Abstract 1067P
Background
Immune checkpoint inhibitors (ICIs) are used for the treatment of various tumours. They are amongst the best-selling cancer drugs. The introduction of several new ICIs in the past few years has not resulted in price competition. From clinical and societal perspectives, it is worthwhile to investigate whether the six available ICIs are therapeutically interchangeable. If so, this may facilitate use and stimulate price reduction by competition.
Methods
We investigated by means of a literature review, whether the ICIs for the indications with the greatest expenditure and number of patients, namely lung cancer and melanoma, are being interchangeable. Due to the lack of direct comparative studies we conducted a systematic search in PubMed, Embase en de Cochrane Library to identify all eligible (network)meta-analyses (NMA) until November 2022. Literature search terms used were “network meta-analysis” ’PD[L] 1” AND non small lung carcinoma AND melanoma. Only NMA’s including randomized clinical trials that compared the efficacy (overall survival and progression free survival) and safety (treatment related side-effects) of the PD-(L)1 inhibitors nivolumab, pembrolizumab, atezolizumab, durvalumab and/or cemiplimab with or without chemotherapy to chemotherapy were eligible.
Results
A total of 3 NMA’s involving patients with advanced NSCLC were included, and one NMA involving not-previously treated patients with advanced melanoma. Where indications do overlap - mainly monotherapy – no studies with head-to-head comparisons of ICIs have been conducted. By indirect comparison of evidence, no clinically relevant differences in effectiveness and safety are apparent. However, the validity of these indirect comparisons have strong limitations, due to the differences in inclusion criteria and patient characteristics.
Conclusions
We conclude that the determination of interchangeability of ICIs is complicated due to the limited overlap in authorized indications and lack of direct comparison between ICIs. Where indications do overlap, we expect that any differences will have limited clinical significance. We call for (publicly funded) randomized multi-cancer trials for a direct head-to-head comparison of ICIs. Such direct comparative evidence is needed to reach a competitive field.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Dutch Health Care Institute.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
1353P - Effect of TP53 co-mutation in non-small cell lung cancer (NSCLC) with driver mutations
Presenter: Jamie Feng
Session: Poster session 19
1354P - Beyond the common mutation: Examining chemotherapy success in uncommon EGFR mutations
Presenter: Chien-Chung Lin
Session: Poster session 19
1355P - Evaluation of the role of variant allele frequency in EGFR mutated non-small cell lung cancer treated with first line osimertinib
Presenter: Marta Brambilla
Session: Poster session 19
1356P - 10-year survivors treated with tyrosine kinase inhibitor for advanced non-small cell lung cancer
Presenter: Yu Tanaka
Session: Poster session 19
1357P - Bevacizumab improved prognosis for advanced EGFR mutant lung adenocarcinoma with brain metastasis receiving cerebral radiotherapy
Presenter: YuanLiang Zhou
Session: Poster session 19
1358P - Safety of tepotinib + EGFR TKI (osimertinib or gefitinib) in patients with EGFRm NSCLC
Presenter: Ernest Nadal
Session: Poster session 19
1359P - Relationship between tumor TP53 gene mutation, circulating anti-p53 antibodies and response to first-line osimertinib in EGFR-mutated NSCLC patients
Presenter: Marc Denis
Session: Poster session 19
1361P - Alectinib for treatment-naïve advanced ALK+ NSCLC selected via blood-based NGS: Updated analyses of outcomes, circulating tumour (ct)DNA and biomarker subgroups from BFAST Cohort A
Presenter: Shirish Gadgeel
Session: Poster session 19
1362P - Association of baseline (BL) anaplastic lymphoma kinase (ALK) fusion detected by circulating tumor DNA (ctDNA) with clinical features and outcomes in the phase III ALTA-3 trial
Presenter: Charu Aggarwal
Session: Poster session 19