Lung Cancer In France Research Articles

Impact of pembrolizumab treatment duration on overall survival and prognostic factors in advanced non-small cell lung cancer: a nationwide retrospective cohort study

The efficacy of front-line pembrolizumab has been established in studies that limit treatment duration to 2 years, but decision to stop pembrolizumab after 2 years is often at physician's discretion. ATHENA is a retrospective cohort study using a comprehensive administrative database aimed firstly at exploring the optimal duration of pembrolizumab and secondly real-life prognosis factors in patients with advanced non-small cell lung cancer (NSCLC). Using the French National Health Insurance database (SNDS), we identified patients with incident lung cancer in France from 2015 to 2022. Treatments and patients' characteristics were extracted or inferred from hospital, outpatient care, pharmacy delivery reports. The duration's hazard ratio (HR) was estimated with Cox model weighted by inverse of propensity score to account for confounding. Prognostics factors in first line population were identified with Cox model selected by a LASSO procedure. 391,106 patients with lung cancer were identified, of whom 43,359 received up-front pembrolizumab for an advanced disease. There were 67% (29,040/43,359) of male and the median age at diagnosis was 65 years old. After a median follow-up time of 25.9 months (min-max, [0-97.6]), the median overall survival (OS) after pembrolizumab initiation in first line was 15.7 [CI 95, 15.3-16.0] months. In multivariable analysis, several covariables were independently associated with worse OS, including male sex with chemo-immunotherapy, age, hospital category, high deprivation index, inpatient hospitalization for first pembrolizumab, and history of diabetes, diuretic, beta blocker, painkiller prescription. At landmark time of 29 months after pembrolizumab initiation, continuation beyond 2 years was not associated with better OS than a fixed 2-year treatment, HR=0.97 [0.75-1.26] p=0.95. This study supports the notion that stopping pembrolizumab after 2 years could be safe for patients with advanced NSCLC. However, because observational studies are prone to confounding and selection bias, causality cannot be affirmed. This study did not receive any specific grant.

170P Change in the epidemiology and costs of metastatic lung cancer in France between 2013 and 2021: Observational study using the SNDS

170P Change in the epidemiology and costs of metastatic lung cancer in France between 2013 and 2021: Observational study using the SNDS

Mortality and failure-to-rescue major complication trends after lung cancer surgery between 2005 and 2020: a nationwide population-based study

ObjectivesTo estimate the evolution of quality indicators (30-day mortality and failure-to-rescue) inpatients who underwent lung cancer surgery in France over the past 15 years and to study the potential influencing...

Access to innovation through clinical trials and the national early access program for patients with lung cancer in France: focus on atezolizumab and durvalumab.

Tumor genomic profiling and PD-L1 testing mean lung cancer management can be tackled through a personalized approach. Targeted therapies and immunotherapy are necessary to improve survival and preserve the patients' quality of life. Early access to innovation before marketing authorization (MA) is possible in France through clinical trials and an early-access program called a Temporary Authorization for Use (ATU), which is a unique regulatory system in Europe. This study aims to assess the impact of early access to innovation through clinical trials and ATUs in thoracic oncology. Data from clinical trials between 2018 and 2021 and ATUs between 2005 and 2019 were collected internally and assessed for drugs in thoracic oncology, with specific focus on 2 ATUs, respectively, atezolizumab and durvalumab. From 2018 to 2021, the National Agency for the Safety of Medicines and Health Products authorized 145 clinical trials in lung cancer. Between 2005 and 2019, 19 drugs obtained an EU MA or an MA extension for a therapeutic indication in lung cancer. During this period, 11 of these drugs were granted an ATU, corresponding to 6851 patients treated. Of this total number of patients, data were collected for 33.1% and 71.2%, who received durvalumab and atezolizumab, respectively. Real-life efficacy data were consistent with the clinical trial data. Over the past 15years, clinical trials and the French early access program have allowed considerable early access to therapeutic innovation in real life for patients, especially in thoracic oncology.

