Abstract
BackgroundThe impact of programmed death receptor-ligand1 (PD-L1) on costs and value of the immune check point inhibitors (ICPI) has received minimal attention. Objectives: 1- Design a sliding scale to grade survival in 2nd-line non-small-cell lung cancer (NSCLC). 2- Compare costs and value of Nivolumab (Nivo), Atezolizumab (Atezo) and Pembrolizumab (Pembro) vs. Docetaxel (Doc).MethodsPreviously reported median overall survival (OS) and prices posted by parent company were utilized. The OS gains over controls in days were graded (gr) from A+ to D. Docetaxel costs were calculated for 6–12 cycles and the ICPI for 1 year. Adverse events treatment costs (AEsTC) were reported separately. The cost/life-year gain (C/LYG) was computed as drug yearly-cost/OS gain over control in days × 360 days. The relative value of the ICPI were expressed as $100,000/C/LYG.ResultsCosts of Doc 6 cycles were $23,868, OS/gr 87/C, AEs gr ¾ > 20%, AEsTC $1978 and 6- 12 cycle C/LYG $98,764 -$197,528. Nivo, Atezo and Pembro gr ¾ were < 20% at average costs of $1480. In non-squamous NSCLC, Nivo demonstrated OS/g 84/C and C/LYG $558,326 as compared with 264/A and $177,645 in PD-L1 > 10%. Atezolizumab OS/g were 87/B and C/LYG $551,407 improving in enriched PD-L1 to 162/A and $332,020 respectively. Pembrolizumab in PD-L1 > 1.0% demonstrated OS/g 57/C and C/LYG $659,059 improving in > 50% PD-L1 to 201/A and $186,897. PD-L1 enrichment increased RV of Nivo from 0.18 to 0.56, Atezo from 0.16 to 0.66 and Pembro from 0.15 to 0.53.ConclusionsSimplified methodology to grade OS and weigh value of anticancer drugs was proposed. In 2nd-line non-squamous NSCLC, value of Doc, Nivo, Atezo and Pembro regardless of PDL-1 expression were limited and modest. Enrichment of PD-L1 resulted in unprecedented OS, improved grades and enhanced value at seemingly justifiable costs.
Highlights
The impact of programmed death receptor-ligand1 (PD-L1) on costs and value of the immune check point inhibitors (ICPI) has received minimal attention
Nivolumab (Nivo) [4, 5] and Pembrolizumab (Pembro) [6, 7] both directed against the program death potein1 (PD-1) and Atezolizumab (Atezo) [8,9,10] targeting the ligand PD-Ligand 1 (PD-L1) were approved by the Federal Drug Administration (FDA) in 2nd-line
The ICPI In phase III trials of nivolumab vs docetaxel in previously treated non-small-cell lung cancer (NSCLC), all-grade Adverse events (AEs) were less frequent with nivolumab than with docetaxel [4, 5]
Summary
The impact of programmed death receptor-ligand (PD-L1) on costs and value of the immune check point inhibitors (ICPI) has received minimal attention. Nivolumab (Nivo) [4, 5] and Pembrolizumab (Pembro) [6, 7] both directed against the program death potein (PD-1) and Atezolizumab (Atezo) [8,9,10] targeting the ligand PD-Ligand 1 (PD-L1) were approved by the Federal Drug Administration (FDA) in 2nd-line. These inhibitors block the PD1 pathway, up-regulate the T cell immunity and allow the immune system to attack tumor cells.
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