Skip to main content
Open access
Research Article
22 August 2022

Comparative effectiveness of larotrectinib versus entrectinib for the treatment of metastatic NTRK gene fusion cancers

Abstract

Aim: To extrapolate clinical trial results to estimate and compare expected progression-free and overall life years (LYs) and quality-adjusted LYs (QALYs) for larotrectinib and entrectinib in patients with colorectal cancer (CRC), soft tissue sarcoma (STS) and brain metastases prior to treatment with larotrectinib or entrectinib. Methods: A naive direct comparison of larotrectinib versus entrectinib was made using partitioned survival modeling methods from clinical trial data. Results: Larotrectinib resulted in an additional 1.58 LYs (1.17 QALYs), 5.81 LYs (2.02 QALYs) and 1.01 LYs in CRC, STS and baseline brain metastases, respectively, compared with entrectinib. Conclusion: Larotrectinib provided life expectancy and QALY gains compared with entrectinib. Additional studies will be beneficial as more patients are treated and survival data develop to better inform comparative effectiveness results.

Supplementary Material

File (supplementary materials (8).docx)

References

Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Chabner BA, Roberts TG Jr. Timeline: chemotherapy and the war on cancer. Nat. Rev. Cancer 5(1), 65–72 (2005).
2.
Hyman DM, Taylor BS, Baselga J. Implementing genome-driven oncology. Cell 168(4), 584–599 (2017).
3.
Chen Y, Chi P. Basket trial of TRK inhibitors demonstrates efficacy in TRK fusion-positive cancers. J. Hematol. Oncol. 11(1), 78 (2018).
4.
Woodcock J, LaVange LM. Master protocols to study multiple therapies, multiple diseases, or both. N. Engl. J. Med. 377(1), 62–70 (2017).
5.
Drilon A, Laetsch TW, Kummar S et al. Efficacy of larotrectinib in TRK fusion-positive cancers in adults and children. N. Engl. J. Med. 378(8), 731–739 (2018).
• Across three clinical trials, larotrectinib demonstrated promising efficacy results.
6.
Hong DS, DuBois SG, Kummar S et al. Larotrectinib in patients with TRK fusion-positive solid tumours: a pooled analysis of three phase 1/2 clinical trials. Lancet Oncol. 21(4), 531–540 (2020).
7.
Doebele RC, Drilon A, Paz-Ares L et al. Entrectinib in patients with advanced or metastatic NTRK fusion-positive solid tumours: integrated analysis of three phase 1–2 trials. Lancet Oncol. 21(2), 271–282 (2020).
8.
Cocco E, Scaltriti M, Drilon A. NTRK fusion-positive cancers and TRK inhibitor therapy. Nat. Rev. Clin. Oncol. 15(12), 731–747 (2018).
9.
Farago AF, Le LP, Zheng Z et al. Durable clinical response to entrectinib in NTRK1-rearranged non-small cell lung cancer. J. Thorac. Oncol. 10(12), 1670–1674 (2015).
10.
Rosen EY, Schram AM, Young RJ et al. Larotrectinib demonstrates CNS efficacy in TRK fusion-positive solid tumors. JCO Precis. Oncol. 3, 19.00009 (2019).
11.
Ziegler DS, Wong M, Mayoh C et al. Brief report: potent clinical and radiological response to larotrectinib in TRK fusion-driven high-grade glioma. Br. J. Cancer 119(6), 693–696 (2018).
12.
Hatiboglu MA, Wildrick DM, Sawaya R. The role of surgical resection in patients with brain metastases. Ecancermedicalscience 7, 308 (2013).
13.
Liu Q, Tong X, Wang J. Management of brain metastases: history and the present. Chin. Neurosurg. J. 5(1), 1 (2019).
14.
Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Non-Small Cell Lung Cancer (V.6.2021). © National Comprehensive Cancer Network, Inc. 2021 All rights reserved. Accessed [September 30, 2021]. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
15.
Roth JA, Carlson JJ, Xia F, Williamson T, Sullivan SD. The potential long-term comparative effectiveness of larotrectinib and entrectinib for second-line treatment of TRK fusion-positive metastatic lung cancer. J. Manag. Care Spec. Pharm. 26(8), 981–986 (2020).
