Pembrolizumab with Pemetrexed and Platinum Chemotherapy for Untreated Metastatic Non-Squamous Non-Small-Cell Lung Cancer [ID1173]
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Pembrolizumab with pemetrexed and platinum chemotherapy for untreated metastatic non-squamous non-small-cell lung cancer [ID1173] A Single Technology Appraisal Produced by Peninsula Technology Assessment Group (PenTAG) University of Exeter Medical School, South Cloisters, St Luke’s Campus, Heavitree Road, Exeter EX1 2LU Authors Mr Ed Griffin, Research Fellow1 Dr Caroline Farmer, Research Fellow1 Mr David Packman, Postdoctoral Research Associate 1 Dr Elham Nikram, Postdoctoral Research Associate 1 Mr Justin Matthews, Research Fellow 2 Dr Max Barnish, Postdoctoral Research Associate1 Mr Simon Briscoe, Information Specialist1 Dr Nicole Dorey, Consultant Clinical Oncologist3 Dr Adam Dangoor, Consultant Medical Oncologist4 Dr Ruben Mujica Mota, Senior Lecturer1 1 Peninsula Technology Assessment Group (PenTAG), Exeter, UK 2 Health Statistics, PenCLAHRC, University of Exeter Medical School, Exeter, UK 3 Royal Devon and Exeter NHS Foundation Trust, Exeter, UK 4 University Hospitals Bristol NHS Foundation Trust, Bristol, UK Correspondence to E A Griffin, PenTAG, South Cloisters, St Luke's Campus, Heavitree Road, Exeter EX1 2LU. [email protected] 1 Copyright 2018 Queen's Printer and Controller of HMSO. All rights reserved. Date completed 11/09/2018 Source of funding This report was commissioned by the NIHR Systematic Reviews Programme as project number 17/46/14. JM was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC South West Peninsula). Declared competing Dr Nicole Dorey has received educational grants from Amgen, interests of the authors Boehringer Ingelheim, Lilley, Roche, and Teva. Dr Adam Dangoor has received honoraria from Roche and Amgen. Rider on responsibility for The views expressed in this report are those of the authors and not document necessarily those of the NHS, the NIHR SER programme or the Department of Health and Social Care. Any errors are the responsibility of the authors. This report should be Griffin E, Farmer C, Packman D, Nikram E, Matthews J, Barnish M, referenced as follows Briscoe S, Dorey N, Dangoor A, Mujica Mota M. Pembrolizumab with pemetrexed and platinum chemotherapy for untreated metastatic non-squamous non-small-cell lung cancer [ID1173]: A Single Technology Appraisal. Peninsula Technology Assessment Group (PenTAG), 2018. Copyright © 2018 PenTAG, University of Exeter. Copyright is retained by MSD for tables and figures reproduced in this document. 2 Copyright 2018 Queen's Printer and Controller of HMSO. All rights reserved. Confidentiality Please note that text highlighted in yellow and underlined is ‘***********************. Text highlighted in aqua and underlined is ‘************************’. Text highlighted green and underlined is ‘***************************’. 3 Copyright 2018 Queen's Printer and Controller of HMSO. All rights reserved. Contents Pembrolizumab with pemetrexed and platinum chemotherapy for untreated metastatic non- squamous non-small-cell lung cancer [ID1173] ..................................................................... 1 Confidentiality ....................................................................................................................... 3 Contents ............................................................................................................................... 4 List of Tables ........................................................................................................................ 8 List of Figures ..................................................................................................................... 12 Abbreviations ...................................................................................................................... 13 1 Summary ..................................................................................................................... 16 1.1 Critique of the decision problem in the company submission ................................ 16 1.2 Summary of clinical effectiveness evidence submitted by the company ................ 17 1.3 Summary of the ERG’s critique of the clinical effectiveness evidence submitted ... 19 1.4 Summary of cost-effectiveness evidence submitted by the company, with ERG critique............................................................................................................................. 21 1.4.1 Search for and review of evidence ................................................................. 21 1.4.2 The decision problem and reference case ..................................................... 21 1.4.3 The model structure ....................................................................................... 22 1.4.4 Treatment effect ............................................................................................. 22 1.4.5 HRQoL........................................................................................................... 23 1.4.6 Resources and their cost ............................................................................... 24 1.4.7 Company results ............................................................................................ 25 1.4.8 ERG results ................................................................................................... 26 1.4.9 Face validity ................................................................................................... 26 1.4.10 End-of-life ...................................................................................................... 27 1.5 ERG commentary on the robustness of evidence submitted by the company ....... 27 1.5.1 Strengths ....................................................................................................... 27 1.5.2 Weaknesses and areas of uncertainty ........................................................... 27 1.6 Summary of exploratory and sensitivity analyses undertaken by the ERG ............ 28 1.6.1 Clinical analyses ............................................................................................ 28 1.6.2 Economic analyses ........................................................................................ 29 2 Background .................................................................................................................. 31 2.1 Critique of company’s description of underlying health problem ............................ 31 2.2 Critique of company’s overview of current service provision ................................. 31 3 Critique of company’s definition of decision problem .................................................... 33 4 Copyright 2018 Queen's Printer and Controller of HMSO. All rights reserved. 3.1 Population ............................................................................................................. 33 3.2 Intervention ........................................................................................................... 33 3.3 Comparators ......................................................................................................... 34 3.4 Outcomes ............................................................................................................. 35 3.5 Other relevant factors ........................................................................................... 37 4 Clinical effectiveness ................................................................................................... 38 4.1 Critique of the methods of review(s) ...................................................................... 38 4.1.1 Searches ....................................................................................................... 38 4.1.2 SLR Inclusion criteria ..................................................................................... 39 4.1.3 Study screening and data extraction .............................................................. 42 4.1.4 Quality assessment........................................................................................ 43 4.1.5 Evidence Synthesis........................................................................................ 43 4.2 Critique of trials of the technology of interest, their analysis and interpretation (and any standard meta-analyses of these) ............................................................................. 44 4.2.1 Excluded studies ............................................................................................ 44 4.2.2 Included studies ............................................................................................. 45 4.2.3 Quality assessment........................................................................................ 70 4.2.4 Clinical effectiveness results for Pembrolizumab Combination Therapy ......... 73 4.2.5 Meta-analysis............................................................................................... 101 4.2.6 Applicability to clinical practice ..................................................................... 103 4.3 Critique of trials identified and included in the indirect comparison and/or multiple treatment comparison .................................................................................................... 105 4.3.1 Search strategy ............................................................................................ 105 4.3.2 Feasibility assessment ................................................................................. 105 4.3.3 Study