Background

Predictive biomarkers are essential for selecting the best therapeutic strategy in cancer patients. Yet, the promise of superior treatment outcomes cannot be realised if patients do not have access to high quality biomarker testing. The International Quality Network for Pathology (IQN Path ASBL), the European Cancer Patient Coalition (ECPC) and the European Federation of Pharmaceuticals Industries and Associations (EFPIA) launched an initiative to evaluate the access to and quality of biomarker testing (BMT) across Europe.

Methods

Four access metrics (laboratory access, test availability, test reimbursement, test order rate) and three quality metrics (quality scheme participation, laboratory accreditation, test turnaround time) were applied. Secondary sources included surveys of 141 laboratory managers and of 1.665 patients, and 58 in-depth interviews with laboratory managers, physicians, and payers. The findings were reviewed over a series of meetings by IQN Path, ECPC, EFPIA and key opinion leaders, in order to develop an unbiased view of existing test access barriers and to establish a consensus on critical policy recommendations for immediate, concerted action.

Results

A detailed mapping showed the status of each country according to the applied metrics and six key barriers to BMT were identified in the majority of European countries: 1) Limited availability of precision medicine linked to biomarkers; 2) Unclear value assessment approaches for diagnostic tests; 3) Very diverse laboratory infrastructure, capabilities and referral pathways; 4) Limited availability of public funding to support biomarker testing; 5) Limited stakeholder awareness and education; 6) Inconsistent participation of laboratories in quality assurance schemes.

Conclusions

To address the barriers to high quality BMT, multi-disciplinary and concerted action is needed. Short-term and long-term policy recommendations to address the shortcomings in BMT access would be presented and discussed with the ESMO audience. The project was initiated and financed by IQN Path, ECPC and EFPIA together with a consortium of industry and academic partners, and conducted by L.E.K. Consulting.

Legal entity responsible for the study

EFPIA and IQN Path.

Funding

EFPIA and IQN Path.

Disclosure

N. Normanno: Financial Interests, Personal, Other, Speaker's fee and/or advisory board: MSD; Financial Interests, Personal, Other, Speaker's fee and/or advisory board: Qiagen; Financial Interests, Personal, Other, Speaker's fee and/or advisory board: Bayer; Financial Interests, Personal, Other, Speaker's fee and/or advisory board: Biocartis; Financial Interests, Personal, Other, Speaker's fee and/or advisory board: Illumina; Financial Interests, Personal, Other, Speaker's fee and/or advisory board: Incyte; Financial Interests, Personal, Other, Speaker's fee and/or advisory board: Roche; Financial Interests, Personal, Other, Speaker's fee and/or advisory board: BMS; Financial Interests, Personal, Other, Speaker's fee and/or advisory board: Merck; Financial Interests, Personal, Other, Speaker's fee and/or advisory board: Thermo Fisher; Financial Interests, Personal, Other, Speaker's fee and/or advisory board: AstraZeneca; Financial Interests, Personal, Other, Speaker's fee and/or advisory board: Sanofi; Financial Interests, Personal, Other, Speaker's fee and/or advisory board: Eli Lilly; Financial Interests, Personal, Other, Speaker's fee and/or advisory board: Novartis; Financial Interests, Institutional, Research Grant: Merck; Financial Interests, Institutional, Research Grant: Thermo Fisher; Financial Interests, Institutional, Research Grant: Qiagen; Financial Interests, Institutional, Research Grant: Roche; Financial Interests, Institutional, Research Grant: AstraZeneca; Financial Interests, Institutional, Research Grant: Biocartis; Financial Interests, Institutional, Research Grant: Illumina; Financial Interests, Institutional, Research Grant: Blueprint; Non-Financial Interests, Personal, Member of the Board of Directors: International Quality Network for Pathology (IQN Path); Non-Financial Interests, Personal, Member of the Board of Directors: Italian Cancer Society (SIC). M. Akkermans: Financial Interests, Personal, Full or part-time Employment: MSD. C. Bedard Pfeiffer: Financial Interests, Personal, Full or part-time Employment: Roche. I. Cattaneo: Financial Interests, Personal, Full or part-time Employment: Novartis. J. Emch: Financial Interests, Personal, Full or part-time Employment: GSK. P. Fivey: Financial Interests, Personal, Full or part-time Employment: AstraZeneca. S. Hall: Financial Interests, Personal, Full or part-time Employment: Novartis. E. Rouleau: Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Advisory Board: BMS; Financial Interests, Personal, Advisory Board: Roche; Financial Interests, Personal, Invited Speaker: Clovis; Financial Interests, Personal, Invited Speaker: AstraZeneca; Financial Interests, Personal, Invited Speaker: BMS; Financial Interests, Personal, Invited Speaker: Roche; Financial Interests, Personal, Other, Travel: BMS; Financial Interests, Personal, Other, Travel: AstraZeneca. M. van Meerveld: Financial Interests, Personal, Full or part-time Employment: MSD. All other authors have declared no conflicts of interest.

