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International Journal of Colorectal Disease

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01-11-2018 | Review

First-line therapies in metastatic colorectal cancer: integrating clinical benefit with the costs of drugs

Authors: Jacopo Giuliani, Andrea Bonetti

Published in: International Journal of Colorectal Disease | Issue 11/2018

Abstract

Purpose

In light of the relevant expenses of pharmacological interventions, it might be interesting to make a balance between the cost of the new drugs administered and the added value represented by the improvement in progression free survival (PFS) in first-line for metastatic colorectal cancer CRC (mCRC).

Methods

Phase III randomized controlled trials (RCTs) that compared at least two first-line chemotherapy regimens for mCRC patients were evaluated. Differences in PFS between the different arms were compared with the pharmacological costs (at the pharmacy of our hospital). The European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) was applied to the above RCTs.

Results

Overall 28 phase III RCTs, including 19,958 patients, were analyzed. The FOLFOX resulted the least expensive (56 € per month of PFS gained) while the addition of irinotecan to FOLFOX (FOLFOXIRI) increased only marginally the costs (90 € per month of PFS gained). Treatments including the monoclonal antibodies showed a cost per month of PFS gained of 2823 € (FOLFIRI with cetuximab in KRAS wild-type patients and liver-only metastases), of € 15,822 (FOLFOX with panitumumab in KRAS wild type), and of 13,383 € (FOLFOX with bevacizumab). According to the ESMO-MCBS, the treatments including an EGFR-inhibitor (cetuximab or panitumumab) were associated with a score of 4, while the inclusion of bevacizumab reached a score of 3.

Conclusions

Our data demonstrate a huge difference in cost per month of PFS gained in modern first-line treatments in mCRC.

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Title: First-line therapies in metastatic colorectal cancer: integrating clinical benefit with the costs of drugs
Authors: Jacopo Giuliani
Andrea Bonetti
Publication date: 01-11-2018
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 11/2018
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-018-3158-8

At a glance: The STEP trials

Springer Medicine

First-line therapies in metastatic colorectal cancer: integrating clinical benefit with the costs of drugs

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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