Diffusion of Minimally Invasive Approach for Lung Cancer Surgery in France: A Nationwide, Population-Based Retrospective Cohort Study

Background. The minimally invasive approach (MIA) has gained popularity thanks to its efficacy and safety. Our work consisted of evaluating the diffusion of the MIA in hospitals and the variability of this approach (within and between regions). Methods. All patients who underwent limited resection or lobectomy for lung cancer in France were included from the national hospital administrative database (2013–2020). We described between-hospital differences in the MIA rate over four periods (2013–2014, 2015–2016, 2017–2018, and 2019–2020). The potential influence of the hospital volume, hospital type, and period on the adjusted MIA rate was estimated by a multilevel linear regression. Results. From 2013 to 2020, 77,965 patients underwent a lobectomy or limited resection for lung cancer. The rate of the MIA increased significantly over the four periods (50% in 2019–2020). Variability decreased over time in 7/12 regions. The variables included in the multilevel model were significantly related to the adjusted rate of the MIA. Variability between regions was considerable since 18% of the variance was due to systematic differences between regions. Conclusions. We confirm that the MIA is part of the surgical techniques used on a daily basis for the treatment of lung cancer. However, this technology is mostly used by surgeons in high volume institutions.

Is there variation between hospitals within each region in postoperative mortality for lung cancer surgery in France? A nationwide study from 2013 to 2020.

The practice of thoracic surgery for lung cancer is subject to authorization in France. We evaluated the performance of hospitals using 30-day post-operative mortality as a quality indicator, estimating its distribution within each region and measuring its variability between regions. All data for patients who underwent pulmonary resection for lung cancer in France (2013-2020) were collected from the national hospital administrative database. Thirty-day mortality was defined as any patient who died in hospital (including transferred patients) within the first 30 days after the operation and those who died later during the initial hospitalization. The Standardized Mortality ratio (SMR) was the smoothed, adjusted, hospital-specific mortality rate divided by the expected mortality. To describe the variation in hospital mortality between hospitals in each region, we used different commonly used indicators of variation such as coefficients of variation (CV), interquartile interval or range (IQR), extreme ratio, and systematic component of variance (SCV). In 2013-2020, 87,232 patients underwent lung resection for cancer in France. The number of deaths was 2,537, a rate of 2.91%. The median SMR of 199 hospitals was 0.99 with an IQR of 0.86 to 1.18 and a CV of 0.25. Among the regions that had the most hospitals performing lung resections for cancer, the extreme ratio was >2, which means that the maximum value is twice as high as the minimum value. The SCV between hospitals was >10 for two of these regions, which is considered indicative of very high variation. For the other regions (with few hospitals performing lung resections for cancer), the variation between hospitals was lower. Globally, the variability between regions concerning the SMR was moderate, 6% of the variance was due to differences across regions. On the contrary, the hospital volume was significantly related to the SMR (p = 0.003) with a negative linear trend, whatever the region. This work shows significant differences in the practices of the various hospitals within regions. However, overall, the variability in the 30-day mortality rate between regions was moderate. Our findings raises questions regarding the regionalization of major surgical procedures in France.

EPH129 Hospitalizations for Chemotherapy-Induced Febrile Neutropenia in Patients With Lung Cancer in France From 2017 to 2020

EPH129 Hospitalizations for Chemotherapy-Induced Febrile Neutropenia in Patients With Lung Cancer in France From 2017 to 2020

1-year mortality in lung cancer in France according to key timepoints of care pathways.

It is unclear whether delays in care affect prognosis of patients with lung cancer. The primary objective of this study was to describe the care pathway of patients diagnosed with lung cancer in a French region. Secondary objectives were to identify markers associated with 1) time from imaging to treatment and 2) with 1-year survival. In a retrospective cohort study, clinical data from multidisciplinary team meetings for all incident lung cancer cases discussed in 2018 in one French region were matched with medico-administrative data from the National Health Insurance Database. Care pathway time intervals were estimated for small cell lung cancer (SCLC), resected nonsmall cell lung cancer (NSCLC) and unresected NSCLC. Factors associated with delay in the care pathway were identified using linear regression; 1-year survival was analysed using Cox modelling. A total of 685 patients were included. Median time between imaging and treatment was 49 days (interquartile range: 33-73), and was lower in cases of metastatic disease, SCLC and private care. At 1 year, 48% had died (resected NSCLC 12%). In unresected NSCLC, time from diagnostic imaging to first treatment <49 days was associated with a higher risk of death. Time intervals were similar in patients with squamous cell carcinoma versus adenocarcinoma or undifferentiated carcinoma. Time intervals in the care pathways of lung cancer were similar to previous reports, confirming the robustness of retrospective databases. In unresectable NSCLC, rapid care was not associated with better survival.