Background

Calculating breast cancer (BC) risks is becoming increasingly accurate and important in the care of healthy women with a cancer family history. Clinical recommendations are commonly based on cancer family history and germline mutation status. More recently, risk-modifying single- nucleotide polymorphisms (SNPs) which can be used to calculate polygenic risk score (PRS) as well as non-genetic risk factors (NGRF) have been incorporated into established risk prediction tools. We evaluated the impact of personalized BC risk calculation incorporating PRS and NGRF on clinical recommendations for intensified breast surveillance (IBS), based on the 10-year BC risk with a threshold of ≥5% for IBS indication (German Guideline) and a lifetime risk of ≥20 % (French/Dutch), respectively.

Methods

Cancer-unaffected women with a family history of BC and/or ovarian cancer were enrolled in a prospective observational study at their first counselling at the Familial Breast and Ovarian Cancer Centre Cologne from 11/2019 - 9/2020. BC-risks were calculated for women aged 30-50 years with non-informative genetic test results, variants of uncertain significance and pathogenic variants not associated with BC. Two risk versions were calculated using the CanRisk©-Tool (Boadicea-algorithm): A basic risk version (BR) and a comprehensive risk version (CR), that includes a >300 SNP PRS and NGRF.

Results

BC risks were calculated for 123 women aged 30 - 50 years (mean 40.37, SD: 5.63). With BR, 28 women (22.8%) were recommended IBS. With CR, 44 (35.8%) women were offered IBS. Clinical recommendations changed for 21.2% of all women when comparing BR/CR. With ≥20% lifetime BC-risk as cut-off for IBS indication, recommendations change for 24.4% (CR) of women compared with the German guideline: 7 women are not eligible anymore, 23 additional women are.

Conclusions

Integrating PRS and NGRF for risk calculation led to (1) an increase in patients eligible for IBS and (2) a recommendation change for every fifth woman. When switching country guideline, clinical recommendations changed for a quarter of women (CR). Prospective validation studies, as well as evaluating and harmonizing guidelines are necessary.

Legal entity responsible for the study

The authors.

Funding

European Commission: Horizon2020 funded BRIDGES (Breast Cancer Risk after Diagnostic Gene Sequencing) study.

