Value assessment of PD-1/PD-L1 inhibitors in the treatment of oesophageal and gastrointestinal cancers

Background: Evidence of efficacy and safety of programmed cell death 1 (PD-1) and programmed death ligand-1 (PD-L1) checkpoint inhibitors in oesophageal cancer (EC), gastric cancer (GC) and colorectal cancer (CRC) was inconsistent, obscuring their clinical application and decision-making. The aim of...

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Autores principales: Ou, Shun-Long, Luo, Jing, Wei, Hua, Qin, Xiao-Li, Jiang, Qian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10160363/
https://www.ncbi.nlm.nih.gov/pubmed/37153768
http://dx.doi.org/10.3389/fphar.2023.1106961
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author Ou, Shun-Long
Luo, Jing
Wei, Hua
Qin, Xiao-Li
Jiang, Qian
author_facet Ou, Shun-Long
Luo, Jing
Wei, Hua
Qin, Xiao-Li
Jiang, Qian
author_sort Ou, Shun-Long
collection PubMed
description Background: Evidence of efficacy and safety of programmed cell death 1 (PD-1) and programmed death ligand-1 (PD-L1) checkpoint inhibitors in oesophageal cancer (EC), gastric cancer (GC) and colorectal cancer (CRC) was inconsistent, obscuring their clinical application and decision-making. The aim of this study was to comprehensively evaluate the value of PD-1/PD-L1 inhibitors in EC, GC and CRC to select valuable PD-1/PD-L1 inhibitors, and to assess the association between the value and cost of PD-1/PD-L1 inhibitors. Methods: A comprehensive search of trials of PD-1/PD-L1 inhibitors in EC, GC and CRC was performed in Chinese and English medical databases with a cut-off date of 1 July 2022. Two authors independently applied the ASCO-VF and ESMO-MCBS to assess the value of PD-1/PD-L1 inhibitors. A receiver operating characteristic (ROC) curve was generated to establish the predictive value of the ASCO-VF score to meet the threshold of the ESMO-MCBS grade. Spearman’s correlation was used to calculate the relationship between the cost and value of drugs. Results: Twenty-three randomized controlled trials were identified: ten (43.48%) in EC, five (21.74%) in CRC, and eight (34.78%) in GC or gastroesophageal junction cancer (GEJC). For advanced diseases, ASCO-VF scores ranged from −12.5 to 69, with a mean score of 26.5 (95% CI 18.4–34.6). Six (42.9%) therapeutic regimens met the ESMO-MCBS benefit threshold grade. The area under the ROC curve was 1.0 (p = 0.002). ASCO-VF scores and incremental monthly cost were negatively correlated (Spearman’s ρ = −0.465, p = 0.034). ESMO-MCBS grades and incremental monthly cost were negatively correlated (Spearman’s ρ = −0.211, p = 0.489). Conclusion: PD-1/PD-L1 inhibitors did not meet valuable threshold in GC/GEJC. Pembrolizumab met valuable threshold in advanced microsatellite instability–high CRC. The value of camrelizumab and toripalimab may be more worth paying in EC.
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spelling pubmed-101603632023-05-06 Value assessment of PD-1/PD-L1 inhibitors in the treatment of oesophageal and gastrointestinal cancers Ou, Shun-Long Luo, Jing Wei, Hua Qin, Xiao-Li Jiang, Qian Front Pharmacol Pharmacology Background: Evidence of efficacy and safety of programmed cell death 1 (PD-1) and programmed death ligand-1 (PD-L1) checkpoint inhibitors in oesophageal cancer (EC), gastric cancer (GC) and colorectal cancer (CRC) was inconsistent, obscuring their clinical application and decision-making. The aim of this study was to comprehensively evaluate the value of PD-1/PD-L1 inhibitors in EC, GC and CRC to select valuable PD-1/PD-L1 inhibitors, and to assess the association between the value and cost of PD-1/PD-L1 inhibitors. Methods: A comprehensive search of trials of PD-1/PD-L1 inhibitors in EC, GC and CRC was performed in Chinese and English medical databases with a cut-off date of 1 July 2022. Two authors independently applied the ASCO-VF and ESMO-MCBS to assess the value of PD-1/PD-L1 inhibitors. A receiver operating characteristic (ROC) curve was generated to establish the predictive value of the ASCO-VF score to meet the threshold of the ESMO-MCBS grade. Spearman’s correlation was used to calculate the relationship between the cost and value of drugs. Results: Twenty-three randomized controlled trials were identified: ten (43.48%) in EC, five (21.74%) in CRC, and eight (34.78%) in GC or gastroesophageal junction cancer (GEJC). For advanced diseases, ASCO-VF scores ranged from −12.5 to 69, with a mean score of 26.5 (95% CI 18.4–34.6). Six (42.9%) therapeutic regimens met the ESMO-MCBS benefit threshold grade. The area under the ROC curve was 1.0 (p = 0.002). ASCO-VF scores and incremental monthly cost were negatively correlated (Spearman’s ρ = −0.465, p = 0.034). ESMO-MCBS grades and incremental monthly cost were negatively correlated (Spearman’s ρ = −0.211, p = 0.489). Conclusion: PD-1/PD-L1 inhibitors did not meet valuable threshold in GC/GEJC. Pembrolizumab met valuable threshold in advanced microsatellite instability–high CRC. The value of camrelizumab and toripalimab may be more worth paying in EC. Frontiers Media S.A. 2023-04-21 /pmc/articles/PMC10160363/ /pubmed/37153768 http://dx.doi.org/10.3389/fphar.2023.1106961 Text en Copyright © 2023 Ou, Luo, Wei, Qin and Jiang. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pharmacology
Ou, Shun-Long
Luo, Jing
Wei, Hua
Qin, Xiao-Li
Jiang, Qian
Value assessment of PD-1/PD-L1 inhibitors in the treatment of oesophageal and gastrointestinal cancers
title Value assessment of PD-1/PD-L1 inhibitors in the treatment of oesophageal and gastrointestinal cancers
title_full Value assessment of PD-1/PD-L1 inhibitors in the treatment of oesophageal and gastrointestinal cancers
title_fullStr Value assessment of PD-1/PD-L1 inhibitors in the treatment of oesophageal and gastrointestinal cancers
title_full_unstemmed Value assessment of PD-1/PD-L1 inhibitors in the treatment of oesophageal and gastrointestinal cancers
title_short Value assessment of PD-1/PD-L1 inhibitors in the treatment of oesophageal and gastrointestinal cancers
title_sort value assessment of pd-1/pd-l1 inhibitors in the treatment of oesophageal and gastrointestinal cancers
topic Pharmacology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10160363/
https://www.ncbi.nlm.nih.gov/pubmed/37153768
http://dx.doi.org/10.3389/fphar.2023.1106961
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