ECE2020 Audio ePoster Presentations Thyroid (144 abstracts)
Radioactive Iodine-Refractory (RAI) Differentiated Thyroid Cancer (rDTC): Analysis of the Canadian Patient Support Program (PSP) for the Prescription and Treatment Patterns of Lenvatinib (LEN)
Andree Boucher 1 , Mircescu Hortensia 1 , Rondeau Geneviève 1 , Leboeuf Rebecca 1 , Lemieux Bernard 1 , Brassard Maryse 2 , Massicotte Marie-Hélène 3 , Krzyzanowska monika 4 , Ruether Dean 5 , Bouganim Nathaniel 6 , Lamond Nathan 7 , Ezzat Shereen 8 , Winquist Eric 9 , Laurie Scott 10 , Chua Neil 11 , Klimo Paul 12 , Lim Howard 13 , Wong Ralph 14 , Zahra Ramji 15 , Flint Alexander 16 , Wendy Hauck 17 & Hotte Sebastien 18
1CHUM, Medicine, Montréal, Canada; 2CHUL, Medicine; 3CHUS, Medicine; 4UHN, Medicine; 5Tom Baker Cancer Centre, Medicine; 6McGill University, Medicine; 7Nova Scotia Cancer Centre & Dalhousie University, Medicine; 8Princess Margaret Cancer Centre, Medicine; 9London Health Sciences Center, Medicine; 100The Ottawa hospital, Medicine; 11Cross Cancer Center, Medicine; 12North Vancouver, Medicine; 13British Columbia Cancer Agency; 15Cancer Care Manitoba; 16Eisai; 17Eisai Ltd Canada, Toronto, Canada; 18Juravinski Cancer Center, Medicine
Differentiated thyroid carcinoma (DTC) is viewed as an indolent disease but 5–15% of patients (pts) become refractory to RAI treatment. This is associated with poor prognosis, a 3–6 years life expectancy and accounts for approximately 200 deaths per year in Canada. There is no universal definition of rDCT and management evolves over time, with either monitoring or systemic therapy including LEN. In the Select Study on LEN in DTC, LEN provided a 19.4 month (mo) median PFS (progression free survival) and an objective response rate of 60.2%; however, all ptsexperienced some toxicity. In Canada, a PSP was created to offer LEN to pts with rDTC prior to public funding. We report the prescription practices and treatment patterns of these pts. Between August 2015 and January 2019, 223 pts with rDTC started LEN as part of the PSP. Prescriber information, patient demographics, start and discontinuation dates, starting/modification doses and reasons for discontinuation were ascertained whenever possible and are described in the statistics. Kaplan-Meyer method was used to estimate persistency on LEN, defined as time from first prescription to discontinuation. Treating physicians were medical oncologists (n = 141), endocrinologists (n = 21) or other various disciplines (n = 55). Two-hundred twenty-three rDTC pts were analyzed (42% female, mean age 63.4 years). Median study follow-up was 15.8 mo. Mean starting dose was 21.2 mg using 24 mg for 158 pts (66%), 20mg for 35 pts (15%) and lower for 47 pts. Median KM estimate of persistency on LEN was 15.8 mo and was similar for pts starting on full or reduced dose. Treatment persistency was similar between all provinces but there was a trend favouring prescribers with more than one patient in the PSP versus those with only one patient (18.0 vs 10.2 mo) and for pts treated by endocrinologists compared to other specialties (10.4 vs 6.0 mo). There was also a trend for longer persistency in pts who had dose modifications compared to pts treated with constant doses (19.0 mo vs 9.8 mo). LEN was discontinued in 112 patients (39 deaths from disease, 23 progressive disease/palliation, 15 for medical reasons other than toxicity [including decision to pursue alternative therapy], 21 undisclosed/other reasons and only 14 from toxicity). To date, this is the largest presented real-world analysis of the treatment patterns of LEN in pts with rDTC and our estimates of treatment duration as proxy for effectiveness are comparable to the phase 3 SELECT trial.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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