Disclosure

K.E. Rhiem: Financial Interests, Personal and institutional, Advisory Board: MSD; Financial Interests, Personal and institutional, Advisory Board: AstraZeneca; Financial Interests, Personal, Other, Honorars: AstraZeneca; Financial Interests, Personal, Other, Honorars: Roche; Financial Interests, Personal, Other, Honorars: MSD; Financial Interests, Institutional, Research Grant: AstraZeneca; Financial Interests, Personal and Institutional, Invited Speaker: MSD, Pfizer, Amgen; Non-Financial Interests, Personal and Institutional, Member: German Cancer Society (DKG), German Society for Gynaecology and Obstetrics, Lower Rhine-Westphalian Society for Gynaecology and Obstetrics e.V. (NWGGG), Arbeitsgemeinschaft Gynäkologische Onkologie (AGO); Non-Financial Interests, Personal and Institutional, Member, Patient organization/Self help: BRCA Netzwerk e.V., Brustkrebs Deutschland e.V.; Non-Financial Interests, Personal and Institutional, Member: German Consortium for Familial Breast and Ovarian Cancer (GC-HBOC), German Breast Group (GBG). D. Stoppa-Lyonnet: Financial Interests, Personal and Institutional, Invited Speaker: AstraZenec; Financial Interests, Personal and Institutional, Research Grant: AstraZeneca; Other, Institutional, Other, PRS genotyping for MammaRisk test: Predilife. R.K. Schmutzler: Financial Interests, Personal, Advisory Role: AstraZeneca, GlaxoSmithKline, Pfizer, MSD, Clovis Oncology; Financial Interests, Personal, Writing Engagements: AstraZeneca; Financial Interests, Institutional, Research Grant: AstraZeneca; Financial Interests, Personal and Institutional, Invited Speaker: AstraZeneca, Pfizer, Janssen-Cilag; Non-Financial Interests, Personal and Institutional, Member: Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) Mamma, German Cancer Society (DKG); Non-Financial Interests, Personal and Institutional, Expert Testimony: S3 Guideline Commissions for Early Breast Cancer Detection and Diagnosis as well as Endometrial carcinoma, National Cancer Plan, Gene Diagnostics Commission at the Robert Koch Institute in Berlin; Non-Financial Interests, Personal and Institutional, Other, Steering Committee: National Cancer Plan; Non-Financial Interests, Personal and Institutional, Other, Patient organization/Self help: BRCA Network e.V; Non-Financial Interests, Personal and Institutional, Advisory Board, Member of the Ethics Advisory Board: National Cohort (NaKo); Non-Financial Interests, Personal and Institutional, Advisory Board: Scientific Advisory Board of the Cancer Information Service (KID) of the German Cancer Research Centre (DKFZ); Non-Financial Interests, Personal and Institutional, Other, Congress President: Congress PerMediCon; Non-Financial Interests, Personal and Institutional, Other, Coordinator: German Consortium for Familial Breast and Ovarian Cancer (GC-HBOC); Non-Financial Interests, Personal and Institutional, Advisory Board: Scientific Advisory Board of the Institute for Quality and Efficiency in Health Care (IQWIG); Non-Financial Interests, Personal and Institutional, Advisory Board: Scientific Advisory Board of the Federal Institute for Drugs and Medical Devices (BfArM); Non-Financial Interests, Personal and Institutional, Advisory Board: Scientific advisory board of the German Federal Ministry of Health; Non-Financial Interests, Personal and Institutional, Advisory Board: Technologie- und Methodenplattform für die vernetzte medizinische Forschung e.V. (TMF). All other authors have declared no conflicts of interest.

Background

Quality indicators (QIs) assessing the care pathway in onco-hematology are very limited and often linked to hospital concerns. They do not take into account the entire pathway, and in particular the coordination links between non-hospital professionals (GPs, pharmacists and private nurses) and the hospital. Our objective is to select a set of QIs on the care pathway in onco-hematology by involving all relevant stakeholders: hospital professionals, patient associations and non-hospital professionals. In this abstract we present the research conducted with non-hospital professionals.

Methods

A working group was organized with GPs, pharmacists and private nurses from all over France to select the QIs. A review of available QIs assessing the clinical pathway was conducted from the gray literature and literature reviews. Selection criteria were applied to extract oncological clinical pathway indicators. This list of QIs was presented to the working group for a consensus selection of a set of QI based on its adequacy and feasibility (delphi method).

Results

5731 QI were identified in the literature review and 131 included. 13 QIs were selected by non-hospital professionals (table): structure (6), process (5) and results (2). Table: 1507MO

1507MO

Conclusions

A final step will consist in gathering all the actors (hospital professionals, patient associations and non-hospital professionals) and comparing the QIs selected by each group in order to obtain a final and common set of QIs. These QIs could then be tested in the institutions of the project participants in order to validate their metrological qualities.

