Trends in cost of treatment of lung cancer patients in 2014-2019 in Finland - a descriptive register study.

AIM: The aim of this descriptive study is to analyze the cost for the treatment of NSCLC and SCLC patients (2014-2019) in Finland. The primary objective is to understand recent (2014-2019) cost developments. METHODS: The study is retrospective and based on hospital register data. The study population consists of NSCLC and SCLC patients diagnosed in four out of the five Finnish university hospitals. The final sample included 4047 NSCLC patients and 766 SCLC patients. RESULTS: Cost of the treatment in lung cancer is increasing. Both the average cost of the first 12 months as well as the first 24 months after diagnosis increases over time. For patients diagnosed in 2014, the average cost of the first 24 months was 19,000 €and for those diagnosed in 2015 22,000 €. The annual increase in the nominal 24-month costs was 10.4% for NSCLC and 7.3% for SCLC patients. CONCLUSION: The average cost per patient has increased annually for both NSCLC and SCLC. Possible explanations to the cost increase are increased medicine costs (especially in NSCLC), and the increased percentage of patients being actively treated.

The prognostic and predictive roles of plasma C-reactive protein and PD-L1 in non-small cell lung cancer.

BACKGROUND: Anti-PD-(L)1 agents have revolutionized the treatment paradigms of non-small cell lung cancer (NSCLC), while predictive biomarkers are limited. It has been previously shown that systemic inflammation, indicated by elevated C-reactive protein (CRP) level, is associated with a poor prognosis in anti-PD-(L)1 treated. The aim of the study was to analyze the prognostic and predictive value of CRP in addition to traditional prognostic and predictive markers and tumor PD-L1 score. METHODS: We identified all NSCLC patients (n = 329) who had undergone PD-L1 tumor proportion score (TPS) analysis at Oulu University Hospital 2015-22. CRP levels, treatment history, immune checkpoint inhibitor (ICI) therapy details, and survival were collected. The patients were categorized based on CRP levels (≤10 vs. >10) and PD-L1 TPS scores (<50 vs. ≥50). RESULTS: In the whole cohort (n = 329), CRP level of ≤10 mg/L was associated with improved survival in univariate (HR 0.30, Cl 95% 0.22-0.41) and multivariate analyzes (HR 0.44, CI 95% 0.28-0.68). With ICI treated (n = 70), both CRP of ≤10 and PD-L1 TPS of ≥50 were associated with improved progression-free survival (PFS) in univariate (HR 0.51, CI 95% 0.27-0.96; HR 0.54, CI 95% 0.28-1.02) and multivariate (HR 0.48, CI 95% 0.26-0.90; HR 0.50, CI 95% 0.26-0.95) analyzes. The combination (PD-L1 TPS ≥50 and CRP >10) carried a high negative predictive value with a median PFS of 4.11 months (CI 95% 0.00-9.63), which was similar to patients with low PD-L1 (4.11 months, CI 95% 2.61-5.60). CONCLUSIONS: Adding plasma CRP levels to PD-L1 TPS significantly increased the predictive value of sole PD-L1. Furthermore, patients with high CRP beard little benefit from anti-PD-(L)1 therapies independent of PD-L1 score. The study highlights the combined evaluation of plasma CRP and PD-L1 TPS as a negative predictive marker for ICI therapies.

Survival with lung cancer in Finland has not improved during 2007-2019-a single center retrospective population-based real-world study.

