Second-line Treatment Of Advanced Research Articles

EE409 Cost Effectiveness of Tislelizumab Versus Chemotherapy as Second-Line Treatment for Advanced or Metastatic Esophageal Squamous Cell Carcinoma in China

EE409 Cost Effectiveness of Tislelizumab Versus Chemotherapy as Second-Line Treatment for Advanced or Metastatic Esophageal Squamous Cell Carcinoma in China

Sintilimab Plus Autologous NK Cells as Second-Line Treatment for Advanced Non-Small-Cell Lung Cancer Previous Treated with Platinum-Containing Chemotherapy

Sintilimab Plus Autologous NK Cells as Second-Line Treatment for Advanced Non-Small-Cell Lung Cancer Previous Treated with Platinum-Containing Chemotherapy

Cost-Effectiveness Analysis of Camrelizumab Versus Chemotherapy as Second-Line Treatment of Advanced or Metastatic Esophageal Squamous Cell Carcinoma

Background: This study aimed to analyze the cost effectiveness of camrelizumab in the second-line treatment of advanced or metastatic esophageal squamous cell carcinoma in China. Methods: On the basis of the ESCORT clinical trial, a partitioned survival model was constructed to simulate the patient’s lifetime quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratio (ICER). One-way sensitivity and probability sensitivity analyses were performed to test the stability of the model. Results: Treatment of esophageal squamous cell carcinoma with camrelizumab added 0.36 QALYs and resulted in an incremental cost of $1,439.64 compared with chemotherapy, which had an ICER of $3,999 per QALY gained. The ICER was far lower than the threshold of willingness to pay for one time the GDP per capita in China. Sensitivity analysis revealed that the ICERs were most sensitive to the cost of drugs, but the parameters did not have a major effect on the results of the model. Conclusion: Camrelizumab is likely to be a cost-effective option compared with chemotherapy for patients with advanced or metastatic esophageal squamous cell carcinoma. This informs patient selection and clinical path development.

PCN2 First-LINE Maintenance and Second-LINE Treatment of Advanced or Metastatic Gastric Cancer: A Systematic Review of Literature

PCN2 First-LINE Maintenance and Second-LINE Treatment of Advanced or Metastatic Gastric Cancer: A Systematic Review of Literature

Phase I Study of Lapatinib and Pemetrexed in the Second-Line Treatment of Advanced or Metastatic Non–Small-Cell Lung Cancer With Assessment of Circulating Cell Free Thymidylate Synthase RNA as a Potential Biomarker

IntroductionLapatinib is a dual tyrosine kinase inhibitor that targets epidermal growth factor receptor and HER2. We report on a dose-escalation study of lapatinib combined with pemetrexed in second-line treatment to evaluate the safety and efficacy in advanced or metastatic non–small-cell lung cancer (NSCLC) and an exploratory study in which circulating cell-free thymidylate synthase ribonucleic acid (cfTSmRNA) was measured in all patients and compared with clinical benefit. Patients and MethodsEligible patients had stage IIIB or IV NSCLC after 1 previous line of chemotherapy and an Eastern Cooperative Oncology Group performance status of 0 to 2. Three dose levels (DLs) of lapatinib (daily)/pemetrexed (every 21 days) were evaluated: DL0, 1250 mg/400 mg; DL1, 1250 mg/500 mg; and DL2, 1500 mg/500 mg, respectively. The primary outcome was identification of the optimal treatment regimen. ResultsEighteen patients were treated (DL0: n = 4; DL1: n = 8; DL2: n = 6). The most common adverse events (any grade) were diarrhea (61%), rash (44%), nausea (33%), anemia, and fatigue (both 28%). DL1 was determined as optimal after 3 dose-limiting toxicities (DLTs) during the first cycle of DL2 (Grade 3 diarrhea and mucositis, Grade 4 lymphocytopenia); no other DLTs were observed. Partial response was detected in 4 patients. cfTSmRNA was at the limit of detection and was not measurable in all patients. Nonsignificant trends were observed, suggesting that higher levels of cfTSmRNA are associated with poorer outcome. Confirmatory studies are required. ConclusionLapatinib and pemetrexed was well tolerated, and data suggest a similar response rate to pemetrexed monotherapy.

