Clinical and cost effectiveness of paclitaxel, docetaxel, gemcitabine, and vinorelbine in non-small cell lung cancer: a systematic review

Abstract

Background: Lung cancer remains a devastating disease with few effective treatment options. Recent developments in chemotherapy have led to cautious optimism. This paper reviews the evidence on the clinical and cost effectiveness of four of the new generation drugs for patients with lung cancer. Methods: A systematic review of randomised controlled trials (RCTs) identified from 11 electronic databases (including Medline, Cochrane library and Embase), reference lists and contact with experts and industry was performed to assess clinical effectiveness of paclitaxel, docetaxel, gemcitabine and vinorelbine. Clinical effectiveness was assessed using the outcomes of patient survival, quality of life, and adverse effects. Cost effectiveness was assessed by development of a costing model and presented as incremental cost per life year saved (LYS) compared with best supportive care (BSC). Results: Of the 33 RCTs included, five were judged to be of good quality, 10 of adequate quality, and 18 of poor quality. Gemcitabine, paclitaxel, and vinorelbine as first line treatment and docetaxel as second line treatment appear to be more beneficial for non-small cell lung cancer than BSC and older chemotherapy agents, increasing patient survival by 2-4 months against BSC and some comparator regimes. These gains in survival do not appear to be at the expense of quality of life. Survival gains were delivered at reasonable levels of incremental cost effectiveness for vinorelbine, vinorelbine with cisplatin, gemcitabine, gemcitabine with cisplatin, and paclitaxel with cisplatin regimens compared with BSC. Conclusion: Although the clinical benefits of the new drugs appear relatively small, their benefit to patients with lung cancer appears to be worthwhile and cost effective.

Cost-Effectiveness of 99mTc-Sestamibi in Predicting Response to Chemotherapy in Patients with Lung Cancer: Systematic Review and Meta-Analysis

“…The costs of basic supportive care and chemotherapy were obtained from the National Health Service health technology assessment report (23) and were based on the most cost-effective paclitaxel-based therapy, reflecting the chemotherapeutic approach adopted in some of the 99m Tc-MIBI studies. The life expectancies achieved with basic supportive care and chemotherapy were also obtained from randomized trials summarized in the NHS HTA report (23). The survival benefit of chemotherapy was adjusted to account for the prevalence of responders, as determined from the meta-analysis.…”

Adoptive immunotherapy of lung cancer with immobilized anti-TCRγδ antibody-expanded human γδ T Cells in peripheral blood

“…However, the clinical benefits from these conventional therapies are still unsatisfactory to patients with advanced metastatic disease. 1 Because patients with SCLC tend to develop distant metastases, localized forms of treatment alone, such as surgical resection or radiation therapy, rarely produce long-term survival. 2 Combination chemotherapy is the main treatment for extensive SCLC, though it only gives a short increase in median survival time.…”

Cost-effectiveness analysis of paclitaxel + carboplatin vs. alternative combinations in the treatment of non-small cell lung cancer

“…Diversi studi farmacoeconomici hanno, infatti, documentato la costo-efficacia della chemioterapia nelle forme avanzate di NSCLC, dimostrando che tale pratica può essere considerata conveniente e accettabile per i sistemi sanitari dei paesi sviluppati [4,[19][20][21][22][23][24][25][26][27][28][29][30][31].…”

“…Complessivamente, i diversi protocolli chemioterapici utilizzati nei pazienti NSCLC in fase avanzata comportano un sensibile prolungamento della sopravvivenza e un positivo effetto palliativo sui sintomi correlati al tumore [7,19].…”

“…In realtà, differenze significative tra questi trattamenti sono state evidenziate nel profilo degli eventi avversi e nei parametri indicatori della qualità di vita (QoL), variabili che hanno o possono avere un notevole impatto sulle curve di sopravvivenza in terapia [18]. D'altra parte l'apparente equivalenza terapeutica di queste moderne combinazioni chemioterapiche nel trattamento delle forme avanzate di NSCLC deriva, almeno in parte, dal disegno dei protocolli sperimentali e dai criteri di valutazione adottati e, in particolare, dall'aver considerato le curve globali di sopravvivenza e di progressione della malattia senza poter distinguere l'effetto dovuto al trattamento sperimentale di I° linea dall'effetto correlato ai trattamenti successivi, attuati in caso di fallimento o di drop-out per reazioni avverse gravi.Complessivamente, i diversi protocolli chemioterapici utilizzati nei pazienti NSCLC in fase avanzata comportano un sensibile prolungamento della sopravvivenza e un positivo effetto palliativo sui sintomi correlati al tumore [7,19].Questi risultati clinici possono giustificare i costi elevati della chemioterapia. Diversi studi farmacoeconomici hanno, infatti, documentato la costo-efficacia della chemioterapia nelle forme avanzate di NSCLC, dimostrando che tale pratica può essere considerata conveniente e accettabile per i sistemi sanitari dei paesi sviluppati [4,[19][20][21][22][23][24][25][26][27][28][29][30][31].…”