Estimating Long-Term Survival for Patients with Relapsed or Refractory Large B-Cell Lymphoma Treated with Chimeric Antigen Receptor Therapy: A Comparison of Standard and Mixture Cure Models

Medical Decision Making : an International Journal of the Society for Medical Decision Making
Aasthaa BansalScott D Ramsey

Abstract

Patients treated with anti-CD19 chimeric antigen receptor (CAR) T-cell therapies have shown either sustained remission or rapid progression. Traditional survival modeling may underestimate outcomes in these situations, by assuming the same mortality rate for all patients. To illustrate this issue, we compare standard parametric models to mixture cure models for estimating long-term overall survival in patients with relapsed or refractory large B-cell lymphoma treated with axicabtagene ciloleucel (axi-cel). Compared to standard models without cure proportions, mixture cure models have similar fit, but substantially different extrapolated survival. Standard models (Weibull and generalized gamma) estimate mean survival of 2.0 years (95% CI (1.5, 3.0)) and 3.0 years (95% CI (1.7, 5.6)), respectively, compared to 15.7 years (95% CI (9.3, 21.1)) and 17.5 yrs (12.0, 22.8) from mixture cure models (using Weibull and generalized gamme distributions). For cancer therapies where substantial fractions achieve long term remission, our results suggest that assumptions of the modeling approach should be considered. Given sufficient follow-up, mixture cure models may provide a more accurate estimate of long-term overall survival compared with ...Continue Reading

References

Jun 8, 2012·Clinical Cancer Research : an Official Journal of the American Association for Cancer Research·Megan OthusJohn J Crowley
Jan 28, 2017·Molecular Therapy : the Journal of the American Society of Gene Therapy·Frederick L LockeWilliam Y Go
Apr 15, 2017·Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research·Megan OthusScott Ramsey
Aug 15, 2017·Molecular Therapy : the Journal of the American Society of Gene Therapy·James N KochenderferSteven A Rosenberg
Dec 12, 2017·The New England Journal of Medicine·Sattva S NeelapuWilliam Y Go

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Citations

Jan 14, 2020·PharmacoEconomics·Mark Sculpher, Stephen Palmer
Jun 1, 2020·Bone Marrow Transplantation·Salvatore FiorenzaJoshua A Roth
Oct 9, 2020·Journal of Comparative Effectiveness Research·Keith A BettsAnthony S Masaquel
Nov 27, 2020·Drug Discovery Today·Eline van OverbeekeSteven Simoens
Aug 24, 2020·Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research·Megan OthusScott Ramsey

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B-Cell Lymphoma

B-cell lymphomas include lymphomas that affect B cells. This subtype of cancer accounts for over 80% of non-Hodgkin lymphomas in the US. Here is the latest research.

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