OBJECTIVES:

This study aimed to estimate health state utilities in metastatic non–small cell lung cancer (mNSCLC) and to understand utility values by health state, oncology treatment and PD-L1 expression.

METHODS:

This study examined EQ-5D-3L data collected from multiple Phase III, randomized clinical trials in mNSCLC. Two trials evaluated pembrolizumab in previously untreated mNSCLC, one as monotherapy in patients with PD-L1-positive (Tumor Proportion Score [TPS]>=50%) tumors (KEYNOTE-024 (KN024) trial), and the other in combination with platinum-pemetrexed in non-squamous histology (KEYNOTE-189 (KN189)). The third trial evaluated pembrolizumab monotherapy in previously treated PD-L1-positive (TPS>=1%) advanced NSCLC (KEYNOTE-010 (KN010)). Two approaches of defining health states were considered in analyzing utility: time-to-death and progression-based health states.

RESULTS:

The mean utility score for the progression-free state was 0.81 (SE0.008, pembrolizumab), 0.76 (SE0.010, platinum doublet) in KN024, and 0.77 (SE0.005, pembrolizumab-platinum-pemetrexed), 0.76 (SE0.007, platinum-pemetrexed) in KN189. The utility difference between pembrolizumab monotherapy and platinum doublet in KN024 was statistically significant. The mean utility for progressive disease was 0.72(SE0.013)/0.69(SE0.013) in KN024/ KN189.The mean utility by time-to-death categories of >360 days, 180–360 days, 30–180 days, and <30 days was 0.81(SE0.006)/0.79(SE0.008), 0.71(SE0.015)/0.71(SE0.012), 0.63(0.018)/0.64(0.011), and 0.56(SE0.54)/0.50(0.051), respectively from KN024/KN189, with no statistically significant differences between the treatment arms in either trial.

Mean utilities were evaluated for PD-L1-positive (TPS>=50%) populations, and compared with the scores in the overall populations in KN010 and KN189. The difference was smaller than 0.03 across all health state classifications, in both trials.

CONCLUSIONS:

The results quantify the deterioration in quality-of-life utility for mNSCLC patients with disease progression and time-to-death. Pembrolizumab monotherapy compared with platinum-based chemotherapy shows significantly higher utility in the progression-free state. Pembrolizumab-platinum-pemetrexed had similar utilities compared to chemotherapy. Small utility differences were observed between PD-L1 TPS>