Erlotinib seals the deal in NSCLC treatment
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Erlotinib seals the deal in NSCLC treatment – Kimberley Salmon – Lung cancer is the leading cause of cancer-related death in many countries, and non-small cell lung cancer (NSCLC) is the predominant diagnosis. However, this disease can be difficult to treat, with many patients not presenting until the advanced stage, and therefore facing a poor prognosis. Current recommendations for firstline treatment of NSCLC usually involve a platinum-based chemotherapy regimen, followed by docetaxel or pemetrexed as second-line therapy. Erlotinib, an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor which has proven efficacy in NSCLC, has shown superior efficacy to best supportive care (BSC), and is the first effective oral treatment for the disease. The costs associated with using erlotinib as second- or third-line treatment in NSCLC were assessed in several studies conducted in various countries, and presented at the 12th World Conference on Lung Cancer (WCLC) [Seoul, South Korea; September 2007]. Erlotinib is a potent, orally active inhibitor of the epidermal growth factor receptor (EGFR) tyrosine kinase. It targets the underlying molecular mechanisms involving oncogenes and tumour suppressor genes, which play critical roles in the conversion of normal cells into a cancerous state. Erlotinib is cost saving versus docetaxel and cost effective versus best supportive care (BSC) in patients with relapsed NSCLC in The Netherlands, according to researchers from that country and Switzerland.1 They performed two economic analyses, one comparing erlotinib with docetaxel therapy, and the other comparing erlotinib with BSC. Efficacy data from the intention-to-treat population of the phase III BR.21 study were used to construct a Markov model; due to the lack of head-to-head data, the efficacy of erlotinib and docetaxel was assumed to be equal. Dutch healthcare use data for patients with relapsed NSCLC were inserted in the model, and all resource use prices were taken from 2004, except for the erlotinib price (2005). Both costs and outcomes were discounted at a rate of 4% per annum. Table 1. Average costs and LYG for erlotinib vs other therapies in The Netherlands Per-patient cost (€) Life-years gained a
Erlotinib
Docetaxel
BSCa
23 436
24 939
15 450
0.84
0.84
0.62
best supportive care
Dominant for Dutch under most scenarios Erlotinib was found to be cost saving versus docetaxel in most scenarios, "except when assuming an unrealistically low dose of docetaxel (110mg/cycle)", say the researchers [see table 1]. Moreover, erlotinib would be cost effective versus BSC, with an ICER* of €37 551 per life-year gained (LYG), based on an average treatment duration of 4.3 months.** The researchers comment that the ICERs estimated by the model were sensitive to variation in the length and frequency of hospitalisations, and to the number of outpatient consultations. Nevertheless, erlotinib was found to be cost effective compared with BSC in 80% of cases, when a willingness to pay of €50 000 per LYG was assumed, and confiden
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