Pembrolizumab: Cost-Effective for Recurrent, MSI-H Endometrial Cancer

Pembrolizumab is a cost-effective therapy for patients with recurrent endometrial cancer with high microsatellite instability (MSI-H) who progress on first-line chemotherapy, according to a presentation at the 2018 Society of Gynecologic Oncology Annual Meeting on Women’s Cancer in New Orleans.¹

Pegylated liposomal doxorubicin (PLD), bevacizumab, and pembrolizumab, a PD-1 checkpoint inhibitor, are efficacious options for patients with recurrent endometrial cancer who progress on first-line chemotherapy. While pembrolizumab shows high activity in this setting, it can be an expensive option.

For this study, researchers evaluated the relative cost-effectiveness of the 3 treatments in patients with MSI-H or MSI-low (MSI-L) recurrent endometrial cancer. Cost-effectiveness was defined as the 2-year overall survival rate yielded by the drug compared with grade 3-4 toxicities and wholesale cost. Incremental cost-effectiveness ratios (ICERs) were calculated for each patient who survived at least 2 years.

Of 4400 included patients, 800 were classified as MSI-H. The 2-year overall survival rates were 20% with PLD, 40% with bevacizumab, 50% with pembrolizumab among MSI-L patients, and 64% with pembrolizumab among MSI-H patients. Per-cycle, PLD cost $2509, bevacizumab cost $7585, and pembrolizumab cost $9026.

In patients with MSI-L disease, bevacizumab was cost-effective relative to both PLD and pembrolizumab. Pembrolizumab was, however, cost-effective relative to PLD and bevacizumab in patients with MSI-H disease.

The authors noted that for pembrolizumab to be cost-effective among MSI-L patients, the drug should cost $7253 or less. They concluded that among “patients with MSI-H recurrent endometrial cancers who have failed first-line chemotherapy, pembrolizumab is cost-effective relative to other single-agent drugs. To be cost-effective in MSI-L patients, the cost of pembrolizumab should decrease by $1,773 per cycle.”

Read more of Cancer Therapy Advisor‘s coverage of the Society of Gynecologic Oncology 2018 meeting by visiting the conference page.

Reference

1. Barrington DA, Dilley SE, Smith HJ, Straughn JM. Pembrolizumab in advanced recurrent endometrial cancer: a cost-effectiveness analysis. Oral presentation at: 2018 Society of Gynecologic Oncology Annual Meeting on Women’s Cancer; March 24-27, 2018; New Orleans, LA.