Precision Medicine in Oncology II: Economics of Targeted Agents and Immuno-Oncology Drugs
Menées dans un contexte américain, ces différentes études abordent les aspects économiques et financiers liés au cancer et à ses traitements, qu'il s'agisse de l'impact de la maladie sur l'emploi des personnes atteintes, des stratégies pour réduire les coûts des médicaments, du coût des programmes de prévention ou de dépistage, des difficultés financières des patients ayant survécu à la maladie, etc.
Medical oncology is experiencing a transformative shift away from traditional cytotoxic chemotherapies toward targeted small molecules and immune-oncology (TA/IO) drugs. Although biomarker-driven therapy has been successfully used in select cancers for decades, such as estrogen receptor–positive breast cancer, diagnostic and therapeutic advances have increased the application of precision medicine across an array of cancers. Of the 31 new molecules approved for cancer indications by the US Food and Drug Administration (FDA) between 2017 and 2018, 28 were TA/IO drugs.1 However, a full realization of the clinical potential of these agents is hindered not only by mechanistic and biologic considerations, but also by the economic milieu of contemporary cancer research, health policy, and care delivery. In this article, we explore the economics of precision medicine in oncology, with a focus on TA/IO drugs. We first discuss the unique challenges of developing therapeutics in the era of precision oncology, before exploring payer, provider, and patient considerations. Last, we discuss the cancer research ecosystem, with a focus on TA/IO drug development and evaluation, affecting decision making by each of these stakeholders. By presenting distinct, albeit interconnected, perspectives, we hope to highlight the economic challenges and potential solutions to realizing the promise of TA/IOs in modern oncology.
Journal of Clinical Oncology , résumé, 2018