July 2015, Special ASCO Edition

← Back to Issue

Cost-Effectiveness of T-DM1 Examined

Value-Based Cancer Care

For the treatment of advanced HER2-positive breast cancer, the use of trastuzumab emtansine (T-DM1) is not cost-effective when compared with lapatinib plus capecitabine from both a societal and a payer’s perspective, according to an analysis conducted at Western University of Health Sciences College of Pharmacy in Pomona, CA.

From a societal perspective only, T-DM1 may be cost-effective compared with capecitabine monotherapy at the willingness-to-pay threshold of $150,000 per quality-adjusted life-year (QALY), Quang A. Le, PharmD, PhD, and Yuna Bae, PharmD, also reported in a poster.

In the EMILIA trial, T-DM1 significantly increased both median progression-free survival (PFS) and overall survival (OS), relative to lapatinib plus capecitabine, in patients with HER2-positive advanced breast cancer previously treated with trastuzumab and a taxane. Using data from this trial and the EGF100151 trial of capecitabine, the investigators performed an economic analysis of T-DM1 compared with lapatinib/capecitabine (LC) and with monotherapy with capecitabine from both the US payer’s perspective and a societal perspective.

The model assumed a median PFS of 9.6 months with T-DM1, 6.4 months with LC, and 4.3 months with capecitabine; median OS of 30.9 months, 25.1 months, and 15.3 months; overall response rates of 43.6%, 30.8%, and 13.9%; and duration of response of 12.6 months, 6.5 months, and 7.1 months, respectively.

Le and Bae examined outcomes with 4 possible Markov models for advanced breast cancer, comparing the projected lifetime costs and outcomes with the 3 regimens as applied to a typical 53-year-old patient (Table). From the US payer’s perspective, at the willingness-to-pay threshold of $150,000 per QALY, the analysis found a 14.1% probability that T-DM1 was cost-effective versus LC, and a 22.9% probability it was cost-effective against capecitabine. From a society perspective, these probabilities were 29.2% and 88.4%, respectively, the researchers reported.

Uncategorized - August 13, 2015

Urine Assays Detect Early Mutations in Patients with Advanced Cancers

An assay that measures circulating tumor DNA (ctDNA) in the urine can detect mutations in patients with advanced cancers. In one study, tracking cell-free DNA mutations in the urine from patients with refractory cancers found that low-frequency KRAS mutations were present in about 80%, said Filip Janku, MD, PhD. “We [ Read More ]

Immunotherapy - August 13, 2015

ABCs of Immunotherapy

With the surge in new immunotherapies becoming available for the treatment of melanoma, non–small cell lung cancer, bladder cancer, and other solid tumors, it is important to know how to assess response patterns that differ from those of chemotherapy, manage the unique side effects, and understand the mechanisms of action [ Read More ]