Background and importance Non-small cell lung carcinoma (NSCLC) accounts for 85–90% of all forms of lung cancer. In recent years, the development of immune checkpoint inhibitors has completely changed the therapeutic landscape of NSCLC and changed treatment standards. Immuno-oncology is a promising therapeutic option based on the use of synthetic antibodies, such as nivolumab and pembrolizumab which can both improve the survival of patients. All this represents a valid new approach, but the high cost requires a specific evaluation of health outcomes.
Aim and objectives The main aim of this retrospective observational study was to analyse the characteristics of NSCLC patients, treatment outcomes and costs of treatment of advanced stage NSCLC with nivolumab and pembrolizumab in an Italian teaching hospital in a cohort of 102 selected patients.
Material and methods A retrospective observational analysis was conducted in patients treated with immune checkpoint inhibitors from September 2016 to September 2020 at the university hospital ‘Mater Domini’ in Catanzaro, Italy. Data sources were medical records, internal prescription cards and reports of adverse reactions.
Results 102 patients (89.2% men) were diagnosed with advanced NSCLC, 69.6% characterised by a non-squamous histology and 30.4% squamous. Firstline treatment with pembrolizumab was administered to 53 patients for an average of 11.5 months, 9 of whom were receiving innovative treatment with pembrolizumab+pemetrexed as firstline treatment with an average annual patient cost of 4915.78€, while 49 patients were treated with nivolumab for an average of 16.5 months with an average annual patient cost of 11 306.08€. The data showed a survival rate of 64.8% after 12 months, 57.9% after 24 months and 48.1% after 36 months. Most patients received immunotherapy as firstline and the others as subsequent treatment.
Conclusion and relevance Currently, there are numerous clinical studies for NSCLC but no study has compared immunotherapy treatments. From this study, based on real world data, it emerged that the impact on budget was greater for nivolumab which had a higher survival value than pembrolizumab. This analysis was a first step in assessing the impact of introducing a significant new class of treatments, immunotherapy, comparing two drugs that have totally changed the prognosis of NSCLC patients.
References and/or acknowledgements
NCCN guidelines insights: NSCLC, V.5.2018.
Conflict of interest No conflict of interest
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