Nivolumab and pembrolizumab have been approved in France in treatment of several metastatic cancers, with an approximate monthly processing cost of €5,550 per patient. The objective of our study was to evaluate efficacy and correct use of these anti-PD1 antibodies in daily practice since its approvals.
We retrospectively collected data from patients treated with nivolumab or pembrolizumab for solid tumor since July 2015. Data included the correct use of anti-PD1 according to the Summary of Product Characteristics, requiring compliance with indications, a WHO status < 2 and a limit of 20 mg per day of corticosteroids. Progression-free survival (PFS) and overall survival (OS) were analyzed for the global population and according to the correct use of anti-PD1 (C+ group) or not (C- group).
129 patients were treated with nivolumab or pembrolizumab: 108 (83%) patients for lung cancer, 11 (9%) for clear cell renal cancer and 10 (8%) for melanoma. At the cut-off analysis, with a median follow-up of 9,6 months (0,03 – 31,9), 89 patients (69%) had a progressive disease, 64 patients (50 %) were still alive with 18 patients (14%) still receiving anti-PD1, 44 patients (34 %) were deceased and 21 patients (16%) were lost to follow-up. The correct use of anti-PD1 was observed in 85 patients (65%), 29 (21%) patients had a WHO status of 2, 7 (5%) patients had a WHO status of 3, and 12 patients received corticosteroids. The poor utilization of treatment for these 44 patients (34%) totaled 338 injections, costing about €470,000 for a total of €3,000,000 of expenditures using this treatment. Median PFS were respectively 6,7 m (CI 95% 3,9 - 11,7) in the C+ group and 2,5 m (CI 95% 1,6- 5,1) in the C- group (p = 0,03). Median OS were respectively 22,3m (CI 95% 13,6- NR) in the C+ group and 8,4 m (CI 95% 3,9-11,8) in the C- group (p < 0,001). Response rate were respectively 34 % in the C+ group and 25% in the C- group.
In our retrospective study, 34% patients were not meeting the SPC criteria with a WHO status, costing for 25% of the total expenditures. These results reflect the willingness of oncologists to give patients access to innovative and promising treatments but should be balanced with the high cost and the poor outcomes in the C- group.
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The author has declared no conflicts of interest.