Long-term hospital resource utilization and associated costs of care for patients initiating nivolumab in advanced non-small cell lung cancer in France

Objectives In advanced cancers, healthcare resource utilization (HCRU) and costs usually increase until death. However, few studies have measured HCRU over time in patients treated with immunotherapies. The objective was to describe the evolution of HCRU and costs over four years for patients with advanced non-small cell lung cancer (aNSCLC) initiating nivolumab. Materials and methods Based on the French hospital reimbursement database, all aNSCLC patients initiating nivolumab in the 2nd line or later in 2015 or 2016 were followed until 2019. HCRU (including hospitalizations and hospital visits) and costs (payer perspective) were described annually after nivolumab initiation. Trends in HCRU were analyzed with the Mann-Kendall test. As most patients did not reach the four-year follow-up, cost-analysis was performed without adjustment throughout, without adjustment in uncensored cases only or with adjustment using for all patients using the Bang&Tsiatis method. Results 10,452 patients initiating nivolumab were evaluated. The percentage of patients hospitalized or with hospital visits decreased (p < .001) over the four-year follow-up with the exception of consultations. The number of hospital visits per patient decreased from 23.3 in Y1 to 13.2 in Y4 without adjustment and 18.3 with adjustment (p < .001). The overall hospitalization duration per patient (days) decreased from 36.0 (Y1) to 14.9 (Y4-unadjusted) and 20.5 (Y4-adjusted) (p < .001). Annual per capita costs also decreased. The method without adjustment provided the lowest cost over time (€44,404 (Y1), €32,206 (Y2); €28,552 (Y3); €18,841(Y4)) while the Bang&Tsiatis method presented the highest cost (€45,002 (Y1), €36,330 (Y2); €35,080 (Y3); €28,931 (Y4)). Conclusion HCRU and costs for NSCLC patients treated with nivolumab decreased over time. Cost estimates are dependent on the statistical method used to take into account uncertainty, but costs decreased over time whatever the method used.

Risk factors for early mortality of lung cancer patients in France: A nationwide analysis.

Despite therapeutic advances, lung cancer remains the first cause of death from cancer. The main objective of this study was to identify risk factors associated with death within 3-months of the first hospitalization for lung cancer in France. This analysis included patients with a first hospitalization for lung cancer (between January 1, 2016 and December 31, 2018) according to diagnosis-related groups entered into the French national medical-administrative database. Clinical and socioeconomic parameters and characteristics of that first hospitalization were analyzed. A model predictive of early mortality was developed based on those variables. The 144,087 included patients were 67% men; median age of 68 [interquartile range 60-76] years; 47% had metastatic disease at diagnosis; and 34% and 23%, respectively, had received systemic treatment or undergone curative surgery. The 3-month mortality was 19%, and significantly higher for those ≥70 versus <70 years old (OR 1.33, 1.22-1.45), men versus. women (OR 1.50, 1.44-1.55), those with metastatic disease at diagnosis (OR, 3.30, 3.18-3.43), first hospitalization via the emergency room (OR 1.65 1.59-1.71) and first hospitalization lasting >30 days (OR, 1.58 1.49-1.68). In contrast, no socioeconomic characteristic was associated with early mortality. Almost 1 in 5 patients diagnosed with lung cancer in France died within 3months post-diagnosis. Improving survival requires diagnosis at an earlier stage and better organization of diagnosis and specific care pathways.

Brief Report on Teleconsultation in Lung Cancer: Toward a Semiotic Paradigm Shift?

IntroductionTelehealth is taking an increasingly important part of medicine. This practice change is being accelerated by the pandemic linked to coronavirus disease 2019. Oncology is a medical specialty for which this paradigm shift is particularly relevant. MethodsWe developed a survey aiming at evaluating the use of teleconsultation by physicians managing patients with lung cancer in France. The survey was available online from December 15, 2020, to February 10, 2021. ResultsAnswers were obtained from 142 clinicians (73.9% pneumologists, 18.3% medical oncologists, and 7.7% with another specialty), 129 (90.8%) of whom had already performed teleconsultation. Among those, 123 (95.3%) started after the coronavirus disease 2019 pandemic. In addition, 72.9% had a moderate usage of this tool (<10 teleconsultations/mo). The frequency of clinicians never using teleconsultation was higher in private practices (p = 0.029). The two clinical situations for which teleconsultation was frequently used were visits during treatment without imaging assessment (53.5%) and post-treatment surveillance (80.3%). Depending on the type of treatment received, the frequency of teleconsultation was variable. Lung cancer subtype also affected the clinician's practice. Indeed, 47.2% never proposed this tool for SCLC. Teleconsultation was considered to be of no contribution, a moderate contribution, a significant contribution, or a revolution of the clinical practice for 14.1%, 66.2%, 10.6%, and 2.1% of the respondents, respectively. The participants expected to decrease, stabilize, or increase their teleconsultation activity in 18.3%, 52.8%, and 23.2% of the cases, respectively. ConclusionsMost thoracic oncologists in France are using teleconsultation, mostly as an additional tool that should not replace the doctor-patient in-person relationship.

