Value assessment of PD-1/PD-L1 inhibitors in the treatment of oesophageal and gastrointestinal cancers

Shun-Long Ou; Jing Luo; Hua Wei; Xiao-Li Qin; Qian Jiang

doi:10.3389/fphar.2023.1106961

Value assessment of PD-1/PD-L1 inhibitors in the treatment of oesophageal and gastrointestinal cancers

Front Pharmacol. 2023 Apr 21:14:1106961. doi: 10.3389/fphar.2023.1106961. eCollection 2023.

Authors

Shun-Long Ou¹, Jing Luo², Hua Wei³, Xiao-Li Qin⁴, Qian Jiang¹

Affiliations

¹ Department of Pharmacy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
² School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
³ Department of Pharmacy, Chengdu Second People's Hospital, Chengdu, China.
⁴ Department of Pharmacy, The Third People's Hospital of Chengdu, Chengdu, China.

Abstract

Background: Evidence of efficacy and safety of programmed cell death 1 (PD-1) and programmed death ligand-1 (PD-L1) checkpoint inhibitors in oesophageal cancer (EC), gastric cancer (GC) and colorectal cancer (CRC) was inconsistent, obscuring their clinical application and decision-making. The aim of this study was to comprehensively evaluate the value of PD-1/PD-L1 inhibitors in EC, GC and CRC to select valuable PD-1/PD-L1 inhibitors, and to assess the association between the value and cost of PD-1/PD-L1 inhibitors. Methods: A comprehensive search of trials of PD-1/PD-L1 inhibitors in EC, GC and CRC was performed in Chinese and English medical databases with a cut-off date of 1 July 2022. Two authors independently applied the ASCO-VF and ESMO-MCBS to assess the value of PD-1/PD-L1 inhibitors. A receiver operating characteristic (ROC) curve was generated to establish the predictive value of the ASCO-VF score to meet the threshold of the ESMO-MCBS grade. Spearman's correlation was used to calculate the relationship between the cost and value of drugs. Results: Twenty-three randomized controlled trials were identified: ten (43.48%) in EC, five (21.74%) in CRC, and eight (34.78%) in GC or gastroesophageal junction cancer (GEJC). For advanced diseases, ASCO-VF scores ranged from -12.5 to 69, with a mean score of 26.5 (95% CI 18.4-34.6). Six (42.9%) therapeutic regimens met the ESMO-MCBS benefit threshold grade. The area under the ROC curve was 1.0 (p = 0.002). ASCO-VF scores and incremental monthly cost were negatively correlated (Spearman's ρ = -0.465, p = 0.034). ESMO-MCBS grades and incremental monthly cost were negatively correlated (Spearman's ρ = -0.211, p = 0.489). Conclusion: PD-1/PD-L1 inhibitors did not meet valuable threshold in GC/GEJC. Pembrolizumab met valuable threshold in advanced microsatellite instability-high CRC. The value of camrelizumab and toripalimab may be more worth paying in EC.

Keywords: ASCO-VF; ESMO-MCBS; PD-1/PD-L1 inhibitors; cost; value.

Publication types

Systematic Review

Grants and funding

This study was supported by the National Natural Science Foundation of China (grant number 72204039); Natural Science Foundation of Sichuan Province (grant number 23NSFSC4722); Sichuan Provincial Hospital Association 2022 Young Pharmacists Scientific Research Special Fund Project (grant number 22006).