MA08.01 Phase 3 Trial of Whole Brain Radiotherapy with Concurrent Erlotinib Versus WBRT Alone for NSCLC with Brain Metastases (ENTER)

Abstract

trials conversation with their provider. Patients who had not started treatment or were on first-line treatment reported lower discussion rates (30%) than those on later treatment lines (60%). Among patients with follow up, 13 of 20 patients who had not discussed trials with their provider reported doing so after navigation. Ten of eleven patients that had a previous trial conversation initiated an additional one. Primary reasons given for not talking discussing after navigation were having stable disease on a current treatment or waiting for a clinical result. Ten patients reported contacting a trial. Primary reasons for not contacting a trial after discussion were disease progression, choosing a standard of care alternative, or waiting for a clinical result. Four patients have enrolled on a trial. Two patients were determined ineligible for a trial they approached for not meeting listed eligibility criteria and two for reasons not appearing in public trial information. Conclusion: We identified barriers throughout the clinical trials consideration and enrollment process. One set of barriers was related to care coordination, as exemplified by low rates of trial discussion during early stages of treatment and patient reports of delayed trial consideration when currently receiving treatment or waiting on a clinical result. Communication of trial information was another area presenting barriers, as exemplified by exclusion of patients from trials for reasons not readily apparent from public trial information. Improving integration of trial discussion during care and ensuring availability of accurate, updated trial information may be essential to increase trial participation.Background: In our recent decade we are seen new drugs coming up with high speed development to attend personalized conditions in lung cancer treatment. After the first TKI for EGFR mutation, many other target drugs such as TKI for ALK/ROS1 alteration, third-generation EGFR TKI, anti-PD-1/PD-L1 immunotherapies bring together an improvement in survival with better quality of life than chemotherapies. But this new specialty drugs are also testing the affordability of the market with new launched ceiling prices. Frequently, their prices have been settled down in a context of an unmet condition appeal rather than the truly health benefits. In pricing it is a common practice to use the external reference price between countries to align the prices based on international market. But if the first price is launched (frequently in USA) in countries that don't use metrics based on evidence or clinical benefits, the price plateau could be replicated even without necessarily deserving this price. The objective of this presentation is to show the price comparison of drugs included in TKI class and immunotherapy class between high and middle-income countries. Then to compare the cost-treatment of therapies commonly used in advanced lung cancer and their magnitude of clinical benefit. Method: All local currencies were converted to US dollars using PPP factor. ...

Treatment modes for EGFR mutations in patients with brain metastases from non-small cell lung cancer: controversy, causes, and solutions

“…Interestingly, Professor Wu's AURA3 study on brain metastases published in the Journal of Clinical Oncology in 2018 (25) showed that in the osimertinib group, brain radiotherapy treatment within six months before osimetinib was associated with longer survival compared to no brain radiotherapy. At the World Congress on Lung Cancer 2018 (26), a clinical study compared TKI with brain radiotherapy, and the results showed that TKI combined with WBRT did not benefit patients when compared with WBRT alone. The negative results poured cold water on targeted therapy combined with brain radiotherapy in the era of TKI.…”