Legal entity responsible for the study

Novartis.

Funding

Novartis.

Disclosure

M. di Palma: Financial Interests, Personal, Advisory Board: Novartis. M. Ferrua: Financial Interests, Personal, Invited Speaker: novartis. A. Fourcade: Financial Interests, Personal, Advisory Board: novartis. M. Chirrane: Financial Interests, Personal, Full or part-time Employment: novartis. B. Clairaz: Financial Interests, Personal, Advisory Board: novartis. J. De La Cruz: Financial Interests, Personal, Full or part-time Employment: novartis. F. Loiseau: Financial Interests, Personal, Advisory Board: novartis. B. Ortolan: Financial Interests, Personal, Advisory Board: novartis. R. Pêcheux: Financial Interests, Personal, Advisory Board: novartis. R. Schwaller: Financial Interests, Personal, Advisory Board: novartis. J. Sicard: Financial Interests, Personal, Advisory Board: novartis. S. Siegrist: Financial Interests, Personal, Advisory Board: novartis. P. Sontag: Financial Interests, Personal, Advisory Board: novartis. J. Stoklosa: Financial Interests, Personal, Advisory Board: novartis. G. Tasseel: Financial Interests, Personal, Advisory Board: novartis. C. Trentini: Financial Interests, Personal, Advisory Board: novartis. F. veron: Financial Interests, Personal, Advisory Board: novartis. L. Verone: Financial Interests, Personal, Advisory Board: novartis. C. VogensthaL: Financial Interests, Personal, Advisory Board: novartis. All other authors have declared no conflicts of interest.

Background

Molecularly targeted agents (MTA) and immunotherapies (IO) are approved for cancer pt. OLD can be used before the upcoming approval and in different scenarios or conditions from those reflected in regulatory summary approvals. ME programs allow pt to receive OLD. We aimed to improve ME pt selection by developing a prognostic score (ICO MEscore) that included clinic-analytical (CA) variables readily available in real practice.

Methods

Retrospective cohort of metastatic solid tumor pt treated with ME MTA/IO between Jan’11-Dec’19. A multivariate Cox regression model was fitted to predict the risk of death. The Akaike information criterion was considered in a backward selection method. ICO MEscore was derived from a final prognostic model and was categorized using the nomogram and prognostic scores resulting in similar Kaplan-Meier curves.

Results

In total, 441 out of 541 (82%) cases treated with MTA (67%) or IO (33%) had available CA data. Most pt presented ECOG <2 (87%) and had received <3 previous lines (83%). Most frequent subtypes were thoracic (38%) and breast (19%) cancers, and 39% of all tumors harbored actionable oncogenic drivers. Overall, median overall survival (mOS) was 17.7 months (m) (95% CI 14-23). The final multivariate prognostic model included 8 risk factors: ECOG >=1, Body Mass Index <25, non-breast/thoracic tumors, hemoglobin <10.5 g/dL, neutrophil-to-lymphocyte ratio >3, platelet-to-lymphocyte ratio <150, >=2 sites of metastases and >=3 previous lines. Four prognostic groups were defined: low risk (LR) mOS 41.5 m (95% CI 35-NR), intermediate-low risk (ILR) mOS 18.1 m (95% CI 13.3-24), intermediate-high risk (IHR) mOS 7 m (95% CI 5.6-9.4) and high risk (HR) mOS 1.5 m (95% CI 1.2-4.2)(log rank test, p<0.001). 1-year OS rates were LR 80%, ILR 60% and IHR 36%, whereas there were no alive pt at 1-year in the HR group.

Conclusions

ICO MEscore is the first prognostic index under development for ME pt selection and our results suggest that could serve to identify HR pt with dismal prognosis. Further validation is warranted to confirm its applicability to rationalize ME decision-making.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Background

Combinations of cancer therapeutics (combo) have potential to improve antitumor efficacy over monotherapies, but their development remains challenging. To improve likelihood for success, the FDA issued guidance for the co-development of ≥2 INDs in 2013.

