Trastuzumab deruxtecan versus trastuzumab emtansine for patients with human epidermal growth factor receptor 2-positive metastatic breast cancer: A cost-effectiveness analysis

Ying, Zhu; Liu, Kun; Wang, Min; Wang, Kai-Ling; Zhu, Hong

doi:10.1016/j.breast.2022.10.010

Cited by 17 publications

(4 citation statements)

References 33 publications

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“…Utilizing a higher WTP threshold ($29 300/QALY) would have resulted in durvalumab plus GemCis being the most cost‐effective strategy in the United States. The GDP per capita in China also varies markedly among different regions, with respective WTP thresholds in Beijing, Shanghai, Guangdong, Hubei, Hunan, Sichuan, Xizang, Heilongjiang and Gansu of $82 974, $78 308, $44 434, $40 232, $32 081, $29 588, $25 434, $22 210 and $19 636 per QALY in 2022 36 . Strikingly, while durvalumab plus GemCis is likely to be the most cost‐effective treatment option in the majority of the regions of China (27/34), pembrolizumab plus GemCis may be the best therapeutic option in less developed regions (7/34).…”

Section: Discussionmentioning

confidence: 99%

Immune checkpoint inhibitor for patients with advanced biliary tract cancer: A cost‐effectiveness analysis

Zhu,

Liu,

Zhu

2023

Liver International

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Background and AimsThe increasingly widespread of immune checkpoint inhibitors (ICIs) in the field of antitumors has brought a new dawn for patients with advanced biliary tract cancer (aBTC). However, the choice of treatment needs to be supported by economic evaluation. Therefore, the cost‐effectiveness comparison of first‐line durvalumab or pembrolizumab plus gemcitabine and cisplatin (GemCis) treatment of aBTC was explored from the perspective of American and Chinese healthcare systems.MethodsGround on the TOPAZ‐1 and KEYNOTE‐966 trials, the Markov model with a 15‐year horizon including three health states to imitate cost and effective outcomes was established. Incremental cost‐effectiveness ratio (ICER) at willingness‐to‐pay (WTP) thresholds of $100 000/QALY and $37 408/ALY in the USA and China was used as the most important indicator. Other endpoint indexes included total cost, life years (LYs), quality‐adjusted life years (QALYs) and incremental net‐health benefit (INHB). To verify the robustness, sensitivity and subgroup analyses were performed.ResultsDurvalumab plus GemCis ($322 211 [2.94 QALYs] and $35 695 [2.76 QALYs]) increased cost (effectiveness) by $63 777 (.22 QALYs) and $5234 (.20 QALYs) than pembrolizumab plus GemCis ($258 434 [2.72 QALYs] and $30 461 [2.56 QALYs]) in the USA and China, respectively. The corresponding ICER was $288 725/QALY and $26 401/QALY, with INHB of −.42 and .06 QALYs, respectively. The cost of ICIs was the most important factor influencing results.ConclusionsIn China, first‐line durvalumab plus GemCis versus pembrolizumab plus GemCis was a cost‐effective option for patients with aBTC, but not in the USA.

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Section: Discussionmentioning

confidence: 99%

Immune checkpoint inhibitor for patients with advanced biliary tract cancer: A cost‐effectiveness analysis

Zhu,

Liu,

Zhu

2023

Liver International

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“…So far, none of the ADCs approved for solid tumors can be considered cost-effective. However, cost effectiveness is highly dependent on the local markets and may vary from country to country [ 8 , 102 , 103 ].…”

Section: Mirvetuximab Soravtansine (Elahere™)mentioning

confidence: 99%

“…In regard to solid tumors, in 2013, the FDA approved ado-trastuzumab emtansine (T-DM1) (payload is a microtubule inhibitor) for the treatment of metastatic breast cancer on the basis of its HER-2 targeting [ 4 ]. Another first-in-class ADC, trastuzumab deruxtecan (T-Dx) (payload is a topoisomerase I inhibitor), was first approved in 2021; currently, it is approved for HER2-positive breast cancer and, more recently, HER2-low (immunohistochemistry 1+ or 2+) breast cancer, HER2 positive gastric or gastroesophageal cancer, and HER2 -mutated non-small cell lung cancer (NSCLC) [ 5 , 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Antibody-Drug Conjugates in Solid Tumor Oncology: An Effectiveness Payday with a Targeted Payload

