Bruce CM Wang’s research while affiliated with Novocure GmbH and other places

Purpose Lung cancer remains a leading cause of cancer-related mortality. Tumor Treating Fields (TTFields) therapy extended survival in patients with metastatic non-small cell lung cancer (NSCLC) on or after platinum-based therapy. This study evaluates the cost-effectiveness of TTFields therapy concomitant with immune checkpoint inhibitors (ICIs) or docetaxel. Methods A model-based health economic evaluation estimated lifetime costs, clinical benefits, and humanistic outcomes of TTFields therapy plus ICI or docetaxel versus ICI or docetaxel alone in metastatic NSCLC. The model used clinical data from the LUNAR study, US healthcare cost data, and quality-adjusted life year (QALY) measures. Results The addition of TTFields therapy to an ICI or docetaxel resulted in a mean life-year gain of 0.92 and a QALY gain of 0.66, with an incremental cost-effective ratio (ICER) of $89,808 per QALY gained. TTFields therapy plus an ICI had 1.67 additional life years and 1.21 additional QALYs compared to an ICI alone, with an ICER of$58,764 per QALY gained. For TTFields therapy plus docetaxel, the life-year gain was 0.23 and the QALY gain was 0.17, with an ICER of $306,029 per QALY gained. Sensitivity analyses confirmed the robustness of these findings. Conclusion The addition of TTFields therapy to an ICI or docetaxel in metastatic NSCLC demonstrates comparable cost-effectiveness to other approved treatments. ICERs fall within the accepted range for US cost-effectiveness thresholds, supporting their use in clinical practice. TTFields therapy extended mean lifetime survival, offering a clinically meaningful and economically justifiable option for patients progressing after platinum-based chemotherapy.

Article highlights A subset of patients with early breast cancer (EBC) (i.e., hormone receptor positive, human epidermal growth factor receptor 2 negative, stage IA–IIIC patients) presenting with node-positive characteristics and high-risk clinical features (‘high-risk’), are at higher risk of recurrence. This study used Taiwan’s National Health Insurance Research Database and Taiwan Cancer Registry to understand the patient population facing this higher risk in Taiwan. There were 4500 patients with high-risk EBC (10.4% of all patients with EBC) from 2012 to 2018, with an annual average incidence of 643, which increased annually. Within both the adjuvant therapy only and in combination with neoadjuvant therapy, the triple therapy combination of chemotherapy, radiotherapy and hormone therapy was the most common treatment. Within hormone therapy, tamoxifen and letrozole were the most used treatments. Five-year progression was higher in the EBC high-risk cohort compared with all patients with EBC cohort. Eight-year survival was low in patients with high-risk EBC. Novel treatments and innovations are needed to alleviate patient burden.

Introduction Alopecia Areata (AA) is an autoimmune disease characterized by non-scarring hair loss that may cause substantial psychological and emotional distress. This study used Taiwan’s National Health Insurance Research Database (NHIRD) to describe the epidemiology, treatment patterns, and healthcare resource utilization (HCRU) of AA patients of varying severities in Taiwan. Materials and Methods This observational study used Taiwan's National Health Insurance Research Database (NHIRD), a claims-based dataset with data on demographics, diagnosis and treatment, and HCRU for the 23 million residents covered by the National Health Insurance system. Severity was based on both treatment use (i.e. corticosteroids, systemic immunosuppressants, topical immunotherapy, and phototherapy) and diagnostic codes in the year after enrollment. A cross-sectional analysis by calendar year was conducted to estimate the incidence and prevalence of AA (2016-2020). For the longitudinal analysis two AA cohorts: mild/moderate (matched 4:1 mild/moderate patients: severe based on age, gender, CCI), and severe, were identified and enrolled upon their first claim with an AA diagnosis during the index period (2017-18). Results The cross-sectional analysis showed the number of AA patients rose from 3221 to 3855 between 2016 – 2020 (Figure 1). The longitudinal analysis identified 452 severe patients and 1808 mild/moderate patients (53.42% male and 46.58% female) after matching. During the follow-up period, severe patients used more topical non-steroids (41.81%) and systemic therapies (51.77%) than the mild/moderate patients (0.44%/ 16.15%). Conversely, severe patients used less topical corticosteroids (73.45%) than mild/moderate patients (82.41%). Use of oral glucocorticoids was higher in severe patients (47.57%) vs. the mild/moderate (14.88%), while the use of injectable forms was similar. The most common systemic immunosuppressants used were: methotrexate, cyclosporin, and azathioprine (Table 2). For severe patients, usage of topical immunotherapy decreased from 187 patients in line 1 to 95 and 71 patients in lines 2 and 3, respectively. Use of immunosuppressants-based therapy increased in subsequent treatment lines. Treatment persistence at 6 months was 25.00% for cyclosporine, 22.22% for azathioprine, and 7.69% for methotrexate. Despite being the most common treatment strategies for severe AA, persistence for systemic glucocorticoids (7.02%-15.63%) and topical immunotherapy (6.42%) was low. Annual AA-related outpatient visits were higher for severe patients than for the mild/moderate cohort. Discussion There was an increase in the number of patients with AA recorded in Taiwan's NIHRD from 2016 to 2020. Patients often underwent multiple lines of therapy and we observed overall low persistence rates of current therapeutic options. Additional innovations and therapies are needed to address the clinical and economic burden associated with AA.

