ESMO Supporter 2018

Displaying One Session

Hall B3 - Room 22 Proffered Paper session
Date
22.10.2018
Time
14:45 - 16:15
Location
Hall B3 - Room 22
Chairs
  • Michel P. Coleman (London, GB)
  • Carin A. Uyl-de Groot (Rotterdam, NL)
Proffered paper session - Public health policy Proffered Paper session

Session DOI

Lecture Time
14:45 - 14:45
Location
Hall B3 - Room 22, ICM München, Munich, Germany
Date
22.10.2018
Time
14:45 - 16:15
Proffered paper session - Public health policy Proffered Paper session

1555O_PR - Magnitude of clinical benefit of cancer drugs and time to health technology assessment (HTA) decisions in Europe

Presentation Number
1555O_PR
Lecture Time
14:45 - 14:57
Speakers
  • Thomas Hwang (Boston, US)
Location
Hall B3 - Room 22, ICM München, Munich, Germany
Date
22.10.2018
Time
14:45 - 16:15

Abstract

Background

A key goal of the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) is to highlight cancer drugs with the greatest clinical benefit that should be rapidly made available by health authorities. We used ESMO-MCBS scores to determine the correlation with national benefit assessments, and evaluate the drugs’ reimbursement statuses and times to health technology assessment (HTA) decisions.

Methods

We identified all new cancer drugs for solid tumors, and subsequent indications for these drugs, approved by the EMA from January 2007 to December 2016. HTA scores (for France and Germany), appraisal evidence, and reimbursement decisions for England, France, Germany, and Scotland were extracted as of January 2018. ESMO-MCBS v1.1 scores were calculated based on the trials submitted to HTA bodies for appraisal. “Highest benefit” was defined as scores of A-B (neo/adjuvant setting) and 4-5 (palliative setting) on the ESMO-MCBS scale, and scores of “moderate”, “considerable”, or “major” benefit by HTA bodies. Fisher’s exact test, Mann-Whitney test, Cohen’s kappa, and Cox proportional hazards models were used to compare drugs categorized as “highest benefit” versus those that were not.

Results

From 2007-2016, the EMA approved 47 drugs for 77 solid tumor indications. Median times from EMA approval to HTA decision were 188 (France), 209 (Germany), 384 (Scotland), and 405 (England) days. Drugs categorized as “highest benefit” by ESMO-MCBS were associated with shorter times to HTA decision in France (median 154 vs. 198 days; hazard ratio [HR] 1.82; 95% confidence interval [CI] 1.06-3.13; p=0.03), Germany (203 vs. 213 days; HR 2.24; CI 1.27-3.93; p=0.005), and England (302 vs. 413 days; HR 1.95; CI 1.10-3.46; p=0.02) but not Scotland (349 vs. 402 days; HR 1.15; CI 0.65-2.03). 90%, 100%, 92%, and 95% of “highest benefit” drugs were reimbursed in France, Germany, England, and Scotland. There was high concordance between ESMO-MCBS and HTA scores for categorization of “highest benefit” (κ 0.8 [Germany], κ 0.6 [France]).

Conclusions

Anticancer drugs with greatest clinical benefit are associated with faster times to HTA decision, and nearly all are approved for reimbursement in Europe.

Collapse
Proffered paper session - Public health policy Proffered Paper session

1556O - Potential for value-based prescribing of oral oncology drugs

Presentation Number
1556O
Lecture Time
14:57 - 15:09
Speakers
  • Mark J. Ratain (Chicago, US)
Location
Hall B3 - Room 22, ICM München, Munich, Germany
Date
22.10.2018
Time
14:45 - 16:15

Abstract

Background

As exemplified by a recent study of abiraterone, we hypothesized that many oral oncology agents are given in doses far in excess of what is needed, thus enabling the development of value-based dosing strategies incorporating lower doses, less frequent dosing, or even therapeutic substitution. We aimed to identify products for which cost-savings could be > 33%.

Methods

We reviewed publicly available documents for all patent-protected oral oncology drugs approved in the US, including official prescribing information, FDA Clinical Pharmacology reviews, and peer-reviewed publications that analyzed the relationship of dose or drug exposure to efficacy. For each drug, we assessed potential cost-savings based on publicly available US pricing data, as well as the potential impact on global sales. For those drugs with flat pricing (i.e., where dose reductions would not impact costs), we only considered opportunities to reduce frequency.