P2-6-3 - A Retrospective Study of Weekly Paclitaxel as Second-Line Treatment for Advanced or Recurrent Esophageal Cancer

Background: Docetaxel and Paclitaxel have been used for advanced or recurrent esophageal cancer who failed first-line chemotherapy. However, standard chemotherapy as second-line setting has not been established.Objectives: To evaluate Paclitaxel by weekly infusion for advanced or recurrent esophageal cancer in second-line setting.Patients and methods: The subjects of this study were 13 patients treated with Paclitaxel from October 2012 to December 2013 at Hyogo Cancer Center. We retrospectively evaluated patient characteristics, response, survival, and toxicity.Results: Median age:62 (47-76), Male/Female:12/1, PS 0/1/2:5/7/1, Advanced/recurrent:3/10, metastatic sites lymph node/lung/liver/others:11/3/1/3, the number of metastatic sites 0/1/2:1/7/5, prior therapy surgery/chemo-radiotherapy/ chemotherapy:6/9/4, and the all patients had Squamous cell carcinoma. The mean number of the course was 2.7. The overall response rate was 37%(3/8), the median progression-free survival was 3.7 months and the median survival time was 7.3 months. As for the grade 3/4 hematological toxicities, the incidences of WBC, ANC and anemia were 23%, 46% and 7%. As for the grade 3/4 non-hematological toxicities, anorexia was 7%, and febrile neutropenia was 7%. There were no treatment-related deaths.Conclusion: weekly Paclitaxel was tolerable as second-line treatment for advanced or recurrent esophageal cancer

Phase 2 Trial of Nonpegylated Doxorubicin (Myocet) as Second-Line Treatment in Advanced or Recurrent Endometrial Cancer

Advanced or recurrent endometrial cancer is associated with a poor prognosis, and results obtained with systemic therapy are far from being impressive. Myocet is an interesting formulation of citrate conjugated doxorubicin encapsulated in nonpegylated liposomes. This phase 2 study was designed to evaluate the objective response rate and the toxicity profile of Myocet in women with advanced or recurrent endometrial cancer. Patients with diagnosis of advanced or recurrent endometrial cancer failing 1 previous carboplatin-paclitaxel chemotherapy were enrolled. Myocet was administered at the dose of 60 mg/m intravenously on day 1 every 4 weeks. Eighteen patients were enrolled in our institution from September 2007 to January 2010. No complete or partial response was observed. Stable disease was registered in 5 patients (27.5%). Median time to progression was 9 weeks. Median time to death was 24 weeks. Grade 3/4 anemia was reported in 2 patients (11%). Grade 3/4 neutropenia was observed in 16.5% and 44% of patients, respectively. The major nonhematologic toxicities (grades 3/4) were fatigue (22%), nausea, and vomiting (5.5%). Myocet presents no activity, and only few stabilizations of disease of limited duration in this recurrent endometrial carcinoma population previously treated with platinum-taxane chemotherapy are reported.

The Role of Vandetanib in the Second-Line Treatment for Advanced Non-Small-Cell-Lung Cancer: A Meta-Analysis of Four Randomized Controlled Trials

The purpose of this study was to assess the efficacy and toxicity of vandetanib in the second-line treatment for advanced non-small cell lung cancer (NSCLC). We systematically searched for randomized clinical trials that compared therapy with vandetanib versus standard second-line treatment, including docetaxel, pemetrexed, erlotinib, or gefitinib, as second-line treatment for patients with histologically proven non-small-cell lung cancer. The primary endpoint was overall survival (OS). Secondary endpoints were progression-free survival, overall response rate, and grade 3 or 4 toxicity. Data were extracted from the studies by two independent reviewers. The meta-analysis was performed by Stata version 10.0 software (Stata Corporation, College Station, TX, USA). Four randomized clinical trials (N=3,292 patients) were eligible. Meta-analysis showed that there was significant improvement in PFS (hazards ration (HR), 0.91; 95% confidence interval (CI), 0.83-1.00; P=0.039) and overall response rate (relative risk (RR), 1.49; 95% CI, 1.04-2.14; P=0.03) in therapy with vandetanib group compared with standard second-line therapy group, although the pooled HR for overall survival (HR, 0.95; 95% CI, 0.88-1.03; P=0.191) showed no significant difference between the two groups. In addition, there were less incidences of grade 3 or 4 anemia (RR, 0.39; 95% CI, 0.22-0.67; P=0.001) in therapy with vandetanib group. With regard to the risk of grade 3 or 4 neutropenia (RR, 1.19; 95% CI, 1.0-1.43; P=0.054), diarrhea (RR, 1.38; 95% CI, 1.0-1.94; P=0.059), nausea and vomiting (RR, 0.77; 95% CI, 0.48-1.26; P=0.308), rash (RR, 2.83; 95% CI, 0.73-10.9; P=0.131), cough (RR, 1.19; 95% CI, 1.0-1.43; P=0.054), and fatigue (RR, 1.0; 95% CI, 0.747-1.35; P=0.971), there was no significant difference between the two groups. Therapy with vandetanib offered a clinically meaningful and statistically significant improvement in PFS and ORR in patients with advanced NSCLC but did not benefit overall survival. Therapy with vandetanib regimens might be suggested as second-line treatment for advanced NSCLC based on a similar toxicity profile compared with standard second-line therapy.