Estimating the number of Chinese cancer patients eligible for and benefit from immune checkpoint inhibitors

doi:10.1007/s11684-021-0902-1

Front. Med.

2022, Vol. 16

Issue (5) : 773-783 https://doi.org/10.1007/s11684-021-0902-1

RESEARCH ARTICLE

Estimating the number of Chinese cancer patients eligible for and benefit from immune checkpoint inhibitors

Kaili Yang, Jiarui Li, Lin Zhao, Zhao Sun, Chunmei Bai(

)

Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China

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Abstract

The total number of cancer patients who are eligible for and will benefit from immune checkpoint inhibitors (ICIs) in China has not been quantified. This cross-sectional study was conducted to estimate the number of Chinese cancer patients with eligibility and response to ICIs based on the 2015 Chinese cancer statistics and the immune checkpoint inhibitor clinical practice guideline of the Chinese Society of Clinical Oncology. A total of 11 ICIs were recommended for 17 cancer types. The estimated number of eligible patients annually was 1 290 156 (55.18%), which included 888 738 males (60.05%) and 400 468 females (46.67%). The estimated number of responders annually was 448 972 (19.20%), which included 309 023 males (20.88%) and 139 764 females (16.29%). Gastric cancer (n=291 000, 12.45%), non-small-cell lung cancer (n=289 629, 12.39%), and hepatocellular carcinoma (n=277 100, 11.85%) were the top three cancer types with the highest number of eligible patients. Non-small-cell lung cancer (n=180 022, 7.70%), hepatocellular carcinoma (n=75 648, 3.24%), and small-cell lung cancer (n=64 362, 2.75%) were the top three cancer types with the highest number of responders. In conclusion, ICIs provide considerable benefit in Chinese cancer patients under optimal estimation.

Keywords benefit China eligibility immune checkpoint inhibitor public health

Corresponding Author(s): Chunmei Bai

Just Accepted Date: 08 April 2022 Online First Date: 30 June 2022 Issue Date: 18 November 2022

Cite this article:

Kaili Yang,Jiarui Li,Lin Zhao, et al. Estimating the number of Chinese cancer patients eligible for and benefit from immune checkpoint inhibitors[J]. Front. Med., 2022, 16(5): 773-783.

URL:

https://academic.hep.com.cn/fmd/EN/10.1007/s11684-021-0902-1
https://academic.hep.com.cn/fmd/EN/Y2022/V16/I5/773