Kondrashov,

Sapkota,

Sharma

et al. 2023

Pharmaceutics

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Antibody–drug conjugates (ADCs) are at the forefront of the drug development revolution occurring in oncology. Formed from three main components—an antibody, a linker molecule, and a cytotoxic agent (“payload”), ADCs have the unique ability to deliver cytotoxic agents to cells expressing a specific antigen, a great leap forward from traditional chemotherapeutic approaches that cause widespread effects without specificity. A variety of payloads can be used, including most frequently microtubular inhibitors (auristatins and maytansinoids), as well as topoisomerase inhibitors and alkylating agents. Finally, linkers play a critical role in the ADCs’ effect, as cleavable moieties that serve as linkers impact site-specific activation as well as bystander killing effects, an upshot that is especially important in solid tumors that often express a variety of antigens. While ADCs were initially used in hematologic malignancies, their utility has been demonstrated in multiple solid tumor malignancies, including breast, gastrointestinal, lung, cervical, ovarian, and urothelial cancers. Currently, six ADCs are FDA-approved for the treatment of solid tumors: ado-trastuzumab emtansine and trastuzumab deruxtecan, both anti-HER2; enfortumab-vedotin, targeting nectin-4; sacituzuzmab govitecan, targeting Trop2; tisotumab vedotin, targeting tissue factor; and mirvetuximab soravtansine, targeting folate receptor-alpha. Although they demonstrate utility and tolerable safety profiles, ADCs may become ineffective as tumor cells undergo evolution to avoid expressing the specific antigen being targeted. Furthermore, the current cost of ADCs can be limiting their reach. Here, we review the structure and functions of ADCs, as well as ongoing clinical investigations into novel ADCs and their potential as treatments of solid malignancies.

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“… 4 Antibody–drug conjugates, such as ado-trastuzumab emtansine (T-DM1) and trastuzumab deruxtecan (T-DXd) are also efficacious against BMs. 5 , 6 Despite advancements in the treatment of HER2+ BCBM with both TKIs and antibody–drug conjugates, the prognosis for these patients remains unfavorable.…”

Section: Introductionmentioning

confidence: 99%

Treatment of HER2-Positive Breast Cancer with Brain Metastases Using Anlotinib and Trastuzumab Deruxtecan: A Case Report

Chen,

Liu,

Wen

et al. 2024

IJWH

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Breast cancer with brain metastasis accounts for the second largest number of brain metastases among solid malignancies. Despite advances in HER2-targeted therapy, 50% of patients with human epidermal growth factor receptor 2-positive (HER2+) breast cancer develop brain metastases and are associated with poor outcomes. In this article, we report the case of a patient with HER2+ metastatic breast cancer who developed brain metastases, despite experiencing a durable effect on extracranial metastases after treatment with trastuzumab and pertuzumab. The patient exhibited intracranial progression while receiving treatment with trastuzumab deruxtecan monotherapy after secondary brain radiotherapy and multiple lines of therapy with anti-HER2 agents, such as pyrotinib, lapatinib, tucatinib, and ado-trastuzumab emtansine. However, the administration of anlotinib (an antiangiogenesis medication) and trastuzumab deruxtecan resulted in intracranial and extracranial partial response and was linked to manageable side effects. The present case indicates that the combination of anlotinib and trastuzumab deruxtecan may be a promising treatment option for patients with HER2+ breast cancer with brain metastasis. Nevertheless, further studies are warranted to verify the present findings.

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Trastuzumab deruxtecan versus trastuzumab emtansine for patients with human epidermal growth factor receptor 2-positive metastatic breast cancer: A cost-effectiveness analysis

Cited by 17 publications

References 33 publications

Immune checkpoint inhibitor for patients with advanced biliary tract cancer: A cost‐effectiveness analysis

Immune checkpoint inhibitor for patients with advanced biliary tract cancer: A cost‐effectiveness analysis

Antibody-Drug Conjugates in Solid Tumor Oncology: An Effectiveness Payday with a Targeted Payload

Treatment of HER2-Positive Breast Cancer with Brain Metastases Using Anlotinib and Trastuzumab Deruxtecan: A Case Report

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