上皮性卵巢癌(EOC)的多腺苷核糖磷酸抑制剂(PARPi)一级与二级维持治疗的过度治疗和成本效益。

Gynecology & obstetrics (Sunnyvale, Calif.) Pub Date : 2021-01-01 Epub Date: 2021-10-07
Peter G Rose, Meng Yao, Laura M Chambers, Lin Mei, Phuc Le
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引用次数: 0

摘要

背景:没有数据表明PARP抑制剂(PARPi)治疗作为一线维持优于PARPi治疗作为二线维持。目的:确定原发性和继发性奥拉帕尼或尼拉帕尼维持治疗上皮性卵巢癌(EOC)的疗效和成本。方法:对EOC女性患者进行回顾性队列研究,以确定原发性或继发性PARPi维持后的生存率。我们分别基于先前发表的基于Solo 1/Solo 2和Prima和Nova试验的成本和治疗持续时间对olaparib和niraparib的成本进行了建模。结果:在40例以PARPi作为主要或次要维持治疗的患者中,总生存期无差异(p=0.97)。在166名III/IV期生殖系BRCA突变EOC的女性中,28.8%的患者在化疗后3年以上无疾病(18.6%从未复发,10.2%在化疗后3年以上复发)。由于29%的BRCA突变患者在3年内没有复发,因此初级奥拉帕尼维持治疗的费用明显高于二级奥拉帕尼维持治疗的260%。BRCA突变、HR缺陷和HR熟练患者的初级尼拉帕尼维持治疗分别比次级尼拉帕尼维持治疗贵4%、51%和15%。通过消除原发性PARPi治疗患者的过度治疗,100名携带BRCA突变的EOC女性患者使用奥拉帕尼可节省37,335,360美元,使用尼拉帕尼可节省8,197,592美元。结论:高达29%的BRCA突变患者可能会过度接受初级PARPi维持治疗,从而显著增加治疗费用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

The Overtreatment and Cost Effectiveness of Primary <i>versus</i> Secondary Maintenance Therapy with Poly-Adenosine Ribose Phosphate Inhibitors (PARPi) for Epithelial Ovarian Cancer (EOC).

The Overtreatment and Cost Effectiveness of Primary versus Secondary Maintenance Therapy with Poly-Adenosine Ribose Phosphate Inhibitors (PARPi) for Epithelial Ovarian Cancer (EOC).

Background: No data exist to suggest PARP inhibitor (PARPi) therapy as first-line maintenance is superior to PARPi therapy as second-line maintenance.

Objective: To determine the efficacy and cost of primary versus secondary olaparib or niraparib maintenance in Epithelial Ovarian Cancer (EOC).

Methods: A retrospective cohort study was performed in women with EOC to determine the survival following primary or secondary PARPi maintenance. We modeled the costs of olaparib and niraparib based on previously published costs and duration of therapy based on the Solo 1/Solo 2 and Prima and Nova trials, respectively.

Results: Among 40 patients treated with PARPi as primary or secondary maintenance there was no difference in overall survival (p=0.97). Among 166 women with stage III/IV germ-line BRCA mutated EOC, 28.8% were disease free for >3 years (18.6% never recurred and 10.2% recurred >3 years after chemotherapy). Since 29% of the BRCA mutated patients did not recur within 3 years, primary olaparib maintenance therapy was significantly more expensive than secondary olaparib maintenance therapy by 260%. Primary niraparib maintenance therapy was slightly more expensive than secondary niraparib maintenance therapy by 4%, 51%, and 15% for BRCA mutated, HR deficient, and HR proficient patients, respectively. By eliminating the overtreatment of patients with primary PARPi therapy, the cost savings for 100 women with EOC with BRCA mutations would be $37,335,360 for olaparib and $8,197,592 for niraparib.

Conclusion: Up to 29% of BRCA mutated patients may be overtreated with primary PARPi maintenance with significantly increased treatment costs.

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