Atezolizumab for First-Line Treatment of Metastatic Nonsquamous NSCLC

Socinski, Mark A.; Jotte, Robert M.; Cappuzzo, Federico; Orlandi, F; Stroyakovskiy, Daniil; Nogami, Naoyuki; Rodríguez-Abreu, Delvys; Moro-Sibilot, Denis; Thomas, Christian A.; Barlési, Fabrice; Finley, Gene Grant; Kelsch, Claudia; Lee, Anthony; Coleman, Shelley; Deng, Yu; Shen, Yijing; Kowanetz, Marcin; López-Chávez, Ariel; Sandler, Alan; Reck, Martin

doi:10.1056/nejmoa1716948

Cited by 3,053 publications

(2,760 citation statements)

References 37 publications

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“…6,7 Atezolizumab is an IgG1 monoclonal antibody that binds to PD-L1 and blocks its interactions with PD-1 and B7-1 (also known as CD80) receptors. 8 This pivotal phase 3 trial demonstrated an improvement of 1.5 months in the median progression-free survival (PFS) and an improvement of 4.5 months in the median overall survival (OS) for patients receiving ABCP when compared with the combination of bevacizumab, carboplatin, and paclitaxel (BCP). 8 This pivotal phase 3 trial demonstrated an improvement of 1.5 months in the median progression-free survival (PFS) and an improvement of 4.5 months in the median overall survival (OS) for patients receiving ABCP when compared with the combination of bevacizumab, carboplatin, and paclitaxel (BCP).…”

Section: Introductionmentioning

confidence: 99%

First‐line atezolizumab in addition to bevacizumab plus chemotherapy for metastatic, nonsquamous non–small cell lung cancer: A United States–based cost‐effectiveness analysis

Wan

Luo

Tan

et al. 2019

Cancer

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BACKGROUND:The IMpower150 trial found that adding atezolizumab to the combination of bevacizumab and chemotherapy improved survival for patients with metastatic, nonsquamous non-small cell lung cancer (NSCLC). However, considering the high cost of immunotherapy, there is a need to assess its value by considering both efficacy and cost. The current study evaluated the cost-effectiveness of atezolizumab in the first-line setting for the treatment of patients with metastatic NSCLC from the US payer perspective. METHODS: A Markov model was developed to compare the lifetime cost and effectiveness of the combination of atezolizumab, bevacizumab, carboplatin, and paclitaxel (ABCP) with the combination of bevacizumab, carboplatin, and paclitaxel (BCP) and carboplatin and paclitaxel (CP) in the first-line treatment of patients with metastatic NSCLC. Life-years (LYs), qualityadjusted LYs (QALYs), and lifetime costs were estimated. One-way and probabilistic sensitivity analyses were performed to evaluate the model uncertainty. Additional subgroup analyses were performed. RESULTS: ABCP provided an additional 0.413 QALYs (0.460 LYs) and 0.738 QALYs (0.956 LYs), respectively, compared with BCP and CP. The corresponding incremental costs were $234,998 and $381,116, respectively. The incremental cost-effectiveness ratio for ABCP was $568,967 per QALY compared with BCP and $516,114 per QALY compared with CP. The subgroup analysis demonstrated that PD-L1 expression of ≥50% on tumor cells (TC3) or ≥10% on immune cells (IC3) decreased the incremental cost-effectiveness ratio to $464,703 per QALY. CONCLUSIONS: From the perspective of the US payer, ABCP is estimated to not be cost-effective compared with BCP or CP in the first-line setting for patients with metastatic, nonsquamous NSCLC at a willingness-to-pay threshold of $100,000 per QALY. Cancer 2019;125:3526-3534.

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Section: Introductionmentioning

confidence: 99%

First‐line atezolizumab in addition to bevacizumab plus chemotherapy for metastatic, nonsquamous non–small cell lung cancer: A United States–based cost‐effectiveness analysis

Wan

Luo

Tan

et al. 2019

Cancer

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“…Adding chemotherapy to anti‐PD1/PD‐L1 therapy is a successful strategy to improve treatment efficacy in various types of cancer, including non‐small‐cell lung cancer (NSCLC), small cell lung cancer, and breast cancer . Chemotherapy may induce immunogenic cell death in the tumor, increase the release of neoantigen, and increase lymphocyte infiltration in the tumor microenvironment .…”

Section: Combination Therapy For Hnsccmentioning

confidence: 99%

Immune checkpoint inhibitors for head and neck squamous cell carcinoma: Current landscape and future directions

Kao

Lou

2019

Head & Neck

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Background Immune checkpoint inhibitors (ICIs) can reinvigorate T cells and activate the immune system to eliminate cancer cells. Head and neck squamous cell carcinoma (HNSCC) is a malignancy with a poor prognosis. The roles of ICIs for HNSCC treatments are emerging. Method We reviewed the study results of Programmed‐Death 1 (PD‐1) and PD‐ligand‐1 (PD‐L1) monoclonal antibodies for HNSCC. The ongoing trials of anti‐PD‐1 and anti‐PD‐L1 were also reviewed. Results Nivolumab showed a significant overall survival benefit in platinum‐refractory HNSCC patients. For platinum‐sensitive or first‐line patients, pembrolizumab monotherapy (patients with PD‐L1 Combined Positive Score ≥ 20) or pembrolizumab‐platinum‐fluorouracil improved overall survival vs the EXTREME (cetuximab‐platinum‐fluorouracil). Many HNSCC studies have combined anti‐PD1/PD‐L1 therapy with various anticancer agents or radiotherapy to improve treatment efficacy. Conclusion ICIs demonstrate their efficacies for R/M HNSCC patients. The incorporation of ICIs showed a great impact on the treatment landscape of HNSCC.

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“…The addition of atezolizumab to bevacizumab (mAb inhibitor of vascular endothelial growth factor; VEGF) plus chemotherapy (carboplatin and paclitaxel) significantly improved PFS and OS among previously untreated patients with metastatic nonsquamous NSCLC . The addition of atezolizumab increased the median PFS from 6.8 to 8.3 months (HR for disease progression or death, 0.62; 95% CI, 0.52‐0.74; P < 0.001).…”

Section: Commentmentioning

confidence: 99%

Monoclonal antibody therapy in cancer: When two is better (and considerably more expensive) than one

et al. 2018

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Atezolizumab for First-Line Treatment of Metastatic Nonsquamous NSCLC

Cited by 3,053 publications

References 37 publications

First‐line atezolizumab in addition to bevacizumab plus chemotherapy for metastatic, nonsquamous non–small cell lung cancer: A United States–based cost‐effectiveness analysis

First‐line atezolizumab in addition to bevacizumab plus chemotherapy for metastatic, nonsquamous non–small cell lung cancer: A United States–based cost‐effectiveness analysis

Immune checkpoint inhibitors for head and neck squamous cell carcinoma: Current landscape and future directions

Monoclonal antibody therapy in cancer: When two is better (and considerably more expensive) than one

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