Crizotinib not cost effective finding possibly relevant to Cabo usage in RET Positive NSCLC
"Crizotinib Not Cost-Effective, Says Canadian Study"
The targeted therapy crizotinib ( Xalkori, Pfizer) has been hailed as a major therapeutic breakthrough for the small subgroup of patients with non-small cell lung cancer (NSCLC) whose tumors test positive for ALK gene rearrangement.
However, as with many of the new cancer drugs, crizotinib comes with very high price tag. In addition, because the biomarker is found in only 3% to 5% of patients with lung cancer, all patients need to be screened.
Therefore, the economic burden of crizotinib on the healthcare system might be too high, Canadian researchers report.
It's likely they'll come to the same conclusion for Cabo as it will be in a very similar status as Crizotinib except for an even smaller sub-population. The strain that the high cost of treatments is putting on the system is becoming evident.
Bif...just found this...check it out at Biomarker Commons..posted 1/17/14 from PR Newswire.
"Surveyed Oncologists Indicate that the Use of Biomarker Testing is Increasing Rapidly in Non-Small-Cell Lung Cancer in China and South Korea"
I suspect that - in an evolving world clinic of target-specific therapeutics - assays will find a way.
One of the things MMM mentioned yesterday is that there will be an update on Cabo in RET positive NSCLC presented at ESMO at the end of this month. Abstract should be out around the 20th of this month.
"However, as with many of the new cancer drugs, crizotinib comes with very high price tag. In addition, because the biomarker is found in only 3% to 5% of patients with lung cancer, all patients need to be screened.... Therefore, the economic burden of crizotinib on the healthcare system might be too high, Canadian researchers report.
Approximately 50% of Caucasian NSCLC can be accounted for by EGFR, KRAS, and ALK mutations. ROS1 another 1-2% and RET another 1-2% and other oncogenes are being identified on a regular basis. The excuse that "all patients need to be screened" is almost specious and I suspect that the guy who said it realizes that is the case. Anyone with an ounce of insight realizes that in a relatively short time all newly diagnosed NSCLC patients will be given a comprehensive test panel, not a series of FISH kit tests as is still commonly done. Now the other and more relevant issue is the "economic burden of crizotinib on the healthcare system might be too high." Regulators don't seem to get excited about the $5 per month for Avastin, but the $10K that all the new drugs are commanding is causing regulators worldwide to look hard at cost/benefit for these drugs, including Cabo. I think Obamacare has moved the U.S. on step closer to moving away from the "whatever the market will bare" model we currently have.
I agree that specific reason is specious as it's very likely that comprehensive diagnostics will be used in the future for every patient, but this will take sometime to get established, and until then how likely is it that a course of Cabo will be used without some confidence that he/she has the RET-fusion mutation? Last time this was brought up, it was mentioned that tests which detect RET-fusion mutations weren't commonly available iirc.
There might be auxiliary characteristics like "never smoker" that are strongly correlated to this specific mutation which make a specific test less necessary. Because of how common RET fusion mutations are in never-smokers with NSCLC who lack other driver oncogenes(see "Response to Cabozantinib in patients with RET fusion-positive lung adenocarcinomas."), it might be cheaper to start dosing advanced patients with Cabo and then check for a response. (I'm not a doctor so I have no idea if this would qualify as breaking the hippocratic oath with the AE profile of Cabo being what it is.)