Larotrectinib is estimated to provide improved life-year and quality-adjusted life-year (QALY) outcomes in comparison with entrectinib for patients with metastatic non–small-cell lung cancer (NSCLC), according to a study published in the Journal of Managed Care & Specialty Pharmacy (2020;26[8]:981-986. doi:10.18553/jmcp.2020.20045).
“Larotrectinib and entrectinib are FDA-approved therapies for patients with… [NSCLC] with neurotrophic receptor tyrosine kinase gene fusion (TRK fusion-positive) whose cancer has metastasized and progressed,” wrote Joshua A Roth , PhD, MHA, Hutchinson Institute for Cancer Outcomes Research and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, and colleagues.
“Early evidence indicates that these targeted therapies may offer dramatic survival benefits versus traditional cytotoxic regimens, but it remains uncertain how larotrectinib and entrectinib compare with each other,” they continued.
Dr Roth and colleagues developed a survival model to project the long-term comparative effectiveness of larotrectinib versus entrectinib in the second-line treatment of metastatic NSCLC.
Survival data from a 13-month follow-up of 12 patients with TRK fusion-positive NSCLC in the NCT02122913 and NAVIGATE trials were used for larotrectinib and survival data from a 13-month follow-up of the ALKA-372-001, STARTRK-1, and STARTRK-2 trials were used for entrectinib.
Treatment with larotrectinib resulted in a median of 5.4 preprogression life-years compared with 1.2 for entrectinib. The median total life-years were 7.0 and 1.8, respectively. Additionally, the mean preprogression life-years (QALYs) were 7.5 (5.0) for larotrectinib and 1.9 (1.2) for entrectinib and mean total life-years (QALYs) were 9.2 (5.8) and 4.4 (2.4), respectively.
“Among TRK inhibitors for metastatic NSCLC, larotrectinib is estimated to provide improved life-year and QALY outcomes versus entrectinib based on parametric extrapolations of in-trial survival data,” explained Dr Roth and colleagues, noting that this analysis is limited by lack of NSCLC-specific data on entrectinib OS, the small samples of patients with NSCLC in the trials, and a cross-trial comparison.
“Future studies should re-evaluate the comparative effectiveness of larotrectinib versus entrectinib as more patients are treated and as long-term survival data mature,” they concluded.—Janelle Bradley
