Economic Evaluation of Sacituzumab Govitecan for the Treatment of Metastatic Triple-Negative Breast Cancer in China and the US

Chen, Jigang; Han, Mingyang; Liu, Aihua; Shi, Bo

doi:10.3389/fonc.2021.734594

Cited by 13 publications

(12 citation statements)

References 34 publications

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“…In particular, PARP inhibitors improved prognosis in metastatic BRCA mutated patients [165,166] and are under evaluation in the neoadjuvant setting; TRK inhibitors showed activity and are approved in rare metastatic breast cancers harboring NTRK fusions and progressing despite previous treatment [171,172]; sacituzumab govitecan, based on the results of the phase III ASCENT trial, showed a PFS of 5.6 months compared to 1.7 months for patients who received chemotherapies of physician's choice, and received accelerated FDA approval for pretreated and advanced metastatic TNBC [184]. However, some criticism arose around the results and the cost/effectiveness ratio of this trial [227,228]. PI3K/Akt/mTOR and EGFR inhibitors as well as antiandrogens showed promising results and are under evaluation in Phase II/III clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Molecular Mechanisms, Biomarkers and Emerging Therapies for Chemotherapy Resistant TNBC

Scatena

Ghilli

Bargagna

et al. 2022

IJMS

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Triple-negative breast cancer (TNBC) is associated with high recurrence rates, high incidence of distant metastases, and poor overall survival (OS). Taxane and anthracycline-containing chemotherapy (CT) is currently the main systemic treatment option for TNBC, while platinum-based chemotherapy showed promising results in the neoadjuvant and metastatic settings. An early arising of intrinsic or acquired CT resistance is common and represents the main hurdle for successful TNBC treatment. Numerous mechanisms were uncovered that can lead to the development of chemoresistance. These include cancer stem cells (CSCs) induction after neoadjuvant chemotherapy (NACT), ATP-binding cassette (ABC) transporters, hypoxia and avoidance of apoptosis, single factors such as tyrosine kinase receptors (EGFR, IGFR1), a disintegrin and metalloproteinase 10 (ADAM10), and a few pathological molecular pathways. Some biomarkers capable of predicting resistance to specific chemotherapeutic agents were identified and are expected to be validated in future studies for a more accurate selection of drugs to be employed and for a more tailored approach, both in neoadjuvant and advanced settings. Recently, based on specific biomarkers, some therapies were tailored to TNBC subsets and became available in clinical practice: olaparib and talazoparib for BRCA1/2 germline mutation carriers larotrectinib and entrectinib for neurotrophic tropomyosin receptor kinase (NTRK) gene fusion carriers, and anti-trophoblast cell surface antigen 2 (Trop2) antibody drug conjugate therapy for heavily pretreated metastatic TNBC (mTNBC). Further therapies targeting some pathologic molecular pathways, apoptosis, miRNAS, epidermal growth factor receptor (EGFR), insulin growth factor 1 receptor (IGF-1R), and androgen receptor (AR) are under investigation. Among them, phosphatidylinositol 3 kinase (PI3K)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) and EGFR inhibitors as well as antiandrogens showed promising results and are under evaluation in Phase II/III clinical trials. Emerging therapies allow to select specific antiblastics that alone or by integrating the conventional therapeutic approach may overcome/hinder chemoresistance.

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Section: Discussionmentioning

confidence: 99%

Molecular Mechanisms, Biomarkers and Emerging Therapies for Chemotherapy Resistant TNBC

Scatena

Ghilli

Bargagna

et al. 2022

IJMS

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“…Conversely, the cabozantinib is not available in the mainland Chinese market now. Like some other cost-effectiveness investigations ( Chen et al, 2021 ), we used the Hongkong price in our study as many mainlanders would go to Hongkong for some unavailable drugs due to the lower prices and easy accessibility. Probabilistic sensitivity analysis showed that cabozantinib had a 50% likelihood to be cost-effective when its price dropped to ¥5.87/mg, near one-third of its current price.…”

Section: Discussionmentioning

confidence: 99%

“…They would also have end-of-life care after disease progressed. We compared our prices with those from other similar cost-effectiveness studies conducted in China and the differences were moderate ( Dranitsaris et al, 2015 ; Zhang et al, 2019 ; Chen et al, 2021 ). Moreover, to make sure our prices were representative enough and account for uncertainties, we used a wide range of ±30% in the sensitivity analyses.…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Apatinib and Cabozantinib for the Treatment of Radioiodine-Refractory Differentiated Thyroid Cancer

Shi

Pan

et al. 2022

Front. Pharmacol.

