Expanding the usage of osimertinib as adjuvant therapy for <i>EGFR</i>-mutated NSCLC: a model-based assessment of its impact on reducing cancer mortality in Russia

Abstract

Introduction. Platinum-based chemo have long been the only option for adjuvant therapy after tumor resection in early-stage NSCLC. Osimertinib is EGFR tyrosine kinase inhibitor which demonstrated efficacy as adjuvant therapy in patients with NSCLC.Aim. To evaluate the effects of expanding the use of osimertinib as adjuvant therapy for EGFR+ NSCLC on reducing cancer mortality in Russia.Materials and methods. According to the ADAURA clinical trial, osimertinib has shown a significant reduction in the risk of recurrence or death, with hazard ratio of 0.17 and a 99% confidence interval of 0.11–0.26, p < 0.001. However, long-term overall survival data is not yet available in the literature. To evaluate the potential benefits of osimertinib as an adjuvant therapy for EGFR+ NSCLC, a model was proposed, which aims to describe the time to recurrence and overall survival of patients over a 10-year horizon, with or without use of osimertinib. We also evaluated the additional costs associated with expanding the use of osimertinib for this particular indication.Results. In Russia, the use of osimertinib as an adjuvant therapy for NSCLC has the potential to benefit approximately 1 280 patients annually. Currently, around 450 patients are already receiving osimertinib as adjuvant therapy, leaving room for an additional 830 patients to be considered for this treatment option. If all eligible patients receive osimertinib, it is estimated that there could be a reduction of 683 cancer-related deaths over a span of 10 years. The long-term effects of osimertinib are particularly noteworthy, as they can positively impact the proportion of patients registered for five or more years by an increase of 0.006 percentage points, and among lung cancer patients by 0.231 percentage points. The additional costs associated with this expansion are estimated at 2.2 billion rubles per year.Conclusions. The use of osimertinib as an adjuvant therapy for EGFR+ NSCLC has a significant and quantifiable impact on reducing cancer-related mortality in Russia.