Estimated Cost-effectiveness of Atezolizumab Plus Cobimetinib and Vemurafenib for Treatment of<i>BRAF V600</i>Variation Metastatic Melanoma

Cai, Chenxi; Yunusa, Ismaeel; Tarhini, Ahmad A.

doi:10.1001/jamanetworkopen.2021.32262

Cited by 7 publications

(5 citation statements)

References 39 publications

(70 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The combination of MEK inhibitor and anti‐PD‐1 immunotherapy was considered as a promising option. However, the phase III clinical trial of atezolizumab plus cobimetinib in advanced melanoma failed to demonstrate superior survival over anti‐PD‐1 monotherapy 43 . Other combination strategies, such as CDK4/6 inhibitors, autophagy inhibitors, or HDAC inhibitors, are also under investigation to overcome the subsequent monotherapy resistance and to prolong the survival 44–46 …”

Section: Discussionmentioning

confidence: 99%

“…However, the phase III clinical trial of atezolizumab plus cobimetinib in advanced melanoma failed to demonstrate superior survival over anti-PD-1 monotherapy. 43 Other combination strategies, such as CDK4/6 inhibitors, autophagy inhibitors, or HDAC inhibitors, are also under investigation to overcome the subsequent monotherapy resistance and to prolong the survival. [44][45][46] Another interesting result in our study is that patients with KIT mutations also showed no survival benefit from anti-PD-1 adjuvant therapy than IFN/OBS.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A real‐world study of adjuvant anti‐PD ‐1 immunotherapy on stage III melanoma with BRAF, NRAS, and KIT mutations

Sun

Yan

et al. 2023

Cancer Medicine

View full text Add to dashboard Cite

BackgroundMelanoma frequently harbors BRAF, NRAS, or KIT mutations which influence both tumor development and treatment strategies. For example, it is still controversial whether adjuvant anti‐PD‐1 monotherapy or BRAF/MEK inhibitors may better improve the survival for resected BRAF‐mutant melanoma. Furthermore, outcomes for melanoma with NRAS and KIT mutation receiving adjuvant immunotherapy remain unclear.MethodsOne hundred seventy‐four stage III melanoma patients who underwent radical surgery in Fudan University Shanghai Cancer Center (FUSCC) during January 2017 to December 2021 were included in this real‐world study. Patients were followed up until death or May 30th, 2022. Pearson's chi‐squared test or Fisher's exact test was performed for univariable analysis of the different category groups. Log‐rank analysis was used to identify the prognostic factors for disease‐free survival (DFS).ResultsThere were 41 (23.6%) patients with BRAF mutation, 31 (17.8%) with NRAS mutation, 17 (9.8%) with KIT mutation, and 85 (48.9%) wild‐type patients without either genomic alteration of those three genes. Most ( n = 118, 67.8%) of them were acral melanoma, while 45 (25.9%) were cutaneous subtype, and 11 were (6.3%) primary unknown. Among them, 115 (66.1%) patients received pembrolizumab or toripalimab monotherapy as adjuvant therapy; 22 (12.6%) patients received high‐dose interferon (IFN), and 37 (21.3%) patients were just for observation. There was no statistical difference in clinicopathologic factors between anti‐PD‐1 group and IFN/OBS group. Of all the enrolled patients, anti‐PD‐1 group had a better DFS than IFN/OBS group ( p = 0.039). In anti‐PD‐1 group, patients with BRAF or NRAS mutations had poorer DFS than wild‐type group. No survival difference was found among patients harboring different gene mutations in IFN/OBS group. In wild‐type patients, anti‐PD‐1 group had a better DFS than IFN/OBS group ( p = 0.003), while no survival benefits were found for patients with BRAF, NRAS, or KIT mutations.ConclusionAlthough anti‐PD‐1 adjuvant therapy provides a better DFS in the general population and in wild‐type patients, patients with BRAF, KIT or, especially, NRAS mutation may not benefit further from immunotherapy than conventional IFN treatment or observation.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A real‐world study of adjuvant anti‐PD ‐1 immunotherapy on stage III melanoma with BRAF, NRAS, and KIT mutations

Sun

Yan

et al. 2023

Cancer Medicine

View full text Add to dashboard Cite

show abstract

“…The cost-effectiveness was evaluated using a partitioned survival model derived from the NCT02253459 trial data ( Partitioned survival model, 2016 ). This model is routinely employed to assess the financial and efficacy outcomes in metastatic oncology research ( Insinga et al, 2018 ; Chouaid et al, 2019 ; Loong et al, 2020 ; Cai C. et al, 2021 ). It delineates three distinct health states ( Figure 1 ): the progression-free state (from patient entry until the onset of disease progression), the progressive disease (PD) state (spanning the time the patient remains alive post the initiation of disease progression), and the terminal state.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of utidelone and capecitabine versus monotherapy in anthracycline- and taxane-refractory metastatic breast cancer

Chen,

Zhang,

et al. 2024

Front. Pharmacol.

