Highlights
- •Cytotoxic drugs had lesser efficacy relative to control, than targeted, anti-angiogenic and immunotherapy agents.
- •Immunotherapy has better safety and tolerability compared to other classes of antineoplastic agents.
- •Drug prices have increased by 13% each year from 2000 to 2015, without significant differences between classes of drugs.
- •There is little to no correlation between efficacy and price of newly approved drugs.
Abstract
Background
New anti-cancer drugs utilize diverse mechanisms of action. Here we evaluate their
differential efficacy, safety, tolerability and price.
Methods
Drugs approved for solid tumor treatment between 2000 and 2015 were identified and
analyzed in subgroups: agents targeting oncogenes (group 1), anti-angiogenics (group
2), immunotherapy (group 3), and chemotherapy (group 4). Hazard ratios (HRs) were
extracted from the registration trials and pooled in a meta-analysis. Odds ratios
for toxic death, treatment discontinuation and grade 3–4 toxicity were compared to
control groups. The Micromedex Red Book was used to calculate the monthly price.
Results
Analysis included 74 studies comprising 48,527 patients. Progression-free survival
(PFS) was improved to a greater degree with groups 1 and 2 than with groups 3 and
4, (pooled HR: 0.54, 0.56, 0.63, and 0.76 for groups 1–4 respectively, p for difference <0.001). Compared to PFS, there was a lower magnitude of improvement
overall survival in all groups and the degree of benefit was less for group 4 than
for other groups (pooled HR: 0.77, 0.78, 0.68, and 0.83 for groups 1–4 respectively,
p for difference = 0.007). Compared to control groups in individual trials, immunotherapy was associated
with better safety and tolerability than other groups. Drug prices have increased
over time with no significant difference between groups. There was no meaningful correlation
between pricing and efficacy.
Conclusions
Compared to control groups, immunotherapeutics and drugs targeting oncogenes or angiogenesis
improve efficacy to a greater degree than chemotherapy. Immunotherapy appears to have
better safety and tolerability profile compared to other cancer therapies. Market
price of drugs is not related to efficacy.
Keywords
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Article Info
Publication History
Published online: April 09, 2017
Accepted:
March 30,
2017
Received in revised form:
March 29,
2017
Received:
February 19,
2017
Identification
Copyright
© 2017 Elsevier Ltd. All rights reserved.
