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David SP Tan,Jack Junjie Chan,Robert Hettle,Wrik Ghosh,Amrita Viswambaram,Cindy Chen Yu 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.2
Objective: To evaluate the cost-effectiveness of olaparib as a maintenance treatment versusroutine surveillance (RS) in patients with BRCA mutated (BRCAm) advanced ovarian cancer(OC) following response to first-line platinum-based chemotherapy in Singapore. Methods: A 4-health state partitioned survival model was developed to simulate the lifetime(50 years) incremental cost-effectiveness ratio (ICER) of olaparib versus RS from a healthcarepayer perspective. Progression-free survival, time to second disease progression, andoverall survival were estimated using SOLO-1 data and extrapolated beyond the trial periodusing parametric survival models. Any patient who remained progression-free at year 7was assumed to be no longer at risk of progression. Mortality rates were based on all-causemortality, adjusted based on BRCA1/2 mutation. Health state utilities and adverse eventfrequencies were from SOLO-1. Drug costs were from local public healthcare institutions. Healthcare resource usage and costs were from local clinician input and publications. A 3%discount rate was applied to costs and outcomes. Deterministic and probabilistic sensitivityanalyses (PSA) were performed to assess the robustness of results. Results: The base-case analysis of olaparib maintenance therapy versus RS resulted in anICER of Singapore dollar (SGD) 19,822 per quality-adjusted life-year (QALY) gained. TheICER was most sensitive to variations in the discount rate. PSA demonstrated that olaparibhad an 87% probability of being cost-effective versus RS at a willingness-to-pay of SGD60,000 per QALY gained. Conclusion: Olaparib has a high potential of being a cost-effective maintenance treatmentversus RS for patients with BRCA1/2m advanced OC after response to first-line chemotherapyin Singapore.
Matilda X. Lee,David SP Tan 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.6
The 3-weekly regimen of carboplatin and paclitaxel is the backbone of first line adjuvant chemotherapy for advanced ovarian cancer. The landmark Japanese Gynaecologic Oncology Group (JGOG) 3016 study demonstrated significant improvements in progression-free survival and overall survival with dose dense weekly administration of paclitaxel in combination with 3-weekly carboplatin. However, efforts to replicate these benefits have failed in subsequent phase III trials. Weekly paclitaxel is purported to have enhanced antitumor activity, with stronger anti-angiogenic effects, and yet is better tolerated. In this review, we explore the rationale for dose dense weekly paclitaxel, and compare the relevant trials as well as quality of life considerations. Possible reasons for the difference in outcomes between the JGOG 3016 and other studies are reviewed, with a focus on how the addition of bevacizumab, the variations between histological and molecular subtypes of epithelial ovarian cancers, and ethnic pharmacogenetic differences may potentially affect the efficacy of dose dense paclitaxel.
이용재,임명철,김병기,Natalie YL Ngoi,최철훈,박상윤,David SP Tan,고윤정,이정윤 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.2
Background: The optimal treatment of BRCA wild-type patients with platinum-sensitiverecurrent ovarian cancer remains unknown. Recently, there is an increase in the evidenceto support the role of the combination of a poly(adenosine diphosphate-ribose) polymeraseinhibitor, anti-angiogenic agents, and immunotherapy as maintenance therapy in BRCAwild-type patients with platinum-sensitive recurrence. We hypothesized that addingpembrolizumab and bevacizumab to olaparib maintenance can increase progression-freesurvival (PFS) in BRCA wild-type patients with platinum-sensitive recurrent ovarian cancer. Methods: BRCA wild-type patients who received two previous courses of platinum-containingtherapy, achieved complete or partial response to last treatment, and the treatment-freeinterval is >6 months after the penultimate platinum-based chemotherapy offered olaparibmaintenance with pembrolizumab and bevacizumab. Forty-four patients will be included from4 sites across Singapore and Korea. The primary endpoint of the study is 6-month PFS rate. Trial Registration: ClinicalTrials.gov Identifier: NCT04361370,Clinical Research Information Service Identifier: KCT0005144