著高于疾病进展时的平均HUS（平均HUS：EGFR，0.70; ALK，0.69; WT NSCLC，0.66; SCLC，0.52）。当评估治疗相关毒性时，在EGFR组中观察到HUS与疲劳和食欲下降的严重程度之间存在显著的负相关关系。在EGFR突变患者和WT NSCLC患者中，临床显著症状总数与HUS之间也存在显著的负相关关系。结论：在北美环境中，转移性肺癌患者产生的HUS在携带驱动突变的经治疗的稳定患者中更高。这可以通过治疗毒性和患者症状差异部分解释。在经济分析中应考虑到这种得分差异。(C)2016 Elsevier Inc. All rights reserved.
There is limited data outside of clinical trials on health utility scores in patients with metastatic lung cancer. This longitudinal cohort study evaluated EQ5D-3L-derived health utility scores in 475 outpatients. Mean scores were higher in patients carrying driver mutations stable on targeted treatments than in patients without alterations stable on chemotherapy. Such differences should be considered in economic analyses of upcoming treatments.Introduction: Economic analyses of upcoming treatments for lung cancer benefit from real-world health utility scores (HUSs) in an era of targeted therapy. Methods: A longitudinal cohort study at Princess Margaret Cancer Centre evaluated 1571 EQ5D-3L-derived HUSs in 475 outpatients with metastatic lung cancer across various disease states. Patients with epidermal growth factor receptor (EGFR) (n = 183) and anaplastic lymphoma kinase (ALK) (n = 38) driver alterations were enriched through targeted enrolment; patients with wild-type non-small-cell lung cancer (WT NSCLC) (n = 224) and small-cell lung cancer (SCLC) (n = 30) were sampled randomly. Results: For patients stable on most appropriate treatment, the mean HUSs were 0.81 and 0.82 in patients receiving EGFR and ALK tyrosine kinase inhibitors (TKIs) respectively (with similar HUSs across agents), which were higher than patients with WT NSCLC (0.78; P = .04) and SCLC receiving chemotherapy (0.72; P = .06). In mutation-specific comparisons, disease stability on appropriate therapy resulted in significantly higher mean HUSs (P < .002-.02) than when disease was progressing (mean HUS: EGFR, 0.70; ALK, 0.69; WT NSCLC, 0.66; SCLC, 0.52). When evaluating treatment-related toxicities, significant inverse relationships were observed between HUS and the severity of fatigue and decreased appetite in the EGFR group. There was also a significant inverse relationship between the total number of clinically significant symptoms and HUS, both in patients who were EGFR-mutated and patients with WT NSCLC. Conclusions: In a North American setting, HUSs generated from patients with metastatic lung cancer are higher in treated, stable patients carrying driver mutations. This is partially explainable by treatment toxicity and patient symptom differences. Such differences in scores should be considered in economic analyses. (C) 2016 Elsevier Inc. All rights reserved.