Impact of the SARS-CoV-2 Epidemic on Lung Cancer Surgery in France: A Nationwide Study.

Simple SummaryFew studies have investigated the link between SARS-CoV-2 and health restrictions and its effects on the health of lung cancer (LC) patients. This study aimed to assess the impact of SARS-CoV-2 on activity volume, postoperative complications and in-hospital mortality (IHM) for LC resections in 2020 at the national level in France. Our study shows a decrease in the volume of LC resections, especially during the first lockdown. We also show that only 0.43% of patients hospitalized for LC surgery during 2020 developed a SARS-CoV-2 infection, but this low rate is counterbalanced by a high IHM (21%) in these 51 patients. Our findings suggest that, even if the IHM is high, LC surgery is feasible during a pandemic provided that the general guidance protocols edited by the surgical societies are respected. Therefore, this study provides further arguments to encourage teams to test for COVID-19 prior to surgery and patients to be vaccinated.Few studies have investigated the link between SARS-CoV-2 and health restrictions and its effects on the health of lung cancer (LC) patients. The aim of this study was to assess the impact of the SARS-CoV-2 epidemic on surgical activity volume, postoperative complications and in-hospital mortality (IHM) for LC resections in France. All data for adult patients who underwent pulmonary resection for LC in France in 2020, collected from the national administrative database, were compared to 2018–2019. The effect of SARS-CoV-2 on the risk of IHM and severe complications within 30 days among LC surgery patients was examined using a logistic regression analysis adjusted for age, sex, comorbidities and type of resection. There was a slight decrease in the volume of LC resections in 2020 (n = 11,634), as compared to 2018 (n = 12,153) and 2019 (n = 12,227), with a noticeable decrease in April 2020 (the peak of the first wave of epidemic in France). We found that SARS-CoV-2 (0.43% of 2020 resections) was associated with IHM and severe complications, with, respectively, a sevenfold (aOR = 7.17 (3.30–15.55)) and almost a fivefold (aOR = 4.76 (2.31–9.80)) increase in risk. Our study suggests that LC surgery is feasible even during a pandemic, provided that general guidance protocols edited by the surgical societies are respected.

Les réadmissions après résection pulmonaire en France : la base de données du PMSI

Readmission within 30 days is an indicator of the quality of care, because it often reflects post-discharge care that is not optimal. The objective of this work is to measure over time on the one hand the readmission rate and on the other hand the number of hospitals with a standardized readmission rate beyond the national average. All patients with major pulmonary resection for lung cancer in France were extracted from the PMSI national database. Readmission within 30 days was defined as any new hospitalization either in the same hospital or in another establishment. From January 1, 2005 to December 31, 2018, 110,603 patients were included. The 30-day all-cause readmissions rate was 24.9% (n=27,540). Patients after pneumonectomy had a readmission rate of 37% (n=4918) and 23% after lobectomy (n=2684) (P<0.0001). For the first period, we counted 10 hospitals with a standardized readmissions rate above the 99.8 limit and 10 hospitals above the 95% limit. For the second period, 8 hospitals had a standardized readmission rate above the 99.8% limit and 11 hospitals above the 95% limit. For the third period, 7 hospitals had a standardized readmission rate above the 99.8% limit and 6 hospitals above the 95% limit. Readmissions to hospital 30 days after major lung resection for cancer in France declined little during these three periods. Measures to prevent readmissions should be introduced.

Predictive molecular pathology in non-small cell lung cancer in France: The past, the present and the perspectives.

