Real‐world health utility scores and toxicities to tyrosine kinase inhibitors in epidermal growth factor receptor mutated advanced non‐small cell lung cancer

Abstract

Background As the treatment landscape in patients with non‐small cell lung cancer (NSCLC) harboring mutations in the epidermal growth factor receptor (EGFRm) continues to evolve, real‐world health utility scores (HUS) become increasingly important for economic analyses. Methods In an observational cohort study, questionnaires were completed in EGFRm NSCLC outpatients, to include demographics, EQ‐5D‐based HUS and patient‐reported toxicity and symptoms. Clinical and radiologic characteristics together with outcomes were extracted from chart review. The impact of health states, treatment type, toxicities, and clinical variables on HUS were evaluated. Results Between 2014 and 2018, a total of 260 patients completed 994 encounters. Across treatment groups, patients with disease progression had lower HUS compared to controlled disease (0.771 vs 0.803; P = .01). Patients predominantly received gefitinib as the first‐line EGFR tyrosine kinase inhibitor (TKI) (n = 157, mean‐HUS = 0.798), whereas osimertinib (n = 62, mean‐HUS = 0.806) and chemotherapy (n = 38, mean‐HUS = 0.721) were more likely used in subsequent treatment lines. In longitudinal analysis, TKIs retained high HUS (>0.78) compared to chemotherapy (HUS < 0.74). There were no differences between the frequency or severity of toxicity scores in patients receiving gefitinib compared to osimertinib; however, TKI therapy resulted in fewer toxicities than chemotherapy (P < .05), with the exception of worse diarrhea and skin rash (P < .001). Severity in toxicities inversely correlated with HUS (P < .001). Clinico‐demographic factors significantly affecting HUS included age, Eastern Cooperative Oncology Group Performance Score (ECOG PS), disease state, treatment group, and metastatic burden. Conclusions In a real‐world EGFRm population, patients treated with gefitinib or osimertinib had similar HUS and toxicities, scores which were superior to chemotherapy. Health utility scores inversely correlated with patient‐reported toxicity scores. In the era of targeted therapies, future economic analyses should incorporate real‐world HUS.

Patient Characteristics, Testing and Treatment Patterns, and Outcomes in EGFR-Mutated Advanced Non-Small Cell Lung Cancer: A Multinational, Real-World Study

“…The overall mean EQ-5D derived health utility score in this study was 0.7, which is similar to that previously reported for EGFR -TKI trial populations [ 52 , 53 ]. This suggests that patients with EGFRm + aNSCLC are generally in good health, as the score is only marginally lower than the average utility score (0.81) of the general UK population of similar age [ 54 ].…”

EGFR Targeting TKI-Related Skin Toxicities in a Patient with Darker Skin: A Case Report

“…In patients who experience severe (grade 3 or 4) rash, a change in therapy is also warranted. In fact, a recent trial found that third generation TKIs (such as osimertinib) had fewer skin toxicities than traditional first-generation TKIs [12]. In our patient, a change from gefitinib to osimertinib was initiated for this reason.…”

Evaluation of Cost-Effectiveness of Adjuvant Osimertinib in Patients with Resected EGFR Mutation-Positive Non-small Cell Lung Cancer

“…As well as the need to use other sources to extrapolate OS data, health-related quality of life assessment in the ADAURA trial did not readily support the creation of HSUVs for Canada. This was because the trial took place in many other countries; thus, HSUVs were assumed from real-world data from Canada [ 33 , 42 ].…”

“…An age-adjustment to the utility in every state was applied [ 32 ]. Literature-based health state utility values (HSUVs) for the DF and DM health states were available from Canadian real-world evidence (RWE) [ 24 , 33 ] and are used as the reference case. Utility data in ADAURA were collected in the Short Form 36 Health Survey Questionnaire (SF-36) and needed to be mapped to the EuroQoL 5-dimensions (EQ-5D) before a Canadian tariff could be applied.…”