Background The addition of targeted treatment to chemotherapy and first and second line treatment significantly improves patient outcomes, raising the response rate with an increase of resectability in patients with metastasis and improving the long-term survival, as demonstrated by several randomised clinical trials.
Purpose To evaluate the cost and effectiveness of treatment with bevacizumab or cetuximab in patients with metastatic colorectal cancer, in particular in maintenance treatment.
Materials and Methods A retrospective analysis was conducted in two Sicilian cancer centres, in patients treated between 01/01/2008 and 30/06/2012, to assess the median time to progression (TTP) and the corresponding cost of maintenance treatment with bevacizumab and cetuximab. Results were compared using the log-rank test.
Results Of 167 patients treated with bevacizumab plus chemotherapy, 41 (24.5%) responded and continued with maintenance treatment: 36 patients on first-line treatment (TTP 412.5 days) and 5 patients on second-line treatment (TTP 314.7 days). Of 71 patients treated with cetuximab plus chemotherapy, 15 (21.1%) responded and continued with maintenance treatment: 9 patients on first-line treatment (TTP 271.2 days), 6 patients on second-line treatment (TTP 366.5 days). Maintenance treatment showed an increase in TTP of 258.2 and 159.3 days on first-line treatment, 188.1 and 243 days on second-line treatment for bevacizumab and cetuximab, respectively. The additional cost of maintenance treatment with bevacizumab and cetuximab, for a standard 70 kg, 1.7 m² patient is €84/day and €118/day for each day of progression-free survival, respectively.
Conclusions In patients responding to maintenance treatment, bevacizumab is more advantageous as TTP in first-line treatment gains about 100 days vs. cetuximab, while cetuximab is more advantageous as second-line treatment, with a gain of about 55 days in TTP vs. bevacizumab. From the economic analysis the most advantageous is bevacizumab, costing €34/day less than cetuximab. A study is in progress to consider the use of targeted treatment with different chemotherapy regimens.
No conflict of interest.
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