Methods

We reviewed all combo protocols in the MD Anderson Phase I Program between 2015-2020 for adherence to 4 key criteria: (1) intention to treat serious illness, (2) biological rationale, (3) full non-clinical characterization of combo, (4) compelling reason to not develop each drug independently. Parameters studied also included drug pharmacology, preclinical data, trial design, sponsor and biomarker use. Categorical variables are shown as percentages and compared by Chi-Square method.

Results

Of 470 protocols, 188 included combos [phase 1 (n=113), phase 1/2 (n=62), and phase 2 (n=13)], and 30 included multiple treatment arms. 166 combos included ≥1 approved drug, while 72 comprised only investigational agents. 54% of combos (n=128/238) met all 4 criteria. Industry-sponsored trials (51%, n=101/204) adhered to FDA guidance less often than non-Industry sponsored (74%, n= 25/34 Investigator and NCI sponsored) trials (p=0.01). Of 72 investigational agent-only combos, All treated a serious illness, 96% (n=69) had biological rationale, 79% (n=57) had full non-clinical characterization, 64% (n=46) had compelling reasons to not develop each drug independently; and 57% of these studies (n=41) met all 4 guidance criteria. Between immunotherapy only combos (IO) and targeted therapy only combos (TT): 98% (n=83/85) IO had biological rationale vs 89% (n=73/82) TT (p=0.03). 84% (n=69/82) TT had full non-clinical characterization vs 69% (n=59/85) IO combos (p=0.02). TT and IO combos had similar rates to not develop each drug independently (68% vs 60%; p=0.26) and to meet all 4 FDA criteria (60% vs 52%; p=0.30). Interestingly, IO combos incorporated patient selection biomarkers less often (15% vs 60%; p<0.001).

Conclusions

The FDA guidance for co-development provides a useful framework to evaluate combos, but only 57% of combos met all criteria. There are differences in adherence to the FDA guidance and use of biomarkers between IO and TT combos.

Legal entity responsible for the study

The Authors.

Funding

Has not received any funding.

