BACKGROUND: In the randomised controlled trial ECHELON-2 (NCT01777152; January 2013), brentuximab vedotin (BV) plus cyclophosphamide, doxorubicin and prednisone (CHP) demonstrated improved efficacy compared with CHOP (CHP and vincristine) in frontline CD30+ peripheral T-cell lymphoma (PTCL), an aggressive cancer with poor survival. In ECHELON-2, 70% of patients had systemic anaplastic large cell lymphoma (sALCL), a subtype of PTCL. Of sALCL patients who progressed from BV+CHP and CHOP, 36% (n = 17) and 56% (n = 36) received subsequent BV-containing therapy, respectively. As BV re-treatment was not funded in England at the time, our objective was to estimate adjusted efficacy and cost-effectiveness by excluding BV re-treatment from BV+CHP. METHODS: To remove the effects of BV re-treatment, the inverse probability of censoring weights (IPCW) and two-stage estimator (TSE) approaches, with and without re-censoring, were applied to overall survival (OS) in the BV+CHP arm of the ECHELON-2 sALCL population. Cost-effectiveness was determined in a three-state partitioned survival (PartSA) model from the perspective of the National Health Service (NHS) in England. RESULTS: The unadjusted hazard ratio (HR) for death in patients with sALCL with BV+CHP versus CHOP was 0.54 (95% CI 0.34, 0.87; p = 0.011). The model base case used TSE analysis without re-censoring, which provided an adjusted HR for death of 0.55 (95% CI 0.33, 0.86; p = 0.014). Incremental cost-effectiveness ratios (ICERs) including and excluding re-treatment with BV were £29,760/QALY and £27,761/QALY, respectively. CONCLUSION: TSE without re-censoring provided the most clinically plausible estimate of survival whilst retaining sufficient information for OS extrapolation. After adjustment for BV re-treatment, BV+CHP remains an efficacious and cost-effective treatment in frontline sALCL compared with CHOP.
BACKGROUND: In the randomised controlled trial ECHELON-2 (NCT01777152; January 2013), brentuximab vedotin (BV) plus cyclophosphamide, doxorubicin and prednisone (CHP) demonstrated improved efficacy compared with CHOP (CHP and vincristine) in frontline CD30+ peripheral T-cell lymphoma (PTCL), an aggressive cancer with poor survival. In ECHELON-2, 70% of patients had systemic anaplastic large cell lymphoma (sALCL), a subtype of PTCL. Of sALCL patients who progressed from BV+CHP and CHOP, 36% (n = 17) and 56% (n = 36) received subsequent BV-containing therapy, respectively. As BV re-treatment was not funded in England at the time, our objective was to estimate adjusted efficacy and cost-effectiveness by excluding BV re-treatment from BV+CHP. METHODS: To remove the effects of BV re-treatment, the inverse probability of censoring weights (IPCW) and two-stage estimator (TSE) approaches, with and without re-censoring, were applied to overall survival (OS) in the BV+CHP arm of the ECHELON-2 sALCL population. Cost-effectiveness was determined in a three-state partitioned survival (PartSA) model from the perspective of the National Health Service (NHS) in England. RESULTS: The unadjusted hazard ratio (HR) for death in patients with sALCL with BV+CHP versus CHOP was 0.54 (95% CI 0.34, 0.87; p = 0.011). The model base case used TSE analysis without re-censoring, which provided an adjusted HR for death of 0.55 (95% CI 0.33, 0.86; p = 0.014). Incremental cost-effectiveness ratios (ICERs) including and excluding re-treatment with BV were £29,760/QALY and £27,761/QALY, respectively. CONCLUSION: TSE without re-censoring provided the most clinically plausible estimate of survival whilst retaining sufficient information for OS extrapolation. After adjustment for BV re-treatment, BV+CHP remains an efficacious and cost-effective treatment in frontline sALCL compared with CHOP.
Authors: Dennis D Weisenburger; Kerry J Savage; Nancy Lee Harris; Randy D Gascoyne; Elaine S Jaffe; Kenneth A MacLennan; Thomas Rüdiger; Stefano Pileri; Shigeo Nakamura; Bharat Nathwani; Elias Campo; Francoise Berger; Bertrand Coiffier; Won-Seog Kim; Harald Holte; Massimo Federico; Wing Y Au; Kensei Tobinai; James O Armitage; Julie M Vose Journal: Blood Date: 2011-01-26 Impact factor: 22.113
Authors: F d'Amore; P Gaulard; L Trümper; P Corradini; W-S Kim; L Specht; M Bjerregaard Pedersen; M Ladetto Journal: Ann Oncol Date: 2015-09 Impact factor: 32.976
Authors: Francine M Foss; Pier Luigi Zinzani; Julie M Vose; Randy D Gascoyne; Steven T Rosen; Kensei Tobinai Journal: Blood Date: 2011-04-14 Impact factor: 22.113
Authors: Mary Gleeson; Clare Peckitt; David Cunningham; Adam Gibb; Eliza A Hawkes; Morgan Back; Binnaz Yasar; Kate Foley; Rebecca Lee; Joanna Dash; Hannah Johnson; Catherine O'Hara; Andrew Wotherspoon; Ayoma Attygalle; Lia Menasce; Patrick Shenjere; Mike Potter; Mark E Ethell; Claire Dearden; John Radford; Ian Chau; Kim Linton Journal: Leuk Lymphoma Date: 2017-11-09
Authors: H Herbst; G Tippelmann; I Anagnostopoulos; J Gerdes; R Schwarting; T Boehm; S Pileri; D B Jones; H Stein Journal: Leuk Res Date: 1989 Impact factor: 3.156
Authors: David Sibon; Marion Fournier; Josette Brière; Laurence Lamant; Corinne Haioun; Bertrand Coiffier; Serge Bologna; Pierre Morel; Jean Gabarre; Olivier Hermine; Anne Sonet; Christian Gisselbrecht; Georges Delsol; Philippe Gaulard; Hervé Tilly Journal: J Clin Oncol Date: 2012-10-08 Impact factor: 44.544