The advent of molecular targets for novel therapeutics in oncology, notably for non-small cell lung carcinoma (NSCLC), led the French National Cancer Institute (INCa) to establish a national network of 28 hospital Molecular Genetics Centers for Cancer (MGCC) in 2007. In each University in France, laboratories were established to develop molecular biology testing to evaluate a few genomic alterations, initially a selection of genes, by using specific targeted polymerase chain reaction (PCR) assays. In a second phase, the number of studied genes was increased. In 2015, the MGCC benefited from an additional dedicated budget from the INCa to develop next-generation sequencing (NGS) technology. In the meantime, a new financial regulation for innovative testing has been established for the acts out of nomenclature. Consequently, all private and public laboratories in France have access to funding for molecular biology testing in oncology. The gene-based PCR assays or NGS tests have benefitted from reimbursement of cost testing by the INCa. Today, the laboratories consider this reimbursement to be only partial, and its use to be complex. In 2018, a strategic plan for medical genomic analyses (France Médecine Génomique 2025) was implemented to introduce more systematic sequencing into the health care pathway and oncology practice. The large panel of molecular tests should be centralized to a limited number of molecular genetic centers. This review describes the evolution of the different stages of implementation of molecular pathology testing for NSCLC patients over the last few years in France.

Are direct oral anticoagulants an economically attractive alternative to low molecular weight heparins in lung cancer associated venous thromboembolism management?

Venous thromboembolism is highly prevalent in lung cancer patients. Low molecular weight heparins are recommended for long term treatment of cancer associated venous thromboembolism. Direct oral anticoagulants are however an interesting alternative as they are administered orally and don't require monitoring. There are currently studies comparing both their efficacy and tolerance for cancer patients and more and more guidelines suggest considering direct oral anticoagulants for cancer associated venous thromboembolism treatment. The objective of this study was to evaluate the budgetary impact that direct oral anticoagulants use would have for lung cancer associated venous thromboembolism treatment and prevention in France. An economic model was made to evaluate the cost of venous thromboembolism treatment and prevention among patients with primary lung cancer in France by two strategies: current guidelines versus direct oral anticoagulants use. The model was fed with clinical and economic data extracted from the French national health information system. The analysis was conducted from the national mandatory Health insurance point of view. The time horizon of the study was the evaluation of the annual management cost. Lung cancer associated venous thromboembolism management's mean cost was estimated of 836€ per patient, that is a total cost of about 40 million euros per year at a national level. A 76% decrease of this cost can be expected with direct oral anticoagulants use. However, despite their benefits, these treatments raise new issues (medication interactions, bleeding management), and would likely not be recommended for all patients.

PCN100 HEALTH-ECONOMIC EVALUATION OF LUNG CANCER DRUGS: DO S AND DON TS IN FRANCE

Since the release of the French decree on October 2nd, 2012, requiring economic evaluation for innovant drugs, 97 efficiency opinions were published by the French Health Authority “HAS/CEESP”. Among them, eight dealt with lung cancer. Objectives were to compare the choices made by pharmaceutical manufacturers and the objections raised by the HAS/CEESP, to identify areas of improvement in health economic evaluation of lung cancer in France. We analyzed the eight opinions which evaluated five drugs: alectinib, atezolizumab, nivolumab, osimertinib and pembrolizumab. Evaluation was conducted by the HAS/CEESP between December 2015 and October 2018. In each of the eight opinions, the methodological choices were described and the acceptability level was analysed. Some methodological settings were more frequently accepted and raised no objections as they abided by the HAS recommendations: time horizon, perspective, discount rate and choice of comparators. Other structural choices were more criticized: adoption of a 3-state-partitioned survival model raised an important objection as it simplifies too much the disease management, although considered relevant in lung cancer. Extrapolation of clinical trial data led to objections in all the dossiers. Simulated population was not accepted in two different dossiers requiring confirmation by real world data and utility data used led to several objections (minor/important) with the need to improve the methodological quality of their generation. The HAS/CEESP concluded that: two dossiers did not demonstrate the efficiency; intervention was not efficient in two other dossiers; and for the four remaining dossiers, Incremental Cost-Effectiveness Ratios (ICERs) were between 105,000 and 226,000 €/QALY. These levels of ICERs were qualified as high or very high despite the lack of a willingness to pay threshold in France. The analysis of the objections allowed to highlight the parameters on which pharmaceutical manufacturers need to be more robust and rigorous, for cost effectiveness analysis and budget impact analysis.