Disclosure

D.S. Hong: Financial Interests, Personal, Advisory Role: Adaptimmune; Financial Interests, Personal, Advisory Role: Alphasights; Financial Interests, Personal, Advisory Role: Axiom Biotechnologies; Financial Interests, Personal, Advisory Role: Baxter; Financial Interests, Personal, Advisory Role: Bayer; Financial Interests, Personal, Advisory Role: Esai; Financial Interests, Personal, Advisory Role: Genentech; Financial Interests, Personal, Advisory Role: GLG; Financial Interests, Personal, Advisory Role: GroupH; Financial Interests, Personal, Advisory Role: Guidepoint Global; Financial Interests, Personal, Advisory Role: Janssen; Financial Interests, Personal, Advisory Role: Medscape; Financial Interests, Personal, Advisory Role: Merrimack; Financial Interests, Personal, Advisory Role: Numab; Financial Interests, Personal, Advisory Role: Pfizer; Financial Interests, Personal, Advisory Role: Seattle Genetics; Financial Interests, Personal, Advisory Role: Takeda; Financial Interests, Personal, Advisory Role: Tries Therapeutics; Financial Interests, Personal, Funding: Abbvie; Financial Interests, Personal, Funding: Adaptimmune; Financial Interests, Personal, Funding: Amgen; Financial Interests, Personal, Funding: AstraZeneca; Financial Interests, Personal, Funding: Bayer; Financial Interests, Personal, Funding: Bristol-Myers Squibb; Financial Interests, Personal, Funding: Daiichi Sankyo; Financial Interests, Personal, Funding: Eisai; Financial Interests, Personal, Funding: Fate Therapeutics; Financial Interests, Personal, Funding: Genentech; Financial Interests, Personal, Funding: Genmab; Financial Interests, Personal, Funding: Ignyta; Financial Interests, Personal, Funding: Infinity Pharmaceuticals; Financial Interests, Personal, Funding: Kite; Financial Interests, Personal, Funding: Kyowa Hakko Kirin; Financial Interests, Personal, Funding: Lilly; Financial Interests, Personal, Funding: Loxo; Financial Interests, Personal, Funding: MedImmune; Financial Interests, Personal, Funding: Merck; Financial Interests, Personal, Funding: Mirati; Financial Interests, Personal, Funding: miRNA Therapeutics; Financial Interests, Personal, Funding: Molecular Templates; Financial Interests, Personal, Funding: MOLOGEN; Financial Interests, Personal, Funding: National Cancer Institute; Financial Interests, Personal, Funding: Novartis; Financial Interests, Personal, Funding: Pfizer; Financial Interests, Personal, Funding: Seattle Genetics; Financial Interests, Personal, Funding: Takeda. S. Fu: Financial Interests, Personal, Funding: Soricimed Biopharma Inc.. D. Karp: Non-Financial Interests, Personal, Invited Speaker: Phosplatin Therapeutics. A. Naing: Financial Interests, Personal, Funding: EMD Serono; Financial Interests, Personal, Funding: MedImmune; Financial Interests, Personal, Funding: Helios Onc. Nutrition; Financial Interests, Personal, Funding: Atterocor/Millendo; Financial Interests, Personal, Funding: Amplimmune; Financial Interests, Personal, Funding: ARMO BioSciences; Financial Interests, Personal, Funding: KaryoPHarm Therapeutics; Financial Interests, Personal, Funding: Incyte; Financial Interests, Personal, Funding: Novartis; Financial Interests, Personal, Funding: Regeneron; Financial Interests, Personal, Funding: Merck; Financial Interests, Personal, Funding: Bristol-Myers Squibb; Financial Interests, Personal, Funding: Pfizer; Financial Interests, Personal, Funding: CytomX Therapeutics; Financial Interests, Personal, Funding: Neon Therapeutics; Financial Interests, Personal, Funding: Calithera Biosciences; Financial Interests, Personal, Funding: Top Alliance; Financial Interests, Personal, Funding: Eli Lilly; Financial Interests, Personal, Funding: Kymab; Financial Interests, Personal, Funding: PsiOxus; Financial Interests, Personal, Funding: Arcus Biosciences; Financial Interests, Personal, Funding: NeoImmune Tech; Financial Interests, Personal, Funding: ImmuneOncia; Financial Interests, Personal, Funding: Surface Oncology; Financial Interests, Personal, Advisory Board: CytomX Therapeutics; Financial Interests, Personal, Advisory Board: Novartis; Financial Interests, Personal, Advisory Board: Genome and Company; Financial Interests, Personal, Advisory Board: OncoSec; Financial Interests, Personal, Advisory Board: Kymab; Financial Interests, Personal, Advisory Board: STCube Pharmaceuticals. S. Pant: Financial Interests, Personal, Other, Honoraria: Tyme; Financial Interests, Personal, Other, Honoraria: Zymeworks; Financial Interests, Personal, Other, Honoraria: Xencor; Financial Interests, Personal, Other, Honoraria: 4-D Pharma. F. Janku: Financial Interests, Personal, Advisory Role: Asana; Financial Interests, Personal, Advisory Role: Bursh Health; Financial Interests, Personal, Advisory Role: Cardiff oncology; Financial Interests, Personal, Advisory Role: Deciphera; Financial Interests, Personal, Advisory Role: Gaurdant Health; Financial Interests, Personal, Advisory Role: Ideaya; Financial Interests, Personal, Advisory Role: IFM Therapeutics; Financial Interests, Personal, Advisory Role: Immunomet; Financial Interests, Personal, Advisory Role: Jazz Pharmaceutuicals; Financial Interests, Personal, Advisory Role: Novartis; Financial Interests, Personal, Advisory Role: PureTech; Financial Interests, Personal, Advisory Role: Sotio; Financial Interests, Personal, Advisory Role: Synlogic; Financial Interests, Personal, Ownership Interest: Cardiff Oncology. S.A. Piha-Paul: Financial