US Oncology, The Woodlands, Texas 75426, USA.
J Thorac Oncol. 2012 Jan;7(1):212-8. doi: 10.1097/JTO.0b013e3182307f33.
A comparison of clinical and economic outcomes among patients receiving second-line monotherapy with erlotinib, docetaxel, and pemetrexed for non-small cell lung cancer was conducted using a large network of outpatient community clinics.
We identified 610 patients with advanced non-small cell lung cancer who received 2L treatment from July 1, 2006, to June 30, 2008, and were followed up through July 1, 2009, to evaluate progression-free survival (PFS), overall survival (OS), costs, and health resource utilization. Cox proportional hazards regression were used to compare PFS and OS across treatment cohorts. Economic outcomes were calculated per patient per month (PPPM) during a 12-month follow-up period.
There were 73 patients who received erlotinib, 87 received docetaxel, and 450 received pemetrexed. The median age was 67 years, and 55% were men. No significant differences in stage, baseline performance status, hemoglobin level, or body mass index were observed by treatment. The median OS was 132 days for docetaxel, 132 days for pemetrexed, and 155 days for erlotinib (p = 0.39). Adjusting for age, gender, stage, performance status, and hemoglobin level, there was no significant association between treatment type and OS (p = 0.36) or PFS (p = 0.26). Relative to pemetrexed, total adjusted costs PPPM was $1579 lower for docetaxel and $1584 lower for erlotinib (p < 0.05). Outpatient visits, laboratory procedures, and acute care visits were also less frequent with erlotinib relative to pemetrexed (-2.6 PPPM, p < 0.05).
We observed no significant differences in OS and PFS between patients receiving erlotinib, docetaxel, and pemetrexed. Nevertheless, erlotinib and docetaxel were associated with a statistically significant lower costs and resource use relative to pemetrexed.
使用大型社区门诊网络，对接受二线单药治疗的非小细胞肺癌患者（接受厄洛替尼、多西他赛和培美曲塞治疗）的临床和经济结局进行了比较。
我们确定了 610 名患有晚期非小细胞肺癌的患者，他们在 2006 年 7 月 1 日至 2008 年 6 月 30 日期间接受了 2L 治疗，并随访至 2009 年 7 月 1 日，以评估无进展生存期（PFS）、总生存期（OS）、成本和卫生资源利用情况。使用 Cox 比例风险回归比较治疗队列之间的 PFS 和 OS。在 12 个月的随访期间，按每个患者每月（PPPM）计算经济结果。
接受厄洛替尼治疗的患者有 73 例，接受多西他赛治疗的患者有 87 例，接受培美曲塞治疗的患者有 450 例。中位年龄为 67 岁，55%为男性。治疗时，各治疗组的分期、基线表现状态、血红蛋白水平或体重指数无显著差异。多西他赛的中位 OS 为 132 天，培美曲塞为 132 天，厄洛替尼为 155 天（p=0.39）。调整年龄、性别、分期、表现状态和血红蛋白水平后，治疗类型与 OS（p=0.36）或 PFS（p=0.26）之间无显著关联。与培美曲塞相比，多西他赛的总调整成本 PPPM 低 1579 美元，厄洛替尼的总调整成本 PPPM 低 1584 美元（p<0.05）。与培美曲塞相比，厄洛替尼的门诊就诊、实验室检查和急性护理就诊次数也分别减少了 2.6 PPPM（p<0.05）。
我们观察到接受厄洛替尼、多西他赛和培美曲塞治疗的患者的 OS 和 PFS 无显著差异。尽管如此，与培美曲塞相比，厄洛替尼和多西他赛的成本和资源使用量具有统计学意义的降低。