1650P - Crossed looks on lung cancer perception and knowledge from general public and physicians in France: Results of a two-fold survey

BackgroundRecent reports suggested gaps in knowledge and misperceptions regarding lung cancer (LC) in the general public and physicians respectively. We aimed to further investigate the topic. MethodsFrom February 21st to March 22nd, 2019, two online surveys were led in parallel among French people (n=6001) and physicians (GP, n=273; pulmonologists, n=97; oncologists, n=67). Questions aimed to assess people’s knowledge about LC prevalence, severity, diagnosis, management and treatments, early screening, as well of social stigma, and also understandings from physicians about public perception. ResultsLC was ranked as the 2nd most feared cancer (n=1980; 33%) and perceived as very or extremely serious by 96% of people (n=5760). Half of French people (n=3360) declared knowing at least one other risk factor than tobacco, and except for asbestos (n=5220; 87%), other potential risk factors were subjects to low to moderate levels of belief. The general population ranked LC as the 3rd easiest cancer to diagnose among French people (n=2220; 37%) and 57% (n=3420) believed that diagnosis was made early after symptoms onset. The general population was not aware of the majority of the symptoms beside blood in the sputum and respiratory symptoms. LC was ranked only the 5th cancer (n=1260; 21%) among those for which medical progress had been the most substantial, whereas physicians ranked it second (n=201; 46%). Also the public was not aware of therapeutic progress as immunotherapy. Physicians tended to be more optimistic about actual treatment improvement than the public and for 90% of them (n=393), systematic screening of at-risk population would have a significant impact on mortality data by LC. ConclusionsOur study confirms the substantial gaps in LC knowledge from the general public and highlights several venues for improvement of communication and public awareness on LC in France. Legal entity responsible for the studyAstraZeneca. FundingAstraZeneca. DisclosureJ. Cadranel: Advisory / Consultancy, Research grant / Funding (institution): AstraZeneca; Advisory / Consultancy, Research grant / Funding (institution): Boerhinger Ingelheim; Advisory / Consultancy, Research grant / Funding (institution): Novartis; Advisory / Consultancy, Research grant / Funding (institution): Pfizer; Advisory / Consultancy: BMS; Advisory / Consultancy: Lilly; Advisory / Consultancy: MSD; Advisory / Consultancy: Roche; Advisory / Consultancy: Takeda. C. Chouaid: Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: Boehringer Ingelheim; Advisory / Consultancy: GSK; Advisory / Consultancy: Roche; Advisory / Consultancy: Sanofi Aventis; Advisory / Consultancy: BMS; Advisory / Consultancy: MSD; Advisory / Consultancy: Lilly; Advisory / Consultancy: Novartis; Advisory / Consultancy: Amgen. J.B. Stern: Speaker Bureau / Expert testimony, Fees for presentation in a Medtronic symposium which were donated to our association.: Medtronic. A. Vergnenegre: Advisory / Consultancy, Research grant / Funding (institution): Roche; Research grant / Funding (institution): Chugai; Advisory / Consultancy, Research grant / Funding (institution): Boehringer Ingelheim; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: MSD; Advisory / Consultancy: BMS; Advisory / Consultancy: Teva; Advisory / Consultancy, Research grant / Funding (institution): Lilly; Advisory / Consultancy: Clovis Oncology. C. Cortot: Full / Part-time employment: AstraZeneca. L. Guery: Full / Part-time employment: AstraZeneca. K. Belkhiria: Full / Part-time employment: AstraZeneca. I. De la Porte: Full / Part-time employment: AstraZeneca. M. Urbieta: Full / Part-time employment: AstraZeneca. M. Perol: Advisory / Consultancy: Novartis; Advisory / Consultancy: AstraZeneca. All other authors have declared no conflicts of interest.

Hospital Readmission after Major Pulmonary Resection for Lung Cancer in France: A Nationwide Medico-Administrative Database