•• In a prior analysis of larotrectinib and entrectinib using similar methods, larotrectinib was projected to gain additional life years and quality-adjusted life years compared to entrectinib in patients with TRK fusion-positive metastatic lung cancer.
16.
Kim H, Gurrin L, Ademi Z, Liew D. Overview of methods for comparing the efficacies of drugs in the absence of head-to-head clinical trial data. Br. J. Clin. Pharmacol. 77(1), 116–121 (2014).
• In the absence of head-to-head trials or the ability to directly compare two treatments, naive direct comparisons can be performed as outlined here.
17.
Hoyle MW, Henley W. Improved curve fits to summary survival data: application to economic evaluation of health technologies. BMC Med. Res. Methodol. 11, 139 (2011).
18.
Cost-Effectiveness in Health and Medicine (2nd Edition). Neumann P, Sanders G, Russell L, Siegel J, Ganiats T. (Eds). Oxford University Press, NY, USA (2017).
19.
Bayer US LLC. Data on file. (2020).
20.
Patel M, Siena S, Demetri G et al. Efficacy and safety of entrectinib in NTRK fusion-positive gastrointestinal cancers: updated integrated analysis of three clinical trials (STARTRK-2, STARTRK-1 and ALKA-372-001). Ann. Oncol. 31, S232–S233 (2020).
21.
Chawla S, Paz-Ares L, Patel M et al. An updated analysis of the clinical efficacy and safety of entrectinib in NTRK fusion-positive sarcoma. Presented at: 2020 CTOS Virtual Meeting, November 18–21, 2020.
22.
Centers for Disease Control and Prevention. United States life tables, 2018. Natl Vital Stat. Rep. 69(13), 1–83 (2021).
23.
Rolfo CD, De Braud FG, Doebele RC et al. Efficacy and safety of entrectinib in patients (pts) with NTRK-fusion-positive (NTRK-fp) solid tumors: an updated integrated analysis. J. Clin. Oncol. 38(Suppl. 15), 3605 (2020).
24.
Färkkilä N, Sintonen H, Saarto T et al. Health-related quality of life in colorectal cancer. Colorectal Dis. 15(5), e215–e222 (2013).
25.
Guest JF, Sladkevicius E, Gough N, Linch M, Grimer R. Utility values for advanced soft tissue sarcoma health states from the general public in the United Kingdom. Sarcoma 2013, 863056 (2013).
26.
Latimer NR. Survival analysis for economic evaluations alongside clinical trials – extrapolation with patient-level data: inconsistencies, limitations, and a practical guide. Med. Decis. Making 33(6), 743–754 (2013).
27.
Rosen EY, Goldman DA, Hechtman JF et al. TRK fusions are enriched in cancers with uncommon histologies and the absence of canonical driver mutations. Clin. Cancer Res. 26(7), 1624–1632 (2020).
28.
Demetri GD, Antonescu CR, Bjerkehagen B et al. Diagnosis and management of tropomyosin receptor kinase (TRK) fusion sarcomas: expert recommendations from the World Sarcoma Network. Ann. Oncol. 31(11), 1506–1517 (2020).
29.
Marchiò C, Scaltriti M, Ladanyi M et al. ESMO recommendations on the standard methods to detect NTRK fusions in daily practice and clinical research. Ann. Oncol. 30(9), 1417–1427 (2019).
30.
Drilon A, Li G, Dogan S et al. What hides behind the MASC: clinical response and acquired resistance to entrectinib after ETV6-NTRK3 identification in a mammary analogue secretory carcinoma (MASC). Ann. Oncol. 27(5), 920–926 (2016).
31.
Russo M, Misale S, Wei G et al. Acquired resistance to the TRK inhibitor entrectinib in colorectal cancer. Cancer Discov. 6(1), 36–44 (2016).
32.
Peters S, Bexelius C, Munk V, Leighl N. The impact of brain metastasis on quality of life, resource utilization and survival in patients with non-small-cell lung cancer. Cancer Treat. Rev. 45, 139–162 (2016).
33.
Percy C, Schubert T, Galant C, Kirchgesner T, Mazzeo F. Larotrectinib in a NTRK-rearranged soft tissue sarcoma in the neoadjuvant setting: a case report. Clin. Case Rep. 9(3), 1694–1698 (2021).
34.
Rabban JT, Devine WP, Sangoi AR et al. NTRK fusion cervical sarcoma: a report of three cases, emphasising morphological and immunohistochemical distinction from other uterine sarcomas, including adenosarcoma. Histopathology 77(1), 100–111 (2020).