Hepatocellular carcinoma (HCC) is the fourth most common driver of cancer-related death globally, with an estimated 72% of cases in Asia. For more than a decade, first-line systemic treatments for advanced or unresectable HCC were limited to the multi-targeted kinase inhibitors sorafenib and, more recently, lenvatinib. Now, treatment options have expanded to include immunotherapy, as exemplified by the immune checkpoint inhibitor (ICI) atezolizumab combined with the antiangiogenic agent bevacizumab. Additional combinations of ICIs with kinase inhibitors, other ICIs, or antiangiogenic agents are under investigation, further supporting the new era of immunotherapy for first-line treatment of advanced or unresectable HCC. We describe this evolving landscape and provide expert opinion on therapeutic best practices in the Asia–Pacific region, where different costs of, and patient access to, treatment are a challenge. With the combination of atezolizumab plus bevacizumab likely to become the clinical standard of care, optimising treatment sequence and ensuring patient access to newer therapies remain priorities. Cost containment and treatment sequencing may be facilitated by characterisation of predictive positive and negative biomarkers. With these considerations in mind, this review and expert opinion focused on advanced HCC in the Asia–Pacific region offers perspectives of multiple stakeholders, including physicians, payer systems, and patients.

2055 Background: The aim of this study was to administer the first large-scale, international survey eliciting real-world patient-reported quality-of-life (QoL) for patients with newly diagnosed and long-term glioblastoma (GBM) currently receiving treatment with TTFields. Methods: A survey was designed and mailed to 2,815 patients actively using TTFields for treatment of GBM in the United States (US, n = 2,182) and Europe (EU, n = 633). The survey included 1) demographic information, 2) patient-reported clinical information and 3) EuroQol’s EQ-5D-5L and EQ visual analogue scale (EQ-VAS) surveys. Univariate and multivariate analyses were performed on five dimensions (mobility, self-care, usual activity, pain/discomfort, anxiety/depression) of the EQ-5D-5L and EQ-VAS to understand the impact of patient demographics and clinical characteristics on QOL. Results: A total of 1,106 patients were included (39.3% response rate) with 782 and 324 responses in the US and EU, respectively. The median time from diagnosis was 14 mos (range, 0-301 mos) and ≥24 mos in 28.4% of patients. Patients were mostly male (62.3%) with a mean age of 58.5 (SD = 12.5) and 69.3% had stable disease. Mean EQ-VAS was 68.2 for all patients and was significantly higher for those with > 15 months since diagnosis compared to < 15 months since diagnosis (p = 0.008). There were significantly fewer problems reported on self-care ( p = 0.04) and usual activity ( p = 0.007) in patients with a longer time since diagnosis in the univariate analysis. In the multivariate analysis, patients with a longer time since diagnosis reported significantly better EQ-VAS ( p = 0.04). The effect size in the multivariate analysis for time since diagnosis on EQ-VAS was higher in the progressed subgroup ( p = 0.17) compared to the broader sample (0.08). The EQ-VAS and all five dimensions including mobility, self-care, usual activity, pain/discomfort, and anxiety/depression were improved for stable patients compared to progressed patients in the univariate and multivariate analyses. However, when stratified by progression status, progressed patients with longer time from diagnosis had significantly fewer reported problems with mobility ( p = 0.04), self-care ( p = 0.004) and usual activity ( p = 0.008), and significantly better self-rated health status ( p = 0.02). Conclusions: GBM survivors receiving TTFields reported significantly improved health status over time since diagnosis. Long-term survival with TTFields does not have a detriment in patient reported quality of life, in fact with longer time from diagnosis QOL significantly improves. This is true for patients with stable and progressed disease. Future prospective clinical trials are needed to further study the impact of our treatment and tumor progression on patient QOL.

Introduction Pneumococcal infections can lead to serious invasive diseases such as meningitis, septicaemia and pneumonia, as well as milder but more common illnesses such as sinusitis and otitis media. The World Health Organization (WHO) recommends the inclusion of pneumococcal conjugate vaccines (PCVs) in infant National Immunization Program (NIP) programs worldwide. Decision-makers in Asian countries planning to introduce PCVs in their respective NIP will need a comprehensive evidence of effectiveness of PCVs at the population level and economic evidence including cost-effectiveness. Areas Covered A systematic literature review (from 1/1/2016 to 10/11/2019) of PCVs in East and Southeast Asia to understand (1) the contributing factors to cost-effectiveness results of PCVs and (2) whether gaps in evidence exist suggesting why the region may have yet to implement full NIPs. Expert Opinion In East and Southeast Asia, vaccination with PCVs was found to significantly reduce the mortality and morbidity of pneumococcal diseases and was cost-effective compared to no vaccination. Study assumptions, specifically vaccine local acquisition, the inclusion or exclusion of indirect effects (serotype replacement and herd effect), cross-protection, and protection against nontypeable haemophilus influenzae and serotype 3, were the main drivers of cost-effectiveness.