scholarly journals Clinical and economic outcomes of treatment sequences for intermediate- to poor-risk advanced renal cell carcinoma

Immunotherapy ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 37-51 ◽  
Author(s):  
Apoorva Ambavane ◽  
Shuo Yang ◽  
Michael B Atkins ◽  
Sumati Rao ◽  
Anshul Shah ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Kinase Inhibitor ◽  
Discrete Event ◽  
Cost Effective ◽  
Advanced Renal Cell Carcinoma ◽  
Poor Risk ◽  
Life Years ◽  
Treatment Sequences

Aim: To assess the cost–effectiveness of treatment sequences for patients with intermediate- to poor-risk advanced renal cell carcinoma. Patients & methods: A discrete event simulation model was developed to estimate patients’ lifetime costs and survival. Efficacy inputs were derived from the CheckMate 214 and CheckMate 025 studies and network meta-analyses. Safety and cost data were obtained from the published literature. Results: The estimated average quality-adjusted life-years (QALYs) gained was the highest on nivolumab + ipilimumab-initiated sequences (3.6–5.3 QALYs) versus tyrosine kinase inhibitor (TKI)-initiated sequences (2.1–3.7 QALYs). Incremental cost per QALY gained for nivolumab + ipilimumab-initiated sequences was below the willingness-to-pay threshold of $150,000 versus other sequences. Conclusion: Immuno-oncology combination therapy followed by TKIs is cost-effective versus TKI sequences followed by immuno-oncology or sequencing TKIs.

Comparative cost-effectiveness analysis of avelumab plus axitinib versus pembrolizumab plus axitinib, ipilimumab plus nivolumab, and sunitnib for advanced renal cell carcinoma in the U.K. Perspective.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 689-689 ◽  
Author(s):  
Ramon Andrade De Mello ◽  
Emili Ayoub ◽  
Pedro Castelo-Branco ◽  
Victor Andre De Almeida Zia ◽  
Andre Savio ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cost Effectiveness ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Advanced Renal Cell Carcinoma ◽  
Main Role ◽  
Total Cost ◽  
Life Years

689 Background: Avelulmab plus axitinib showed to improve clinical outcomes for patients with advanced renal cell carcinoma (aRCC) in the JAVELIN RENAL 101 trial. Several other immunocheckpints inihibitos (ICIs) options acquired a main role in the aRCC treatment, such as nivolumab plus ipilimumab and pembrolizumab plus axitinib. Our aim is to evaluate the cost effectiveness of avelumab/axitinib versus other FDA approved options for previously untreated patients with aRCC. Methods: A Markov model was used to estimate the costs and health outcomes of treatment of aRCC with sunitinib, or avelumab plus axitinib. Univariable and probabilistic sensitivity analyses were performed to determine the robustness of the model outcomes. The primary outputs of the model included the total cost, life-years (LYs), quality-adjusted LYs (QALYs), and incremental cost-effectiveness ratio (ICER). Results: Avelumab plus axitinib provided and 4.77 additional QALY benefit. Total cost per patient was US$ 174,725 for avelumab/axitinib, US$ 178,725 for pembrolizumab/axitinib, US$ 169,390 for ipilimumab/nivolumab and US$ 97,846 for sunitnib. Avelumab/axitinib showed to be more cost-effective (ICER US$ 28,011/QALY) when compared to pembrolizumab/axitinib (ICER US$ 47,916/QALY) and ipilumumab/nivolumab (ICER US$ 95,392/QALY). Conclusions: Avelumab/axitinib is likely to be more cost-effective than ipilimumab/nivolumab, pembrolizumab/axitinib and sunitinib in the UK perspective. However further models, market discounts and stakeholders price negotiations could lead to variations of this scenario across the globe.

scholarly journals Cost-Effectiveness of Frontline Treatment for Advanced Renal Cell Carcinoma in the Era of Immunotherapies

2021 ◽  
Vol 12 ◽  
Author(s):  
SiNi Li ◽  
JianHe Li ◽  
LiuBao Peng ◽  
YaMin Li ◽  
XiaoMin Wan
Keyword(s):  
Renal Cell Carcinoma ◽  
Cost Effectiveness ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Transition Probability ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Advanced Renal Cell Carcinoma ◽  
Life Years ◽  
The Cost

Background: Recent randomized controlled trials have demonstrated that immune checkpoint inhibitors (ICIs) improve patient outcomes, but whether these novel agents are cost-effective for untreated advanced renal cell carcinoma (aRCC) remains unclear.Materials and Methods: A microsimulation model was created to project the healthcare costs and outcomes of six strategies (lenvatinib-plus-pembrolizumab, nivolumab-plus-cabozantinib, nivolumab-plus-ipilimumab, pembrolizumab-plus-axitinib, avelumab-plus-axitinib, and sunitinib monotherapy) for patients with aRCC. Transition probability of patients was estimated from CLEAR, CheckMate 9ER, CheckMate 214, KEYNOTE-426, JAVELIN Renal 101, and other data sets by using parametric survival modeling. Lifetime direct medical costs, life years (LYs), quality-adjusted LYs (QALYs), and incremental cost-effectiveness ratios (ICERs) were estimated from a United States payer perspective. One-way and probabilistic sensitivity analyses were performed, along with multiple scenario analyses, to evaluate model uncertainty.Results: Of the six competing strategies, nivolumab-plus-cabozantinib yielded the most significant health outcomes, and the sunitinib strategy was the least expensive option. The cost-effective frontier consisted of the nivolumab-plus-cabozantinib, pembrolizumab-plus-axitinib, and sunitinib strategies, which displayed the ordered ICERs of $81282/QALY for pembrolizumab-plus-axitinib vs sunitinib and $453391/QALY for nivolumab-plus-cabozantinib vs pembrolizumab-plus-axitinib. The rest of the strategies, such as lenvatinib-plus-pembrolizumab, nivolumab-plus-ipilimumab, and avelumab-plus-axitinib, were dominated. The cost of sunitinib drove the model most influentially.Conclusions: For aRCC, the pembrolizumab-plus-axitinib strategy is likely to be the most cost-effective alternative at the willingness-to-pay threshold of $100,000.