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Background: The effectiveness of apatinib and cabozantinib for the treatment of radioactive iodine–refractory differentiated thyroid cancer (RAIR-DTC) has been demonstrated recently. We aimed to evaluate the cost-effectiveness of these treatments from the Chinese healthcare system perspective.Methods: Two partitioned survival models over a 10-year horizon were built to compare the cost and effectiveness of apatinib vs. placebo and cabozantinib vs. placebo based on the clinical data from the phase 3 randomized REALITY and COSMIC-311 trials. Costs and utility data were obtained from the literature and institutional database. The incremental cost-effectiveness ratio (ICER) was calculated. One-way and probabilistic sensitivity analysis was performed to test the robustness of the conclusion.Results: Apatinib yielded an additional quality-adjusted life-year (QALY) of 0.74 at an additional cost of Chinese Renminbi ¥44,077. The ICER was ¥93,460 (US dollar $13545)/QALY and it was below the current willingness-to-pay (WTP) threshold of ¥217341/QALY. Cabozantinib was associated with an additional QALY of 0.79 at an extra cost of ¥3,55,614 when compared with placebo, and the ICER was ¥4,52,325 ($65,554)/QALY, which was above the WTP threshold. The conclusion were robust under one-way and probabilistic sensitivity analysis. The price of cabozantinib has to drop to ¥5.87/mg (39% of the current price) for it has a 50% likelihood of being cost-effective.Conclusion: Apatinib is cost-effective for RAIR-DTC when compared with placebo from the perspective of Chinese healthcare system. However, based on the current evidence, cabozantinib might not be cost-effective and a reduction of price is warranted.

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“…Despite its clear efficacy, a potential limitation of SG use is represented by its cost. According to a recent analysis conducted in the United States and China, the price of SG should be at least halved to achieve cost-effectiveness [ 56 ]. This practical consideration poses relevant challenges in terms of drug’s accessibility, especially for those patients living in low-income countries.…”

Section: Discussionmentioning

confidence: 99%

A New Kid on the Block: Sacituzumab Govitecan for the Treatment of Breast Cancer and Other Solid Tumors

et al. 2021

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Human trophoblast cell-surface antigen-2 (Trop-2) is a membrane glycoprotein involved in cell proliferation and motility, frequently overexpressed in epithelial tumors. Thus, it represents an attractive target for anticancer therapies. Sacituzumab govitecan (SG) is a third-generation antibody-drug conjugate, consisting of an anti-Trop-2 monoclonal antibody (hRS7), a hydrolyzable linker, and a cytotoxin (SN38), which inhibits topoisomerase 1. Specific pharmacological features, such as the high antibody to payload ratio, the ultra-toxic nature of SN38, and the capacity to kill surrounding tumor cells (the bystander effect), make SG a very promising drug for cancer treatment. Indeed, unprecedented results have been observed with SG in patients with heavily pretreated advanced triple-negative breast cancer and urothelial carcinomas, and the drug has already received approval for these indications. These results are coupled with a manageable toxicity profile, with neutropenia and diarrhea as the most frequent adverse events, mainly of grades 1–2. While several trials are exploring SG activity in different tumor types and settings, potential biomarkers of response are under investigation. Among these, Trop-2 overexpression and the presence of BRCA1/2 mutations seem to be the most promising. We review the available literature concerning SG, with a focus on its toxicity spectrum and possible biomarkers of its response.

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Economic Evaluation of Sacituzumab Govitecan for the Treatment of Metastatic Triple-Negative Breast Cancer in China and the US

Cited by 13 publications

References 34 publications

Molecular Mechanisms, Biomarkers and Emerging Therapies for Chemotherapy Resistant TNBC

Molecular Mechanisms, Biomarkers and Emerging Therapies for Chemotherapy Resistant TNBC

Cost-Effectiveness of Apatinib and Cabozantinib for the Treatment of Radioiodine-Refractory Differentiated Thyroid Cancer

A New Kid on the Block: Sacituzumab Govitecan for the Treatment of Breast Cancer and Other Solid Tumors

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