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How Affordable are Targeted Therapies in Non-Small Cell Lung Cancer?

  • Lung Cancer
  • Published:
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Opinion statement

As the treatment of non-small cell lung cancer (NSCLC) evolves to include more targeted therapies, costs of treatment have increased significantly. Advances in NSCLC treatment include longer survival duration, and in some cases, better progression-free survival and quality of life, and the potential for decreased toxicity. Through pharmacoeconomic analyses, payors seek to value the improvements in outcomes from novel therapies, and relate these improvements to their costs. In NSCLC, three categories of novel agents have been introduced into clinical practice: (1) agents targeting the epidermal growth factor receptor (EGFR); (2) agents targeting the vascular endothelial growth factor (VEGF) and (3) novel chemotherapy agents, specifically pemetrexed. Here we review published economic analyses for these agents in lung cancer, and their potential impact on treatment decisions.

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References and Recommended Reading

  1. Jemal A, Siegel R, Ward E, et al.: Cancer statistics, 2008. CA Cancer J Clin 2008, 58:71–96.

    Article  PubMed  Google Scholar 

  2. Aggarwal S: Targeted cancer therapies. Nat Rev Drug Discov 2010, 9:427–428.

    Article  PubMed  CAS  Google Scholar 

  3. Sandler A, Gray R, Perry MC, et al.: Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med 2006, 355:2542–2550.

    Article  PubMed  CAS  Google Scholar 

  4. Herbst RS, Sandler A, Treatment Outcomes by Tumor Histology in Eastern Cooperative Group (ECOG) Study E4599 of Bevacizumab (BV) with Paclitaxel/Carboplatin (PC) for Advanced Non-small Cell Lung Cancer (NSCLC): Non-small cell lung cancer and antiangiogenic therapy: what can be expected of bevacizumab? J Thorac Oncol 2008, 3:S283.

    Article  Google Scholar 

  5. Reck M, von Pawel J, Zatloukal P, et al.: Phase III trial of cisplatin plus gemcitabine with either placebo or bevacizumab as first-line therapy for nonsquamous non-small-cell lung cancer: AVAil. J Clin Oncol 2009, 27:1227–1234.

    Article  PubMed  CAS  Google Scholar 

  6. Pirker R, Pereira JR, Szczesna A, et al.: Cetuximab plus chemotherapy in patients with advanced non-small-cell lung cancer (FLEX): an open-label randomised phase III trial. Lancet 2009, 373:1525–1531.

    Article  PubMed  CAS  Google Scholar 

  7. Lynch TJ, Patel T, Dreisbach L, et al.: Cetuximab and first-line taxane/carboplatin chemotherapy in advanced non-small-cell lung cancer: results of the randomized multicenter phase III trial BMS099. J Clin Oncol 2010, 28:911–917.

    Article  PubMed  CAS  Google Scholar 

  8. Scagliotti GV, Parikh P, von Pawel J, et al.: Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol 2008, 26:3543–3551.

    Article  PubMed  CAS  Google Scholar 

  9. Mok TS, Wu YL, Thongprasert S, et al.: Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med 2009, 361:947–957.

    Article  PubMed  CAS  Google Scholar 

  10. Maemondo M, Inoue A, Kobayashi K, et al.: Gefitinib or chemotherapy for non-small-cell lung cancer with mutated EGFR. N Engl J Med 2010, 362:2380–2388.

    Article  PubMed  CAS  Google Scholar 

  11. Soon YY, Stockler MR, Askie LM, et al.: Duration of chemotherapy for advanced non-small-cell lung cancer: a systematic review and meta-analysis of randomized trials. J Clin Oncol 2009, 27:3277–3283.

    Article  PubMed  Google Scholar 

  12. Ciuleanu T, Brodowicz T, Zielinski C, et al.: Maintenance pemetrexed plus best supportive care versus placebo plus best supportive care for non-small-cell lung cancer: a randomised, double-blind, phase 3 study. Lancet 2009, 374:1432–1440.

