First-Line Treatment With Atezolizumab Plus Nab-Paclitaxel for Advanced Triple-Negative Breast Cancer

Abstract

Objective: The authors conducted a cost-effectiveness analysis incorporating recent phase III clinical trial (IMpassion130) data to evaluate the cost-effectiveness of atezolizumab in combination with nab-paclitaxel (AnP) against nab-paclitaxel alone as the first-line treatment for advanced triple-negative breast cancer in developed and developing countries. Materials and Methods: A decision-analytic Markov model was developed using IMpassion130 data to evaluate the cost-effectiveness of AnP over a lifetime from the US health care payer and Chinese health care system perspective. Model inputs were derived from IMpassion130 and published literature. The primary outcomes of the model were quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). Uncertainty was addressed using univariate and probabilistic sensitivity analyses. Results: For the intention-to-treat (ITT) population, the projected mean outcome was better with AnP (1.41 QALYs) than with nab-paclitaxel alone (0.99 QALYs). Similar results were obtained for the programmed death ligand 1 (PD-L1)-positive population, with the obtained mean outcomes of 1.66 and 0.88 QALYs, respectively. For the Unites States, the ICER values comparing AnP with nab-paclitaxel were US$331,996.89 and US$229,359.88 per QALY gained for the ITT and PD-L1-positive populations, respectively. For China, the ICER values were US$106,339.26 and US$72,971.88 per QALY gained for the ITT and PD-L1-positive populations, respectively. The univariate sensitivity analysis indicated that the price of atezolizumab was the most influential factor in our study. AnP had 0% cost-effectiveness at the willingness-to-pay thresholds of US$150,000/QALY in the United States and US$29,383/QALY in China. Conclusion: AnP is not a cost-effective choice as the first-line treatment for advanced triple-negative breast cancer in the United States and China.

The Use of Atezolizumab + Nab-Paclitaxel for Women with PD- L1 Positive Advanced Triple-Negative Breast Cancer

“…An article published in November 2018, showed the rousing results of the phase III study that the inclusion of atezolizumab to nab-paclitaxel as the firstline agent in the treatment of patients with advanced TNBC revealed remarkably prolonged OS and PFS, compared with those obtained with nab-paclitaxel alone, which was the great finding in the first-line treatment of this malignancy. [11] In HRQoL, physical, role, and cognitive functioning, Atezolizumab plus nab-paclitaxel had correspondent outcomes compared with placebo plus nab-paclitaxel in IMpassion130. [2] Since routine testing for PD-L1 immune-cell expression is not resectable, it is better to consider advanced and approved diagnostic (VENTANA PD-L1 SP142 assay) in patients who get benefit from treatment with atezolizumab plus nabpaclitaxel.…”

“…[4] It is relevant to consider the economic evaluation of high-cost drugs to minimize the financial burdens for patients with cancer and to completely make use of limited medical resources. [11] For the treatment of patients with metastatic TNBC whose tumors express PD-L1, atezolizumab plus nab-paclitaxel exhibits an appropriate benefit-risk profile. So, as a result, combination therapy with AnP shows logically likely an acceptable safety result in patients with TNBC.…”

“…Many costeffectiveness studies were conducted regarding the atezolizumab as a first-line agent in other cancer patients such as lung cancer. [11] Some studies implied that AnP (atezolizumab plus nab-paclitaxel) have more clinical outcome when compared to nab-paclitaxel as the first-line therapy for advanced TNBC and inclusion of atezolizumab with nab-paclitaxel would not be a cost-effective strategy, to improve this minimizing the price of atezolizumab may be a possible measure. For effective treatment options of TNBC, clinical decision-makers need to consider decisions.…”

“…For effective treatment options of TNBC, clinical decision-makers need to consider decisions. [11] Fortunately, several types of research are in progress in the development of new immunotherapy methods in TNBC to achieve the goal of therapy, especially in patients who are in the early stage of TNBC. Hereof, challenging outcomes issued by IMpassion130 caused the development of more trials in the investigation of PD-1 or PD-L1 inhibitors in patients with the initial phase of TNBC and efficacy of therapy in combination with other chemotherapy agents.…”

“…[1,2] Atezolizumab as a Vol.8; Issue: 7; July 2021 Chemotherapy agent has been proved to have an acceptable safety and efficacy in profile and therapy in patients with TNBC by enhancing the tumor antigen release and antitumor responses to immune checkpoint inhibition. [11] In the process of therapy of metastatic TNBC the accepted dose of atezolizumab is 840 mg which can be administered every 28-day cycle on 1st and 15th of each cycle. [15] The acceptable route of administration for atezolizumab as an infusion and the onset infusion should be administered during 60 min accompanied by infusions over 30 min if the first infusion is tolerated.…”