INTRODUCTION:This study aimed to estimate the NHS costs of managing patients with anaplastic lymphoma kinase positive (ALK+) advanced non-small-cell lung cancer (aNSCLC), with and without brain metastases. Patients were treated with first-line (1 L) ALK tyrosine kinase inhibitors (TKIs). METHODS:We built an economic model to estimate the annual costs of managing ALK+ aNSCLC patients with and without brain metastases using estimated NHS health care resource use (HCRU) consumption. The ALK TKIs included in our model were lorlatinib, crizotinib, alectinib and brigatinib. We based our estimates on the cumulative incidence of brain metastases in four clinical trials - CROWN, ALEX, ALESIA and ALTA-1L. RESULTS:For the first year of treatment, our model estimated the annual cost of managing patients with brain metastases to be £14,870. Patients without brain metastases cost £4,133. The NHS HCRU cost savings generated by treating patients with lorlatinib increased significantly over time and were greater in patients without brain metastases at the start of their treatment (at baseline) with lorlatinib. This reflects the prevention of brain metastases with 1 L lorlatinib. CONCLUSION:The longitudinal cost data demonstrate that lorlatinib leads to potentially lower NHS management costs of brain metastases in patients with ALK+ aNSCLC.
Lung cancer and cardiovascular diseases (CVDs) frequently coexist due to shared risk factors such as aging, smoking, and chronic inflammation. The growing prevalence of elderly surgical candidates with concomitant lung cancer and CVDs presents unique diagnostic and therapeutic challenges. This review explores current strategies for managing such patients, emphasizing the importance of individualized, multidisciplinary treatment planning. Advances in minimally invasive pulmonary resection and parenchymal -sparing surgery-such as segmentectomy-have expanded surgical options, especially in frail patients. Simultaneously, improvements in cardiovascular therapies, including transcatheter aortic valve implantation (TAVI), thoracic endovascular aortic repair (TEVAR), and off-pump coronary artery bypass grafting (OPCAB), have enabled safer, staged approaches. Guideline-directed preoperative risk assessment from Japanese, American, and European societies underscores the need for tailored sequencing of cardiac and oncologic interventions. In general, a staged approach with initial cardiac stabilization followed by pulmonary resection is preferred. However, simultaneous surgery, especially OPCAB combined with pulmonary resection, may be feasible in carefully selected patients. Additionally, the cardiac toxicity of immune checkpoint inhibitors and EGFR-TKIs must be considered when planning neoadjuvant treatment. Integrating cardiovascular expertise into thoracic oncology is crucial to optimizing outcomes in this complex population.
BACKGROUND:This study evaluated the cost-effectiveness of Tepotinib versus Capmatinib in patients with advanced or metastatic non-small cell lung cancer (NSCLC) with MET Exon 14 Skipping Mutations in China. METHODS:An economic evaluation using a 3-state partitioned survival model assessed the cost-effectiveness of Tepotinib versus Capmatinib. The Kaplan-Meier (KM) curves for overall survival (OS) and progression-free survival (PFS) from two clinical trials were digitally extracted. The Exponential model with matching-adjusted indirect comparison (MAIC) was employed at the end of the trials to extrapolate the long-term survivals. RESULTS:The estimated cost and utility of Tepotinib treatment were higher than those of Capmatinib treatment, respectively (95,392.54 USD vs. 51,003.63 USD; 2.11 QALYs vs 1.38 QALYs). The incremental cost-effectiveness ratio (ICER) of Capmatinib treatment vs. Tepotinib treatment was calculated at 60,977.28 USD/QALY. CONCLUSIONS:Tepotinib was not cost-effective compared to Capmatinib as the second-line treatment for advanced or metastatic NSCLC patients with MET exon 14 skipping mutations in China.
The utilization of pathological assessment to evaluate tumor response in patients with early-stage non-small cell lung cancer (NSCLC) has not been documented in the extant literature. A 64-year-old male patient with lung adenocarcinoma was treated with CyberKnife. A subsequent review of the images suggested that the mass in the area of radiotherapy had increased in size compared to the previous one, suggesting tumor recurrence. Consequently, surgery was performed to remove the enlarged mass. Postoperative histopathology showed no tumor tissue. This case underscores the potential efficacy of CyberKnife in the treatment of early-stage non-small cell lung cancer (NSCLC) tumors and confirms its effectiveness as a radical treatment modality, as validated by the gold standard of postoperative pathology.
