Lurbinectedin Is Cost-Effective as a Second-Line Treatment in SCLC

According to the findings published in , cost-effectiveness model findings show that lurbinectedin (Zepzelca) is cost-effective for patients with metastatic small cell lung cancer (SCLC) whose disease has progressed during or after platinum-based chemotherapy. was found to be a high second-line treatment option. 2023 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) World Congress.¹

The incremental cost-effectiveness ratio (ICER) between rubinectedin and the external control arm (ECA) was $20,691/quality-adjusted life-year (QALY), at the generally accepted willingness-to-pay (WTP) threshold in the United States. below the value. $100,000/QALY. These findings held true even under real-world uncertainty, according to the results of a probabilistic sensitivity analysis.

Lung cancer is the leading cause of cancer death, with SCLC in particular accounting for 13% to 15% of all lung cancer diagnoses. If untreated, SCLC patients have a median survival of 2-4 months after diagnosis. Despite treatment, the projected 5-year survival rate in the United States is 7%. Moreover, the treatment and survival rates for SCLC patients have not changed significantly over the last 20 years.

Lurubinectedin is a selective inhibitor of oncogenic transcription.of The agent received accelerated approval from the FDA in June 2020.0 As monotherapy when administered at a dose of 3.2 mg/m² Intravenously (IV) every 21 days for the treatment of patients with metastatic SCLC whose disease has progressed during or after platinum-based chemotherapy.

Investigators developed a cost-effectiveness model to estimate the incremental cost per QALY obtained when administering lurubinectedin compared to comparators. These comparators included platinum rechallenge (PR), topotecan (IV [TOP-IV] and verbal [TOP-oral]), irinotecan, nivolumab (Opdivo), and paclitaxel.

The findings presented at ISPOR reported only lurubinectedin and ECA in the overall population.

Results of a previous study examining SCLC patients enrolled in a basket trial (NCT02454972) showed that lurubinectedin was associated with a median progression-free survival (PFS) of 3.5 months (95% CI, 2.6-4.3) and overall survival ( OS ) was a median of 9.3 months (95% CI, 6.3-11.8).

Overall population HR is based on ECA analysis comparing lurubinectedin and other second-line SCLC treatment combinations. For ECA, median OS was 4.6 months (95% CI, 2.6–9.1). %CI, 0.30-0.58), TOP-IV (HR, 0.43; 95% CI, 0.26-0.70), and TOP-oral (HR, 0.43; 95% CI, 0.27-0.67).

The researchers also evaluated health-related quality of life estimates based on published literature, with a stable disease utility of 0.818 and an advanced disease utility of 0.69, respectively.

Total costs consisted of second-line and subsequent therapy acquisition and management costs, management of serious myelosuppression-related adverse events, primary and secondary prevention, visits, monitoring, and mortality costs.

Regarding safety, the incidence of serious adverse events (SAEs) was estimated for each treatment pivotal trial. Only myelosuppression-related His SAEs were modeled, including anemia, leukopenia, neutropenia, febrile neutropenia, and thrombocytopenia. This analysis also noted that his hospitalization rates for febrile neutropenia and other myelosuppression-related SAEs were estimated at 95% and 10%, respectively.

Looking at the cost-effectiveness acceptance curve across the population, rubinectedin remains 100% likely to be cost-effective compared to ECA when starting from a WTP threshold of $45,000/QALY. Deterministic sensitivity analysis results showed that primary and secondary granulocyte colony-stimulating factor (G-CSF) utilization was the most influential variable influencing cost-effectiveness outcomes .

In the platinum-sensitive group, the ICER for rubinectedin was $63,017/QALY.

$53,835/QALY and $22,999/QALY respectively. This is well below the generally accepted WTP threshold of $100,000/QALY to $150,000/QALY seen in the United States.

Rubinectedin also sustained higher treatment costs compared with the control group, which was partially offset by increased primary and secondary G-CSF use and adverse events.

Patients treated with rubinectedin had higher LY and QALY (1.70 and 1.15) than those treated with PR (0.74 and 0.52), TOP-IV (0.75 and 0.52), and TOP-oral (0.75 and 0.52). I had Furthermore, at a WTP threshold of $100,000/QALY, rubinectedin was likely to be 91%, 95%, and 100% more cost-effective compared to PR, TOP-IV, and TOP-oral, respectively. .

Overall, these data demonstrate that treatment with lurubinectedin is cost-effective as a second-line treatment for patients with metastatic SCLC who have progressed during or after platinum-based chemotherapy.

References:

1. Su W, Rengarajan B, Profant D, et al. Cost-effectiveness modeling of lurubinectedin as second-line treatment for patients with small cell lung cancer (SCLC). Location: 2023 International Society for Pharmacoeconomics and Outcomes Research; May 7-10. Boston, Massachusetts. Abstract EE152

2. Trigo J, Subbiah V, Besse B, et al. Lurubinectedin as second-line treatment for patients with small cell lung cancer: a single-arm, open-label, phase 2 basket trial. lancet on call2020;21(5):645-654.doi:10.1016/S1470-2045(20)30068-1