    Article  PubMed  CAS  Google Scholar 

  13. Cappuzzo F, Ciuleanu T, Stelmakh L, et al.: SATURN: A double-blind, randomized, phase III study of maintenance erlotinib versus placebo following nonprogression with first-line platinum-based chemotherapy in patients with advanced NSCLC. J Clin Oncol 2009, 27:8001.

    Article  Google Scholar 

  14. Shepherd FA, Dancey J, Ramlau R, et al.: Prospective randomized trial of docetaxel versus best supportive care in patients with non-small-cell lung cancer previously treated with platinum-based chemotherapy. J Clin Oncol 2000, 18:2095–2103.

    PubMed  CAS  Google Scholar 

  15. Hanna N, Shepherd FA, Fossella FV, et al.: Randomized phase III trial of pemetrexed versus docetaxel in patients with non-small-cell lung cancer previously treated with chemotherapy. J Clin Oncol 2004, 22:1589–1597.

    Article  PubMed  CAS  Google Scholar 

  16. Douillard JY, Shepherd FA, Hirsh V, et al.: Molecular predictors of outcome with gefitinib and docetaxel in previously treated non-small-cell lung cancer: data from the randomized phase III INTEREST trial. J Clin Oncol 2010, 28:744–752.

    Article  PubMed  CAS  Google Scholar 

  17. Shepherd FA, Rodrigues Pereira J, Ciuleanu T, et al.: Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med 2005, 353:123–132.

    Article  PubMed  CAS  Google Scholar 

  18. Bang Y, Kwak EL, Shaw AT, et al.: Clinical activity of the oral ALK inhibitor PF-02341066 in ALK-positive patients with non-small cell lung cancer (NSCLC). J Clin Oncol 2010, 28:3.

    Article  Google Scholar 

  19. Shaw AT, Costa D, Mino-Kenudson M, et al.: Clinicopathologic features of EML4-ALK mutant lung cancer. J Clin Oncol 2009, 27:11021.

    Article  Google Scholar 

  20. Molinier L, Combescure C, Chouaid C, et al.: Cost of lung cancer: a methodological review. Pharmacoeconomics 2006, 24:651–659.

    Article  PubMed  Google Scholar 

  21. Holmes J, Dunlop D, Hemmett L, et al.: A cost-effectiveness analysis of docetaxel in the second-line treatment of non-small cell lung cancer. Pharmacoeconomics 2004, 22:581–589.

    Article  PubMed  CAS  Google Scholar 

  22. Neymark N, Lianes P, Smit EF, et al.: Economic evaluation of three two-drug chemotherapy regimens in advanced non-small-cell lung cancer. Pharmacoeconomics 2005, 23:1155–1166.

    Article  PubMed  CAS  Google Scholar 

  23. Szczepura A: Healthcare outcomes: gemcitabine cost-effectiveness in the treatment of non-small cell lung cancer. Lung Cancer 2002, 38(2):S21–S28.

    Article  PubMed  Google Scholar 

  24. Fojo T, Grady C: How much is life worth: cetuximab, non-small cell lung cancer, and the $440 billion question. J Natl Cancer Inst 2009, 101:1044–1048.

    Article  PubMed  Google Scholar 

  25. Arrieta O AP, López RJ, Polanco AC: Cost-effectiveness analysis of EGFR mutation testing patients with advanced non small-cell lung cancer treated with gefitinib or carboplatin-paclitaxel. ISPOR 15th Annual International Meeting Atlanta, GA, USA May, 2010

  26. Kim ES, Hirsh V, Mok T, et al.: Gefitinib versus docetaxel in previously treated non-small-cell lung cancer (INTEREST): a randomised phase III trial. Lancet 2008, 372:1809–1818.

    Article  PubMed  CAS  Google Scholar 

  27. Horgan AM, Shepherd FA, Bradbury PA, et al.: Preliminary cost-consequence analysis of the INTEREST trial, a randomized trial of docetaxel versus gefitinib as 2nd line therapy in advanced non-small cell lung cancer. J Clin Oncol 2008, 26:8110.

