Lurubinectedin is cost-effective as a second-line treatment for SCLC

According to the findings published in , cost-effectiveness model findings show that lurbinectedin (Zepzelca) is cost-effective for patients with metastatic small cell lung cancer (SCLC) whose disease has progressed during or after platinum-based chemotherapy. was found to be a high second-line treatment option. 2023 International Society for Pharmacoeconomics and Outcome Research (ISPOR) global conference.¹

The incremental cost-effectiveness ratio (ICER) between rubinectedin and the external control arm (ECA) was $20,691/quality-adjusted life-year (QALY), at the generally accepted willingness-to-pay (WTP) threshold in the United States. below the value. $100,000/QALY. These findings held true even under real-world uncertainty, according to the results of a probabilistic sensitivity analysis.

Lung cancer is the leading cause of cancer death, with SCLC in particular accounting for 13% to 15% of all lung cancer diagnoses. If untreated, SCLC patients have a median survival of 2-4 months after diagnosis. Despite treatment, the projected 5-year survival rate in the United States is 7%. Moreover, the treatment and survival rates for SCLC patients have not changed significantly over the last 20 years.

“Lurbinectedin is an alkaloid that affects RNA transcription. It can also cause DNA adduct formation, DNA double-strand breaks, and disruption of interactions between DNA and proteins. increased apoptosis,” said Apar. Kishor Ganti, MD, MS, University of Nebraska Medical Center told Target Oncology^TMs.

Lurubinectedin, a selective inhibitor of oncogenic transcription, Received accelerated approval from FDA in June 2020 As monotherapy when administered at a dose of 3.2 mg/m² Intravenously (IV) every 21 days for the treatment of patients with metastatic SCLC whose disease has progressed during or after platinum-based chemotherapy.

Investigators developed a cost-effectiveness model to estimate the incremental cost per QALY obtained when administering lurubinectedin compared to comparators. These comparators included platinum rechallenge (PR), topotecan (IV [TOP-IV] and verbal [TOP-oral]), irinotecan, nivolumab (Opdivo), and paclitaxel.

The findings presented at ISPOR reported only lurubinectedin and ECA in the overall population.

Results of a previous study examining SCLC patients enrolled in a basket trial (NCT02454972) showed that lurubinectedin was associated with a median progression-free survival (PFS) of 3.5 months (95% CI, 2.6-4.3) and overall survival ( OS ) was a median of 9.3 months (95% CI, 6.3-11.8).

Overall population HR is based on ECA analysis comparing lurubinectedin and other second-line SCLC treatment combinations. For ECA, median OS was 4.6 months (95% CI, 2.6–9.1). %CI, 0.30-0.58), TOP-IV (HR, 0.43; 95% CI, 0.26-0.70), and TOP-oral (HR, 0.43; 95% CI, 0.27-0.67).

The researchers also evaluated health-related quality of life estimates based on published literature, with a stable disease utility of 0.818 and an advanced disease utility of 0.69, respectively.

Total costs consisted of second-line and subsequent therapy acquisition and management costs, management of serious myelosuppression-related adverse events, primary and secondary prevention, visits, monitoring, and mortality costs.

Regarding safety, the incidence of serious adverse events (SAEs) was estimated for each treatment pivotal trial. Only myelosuppression-related His SAEs were modeled, including anemia, leukopenia, neutropenia, febrile neutropenia, and thrombocytopenia. This analysis also noted that his hospitalization rates for febrile neutropenia and other myelosuppression-related SAEs were estimated at 95% and 10%, respectively.

Looking at the cost-effectiveness acceptance curve across the population, rubinectedin remains 100% likely to be cost-effective compared to ECA when starting from a WTP threshold of $45,000/QALY. Deterministic sensitivity analysis results showed that primary and secondary granulocyte colony-stimulating factor (G-CSF) utilization was the most influential variable influencing cost-effectiveness outcomes .

In the platinum-sensitive group, the ICER for rubinectedin was $63,017/QALY.

$53,835/QALY and $22,999/QALY respectively. This is well below the generally accepted WTP threshold of $100,000/QALY to $150,000/QALY seen in the United States.

Rubinectedin also sustained higher treatment costs compared with the control group, which was partially offset by increased primary and secondary G-CSF use and adverse events.

Patients treated with rubinectedin had higher LY and QALY (1.70 and 1.15) than those treated with PR (0.74 and 0.52), TOP-IV (0.75 and 0.52), and TOP-oral (0.75 and 0.52). I had In addition, rubinectedin may be 91%, 95%, and 100% more cost-effective than PR, TOP-IV, and TOP-oral at a WTP threshold of $100,000/QALY, respectively. bottom.

Overall, these data demonstrate that treatment with lurubinectedin is cost-effective as a second-line treatment for patients with metastatic SCLC who have progressed during or after platinum-based chemotherapy.

“Rubinectedin is cost-effective compared to other second-line treatment options for small cell lung cancer. Although the acquisition cost of rubinectedin is higher, compared to other commonly used second-line treatments, “This is offset by the low cost of managing myelosuppression. Rubinectedin is not only safe and effective, but it is also cost-effective in the care of patients with relapsed SCLC,” added Ganti.

References:

1. Su W, Rengarajan B, Profant D, et al. Cost-effectiveness modeling of lurubinectedin as second-line treatment for patients with small cell lung cancer (SCLC). Location: 2023 International Society for Pharmacoeconomics and Outcomes Research; May 7-10. Boston, Massachusetts. Abstract EE152

2. Trigo J, Subbiah V, Besse B, et al. Lurubinectedin as second-line treatment for patients with small cell lung cancer: a single-arm, open-label, phase 2 basket trial. lancet on call2020;21(5):645-654.doi:10.1016/S1470-2045(20)30068-1