ABSTRACT
Objetivo: Avaliar o impacto clínico e econômico do uso do perfil genômico utilizando Next Generation Sequencing (NGS) em DNA circulante tumoral (ctDNA) na escolha do tratamento de primeira linha (1L) dos pacientes com câncer de pulmão de células não pequenas, não escamoso, metastático e que não apresentam material tecidual suficiente para avaliação das mutações oncogênicas. Métodos: Foi realizada uma análise de custo-efetividade com base em um modelo de árvore de decisão e um modelo de Markov para simular os resultados dos testes diagnósticos e consequentemente o seu impacto clínico e econômico na primeira linha de tratamento. O comparador da análise foi o teste de mutações específicas no gene EGFR por ctDNA. As terapias medicamentosas incluídas na análise foram as terapias-alvo de EGFR e ALK, que estão incorporadas no rol da Agência Nacional de Saúde Suplementar, e a imunoterapia pembrolizumabe combinada à quimioterapia. Os desfechos clínicos foram retirados dos estudos clínicos das terapias avaliadas no modelo. Resultados: O uso do painel de NGS em ctDNA demonstrou uma economia de -R$ 2.076,35 por paciente em um ano, e os resultados de RCEI foram: -R$ 7.652,56 (R$/SLP) e -R$ 33.742,14 (R$/SG). Conclusão: O painel de NGS em ctDNA demonstrou ser uma alternativa dominante em relação ao teste de EGFR em ctDNA.
Objective: The aim of this study was to evaluate the clinical and economic impact of the next generation sequencing (NGS) panel of circulating tumor DNA (ctDNA) in the clinical decision of first line treatment for patients with metastatic non-squamous non-small cell lung cancer who lack of tissue material for evaluation of oncogenic driver mutations. Methods: A cost-effectiveness analysis was performed based on a decision tree model and a Markov model in order to simulate the results of diagnostic tests and therefore its clinical and economic impact in the first line of treatment. The comparators were the single EGFR mutation detection methodologies in ctDNA. The analysis included the anti-EGFR and anti-ALK target therapies; and the combined therapy of pembrolizumab plus chemotherapy. Clinical outcomes were derived from clinical trials of the therapies included in the model. Results: The use of the NGS ctDNA panel showed a saving of -R$ 2,076.35 and the results of the ICER were -R$ 7,652.56 (R$/SLP) and -R$ 33,742.14 (R$/SG). Conclusion: The NGS panel demonstrated to be a dominant alternative in comparison to ctDNA EGFR testing.
Subject(s)
Cost-Benefit Analysis , Carcinoma, Non-Small-Cell Lung , Circulating Tumor DNAABSTRACT
INTRODUCTION: Outcomes data on Non-Small Cell Lung Cancer (NSCLC) are scarce with regard to the private health care in Brazil. The aim of this study was to describe the characteristics, treatments performed, and the survival of patients with NSCLC in a Brazilian private oncologic institution. METHODS: Medical charts from patients treated between 1998 and 2010 were reviewed, and data were transferred to a clinical research form. Long-term follow-up and survival estimates were enabled through active surveillance. RESULTS: Five hundred sixty-six patients were included, and median age was 65 years. Most patients were diagnosed in advanced stages (79.6% III/IV). The overall survival was 19.0 months (95%CI 16.2 - 21.8). The median survival was 99.7, 32.5, 20.2, and 13.3 months for stages I, II, III, and IV, respectively (p < 0.0001). Among patients receiving palliative chemotherapy, the median survival was 12.2 months (95%CI 10.0 - 14.4). CONCLUSIONS: The outcomes described are favorably similar to the current literature from developed countries. Besides the better access to health care in the private insurance scenario, most patients are still diagnosed in late stages. .
INTRODUÇÃO: Dados de desfechos em câncer de pulmão de células não pequenas (CPCNP) são escassos no contexto da saúde suplementar no Brasil. O objetivo deste estudo foi descrever as características, tratamentos realizados e a sobrevida desses pacientes em uma instituição oncológica privada brasileira. MÉTODOS: Foram revisados os prontuários de pacientes atendidos entre 1998 e 2010 com diagnóstico de CPCNP. Os dados foram transferidos para uma ficha clínica individual e posteriormente analisados. Pacientes ou familiares foram contatados a fim de otimizar o seguimento e a estimativa da sobrevida. RESULTADOS: Foram incluídos 566 pacientes, com idade mediana de 65 anos. Predominaram os diagnósticos em estádios avançados (79,6% III/IV). A sobrevida mediana foi de 19,0 meses (IC95% 16,2 - 21,8), sendo de 99,7, 32,5, 20,2 e de 13,3 meses nos estádios I, II, III e IV, respectivamente (p < 0,0001). Entre os pacientes que receberam quimioterapia paliativa, a sobrevida mediana foi de 12,2 meses (IC95% 10,0 - 14.4). CONCLUSÕES: Os desfechos encontrados se assemelham aos de países desenvolvidos. Apesar do maior acesso médico em pacientes com cobertura de planos de saúde, a maioria dos diagnósticos ocorre tardiamente. .
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/diagnosis , Lung Neoplasms/diagnosis , Carcinoma, Non-Small-Cell Lung/epidemiology , Carcinoma, Non-Small-Cell Lung/therapy , Follow-Up Studies , Lung Neoplasms/epidemiology , Lung Neoplasms/therapy , Neoplasm Staging , PrognosisABSTRACT
Objective: The objective of this study was evaluating the reproducibility in Portuguese of Functional Assessment of Cancer Therapy-Fatigue (FACT-F) questionnaire for cancer patients by applying it according to the test-retest method. Material and Methods: Subjects were 85 cancer patients with an average age of 51.0 years, being 56 (65.9%) women and 29 (34.1%) men. FACT-F questionnaire consists of 40 items, divided in five domains, and is applied for evaluating quality of life and fatigue in patients with cancer. We used as a measuring tool intraclass correlation coefficient values obtained from two measures of test-retest and scatter plot proposed by Bland-Altman. Results: In 36.5% of cases the questionnaire was self-administered, and in 63.5% of the cases read by an interviewer and filled after verbal answer. Intraclass correlation coefficient values found for the domains were: physical well-being 0.72; social/family well-being 0.91; emotional well-being 0.90; functional well-being 0.86; fatigue subscale 0.88, and for the FACT-F 0.91. The Bland-Altman plot showed to be adequate, since most points were within the limits of reliability. Conclusions: FACT-F questionnaire in Portuguese has good test-retest reproducibility in patients with different types of cancer, performance status and stages.
Subject(s)
Humans , Male , Female , Fatigue , Quality of Life , Reproducibility of ResultsABSTRACT
Descreveremos um raro e memorável caso de osteoartropatia hipertrófica (OAH), cujos sinais e sintomas osteoarticulares da síndrome conduzem ao diagnóstico de adenocarcinoma de pulmão em uma paciente assintomática respiratória. Discutiremos também as diversas particularidades da síndrome, fazendo uma revisão da literatura. Nesta revisão, destacaremos alguns dos novos aspectos de sua obscura etiopatogenia, seu diagnóstico diferencial com doenças reumáticas clássicas e os achados singulares da ressonância magnética, que podem, inclusive, preceder os do RX convencional.