    Google Scholar 

  28. Chouaid C, Monnet I, Robinet G, et al.: Economic impact of gefitinib for refractory non-small-cell lung cancer: a Markov model-based analysis. Curr Med Res Opin 2007, 23:1509–1515.

    Article  PubMed  Google Scholar 

  29. Leighl NB, Tsao WS, Zawisza DL, et al.: A willingness-to-pay study of oral epidermal growth factor tyrosine kinase inhibitors in advanced non-small cell lung cancer. Lung Cancer 2006, 51:115–121.

    Article  PubMed  Google Scholar 

  30. van Zandwijk N: Epidermal growth factor tyrosine kinase inhibitors (EGFR TKIs) and economics. Lung Cancer 2006, 51:137–138.

    Article  PubMed  Google Scholar 

  31. Ramsey SD, Martins RG, Blough DK, et al.: Second-line and third-line chemotherapy for lung cancer: use and cost. Am J Manag Care 2008, 14:297–306.

    PubMed  Google Scholar 

  32. Ramsey SD, Clarke L, Kamath TV, et al.: Evaluation of erlotinib in advanced non-small cell lung cancer: impact on the budget of a U.S. health insurance plan. J Manag Care Pharm 2006, 12:472–478.

    PubMed  Google Scholar 

  33. Lyseng-Williamson KA: Erlotinib: a pharmacoeconomic review of its use in advanced non-small cell lung cancer. Pharmacoeconomics 2010, 28:75–92.

    Article  PubMed  Google Scholar 

  34. Bradbury PA, Tu D, Seymour L, et al.: Economic analysis: randomized placebo-controlled clinical trial of erlotinib in advanced non-small cell lung cancer. J Natl Cancer Inst 2010, 102:298–306.

    Article  PubMed  CAS  Google Scholar 

  35. Grusenmeyer PA, Gralla RJ: Examining the cost and cost-effectiveness of adding bevacizumab to carboplatin and paclitaxel in advanced non-small cell lung cancer. J Clin Oncol 2006, 24:6057.

    Google Scholar 

  36. Drucker A, Virik K, Skedgel C, et al.: The cost burden of trastuzumab and bevacizumab monoclonal antibody therapy in solid tumors: can we afford it? J Clin Oncol 2006, 24:6044.

    Google Scholar 

  37. Fleeman N, Bagust A, McLeod C, et al.: Pemetrexed for the first-line treatment of locally advanced or metastatic non-small cell lung cancer. Health Technol Assess 2010, 14(Suppl 1):47–53.

    PubMed  Google Scholar 

  38. Vrouchou P, Kandaswamy P, George E, et al.: Pemetrexed approved for the first-line treatment of non-small-cell lung cancer: summary of the NICE appraisal. Lancet Oncol 2009, 10:1031–1032.

    Article  PubMed  Google Scholar 

  39. NICE: Pemetrexed for the first-line treatment of non-small cell lung cancer. Final Appraisal Determination. August, 2009. http://www.nice.org.uk/nicemedia/pdfFADPemetrexedLungCancer.pdf, 2009

  40. Asukai Y, Valladares A, Camps C, et al.: Cost-effectiveness analysis of pemetrexed versus docetaxel in the second-line treatment of non-small cell lung cancer in Spain: results for the non-squamous histology population. BMC Cancer 2010, 10:26.

    Article  PubMed  Google Scholar 

  41. Nadler E, Eckert B, Neumann PJ: Do oncologists believe new cancer drugs offer good value? Oncologist 2006, 11:90–95.

    Article  PubMed  Google Scholar 

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Acknowledgments

PMH/UHN has previously received research funding from Astra Zeneca Canada in 2004 for an unrelated investigator-initiated clinical trial.

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Correspondence to Natasha B. Leighl MD, MMSc, FRCP (C).

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Coate, L.E., Leighl, N.B. How Affordable are Targeted Therapies in Non-Small Cell Lung Cancer?. Curr. Treat. Options in Oncol. 12, 1–11 (2011). https://doi.org/10.1007/s11864-010-0137-x

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  • DOI: https://doi.org/10.1007/s11864-010-0137-x

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