LAUSR

Background: Despite targeted therapies impacted on progression-free survival in EGFR positive metastatic NoneSmall Cell lung carcinoma (NSCLC) these agents are not available in brazilian public health care system (SUS). Polychemotherapy based on platinum still being used in this situation in contrast with international guidelines. This analysis aims to estimate the impact of the lack of access to anti-EGFR therapies on the PFS of these patients. Method: The annual number of patients diagnosed with lung cancer was based on epidemiologic data of Cancer National Institute (INCA). Patients who have access to private health insurances were excluded. Only adenocarcinoma histology was considered. The INCA database, a cohort (Wong, 2016) and four clinical trials: EURTAC, LUX-Lung 3, LUX-Lung 7 and FLAURA were used to estimate stage distribution at diagnosis, recurrence rates and progression free survival in 2 years. The population without mutation in EGFR also was excluded. Results: INCA estimates 28,220 new cases of lung cancer per year in Brazil. Of these, 76.3% are supposed to treated in SUS, totalizing 21,532, upon which 3,790 (40%) have adenocarcinoma histology. Of these, 3,790 (44%) have metastasis at diagnosis, and 3,703 (43%), 603 (7%), 517 (6%) are diagnosed in stages III, II and I, respectively. A recurrences rate of 53.79% in stage III (1,992), 46.49% in II (280) and 26.06% in I (135) in 5 years from diagnosis. Of these, 28% have mutation in EGFR. The outcome of our study was that, if they were treated with polychemotherapy, only 71 would be free of progression after 24 months. In contrast, with the use of inhibitors of tyrosine kinase anti-EGFR, the expectation was 312 patients free from disease for Erlotinib, 377 for Gefitinib, 388 for Afatinib and 720 for Osimertinib. Conclusion: The monthly drug costs, in Brazil, were, approximately, R$ 4,000 for Gefitinib, R$ 5,000 for Afatinib, R$ 8,000 for Erlotinib and R$ 32,000 for Osimertinib. With this, a cost-effectiveness study, presented by Gilberto De Lima Lopes Jr. in ASCO this year, showed that Osimertinib, although its high PFS, was not cost-effective in our country. Larger discounts, pharmaceutics support and more clinical trials are necessary to improve access to Osimertinib. In contrast, the incorporation of Gefitinib, Afatinib and Erlotinib in the public health care system should influence in PFS. Despite this, our study showed that, in two years, should avoid the progression of disease in 378 patients.