title: Real-World EQ5D Health Utility Scores for Patients With Metastatic Lung Cancer by Molecular Alteration and Response to Therapy.
abstract: Economic analyses of upcoming treatments for lung cancer benefit from real-world health utility scores (HUSs) in an era of targeted therapy.
  
  
  
  A longitudinal cohort study at Princess Margaret Cancer Centre evaluated 1571 EQ5D-3L-derived HUSs in 475 outpatients with metastatic lung cancer across various disease states. Patients with epidermal growth factor receptor (EGFR) (n = 183) and anaplastic lymphoma kinase (ALK) (n = 38) driver alterations were enriched through targeted enrolment; patients with wild-type non-small-cell lung cancer (WT NSCLC) (n = 224) and small-cell lung cancer (SCLC) (n = 30) were sampled randomly.
  
  
  
  For patients stable on most appropriate treatment, the mean HUSs were 0.81 and 0.82 in patients receiving EGFR and ALK tyrosine kinase inhibitors (TKIs) respectively (with similar HUSs across agents), which were higher than patients with WT NSCLC (0.78; P = .04) and SCLC receiving chemotherapy (0.72; P = .06). In mutation-specific comparisons, disease stability on appropriate therapy resulted in significantly higher mean HUSs (P < .002-.02) than when disease was progressing (mean HUS: EGFR, 0.70; ALK, 0.69; WT NSCLC, 0.66; SCLC, 0.52). When evaluating treatment-related toxicities, significant inverse relationships were observed between HUS and the severity of fatigue and decreased appetite in the EGFR group. There was also a significant inverse relationship between the total number of clinically significant symptoms and HUS, both in patients who were EGFR-mutated and patients with WT NSCLC.
  
  
  
  In a North American setting, HUSs generated from patients with metastatic lung cancer are higher in treated, stable patients carrying driver mutations. This is partially explainable by treatment toxicity and patient symptom differences. Such differences in scores should be considered in economic analyses.
authors.affiliation: Respirology and Thoracic Surgery Department, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC, Canada; Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Labbé
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Leung
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network (Scholar of the CNPq-Brazil), Toronto, ON, Canada.
authors.forename: João Gabriel
authors.initials: JG
authors.lastname: Silva Lemes
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Erin
authors.initials: E
authors.lastname: Stewart
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Brown
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Andrea Perez
authors.initials: AP
authors.lastname: Cosio
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Doherty
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Grainne M
authors.initials: GM
authors.lastname: O'Kane
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Devalben
authors.initials: D
authors.lastname: Patel
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Cheng
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Mindy
authors.initials: M
authors.lastname: Liang
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Gursharan
authors.initials: G
authors.lastname: Gill
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Rett
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Hiten
authors.initials: H
authors.lastname: Naik
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Lawson
authors.initials: L
authors.lastname: Eng
authors.affiliation: Health Outcomes and PharmacoEconomics (HOPE) Research Centre, Sunnybrook Research Institute, Toronto, ON, Canada.
authors.forename: Nicole
authors.initials: N
authors.lastname: Mittmann
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Natasha B
authors.initials: NB
authors.lastname: Leighl
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Penelope A
authors.initials: PA
authors.lastname: Bradbury
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Frances A
authors.initials: FA
authors.lastname: Shepherd
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada. Electronic address: Geoffrey.Liu@uhn.on.ca.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Liu
authors.affiliation: Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors.forename: Doris
authors.initials: D
authors.lastname: Howell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077548:Anaplastic Lymphoma Kinase; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000453:epidemiology / Q000235:genetics; D015331:Cohort Studies; D066246:ErbB Receptors / Q000235:genetics; D000069347:Erlotinib Hydrochloride / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D009362:Neoplasm Metastasis; D009656:North America / Q000453:epidemiology; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D020794:Receptor Protein-Tyrosine Kinases / Q000235:genetics; D011795:Surveys and Questionnaires
chemical_list: D047428:Protein Kinase Inhibitors; D000069347:Erlotinib Hydrochloride; C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; C512478:EGFR protein, human; D066246:ErbB Receptors; D020794:Receptor Protein-Tyrosine Kinases
keywords: ALK; EGFR; HUS; NSCLC; SCLC