Efficacy, Safety, Tolerability and Price of Newly Approved Drugs in Solid Tumors
A partir d'une revue de la littérature (74 études, 48 527 patients), cette étude compare l'efficacité, la toxicité et les coûts de divers médicaments anti-cancéreux ayant reçu une autorisation de mise sur le marché entre 2000 et 2015 pour le traitement de patients atteints d'une tumeur solide, qu'il s'agisse de chimiothérapies, d'immunothérapies, d'agents anti-angiogéniques ou de thérapies ciblées
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.