Interests, Personal, Advisory Role: Merck. J. Rodon: Financial Interests, Personal, Advisory Role: Bayer; Financial Interests, Personal, Advisory Role: Certara; Financial Interests, Personal, Advisory Role: Ellipses Pharma; Financial Interests, Personal, Advisory Role: iOncologi; Financial Interests, Personal, Advisory Role: Kelun; Financial Interests, Personal, Advisory Role: Merck; Financial Interests, Personal, Advisory Role: Sharpe & Dohme; Financial Interests, Personal, Advisory Role: Peptomyc; Financial Interests, Personal, Advisory Role: Pfizer; Financial Interests, Personal, Advisory Role: Roche/Genentech; Financial Interests, Personal, Advisory Role: Spectrum Pharmaceuticals; Financial Interests, Personal, Funding: Bayer; Financial Interests, Personal, Funding: Novartis. V. Subbiah: Financial Interests, Personal, Advisory Role: Helsinn Therapeutics; Financial Interests, Personal, Advisory Role: Loxo; Financial Interests, Personal, Advisory Role: MedImmune; Financial Interests, Personal, Advisory Role: QED Therapeutics; Financial Interests, Personal, Advisory Role: R-Pharm; Financial Interests, Personal, Other, Bayer; Helsinn Therapeutics; Novartis; PharmaMar: Bayer; Financial Interests, Personal, Other, Bayer; Helsinn Therapeutics; Novartis; PharmaMar: Helsinn Therapeutics; Financial Interests, Personal, Other, Bayer; Helsinn Therapeutics; Novartis; PharmaMar: Novartis; Financial Interests, Personal, Other, Bayer; Helsinn Therapeutics; Novartis; PharmaMar: PharmaMar. A.M. Tsimberidou: Financial Interests, Personal, Advisory Role: Tempus; Financial Interests, Personal, Other, Honoraria: Covance; Financial Interests, Personal, Other, Honoraria: Genentech. F. Meric-Bernstam: Financial Interests, Personal, Advisory Role: Genentech; Financial Interests, Personal, Funding: Genentech; Financial Interests, Personal, Advisory Role: Novartis; Financial Interests, Personal, Advisory Role: Darwin Health; Financial Interests, Personal, Advisory Role: Roche; Financial Interests, Personal, Advisory Role: Inflection; Financial Interests, Personal, Advisory Role: Celgene; Financial Interests, Personal, Research Grant: Pieris; Financial Interests, Personal, Research Grant: Clearlight; Financial Interests, Personal, Research Grant: Samsung Bioepsis; Financial Interests, Personal, Research Grant: Spectrum Pharmaceuticals; Financial Interests, Personal, Research Grant: Aduro Biotech; Financial Interests, Personal, Research Grant: Originimed; Financial Interests, Personal, Research Grant: Xencor; Financial Interests, Personal, Advisory Board: IBM/Watson; Financial Interests, Personal, Research Grant: SeaGen; Financial Interests, Personal, Research Grant: Silverback; Financial Interests, Personal, Research Grant: PACT; Financial Interests, Personal, Research Grant: eFFECTOR; Financial Interests, Personal, Research Grant: TAIHO; Financial Interests, Personal, Research Grant: Novartis; Financial Interests, Personal, Research Grant: Aileron; Financial Interests, Personal, Research Grant: Puma Technology; Financial Interests, Personal, Research Grant: Jounce Therapeutics; Financial Interests, Personal, Research Grant: Zymework; Financial Interests, Personal, Research Grant: Curis; Financial Interests, Personal, Research Grant: AbbVie; Financial Interests, Personal, Research Grant: Boehringer Ingelheim; Financial Interests, Personal, Research Grant: Gaurdant; Financial Interests, Personal, Research Grant: GlaxoSmithKline; Financial Interests, Personal, Research Grant: Daiichi Sanko. T.A. Yap: Financial Interests, Personal, Advisory Role: Aduro; Financial Interests, Personal, Advisory Role: Almac Diagnostics; Financial Interests, Personal, Advisory Role: Astra Zeneca; Financial Interests, Personal, Advisory Role: Atrin Pharmaceuticals; Financial Interests, Personal, Advisory Role: Bayer; Financial Interests, Personal, Advisory Role: Bristol-Myers Squibb; Financial Interests, Personal, Advisory Role: Calithera Biosciences; Financial Interests, Personal, Advisory Role: Clovis Oncology; Financial Interests, Personal, Advisory Role: Cybrexa Therapeutics; Financial Interests, Personal, Advisory Role: EMD Serono; Financial Interests, Personal, Advisory Role: Ignyta; Financial Interests, Personal, Advisory Role: Janssen; Financial Interests, Personal, Advisory Role: Merck; Financial Interests, Personal, Advisory Role: Pfizer; Financial Interests, Personal, Advisory Role: Roche; Financial Interests, Personal, Advisory Role: SeaGen; Financial Interests, Personal, Advisory Role: Tesaro; Financial Interests, Personal, Advisory Role: Vertex; Financial Interests, Personal, Funding: AstraZeneca; Financial Interests, Personal, Funding: AstraZeneca; Financial Interests, Personal, Funding: Bayer; Financial Interests, Personal, Funding: Constellation Pharmaceuticals; Financial Interests, Personal, Funding: Jounce Therapeutics; Financial Interests, Personal, Funding: Kyowa Hakko Kirin; Financial Interests, Personal, Funding: Lilly; Financial Interests, Personal, Funding: Pfizer; Financial Interests, Personal, Funding: Seattle Genetics; Financial Interests, Personal, Funding: Tesaro; Financial Interests, Personal, Funding: Vertex; Financial Interests, Personal, Other, Travel, Accommodations, Expenses: EMD Sorono; Financial Interests, Personal, Other, Travel, Accommodations, Expenses: Pfizer; Financial Interests, Personal, Other, Travel, Accommodations, Expenses: Tesaro. All other authors have declared no conflicts of interest.

