Background Immunotherapy (IT) has revolutionised cancer treatment. As with other anticancer drugs, IT preparations have to be centralised for safety and economic reasons. Nivolumab and pembrolizumab are currently used in France for metastatic melanoma and nivolumab for metastatic lung cancer. Nivolumab was approved recently for advanced renal cancer, pembrolizumab for metastatic lung cancer and both are extensively used for bladder and head and neck (HN) cancers.
Purpose In our institution, all tumorous diseases are treated, except for lung cancers. We evaluated retrospectively the impact of the arrival of IT in dermatology on our pharmaceutical production flow, and the impact of IT in bladder and HN cancers on this flow.
Material and methods Real life data were extracted from our prescription software. In dermatology, production flow was assessed retrospectively for 1 year. We compared these data with those obtained a year prior to the arrival of IT. We also conducted a prospective study on bladder and HN cancers to assess production flow evolution. We considered that IT would be used in secondline treatment of metastatic cancers, as reported in clinical trials. We set up an inventory of the corresponding preparations over 1 year. We estimated IT production for the same period, according to nivolumab and pembrolizumab administration schemes.
Results In dermatology, we produced 503 preparations before the arrival of IT compared with 1938 after (+ 285% a year). In HN cancers and bladder cancers, 546 and 59 preparations were produced, respectively. Prediction of numbers of preparations were 200 and 131 for nivolumab and pembrolizumab, respectively (−67 to −78% a year).
Conclusion Global production increased with IT arrival in dermatology. This may be explained by the increase in survival time. In bladder and HN cancers, production will probably decrease even if its impact on our whole production flow (40 000 preparations a year) remains confidential comparatively with dermatology (−0.65% versus 3.6%, respectively). Nevertheless, our prospective study did not take into account survival time improvement due to IT or the impact of IT in renal cancer. Considering the dermatology experience, we can suppose that survival time will increase and that IT production will grow consequently. It may represent around 3000 additional preparations per year (+7.5%).
No conflict of interest
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