View full text Add to dashboard Cite

BackgroundThis study aimed to assess the cost-effectiveness of combining utidelone with capecitabine, compared to capecitabine monotherapy, for the treatment of anthracycline- and taxane-refractory metastatic breast cancer within the Chinese healthcare system.MethodsA partitioned survival model was formulated based on patient characteristics from the NCT02253459 trial. Efficacy, safety, and health economics data were sourced from the trial and real-world clinical practices. We derived estimates for costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) for the two treatment strategies. Sensitivity and subgroup analyses were conducted to rigorously evaluate uncertainties' impact.ResultsOver a 5-year span, the combination therapy manifested substantially higher costs than capecitabine monotherapy, with a differential of US$ 26,370.63. This combined approach conferred an additional 0.49 QALYs, resulting in an ICER of US$ 53,874.17/QALY. Utilizing the established willingness-to-pay threshold, the combination might not consistently be deemed cost-effective when juxtaposed against monotherapy. However, at an ICER of US$ 53,874.4/QALY, the probability of the combination being cost-effective increased to 48.97%. Subgroup analysis revealed that the combination was more cost-effective than capecitabine alone in specific patient groups, including those <60 years, patients with more than two chemotherapy rounds, patients lacking certain metastases, patients having limited metastatic sites, patients with an Eastern Cooperative Oncology Group status of 0, and patients with particular hormone receptor profiles.ConclusionAlthough the combination of utidelone and capecitabine may not be an economically viable universal choice for anthracycline- and taxane-refractory metastatic breast cancer, it could be more cost-effective in specific patient subgroups than capecitabine monotherapy.

show abstract

“…This model is frequently employed to analyze advanced tumor diagnosis and treatment clinical efficacy and health care costs. [20][21][22][23] Three mutually exclusive health states were constructed in the current study: diseasefree progression, disease progression, and the terminal stage, as depicted in Figure 1. The model operated on a 2-week (14 days) cycle over an evaluation horizon of 240 weeks, consistent with the ASTRUM-007 trial's clinical treatment timeline.…”

Section: Model Constructionmentioning

confidence: 99%

Cost-effectiveness analysis of serplulimab in combination with cisplatin plus 5-fluorouracil chemotherapy compared to cisplatin plus 5-fluorouracil chemotherapy as first-line treatment for advanced or metastatic esophageal squamous cell carcinoma in China

Lin,

Zhou,

et al. 2023

Ther Adv Med Oncol

View full text Add to dashboard Cite

Background: This study evaluated the cost-effectiveness of serplulimab plus chemotherapy versus chemotherapy alone in treating advanced/metastatic esophageal squamous cell carcinoma (ESCC) within the Chinese health care system. Methods: A partitioned survival model based on ASTRUM-007 trial patient characteristics was developed. Efficacy, safety, and medical/economic data were obtained from the trial and real-world clinical practice. Costs, quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICERs) were calculated for both treatment strategies. Sensitivity, subgroup, and scenario analyses were performed to assess the uncertainty impact. Results: Serplulimab combined with chemotherapy yielded an ICER of US$ 53,538.27/QALY. Deterministic sensitivity analysis identified patient survival and serplulimab price as influential parameters. Probabilistic sensitivity analysis showed a 47.33% probability of cost-effectiveness at a willingness-to-pay (WTP) threshold of US$ 53,541/QALY and 0.05% at three times China’s GDP per capita. Subgroup analysis revealed that patients with a programmed death-ligand 1 (PD-L1) expression combined positive score (CPS) ⩾10 had a lower hazard ratio (0.59) and ICER (US$ 29,935.23/QALY), with a 95.36% probability of cost-effectiveness. Scenario analysis demonstrated that the drug donation discount policy significantly increased the likelihood of cost-effective serplulimab-chemotherapy combinations in Jiangsu, Fujian, and Guangdong at 99.99%, 99.90%, and 94.16%, respectively. Conclusion: Compared to chemotherapy alone, serplulimab combined with chemotherapy is currently not a cost-effective first-line treatment for advanced/metastatic ESCC in China. However, as serplulimab plus chemotherapy regimens evolve and price competition among programmed death 1 (PD-1) inhibitors intensifies, this combination may become a cost-effective treatment option.

show abstract

Estimated Cost-effectiveness of Atezolizumab Plus Cobimetinib and Vemurafenib for Treatment ofBRAF V600Variation Metastatic Melanoma

Cited by 7 publications

References 39 publications

A real‐world study of adjuvant anti‐PD ‐1 immunotherapy on stage III melanoma with BRAF, NRAS, and KIT mutations

A real‐world study of adjuvant anti‐PD ‐1 immunotherapy on stage III melanoma with BRAF, NRAS, and KIT mutations

Cost-effectiveness of utidelone and capecitabine versus monotherapy in anthracycline- and taxane-refractory metastatic breast cancer

Cost-effectiveness analysis of serplulimab in combination with cisplatin plus 5-fluorouracil chemotherapy compared to cisplatin plus 5-fluorouracil chemotherapy as first-line treatment for advanced or metastatic esophageal squamous cell carcinoma in China

Contact Info

Product

Resources

About