scholarly journals European Medicines Agency extension of indication to include the combination immunotherapy cancer drug treatment with nivolumab (Opdivo) and ipilimumab (Yervoy) for adults with intermediate/poor-risk advanced renal cell carcinoma

ESMO Open ◽  
2020 ◽  
Vol 5 (6) ◽  
pp. e000798
Author(s):  
Sahra Ali ◽  
Jorge Camarero ◽  
Paula van Hennik ◽  
Bjorg Bolstad ◽  
Maja Sommerfelt Grønvold ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Phase Iii ◽  
Advanced Renal Cell Carcinoma ◽  
Cancer Drug ◽  
European Medicines Agency ◽  
Poor Risk ◽  
Significant Difference ◽  
Risk Patients

On the 15 November 2018, the Committee for Medicinal Products for Human Use adopted an extension to an existing indication for the use of nivolumab (Opdivo) in combination with ipilimumab (Yervoy) for the first-line treatment of adult patients with intermediate/poor-risk advanced renal cell carcinoma (RCC). The approval was based on results from the Pivotal CA209214 study, a randomised, open-label, phase III study, comparing nivolumab +ipilimumab with sunitinib in subjects≥18 years of age with previously untreated advanced RCC (not amenable for surgery or radiotherapy) or metastatic RCC, with a clear-cell component. A total of 1096 patients were randomised in the trial, of which 847 patients had intermediate/poor-risk RCC and received either nivolumab (n=425) in combination with ipilimumab administered every 3 weeks for 4 doses followed by nivolumab monotherapy 3 mg/kg every 2 weeks or sunitinib (n=422) administered orally for 4 weeks followed by 2 weeks off, every cycle. A statistically significant difference in overall survival (OS) was observed in the nivolumab + ipilimumab group compared with the sunitinib group in intermediate/poor-risk subjects (HR 0.63 (99.8% CI 0.44 to 0.89); stratified log-rank 2-sided p-value<0.0001). The median OS was not reached for the nivolumab + ipilimumab group and was 25.95 months for the sunitinib group. The OS rates were 89.5% and 86.2% at 6 months, and 80.1% and 72.1% at 12 months in the nivolumab +ipilimumab and the sunitinib groups, respectively. K-M curves separated after approximately 3 months, favouring nivolumab + ipilimumab. This was not mirrored in the favourable-risk patients where no statistically significant difference was observed between nivolumab + ipilimumab and sunitinib in favourable-risk patients (HR 1.45 (descriptive 99.8% CI 0.51 to 4.12), p =0.2715).

Pazopanib-the Latest First-Line Standard of Care Targeted Kinase Inhibitor for the Treatment of Advanced Renal Cell Carcinoma

2014 ◽  
Vol 6 ◽  
pp. CMT.S9280
Author(s):  
Taylor Y. Lu ◽  
Edward N. Rampersaud
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Kinase Inhibitor ◽  
Interleukin 2 ◽  
Standard Of Care ◽  
Advanced Renal Cell Carcinoma ◽  
First Line ◽  
Treatment Paradigm ◽  
Vegf Pathway

Kidney cancer is the most lethal of the genitourinary malignancies. Prior to the advent of cytokine-based immunotherapy 25 years ago, surgery was the only viable treatment for advanced renal cell carcinoma (RCC). Adjuvant therapy with interferon and interleukin-2 revolutionized the treatment paradigm, although responders were too often uncommon. The mid-portion of the last decade saw born a new class of drugs aimed at the angiogenesis/VEGF pathway, common to most clear-cell RCC. The latest FDA-approved compound in this class has promised to yield equal or better first-line efficacy as its predecessors while, perhaps, providing better tolerability. Here we review the available data at present regarding pazopanib.

scholarly journals Pazopanib for the Treatment of Patients with Advanced Renal Cell Carcinoma

2010 ◽  
Vol 4 ◽  
pp. CMO.S4088 ◽  
Author(s):  
Joshua M. Lang ◽  
Michael R. Harrison
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Tyrosine Kinases ◽  
Renal Cell ◽  
Kinase Inhibitor ◽  
Pharmacokinetic Profile ◽  
Phase Iii ◽  
Advanced Renal Cell Carcinoma ◽  
National Meeting ◽  
Level I

Dramatic advances in the care of patients with advanced renal cell carcinoma have occurred over the last ten years, including insights into the molecular pathogenesis of this disease, that have now been translated into paradigm-changing therapeutic strategies. Elucidating the importance of signaling cascades related to angiogenesis is notable among these achievements. Pazopanib is a novel small molecule tyrosine kinase inhibitor that targets VEGFR-1, -2, and -3; PDGFR-α, PDGFR-β; and c-kit tyrosine kinases. This agent exhibits a distinct pharmacokinetic profile as well as toxicity profile compared to other agents in the class of VEGF signaling pathway inhibitors. This review will discuss the scientific rationale for the development of pazopanib, as well as preclinical and clinical trials that led to approval of pazopanib for patients with advanced renal cell carcinoma. The most recent information, including data from 2010 national meeting of the American Society of Clinical Oncology, and the design of ongoing Phase III trials, will be discussed. Finally, an algorithm utilizing Level I evidence for the treatment of patients with this disease will be proposed.

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