Results

For 33/53 (62%) oral oncology products, prescribing costs can potentially be reduced by > 33%, with >50% reductions possible for 26 (49%). Strategies include dose reduction (19 drugs, 7 with positive food effect), frequency reduction (13 drugs), and therapeutic substitution (sirolimus for everolimus). Even with current US flat pricing schemes, the potential savings are $91.300+$33.000 (range $35.700-$186.400) per patient-year for these 33 drugs. Based on recent sales, the potential global savings opportunity is >$12 billion per year, with ≈75% of the potential savings encompassed by the top six opportunities: ibrutinib ($2.6B), abiraterone ($1.9B), enzalutamide ($1.6B), everolimus ($1.4B), nilotinib ($0.9B), and erlotinib ($0.7B).

Conclusions

Development of value-based prescribing strategies has the potential to significantly impact prescribing costs of many oral oncology drugs. Our estimates are likely conservative, given the expanding indications and prolonged treatment courses for many drugs (e.g, ibrutinib and abiraterone). Similar opportunities exist for parenteral monoclonal antibodies with long half-lives.

Legal entity responsible for the study

Value in Cancer Care Consortium.

Funding

Has not received any funding.

Disclosure

M.J. Ratain: Expert testimony on behalf of multiple generic pharmaceutical companies; Research funding: AbbVie; Consulting: Cyclacel, Ascentage. A.S. Lichter: Scientific advisor: Ascentage.

Collapse
Proffered paper session - Public health policy Proffered Paper session

1557O - Relation between center volumes for pancreatic and esophageal cancer surgeries and outcome in Belgium: a plea for centralization

Presentation Number
1557O
Lecture Time
15:09 - 15:21
Speakers
  • Liesbet Van Eycken (Brussels, BE)
Location
Hall B3 - Room 22, ICM München, Munich, Germany
Date
22.10.2018
Time
14:45 - 16:15

Abstract

Background

Known for its accessible health care, Belgium currently counts over 100 hospitals providing oncological care, resulting in shattered care which may negatively influence outcomes. In the context of recent centralization initiatives, this study aimed to evaluate relations between complex surgeries and outcomes for (peri)pancreatic and esophageal cancers at the Belgian population level.

Methods

All patients with (peri)pancreatic (ICD)10: C25, C17.0, C24.0-1) or esophageal (C15-C16.0) cancer between 2007 and 2014 were extracted from the Belgian Cancer Registry and linked with surgeries (Sx) from reimbursement data. Concordant with previous reports, three yearly volume categories of Sx per center were defined ((peri)pancreatic: <6, 6-14 and ≥15 Sx/yr; esophageal: <6, 6-19 and ≥20 Sx/yr). Relations between surgical volumes and 30-days postoperative mortality as well as 5-year overall survival (OS) were analyzed with multivariable regression models adjusting for case-mix (including age, stage, sex, comorbidities).

Results

16,471 (peri)pancreatic and 12,241 esophageal cancers were retrieved, corresponding to 4,081 (peri)pancreatic and 3,387 esophageal cancer surgeries performed by 96 hospitals in total (in 2014: 68 hospitals for (peri)pancreatic and 54 for esophageal cancer Sx). Surgical volumes were significantly related with 30-days postoperative mortality for (peri)pancreatic and esophageal cancer (p = 0.005 and p < 0.0001 respectively), with 52% and 81% mortality reduction for high vs low volume hospitals, respectively. The volume effect was also seen for OS: for both cancer types, high volume hospitals had a better OS compared to low volume which remained significant after case mix adjustment. For (peri)pancreatic cancer, 1-yr and 5-yr OS for high versus low volume centers was 75% vs 69% and 34% vs 31%, respectively (HR 0.65 [0.55, 0.78], p < 0.0001). For esophageal cancer, 1-yr and 5-yr OS for high versus low volume centers was 79% vs 71% and 44% vs 38%, respectively (HR 0.88 [0.79;0.99], p = 0.04).

Conclusions

High surgical volume centers showed better results for postoperative mortality and survival for (peri)pancreatic and esophageal cancers, supporting centralization initiatives in Belgium.

Legal entity responsible for the study

Foundation Belgian Cancer Registry.

Funding

Federal and Regional Authorities.

Disclosure

All authors have declared no conflicts of interest.

Collapse
Proffered paper session - Public health policy Proffered Paper session

Invited Discussant 1555O_PR, 1556O and 1557O

Lecture Time
15:21 - 15:36
Speakers
  • Michel P. Coleman (London, GB)
Location
Hall B3 - Room 22, ICM München, Munich, Germany
Date
22.10.2018
Time
14:45 - 16:15
Proffered paper session - Public health policy Proffered Paper session

1558O - Worldwide comparison of colorectal cancer survival, by topography and stage at diagnosis (CONCORD-2)

Presentation Number
1558O
Lecture Time
15:36 - 15:48
Speakers
  • Sara Benitez Majano (London, GB)
Location
Hall B3 - Room 22, ICM München, Munich, Germany
Date
22.10.2018
Time
14:45 - 16:15

Abstract

Background

Colorectal cancer is one of the most important causes of cancer morbidity and mortality worldwide. We have explored international variation in colorectal cancer survival, by topography and disease extension.