Background

Despite the efforts of scientific organisations, patients’ views of immunotherapy are unclear. CareAcross, a multilingual digital platform which provides personalised, evidence-based support to cancer patients, investigated their views on immunotherapy.

Methods

In the second half of 2020, members of the CareAcross platforms (primarily from the UK, France, Spain, Italy or Germany) responded to relevant questions.

Results

Among 5589 patients who responded, 4064 had breast (BC), 1131 lung (LC), 231 prostate (PC) and 163 colorectal cancer (CC). When asked “How does immunotherapy work?”, 55% of BC, 34% of LC, 60% of PC and 45% of CC responded either “Not Sure” or “Do Not Know”. Regarding its timing of action, most (50-61%) responded “Do Not Know”. Responses to these 2 questions are detailed below: Table: 1510MO

1510MO

When comparing immunotherapy’s side-effects with chemotherapy’s, 24% of BC, 23% of LC, 31% of PC and 34% of CC responded “Do Not Know”. Most (60-74%) perceived chemotherapy as more toxic; very few considered immunotherapy more toxic (2-5%). Compared to targeted therapy, most (58-65%) did not know. 21-26% believed targeted therapy is more toxic, and few that immunotherapy is more toxic (9-15%). Regarding costs to the healthcare system, patients were asked to compare immunotherapy, chemotherapy and targeted therapy. Most did not know (53-58%), while BC and PC patients believe that chemotherapy costs the most. Chemotherapy, immunotherapy and targeted therapy were selected as the most expensive by 23%, 11%, 6% (BC); 12%, 17%, 12% (LC); 25%, 10%, 8% (PC); and 11%, 17%, 12% (CC), respectively. Among LC patients, those receiving immunotherapy (241 of 1131) had as much as twice the correct answer percentages, except side-effects (they perceived it more toxic compared to LC patients not receiving it).

Conclusions

Most patients do not know enough about immunotherapy, its mechanism and timing of action, and its costs to the healthcare system. Among 4 cancer types, lung cancer patients (especially those treated with immunotherapy) are better informed.

Legal entity responsible for the study

Care Across Ltd.

Funding

Care Across Ltd.

Disclosure

All authors have declared no conflicts of interest.