OBJECTIVES: According to the CONCORD-3 study, the 5-year survival rate of lung cancer patients in Finland has not improved during the twenty-first century. In the present study, we evaluated the survival trends of lung cancer patients diagnosed and treated in one of the five university hospitals in Finland to determine possible explanatory factors behind the lack of improved survival. MATERIAL AND METHODS: This retrospective population-based study included all lung cancer patients diagnosed in Tampere University Hospital in 2007-2019 (N = 3041). The study population was divided into two subcohorts: the patients diagnosed in 2007-2012 and those diagnosed in 2013-2019. The two subcohorts were then compared to analyze the temporal changes in survival and the distribution of prognostic factors. RESULTS: A comparison of the patients diagnosed in 2007-2012 and 2013-2019 showed that the patients' overall survival had remained unchanged. The median overall survival was 8.7 months in the earlier subcohort and 9.2 months in the later subcohort. The respective 5-year survival rates were 16.6% and 17.8%, and these differences were not statistically significant. The proportion of stage IV patients (approximately 59% in both subcohorts) and their risk of death were similar for the two subcohorts. According to the regression analysis, male gender, advanced stage, and poor Eastern Cooperative Oncology Group performance status were independent risk factors for death, while a never-smoking status and mutation-positive disease were associated with a decreased risk of death, but only in the later cohort. CONCLUSION: Echoing the results of CONCORD-3, this study confirmed that the real-world survival of unselected lung cancer populations in Finland has not improved over the last 15 years, mainly because of the unchanged proportions of patients with late-stage lung cancer. This calls for earlier recognition of lung cancer, achieved by screening and increasing awareness of the disease.

Trends in treatment of non-small cell lung cancer in Finland 2014-2019.

INTRODUCTION: Non-small cell lung cancer (NSCLC) is a leading cause of cancer mortality in the Western world. However, emerging treatment options and more patients directed to active treatments might improve the outcomes. Here, we retrospectively studied the patient characteristics and treatment practices for NSCLC in Finland 2014-2019 with a special focus on changes in trends over time. MATERIAL AND METHODS: The cohort consisted of patients diagnosed with NSCLC in Finland 2014-2018. Cancer treatments for the patients were followed until the end of 2019. The data, both structured and unstructured, were collected from electronic medical records of four university hospitals in Finland. RESULTS: Of the study population (n = 4047), 65% had adenocarcinoma and 29% squamous cell carcinoma. The share of patients who had not received any active treatment (except palliative radiotherapy) decreased from 32% to 18% between 2014-18. The percentage of patients receiving surgery increased slightly from 22.7% to 24% and for patients receiving chemotherapy or immuno-oncological (IO) treatments from 29% to 41.2% and from 0.8% to 8%, respectively between, 2014-18. However, the time of treatment for patients receiving systemic cancer treatments did not change during the same time period. DISCUSSION: The current study suggests a trend in NSCLC towards more active treatment approaches in 2014-18.

Elevated CRP levels indicate poor progression-free and overall survival on cancer patients treated with PD-1 inhibitors.

BACKGROUND: Anti-PD-(L)1 agents are standard of care treatments in various cancers but predictive factors for therapy selection are limited. We hypothesised that markers of systemic inflammation would predict adverse outcomes in multiple cancers treated with anti-PD-(L)1 agents. MATERIAL AND METHODS: Discovery cohort consisted of patients who were treated with anti-programmed cell death protein-1 (PD-1) agents for advanced melanoma (MEL), non-small cell lung cancer (NSCLC) or renal and bladder cancers (GU) at Oulu University Hospital and had pretreatment C reactive protein (CRP), or neutrophil/lymphocyte values available. As a validation cohort, we collected patients treated with anti-PD-1 agents from three other hospitals in Finland. RESULTS: In the discovery cohort (n=56, MEL n=23, GU n=17, NSCLC n=16), elevated CRP over the upper limit of normal (ULN) (>10 mg/mL) indicated poor progression-free (PFS; p=0.005) and overall survival (OS; p=0.000004) in the whole population and in MEL subgroup. Elevated neutrophil-to-lymphocyte ratio (>2.65) also indicated inferior PFS (p=0.02) and OS (p=0.009). In the validation cohort (n=107, MEL n=44, NSCLC n=42, GU n=17, other n=4), CRP over ULN also was a strong indicator for poor PFS (p=0.0000008), and OS (p=0.000006) in the whole population, and in MEL and NSCLC also. CONCLUSIONS: Systemic inflammation suggested by elevated CRP is a very strong indicator for adverse prognosis on patients treated with anti-PD-(L)1 agents and has a potential negative predictive value for treatment with anti-PD-(L)1 agents. Prospective trials should investigate whether patients with elevated CRP gain any significant benefit from anti-PD-1 therapy.