BM-19 * SYMPTOMATIC AND ECONOMIC BURDEN OF BRAIN METASTASES IN PATIENTS WITH ALK+ NSCLC

Abstract

BACKGROUND: Brain is one of the most common sites of metastasis in anaplastic lymphoma kinase positive (ALK+) locally advanced or metastatic non-small cell lung cancer (NSCLC). This study investigated symptoms and costs of ALK+ NSCLC patients before and after brain metastases (BM) as well as their treatment changes. METHODS: Retrospective data from 3 large US administrative databases (06/2011 to 06/2013) were evaluated. ALK+ NSCLC patients with BM were identified based on the use of crizotinib and diagnoses for secondary malignant brain tumors. Symptoms and costs were analyzed pre and post BM diagnosis (30 days before the first BM diagnosis). RESULTS: Among 213 ALK+ NSCLC patients with BM 70.4% had BM before initiating crizotinib, 19.2% were diagnosed with BM during crizotinib, and 10.3% after crizotinib. The frequency of BM-related symptoms post BM increased compared to pre BM, including fatigue (from 15% to 39%), headache (from 5% to 24%), depression (from 5% to 15%), altered mental status (from 1% to 13%), seizure (from 1% to 12%), stroke (from 0% to 10%), vision disorder (from 2% to 8%), drowsiness (from 0% to 6%), cognitive impairment (from 1% to 5%), and speech problems (from 0% to 4%). Average medical costs per patient per month were 5 times higher post BM compared to pre BM ($13,095 vs $2,517; p < .001), while pharmacy costs were more than 3 times higher post BM compared to pre BM ($7,213 vs $1,958; p < .001). The difference of medical costs was due to increases in inpatient costs ($6,677 vs $851) and outpatient costs ($5,863 vs $1,600), which were mainly related to radiotherapy or radiosurgery ($2,371 vs $410). CONCLUSIONS: BM presents a substantial symptomatic and economic burden in patients with ALK+ NSCLC. Given the large percentage of ALK+ NSCLC patients who will eventually develop BM, this highlights an important unmet need.