Current Status and Future Perspectives of Immunotherapy in Middle-Income Countries: A Single-Center Early Experience

Abstract

Background Immunotherapy agents offer novel treatment options in advanced cancers. However, their use is limited in developing countries lacking unifying guidelines and can be followed by a financial burden. In this study, we aimed to provide an overview regarding the use of immunotherapy and the overall response to treatment in patients with metastatic disease in relation to cost-effectiveness. Methods This was a retrospective study involving adult metastatic cancer patients, treated with programmed cell death-1 (PD-1) inhibitors at American University of Beirut Medical Center (AUBMC), a tertiary cancer center in Lebanon. Study enrollment began on January 1, 2014 and ended on January 12, 2016. Baseline demographics, epidemiological and clinical data were collected from the patients’ records. Results Our study consisted of 34 patients. Fifteen patients self-financed the treatment. The patients were prescribed immunotherapy without programmed cell death-ligand 1 (PD-L1) testing as it was not part of the guidelines at the time. Twenty-two patients were treated with nivolumab and 12 patients with pembrolizumab. Thirteen patients showed partial response or stable disease, while 21 patients showed progression. Conclusion Improvement in terms of overall survival and progression-free survival has been undercut by the lack of availability of these drugs and their cost. Considering that a large percentage of patients do not respond to immunotherapy, there is a need to use guidelines such as a preset PD-L1 level that ensure cost-effectiveness and prevent resource waste.

Microtubule targeting agents influence the clinical benefit of immune response in early breast cancer

“…However, FDA recommends a chemotherapy backbone for all ICIs, but the optimal chemotherapy backbone to use with these ICIs and their optimum sequencing is currently unknown (37). Further, immunotherapy’s high cost limits its widespread adoption in low-income countries (38). Therefore, the present study’s results have two implications.…”

Adoption and use of immunotherapy in breast cancer management in Africa: barriers and prospect – a narrative review

“…According to Akl et al . 12 , another barrier to use is the limited number of oncology professionals available in Africa to deal with the side effects of novel immunotherapies. Other barriers to adopting immunotherapy for BC in Africa include limited awareness and education about immunotherapy among healthcare professionals and patients, contributing to limited adoption and use of immunotherapy in Africa 35 .…”

“…However, despite the growing body of evidence supporting its effectiveness, immunotherapy’s adoption and use in Africa’s BC management remain limited. Furthermore, the availability of new immunotherapies and the distribution of use in LMICs has been limited due to a variety of reasons, including cost 12 . This review aims to explore the barriers and prospects of immunotherapy adoption and use in BC management in Africa.…”