Cetuximab more cost effective for wild-type KRAS colorectal cancers

NEW YORK (Reuters Health) - From a cost-effectiveness standpoint, it may be best to limit cetuximab therapy to advanced colorectal cancer with a wild-type KRAS gene, suggest results of a new study.

Although the cost-effectiveness ratio of treating wild-type KRAS tumors with cetuximab is high, it is lower than that seen when the drug is simply given to all patients with advanced disease, the study team reports in the August 7th online issue of the Journal of the National Cancer Institute.

In the National Cancer Institute of Canada Clinical Trials Group CO.17 trial, adding cetuximab, an epidermal growth factor receptor-targeting antibody, to best supportive care increased overall survival in patients with advanced colorectal cancer. The survival advantage was greater for patients whose tumors harbored wild-type KRAS.

Using data from 557 patients included in that trial, Dr. Nicole Mittman and colleagues sought to determine the cost-effectiveness of cetuximab therapy.

The current analysis featured 283 patients who received cetuximab plus best supportive care and 274 who received best supportive care alone, Dr. Mittman, from the National Cancer Institute of Canada, Kingston, and associates note.

In the entire study group, cetuximab therapy yielded a "very high" incremental cost-effectiveness ratio (ICER) of $199,742 per life-year gained. If only patients with wild-type KRAS tumors were treated, the ICER was "more favorable...but still in excess of $120,000 per life-year gained," the researchers report.

"Consequently...it would not be efficient to fund cetuximab treatment for all patients with advanced colorectal cancer," they conclude. "Use of cetuximab may be restricted based on a patient's tumor KRAS status."

Sensitivity analysis revealed that cetuximab cost and patient survival were the only factors that influenced cost-effectiveness, the authors note.

"Although 'personalizing' therapy by identifying the subset of metastatic colorectal cancer patients most likely to benefit makes the ICER for cetuximab therapy reported by (the researchers) more favorable, it is still higher than thresholds commonly used to identify 'good value'," Dr. K. Robin Yabroff, from the National Cancer Institute, Bethesda, Maryland, and Dr. Deborah Schrag, from Harvard Medical School, Boston, comment in a related editorial.

"Systematic and transparent approaches for assessing value for money," they add, "are needed to ensure that increases in the costs of cancer care are accompanied by increases in high-quality effective cancer care."

J Natl Cancer Inst 2009.

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