	Total	Grade 1 and 2 recommendations (eligible)
Total clinical trials, n (%)	79 (100)	52 (100)
Study design
Randomized controlled trial	35 (44.3)	29 (55.8)
Single-arm clinical trial	41 (51.9)	22 (42.3)
Other	3 (3.8)	1 (1.9)
Clinical trial phase
Phase 1	12 (15.2)	5 (9.6)
Phase 2	29 (36.7)	18 (34.6)
Phase 3	34 (43.0)	28 (53.8)
Not specified	4 (5.1)	1 (1.9)
Participants, median (IQR)	305 (91?763)	412 (99?827.5)
Female participants (%), median (IQR)	33.6 (22.8?40.9)	30.4 (22.8?41.2)
Chinese patient participation^b
Major	17 (21.5)	11 (21.2)
Minor	25 (31.6)	19 (36.5)
None	37 (46.8)	22 (42.3)
Cancer types^c
HNSCC (except nasopharyngeal carcinoma)	3 (3.8)	3 (5.8)
Nasopharyngeal carcinoma	5 (6.3)	0
Esophageal squamous cell carcinoma	3 (3.8)	3 (5.8)
Non-small-cell lung cancer	10 (12.7)	10 (19.2)
Small-cell lung cancer	5 (6.3)	2 (3.8)
Breast cancer	1 (1.3)	0
Gastric cancer	3 (3.8)	2 (3.8)
Hepatocellular carcinoma	9 (11.4)	5 (9.6)
Colorectal cancer	2 (2.5)	2 (3.8)
Renal cell carcinoma	7 (8.9)	6 (11.5)
Urothelial carcinoma	8 (10.1)	1 (1.9)
Cervical cancer	2 (2.5)	2 (3.8)
Endometrial cancer	2 (2.5)	1 (1.9)
Ovary cancer	1 (1.3)	1 (1.9)
Melanoma	10 (12.7)	7 (13.5)
Skin cancer (except melanoma)	6 (7.6)	4 (7.7)
Hematological malignancy	7 (8.9)	6 (11.5)
ICI type^c
CTLA-4 inhibitors	4 (5.1)	3 (5.8)
Ipilimumab	4 (5.1)	3 (5.8)
PD-1 inhibitors	64 (81.0)	44 (84.6)
Pembrolizumab	28 (35.4)	22 (42.3)
Nivolumab	21 (26.6)	13 (25.0)
Camrelizumab	9 (11.4)	4 (7.7)
Toripalimab	3 (3.8)	2 (3.8)
Sintilimab	1 (1.3)	1 (1.9)
Tislelizumab	1 (1.3)	1 (1.9)
Cemiplimab	1 (1.3)	1 (1.9)
PD-L1 inhibitors	15 (19.0)	8 (15.4)
Atezolizumab	10 (12.7)	6 (11.5)
Avelumab	3 (3.8)	1 (1.9)
Durvalumab	2 (2.5)	1 (1.9)
Treatment regimen^c
ICI monotherapy	56 (70.9)	38 (73.1)
ICI + chemotherapy	11 (13.9)	7 (13.5)
ICI + targeted therapy	9 (11.4)	4 (7.7)
ICI + chemotherapy + targeted therapy	1 (1.3)	1 (1.9)
ICI + ICI	4 (5.1)	3 (5.8)
Biomarker requirement^c
PD-L1 CPS ≥ 1	6 (7.6)	3 (5.8)
PD-L1 TPS ≥ 50%	1 (1.3)	1 (1.9)
PD-L1 TPS ≥ 1%	2 (2.5)	2 (3.8)
PD-L1 IPS ≥ 1%	2 (2.5)	1 (1.9)
MSI-H status	3 (3.8)	3 (5.8)
^aPivotal clinical trials were defined as clinical trials that were described as pivotal for making recommendations in the CSCO guideline. ^bMajor participation was defined as the condition that participants of a clinical trial were exclusively Chinese; minor participation was defined as the presence of Chinese participants in a clinical trial; none participation was defined as the absence of Chinese participants in a clinical trial. ^cThe types of cancer, ICI, treatment regimen, and biomarker requirement were identified based on the recommendations in the CSCO guideline. Abbreviations: CPS, combined positive score; CTLA-4, cytotoxic T lymphocyte-associated antigen-4; HNSCC, head and neck squamous cell carcinoma; ICI, immune checkpoint inhibitor; IPS, immune positive score; IQR, interquartile range; MSI-H, microsatellite instability-high; PD-1, programmed cell death-1; PD-L1, programmed cell death-ligand 1; TPS, tumor proportion score.

Tab.1 Characteristics of pivotal clinical trials^a

Fig.1 Eligibility and benefit of ICIs for different cancer types. Non-melanoma skin cancers were not estimated for eligibility and response in Chinese patients because no cancer death statistics was available. HNSCC, head and neck squamous cell carcinoma; NSCLC, non-small-cell lung cancer; SCLC, small-cell lung cancer.

Fig.2 Percentage of Chinese cancer patients who receive ICIs with eligibility. HNSCC, head and neck squamous cell carcinoma; NSCLC, non-small-cell lung cancer; SCLC, small-cell lung cancer.

Fig.3 Sex-specific eligibility and benefit of ICIs for different cancer types. Non-melanoma skin cancers were not estimated for eligibility and response in Chinese patients because no cancer death statistics was available. HNSCC, head and neck squamous cell carcinoma; NSCLC, non-small-cell lung cancer; SCLC, small-cell lung cancer.

Fig.4 Percentage of Chinese cancer patients who receive ICIs with response. HNSCC, head and neck squamous cell carcinoma; NSCLC, non-small-cell lung cancer; SCLC, small-cell lung cancer.

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