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

PurposeIn 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).MethodsPhase 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.ResultsOverall 28 phase III RCTs, including 19,958 patients, were analyzed. The FOLFOX resulted the least expensive (56 Euro per month of PFS gained) while the addition of irinotecan to FOLFOX (FOLFOXIRI) increased only marginally the costs (90 Euro per month of PFS gained). Treatments including the monoclonal antibodies showed a cost per month of PFS gained of 2823 Euro (FOLFIRI with cetuximab in KRAS wild-type patients and liver-only metastases), of Euro 15,822 (FOLFOX with panitumumab in KRAS wild type), and of 13,383 Euro (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.ConclusionsOur data demonstrate a huge difference in cost per month of PFS gained in modern first-line treatments in mCRC.