Switch to anti-programmed cell death protein 1 (anti-PD-1) fixed-dose regimen: What is the economic impact?

Bayle, Arnaud; Besse, Benjamin; Annereau, Maxime; Bonastre, Julia

doi:10.1016/j.ejca.2019.02.016

Cited by 33 publications

(32 citation statements)

References 10 publications

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“…Fixed dosing of ICI is common now, but it is resulting in financial toxicity in both the USA and in Europe (91). Nivolumab fixed dose (240 mg/2 weeks or 480 mg/4 weeks) corresponds to a body weight of 80 kg, pembrolizumab 200 mg/3 weeks corresponds to a body weight of 100 kg.…”

Section: Perspectivesmentioning

confidence: 99%

Immunotherapy: From Advanced NSCLC to Early Stages, an Evolving Concept

et al. 2020

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Immunotherapy in lung cancer treatment is a long history paved with failures and some successes. During the last decade, the discovery of checkpoints inhibitors led to major advances in treating advanced and metastatic non-small cell lung cancer (NSCLC). Impressive data from early phase I-II studies were subsequently confirmed in large prospective randomized trials and meta-analyses (High-level of evidence). Three anti-programmed death-1 (PD1) (pembrolizumab, nivolumab) or antiPD-ligand(L)1 (atezolizumab) antibodies showed clinically significant improved survival compared to second-line docetaxel. Then, first-line pembrolizumab monotherapy demonstrated its superiority over platinum-doublet in high PD-L1 NSCLC. The addition of pembrolizumab or atezolizumab to chemotherapy derived the same results regardless of the PD-L1 status. On the opposite, antiCTLA4 (Cytotoxic T-Lymphocyte Associated 4) results are currently disappointing in unselected patients while recent development suggest that the combination of antiPD1 and antiCTLA4 (nivolumab-ipilimumab) positively impact on overall survival. Some secondary analyses also showed that immunotherapy has a positive impact on quality of life and that the clinical improvement can be done at an acceptable incremental cost per QALY. A lot of questions remain unresolved: which is the best treatment duration and is it the same for all patients, how to choose the patients that will have the highest benefit of immunotherapy, how to identify the patients who will have rapid progression, how to improve the current data (new targets, new combinations)…

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Section: Perspectivesmentioning

confidence: 99%

Immunotherapy: From Advanced NSCLC to Early Stages, an Evolving Concept

et al. 2020

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“…In one study, first‐line pembrolizumab spending in the US for non‐small cell lung cancer increased by more than $800 million USD annually . In another study, pembrolizumab and nivolumab spending in France increased by €55 million, or $61 million USD annually …”

Section: Introductionmentioning

confidence: 99%

“…18 In another study, pembrolizumab and nivolumab spending in France increased by €55 million, or $61 million USD annually. 19 Clinical studies have failed to detect differences in efficacy among the approved fixed doses and various weightbased doses. Therefore, we estimated potential savings from different dosing strategies.…”

Section: Introductionmentioning

confidence: 99%

Economics of alternative dosing strategies for pembrolizumab and nivolumab at a single academic cancer center

et al. 2020

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Background The FDA initially approved pembrolizumab and nivolumab for doses based on patient weight, but subsequently amended approval to fixed doses. We estimated savings from novel dosing strategies based on real‐world patient data from a single cancer center. Methods We analyzed all outpatient doses of pembrolizumab and nivolumab administered at three infusion centers affiliated with our academic hospital between July 1, 2018 and Oct 31, 2018. We estimated savings from several dosing strategies with and without vial sharing between patients. Results A total of 1029 doses of pembrolizumab or nivolumab were administered for multiple cancer types. For 77% of doses, the weight‐based dose was less than the fixed dose. “Dose‐minimization” (DM), defined as the lesser of weight‐based and fixed dose decreased nivolumab spending by 9% without affecting pembrolizumab spending. DM plus vial sharing decreased pembrolizumab spending by 19% without affecting nivolumab. The differences in savings were due to availability of multiple vial sizes for nivolumab but not pembrolizumab. DM plus vial sharing for both drugs would have saved $1.5 million USD over the 4‐month study period. Conclusion New dosing strategies for pembrolizumab and nivolumab can generate large savings without anticipated decrease in efficacy. Barriers include FDA dosing labels, hospital policies against vial sharing, and inaccessibility of smaller vial sizes, which are currently available in other worldwide markets.

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“…The resulting pharmacokinetic-based regimens used revised dose based on patients' body weight rather than individual dose adjustment based on concentration-effect relationships used in TDM. However, this study was included as the pharmacokinetic-based regimens were based on pharmacokinetic and pharmacodynamic relationships to optimised the dosage of high cost cancer treatments is of topical importance [28,29].…”

Section: Resultsmentioning

confidence: 99%

A comprehensive review of economic evaluations of therapeutic drug monitoring interventions for cancer treatments

Vithanachchi

Maujean

Downes

et al. 2020

Brit J Clinical Pharma

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This is the peer reviewed version of the following article: A comprehensive review of economic evaluations of therapeutic drug monitoring interventions for cancer treatments, British Journal of Clinical Pharmacology, Early ViewR, which has been published in final form at 10.1111/bcp.14494. This article may be used for noncommercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (

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Switch to anti-programmed cell death protein 1 (anti-PD-1) fixed-dose regimen: What is the economic impact?

Cited by 33 publications

References 10 publications

Immunotherapy: From Advanced NSCLC to Early Stages, an Evolving Concept

Immunotherapy: From Advanced NSCLC to Early Stages, an Evolving Concept

Economics of alternative dosing strategies for pembrolizumab and nivolumab at a single academic cancer center

A comprehensive review of economic evaluations of therapeutic drug monitoring interventions for cancer treatments

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