The financial toxicity of non-small lung cancer treatment: the optimization of first and second-line therapy with immune check point inhibitors

Date 24 November 2018
Event ESMO Asia 2018 Congress
Session Poster display - Cocktail
Topics Bioethics, Legal, and Economic Issues
Immunotherapy
Presenter Jacopo Giuliani
Citation Annals of Oncology (2018) 29 (suppl_9): ix150-ix169. 10.1093/annonc/mdy425
Authors J. Giuliani1, A. Bonetti2
  • 1Oncology, Mater Salutis Hospital - Az. ULSS 9 Scaligera, 37045 - Legnago/IT
  • 2Medical Oncology, Ospedale di Legnago, 37045 - Legnago/IT

Abstract

Background

Immune check point inhibitors are changing cancer treatment in several malignancies, including non-small cell lung cancer (NSCLC). The present analysis was conducted to assess the pharmacological costs of first and second-line treatments with check point inhibitors (pembrolizumab and nivolumab) for metastatic NSCLC.

Methods

The present evaluation was restricted to phase III randomized controlled trials (RCTs) in first and second-line treatments with check point inhibitors (pembrolizumab and nivolumab) for metastatic NSCLC without EGFR)-activating mutations, ALK-translocations or ROS1 translocation/re-arrangements. Calculations were based on an “ideal patient” (BSA 1.8 sqm; weight 70 Kg). The costs of drugs are at the Pharmacy of our Hospital and are expressed in euros (€).

Results

Our analysis evaluated 4 phase III RCTs, including 2713 patients. In first-line treatment, ESMO-MCBS reached high score (grade 5) for the KEYNOTE-024 trial, while nivolumab had rythema a low score (grade 1) ESMO-MCBS in the CheckMate026 trial. In second-line treatment, ESMO-MCBS reached high score (grade 5) for the CheckMate 017 and KEYNOTE-010 trials; CheckMate 057 reached grade 4 in the ESMO-MCBS. Concerning first-line, the lowest cost per month of PFS-gain was associated with the use of pembrolizumab (10 045 €); OS data of pembrolizumab are not yet mature to draw conclusions. Concerning second-line treatment, the lowest cost per month of OS-gain was associated with the use of nivolumab both in non squamous and squamous NSCLC (4809 €and 5623 €, respectively). A separate consideration deserves the concept of system sustainability, because, actually, the costs of first-line therapy with pembrolizumab are not in line with those reported by Azimi and Welch, that found a rythema implementing intervention for thresholds of less than $61,500 per life-year gained, probably because OS data are not yet mature. On the contrary, the costs of the second line-therapy with nivolumab are in line with those reported per life-year gained.

Conclusions

Nivolumab is a cost-effective second-line treatment for metastatic NSCLC. Data concerning pembrolizumab in first-line for metastatic NSCLC are not mature to draw conclusions.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.