Sequential Treatment Approaches in  the Management of
            <i>BRAF</i>
            Wild-Type Advanced Melanoma: A Cost–Effectiveness Analysis

Tarhini, Ahmad A.; Benedict, Ágnes; McDermott, David F.; Rao, Sumati; Ambavane, Apoorva; Gupte-Singh, Komal; Sabater, J; Ritchings, Corey; Ribero, V Aponte; Regan, Meredith M.; Atkins, Michael B.

doi:10.2217/imt-2018-0085

Cited by 22 publications

(26 citation statements)

References 34 publications

(58 reference statements)

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“…[2][3][4] Combination therapy with nivolumab plus ipilimumab has also had clinical efficacy in patients with metastatic melanoma and untreated brain metastases. 5,6 Some patients who have received nivolumab plus ipilimumab have also discontinued therapy without subsequent systemic treatment for melanoma 4,[7][8][9] ; this is one aspect of the value of combination nivolumab plus ipilimumab treatment. In this article, we provide an update of survival outcomes from the CheckMate 067 trial with a minimum of 5 years of follow-up as well as an assessment of the longterm benefit of combination nivolumab plus ipilimumab treatment with respect to outcomes in patients who have not received subsequent systemic treatment for melanoma and with respect to health-related quality of life.…”

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confidence: 99%

Five-Year Survival with Combined Nivolumab and Ipilimumab in Advanced Melanoma

et al. 2019

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Terms of use This work is brought to you by the University of Southern Denmark through the SDU Research Portal. Unless otherwise specified it has been shared according to the terms for self-archiving. If no other license is stated, these terms apply: • You may download this work for personal use only. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying this open access version T h e ne w e ngl a nd jou r na l o f m e dicine n engl j med 381;16 nejm.org

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confidence: 99%

Five-Year Survival with Combined Nivolumab and Ipilimumab in Advanced Melanoma

et al. 2019

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“…Delea et al [29] evaluated the cost effectiveness of BRAF inhibitors but did not assess the impact of BRAF testing separately. Tarhini et al [46] assessed the sequence of different targeted therapy options in melanoma but did not consider biomarker status. Curl et al [47] also estimated the cost effectiveness of treatments for patients with BRAF-mutated metastatic melanoma.…”

Section: Discussionmentioning

confidence: 99%

HSP27 Expression as a Novel Predictive Biomarker for Bevacizumab: is it Cost Effective?

Seo

Straume

Akslen

et al. 2020

PharmacoEconomics Open

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Background Despite the extensive use of bevacizumab in a range of oncology indications, the US FDA revoked its approval for breast cancers, and multiple negative trials in several solid malignancies have been reported, so the need for predictive biomarkers has increased. The development of predictive biomarkers for anti-angiogenic bevacizumab therapy has long been pursued but without success. Introduction Heat shock protein (HSP)-27 expression has recently been identified as a predictive biomarker for bevacizumab in treating metastatic melanoma. This study aimed to evaluate the cost effectiveness of HSP27 biomarker testing before administration of bevacizumab. Methods A partitioned survival analysis model with three mutually exclusive health states (progression-free survival, progressed disease, and death) was developed using a Norwegian health system perspective. The proportion of patients in each state was calculated using the area under the Kaplan-Meier curve for progression-free and overall survival derived from trials of bevacizumab and dacarbazine. Three strategies were compared: (1) test-treat with HSP27 biomarker and bevacizumab, (2) treat-all with dacarbazine without HSP27 testing, (3) treat-all with bevacizumab without HSP27 testing. Quality-adjusted life-years (QALYs) and costs were calculated for each strategy and discounted at 4%. A lifetime horizon was applied. Uncertainty analyses were performed. Expected value of perfect information (EVPI) was estimated to assess the potential value of further research to generate more evidence. Results Although the test-treat strategy was cost effective compared with treat-all with dacarbazine, it was not cost effective compared with treat-all with bevacizumab without HSP27 testing. However, EVPI results showed very minimal or no value in conducting further research efforts to reduce uncertainties around current information.Conclusion The results of this study suggested that testing for HSP27 expression before administering bevacizumab is not cost effective compared with treat-all with bevacizumab without testing. It indicates that HSP27 expression is not cost effective as a potential predictive biomarker for bevacizumab. This may not necessarily mean that HSP27 is a bad biomarker for bevacizumab, but it may mean that bevacizumab is much better than dacarbazine regardless of HSP27 expression, so patient stratification according to HSP27 status is meaningless. Or, indeed, it may imply that HSP27 is not sufficiently good at identifying the right patients for bevacizumab.

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“…The combination therapy is more effective than monotherapy with significantly longer median progression‐free survival of 11.5 months compared to 6.9 months for nivolumab in the Checkmate 067 trial 5 . Although median overall survival had not been reached yet in this study, first‐line combination therapy was estimated to offer an additional 14.4‐36 months of life time compared to first‐line CTLA‐4 or anti–PD‐1 alone 5,6 …”

Section: Introductionmentioning

confidence: 89%

Therapy preferences in melanoma treatment—Willingness to pay and preference of quality versus length of life of patients, physicians, healthy individuals and physicians with oncological disease

2020

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Background In recent years, monoclonal antibodies such as ipilimumab, nivolumab, and pembrolizumab have made a significant impact on the treatment of advanced melanoma. Combination of immune checkpoint inhibitors leads to improved survival and response rates of 58%‐61% as compared to monotherapy (36%‐44%). However, the price for the better response rates is also a higher frequency of severe adverse events (59%) as compared to monotherapy (17%‐21%). This study examines attitudes towards melanoma therapy options of physicians, healthy individuals, melanoma patients, and physicians with oncological disease, their willingness to pay, and preference of quality versus length of life. Methods After obtaining ethical approval and informed consent surveys were conducted in 111 participants divided into four groups: melanoma patients (n = 30), healthy individuals as controls (n = 30), physicians (n = 27), and physicians with oncological disease (n = 24). Statistical analyses were conducted using SPSS statistics (version 25, IBM), applying the Pearson´s chi‐squared test, Spearman correlation coefficient, Wilcoxon‐Mann‐Whitney test, and Kruskal‐Wallis test. Results Life prolongation is more valued by melanoma patients and physicians with oncological disease compared to healthy controls and healthy physicians. In total, 30% of melanoma patients opt for a life prolonging therapy in all cases, even if this life prolongation is only marginal. Physicians are the strongest proponents of combination immunotherapy. Conclusion The valuation of the different treatment options differs in the four study groups with affected people valuing life prolongation much more. The individual value of cancer therapies is high, but differs from the societal standpoint.

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Sequential Treatment Approaches in the Management of BRAF Wild-Type Advanced Melanoma: A Cost–Effectiveness Analysis

Abstract: Anti-PD-1 + anti-CTLA-4 initiating sequences for BRAF wild-type melanoma are cost-effective versus anti-PD-1.

Cited by 22 publications

References 34 publications

Five-Year Survival with Combined Nivolumab and Ipilimumab in Advanced Melanoma

Five-Year Survival with Combined Nivolumab and Ipilimumab in Advanced Melanoma

HSP27 Expression as a Novel Predictive Biomarker for Bevacizumab: is it Cost Effective?

Therapy preferences in melanoma treatment—Willingness to pay and preference of quality versus length of life of patients, physicians, healthy individuals and physicians with oncological disease

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