Objectives: After major pulmonary resection for lung cancer, hospital readmission is considered an indicator of the quality of care. Our main objective was to define the readmission rate at 30 days after pulmonary resection. Secondary objectives were to determine the causes and predictive factors. Methods: Data for all patients operated for lung cancer were extracted from the national medico-administrative database of the Programme de Medicalisation des Systemes d'Information (PMSI). Thirty-days hospital readmission was defined as any new hospitalization within 30 days after discharge from the surgical department following major lung resection, regardless of the reason for readmission. Results: From January 1st, 2008 to December 31st, 2016, 68,575 patients were operated for lung cancer in France. The all-cause readmission rate was 23.6% (n=16214). Overall, 3,695 patients were readmitted for a complication (5.4%) and 12,519 were readmitted for other causes (18%). The main complications were surgical complications (n=1778, 44%), pneumopathy (n=574, 14%), respiratory failure (n=426, 11%), cardiovascular disease (n=372, 9%), malnutrition (n=329, 8%) and bleeding (n=131, 3%). Patients operated on in a teaching hospital and discharged to another establishment had an adjusted odds ratio (AOR) of 0.73 (95% Confidence Interval (CI) 0.58-0.92; p<0.008). The type of pulmonary resections and the approach had a significant influence on the occurrence of hospital readmission. An initial length of stay of more than 14 days resulted in an AOR of 1.4 (95% CI 1.3-1.54) (p<0.0001). The occurrence of sepsis during the 1st hospitalization is significantly related to a readmission with an AOR of 0.89 (95CI 0.83-0.97) (p<0.005). Conclusion: The rate of hospital readmission after major pulmonary resection for lung cancer in France was 23.6%. This work demonstrates the need to implement measures to reduce readmission after surgery. Funding Statement: The author(s) received no specific funding for this work. Declaration of Interest: The authors have no disclosure to declare for this work. Ethical Approval Statement: Ethics approval for use of this database was obtained from the National Commission for Data protection (CNIL No 1576793), and this study adhered to the tenets of the declaration of Helsinki.

Oncologie thoracique et charge tumorale mutationnelle : vers un nouveau défi pour le pathologiste ?

Among the different promising predictive biomarkers in immuno-oncology, the tumor mutational burden (TMB) may soon impose itself in clinical routine practice, in association with PD-L1 immunohistochemistry testing. However, the TMB is used currently in clinical trials only, in particular in the thoracic oncology field. If this biomarker becomes mandatory in the near future, the pathologist will have to respond to new challenges in tight collaboration with the activity of molecular pathology platforms. Given the high incidence of lung cancer in France, this new development could have a strong impact on the daily life of the laboratories. This review addresses the different challenges which could be soon proposed to the laboratories and the pathologists due to the use of TMB assays on a daily practice.

Cost-effectiveness analysis of pembrolizumab versus standard-of-care chemotherapy for first-line treatment of PD-L1 positive (>50%) metastatic squamous and non-squamous non-small cell lung cancer in France

IntroductionIn the KEYNOTE-024 trial, pembrolizumab demonstrated significant improvements in progression-free survival (PFS) and overall survival (OS) versus Standard-of-Care (SoC) platinum-based doublets for first-line treatment of PD-L1 -positive (≥50%) metastatic Non-Small-Cell Lung Cancer (NSCLC) patients with no EGFR mutations or ALK translocations. This study aims to assess the cost-effectiveness of pembrolizumab versus SoC platinum-based chemotherapy from the French healthcare system perspective. MethodsA three-state partitioned-survival model was adapted to project outcomes and costs of squamous and non-squamous NSCLC patients respectively, over a 10-year time horizon. Clinical and utility data were collected from the trial. A network meta-analysis was performed to consider platinum-based triplets also used for non-squamous NSCLC. Direct medical costs were considered based on ressources identified from the trial and literature. Costs and outcomes were discounted at 4% per year. Incremental cost-effectiveness ratios (ICERs) were calculated as cost per Life Year (LY) and cost per Quality-Adjusted Life Year (QALY). Sensitivity and scenario analyses were performed to assess the robustness of results. ResultsFor squamous NSCLC, pembrolizumab was projected to increase life expectancy of patients by 0.93 LY (11 months), and 0.74 QALY (9 months) for an incremental cost of €62,032 compared with platinum-based doublets. The ICER of pembrolizumab versus platinum-based doublets was €66,825/LY and €84,097/QALY. For non-squamous NSCLC, pembrolizumab was projected to increase life expectancy of patients by 0.85–1.32 LYs (10.2–15.8 months) and 0.64–1.02 QALYs (7.7–12.2 months) for an incremental cost varying from €-14,947-+47,064 depending on the specific comparator. The ICER of pembrolizumab versus platinum-based chemotherapy with paclitaxel plus bevacizumab was €62,846/LY and €78,729/QALY; regimens including pemetrexed were dominated. Results were most sensitive to extrapolations of survival outcomes and assumptions for continued effectiveness and treatment duration of pembrolizumab. ConclusionsPembrolizumab appears cost-effective versus SoC chemotherapy for first-line treatment of PD-L1-positive (50%) metastatic NSCLC patients in France, assuming willingness-to-pay under 100,000€/QALY (OECD threshold in the discussion section).