Immuno-Therapy in the Treatment of Cancer: Implications for Efficacy and Economic Evaluations

L'immunoterapia Nel Trattamento Del Cancro: Implicazioni Per Le Valutazioni Di Efficacia Ed Economiche

Abstract

In the last few years, immuno-oncology has partially modified the paradigm of cancer treatment, due to the observation of long-term survivors among patients with advanced tumors and with a predicted limited life expectancy, if treated with immunotherapeutic agents. This paper illustrates the opinion of an expert panel (Scientific Board on Immuno-oncology and Cancer Treatment) regarding the clinical and economic assessments of immunologic anticancer treatments. The agreement on the document was reached through a Consensus Conference. Overall survival and/or survival rates at specific time-points are the ideal parameters to evaluate the efficacy and effectiveness of immunotherapies. Since benefits affect different patients at different times across cancer indications of immunotherapies, short-term (on most of targeted patients) and long-term effects on smaller groups should be considered. When market access decisions are taken, the benefit profile of immunotherapies has important implications for their economic assessment. Robust long-term extrapolation of expected survival rates should be carried out when cost-efficacy (effectiveness) of immunotherapies is estimated; mean instead of median incremental survival rate is a more appropriate measure; real-world data collection should be strengthened and used to eventually revise decisions taken on price and reimbursement.