Methods

We analysed data on 4,877,818 individual malignant tumours of the colon or rectum diagnosed during 1995-2009, provided by 228 population-based cancer registries in 55 countries participating in the CONCORD programme for global surveillance of cancer survival. We defined four anatomic sub-sites: right colon, left colon, other/unspecified colon, and rectum. Data on stage at diagnosis were available for 655,844 patients diagnosed during 2001-2009, from 63 cancer registries in 21 countries. We only included registries with stage data available for 70% or more of patients. We estimated age-standardised net survival at five years after diagnosis, by country, topography and stage.

Results

During 2004-2009, 5-year net survival ranged from 29 to 70% for patients with colon cancer, and from 32 to 74% for rectal cancer. In most countries, survival was comparable between tumours in the right colon (40-69%) and the left colon (33-71%), but tended to be lower for tumours of unspecified/other topography (18-63%). Five-year survival for localised colorectal cancer (38-94%) was considerably higher than for advanced disease (22-75%).

Conclusions

Five-year survival from colorectal cancer varies widely between countries, but also by sub-site and stage. These results offer the widest picture on the availability of data on stage at diagnosis and stage-specific cancer survival worldwide. Complete and standardised registration of stage at diagnosis is essential for valid population-based monitoring and international comparisons of cancer survival.

Legal entity responsible for the study

London School of Hygiene and Tropical Medicine.

Funding

Canadian Partnership Against Cancer (Toronto, Canada), Cancer Focus Northern Ireland (Belfast, UK), Cancer Institute New South Wales (Sydney, Australia), Cancer Research UK (London, UK), Centers for Disease Control and Prevention (Atlanta, GA, USA), Swiss Re (London, UK), Swiss Cancer Research foundation (Bern, Switzerland), Swiss Cancer League (Bern, Switzerland), and University of Kentucky (Lexington, KY, USA).

Disclosure

All authors have declared no conflicts of interest.

Collapse
Proffered paper session - Public health policy Proffered Paper session

1559O - Increasing colorectal cancer incidence among young adults in England diagnosed during 2001-2014

Presentation Number
1559O
Lecture Time
15:48 - 16:00
Speakers
  • Aimilia Exarchakou (London, GB)
Location
Hall B3 - Room 22, ICM München, Munich, Germany
Date
22.10.2018
Time
14:45 - 16:15

Abstract

Background

Colorectal cancer predominantly affects adults above 50 years of age, but emerging evidence suggests that, in high-income countries, incidence has been increasing among young adults.

Methods

We examined incidence trends for primary, invasive malignancy of the large bowel among all adults (20-99 years) diagnosed during 2001-2014, using joinpoint regression to analyse data from the national cancer registry for England (pop. 55 million). We present the annual percentage change (APC%) in incidence rates by sex, age, deprivation (five categories) and anatomic sub-site.

Results

Annual incidence rates among the youngest adults (20-29 years) increased 3-fold between 2001 and 2014 (APC 7.2% for men, 9.4% for women), with a 2-fold increase among slightly older adults (30-39 years). Among adults over 50 years of age, incidence rates have barely changed. Incidence increased in all five deprivation groups, but more quickly among the two most deprived groups. Among the two age groups combined (20-39 years), the APC for the right colon was 6.9% between 2001 and 2010, with a dramatic jump to 19.5% per year between 2010 and 2014.

Conclusions

The cause of this striking increase is unknown, but our study suggests that GPs and hospital clinicians should be alert to the increasing risk of colorectal cancer in young adults. National strategies to raise awareness of symptoms or ways to seek medical care may also be considered for high-risk groups, such as those who are obese, with high alcohol consumption or a sedentary lifestyle.

Legal entity responsible for the study

Cancer Survival Group, London School of Hygiene and Tropical Medicine.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Collapse
Proffered paper session - Public health policy Proffered Paper session

Invited Discussant 1558O and 1559O

Lecture Time
16:00 - 16:15
Speakers
  • Bengt Jönsson (Stockholm, SE)
Location
Hall B3 - Room 22, ICM München, Munich, Germany
Date
22.10.2018
Time
14:45 - 16:15