The role and economics of immunotherapy in solid tumour management

Abstract

Cancer therapeutics is a rapidly changing field which offers patients the prospect of a better quality of life and cure. Immunotherapy has become a unique approach for select metastatic solid tumours. While initial results do show durable responses in select patients, there are concerns on how best to utilise this expensive resource which can result in costly side effects and in whom the use of biomarkers to stratify patients is still in its infancy. Given the ageing population and extreme challenges on healthcare, economic modelling with regards to immunotherapy is imperative especially now when it is being considered for further cancer types.

Growth of community‐based immunotherapy treatment in the Veterans Health Administration

“…Findings in the literature support these analyses, as researchers have yet to find a substantial way to mitigate cost of treatment 15 . With this in mind, the field is turning toward comparative analyses and rigorous patient screening to mitigate treatment costs 18,20,21,22 . Nonetheless, given the high cost of oncology treatment, further operational analyses of ways to contain costs without compromising quality of care are warranted.…”

Adjuvant Immunotherapy in Stage II Melanoma—Further Risk Stratification is Needed

“…2 Mean direct 30-day costs of an individual irAE, including inpatient and outpatient expen- ditures, range from $17 570 to $30 534, with many patients affected by toxicities of more than 1 organ system (including cutaneous, respiratory, central nervous system/psychiatric, gastrointestinal, rheumatologic, ocular, cardiac, hepatic, hematologic, and endocrine toxicities). 1 As a conservative estimate, ICI treatment for all patients with stage IIB/IIC melanoma would contribute $1.3 billion of annual direct costs. 1,2 Risk Stratification Tools to Identify Optimal Candidates for ICI Although the new clinical standard of care is to consider ICIs in all patients with stage IIB/IIC melanoma, adjuvant therapy based on AJCC staging alone may result in considerable negative consequences for an uncertain melanoma-specific survival or overall survival benefit among a minority of treated patients.…”

“…1 As a conservative estimate, ICI treatment for all patients with stage IIB/IIC melanoma would contribute $1.3 billion of annual direct costs. 1,2 Risk Stratification Tools to Identify Optimal Candidates for ICI Although the new clinical standard of care is to consider ICIs in all patients with stage IIB/IIC melanoma, adjuvant therapy based on AJCC staging alone may result in considerable negative consequences for an uncertain melanoma-specific survival or overall survival benefit among a minority of treated patients. Improving our ability to identify patients who may benefit from ICI therapy will become increasingly important in the use of these potentially lifeprolonging therapies while minimizing the harms for patients who would derive no benefit, a position in agreement with the American Society of Clinical Oncology.…”

“…Of the 91 000 invasive melanomas diagnosed annually in the US, 9.2% are stage IIB/ IIC compared to 13% of stage III-IV disease (the setting previously approved for immunotherapy). [1][2][3] As a result, this expansion in indication for ICIs could nearly double the size of the ICI-eligible melanoma population, with more than 8000 additional patients meeting treatment criteria annually. 4 Dermatologists, who have historically managed patients with stage IIB/IIC melanoma with surgeons (typically surgical oncologists), will need to adapt to a new clinical framework where increasing numbers of patients with localized melanoma will also require involvement of medical oncologists.…”

Advancements in nanoparticle-based treatment approaches for skin cancer therapy

“…Nonetheless, even after surgery and radiotherapy, the ITC is preferred chiefly to abolish the recurrence of skin cancer sooner or later. But the drawbacks associated with immunotherapy and targeted therapy, such as poor bioavailability and high cost, turn the patient’s eyes towards chemotherapy [ 30 – 32 ]. Although chemotherapy dramatically reduces the treatment cost of skin cancer, it suffers from poor therapeutic efficacy followed by causing severe side effects due to tumor resistance, inadequate solubility and permeability, poor bioavailability, non-targetability, and so on [ 33 ].…”