During a session at AMCP Nexus 2023, presenters discussed the delicate balance between cost and innovation as it relates to forthcoming oncology treatments.
Oncology continues to be an area of healthcare churning with innovation, with a steady stream of FDA approvals of new therapies and researchers expanding the boundaries of new approaches and strategies.
But for those concerned about the cost of healthcare, some of the dazzle of oncology’s advances is clouded by worry and consternation about the price tags. Four of five new oncology launches have had annual costs above $100,000, increasing spend in this area. Global cancer medicine spend was $196 billion in 2022 and expected to reach $375 billion by 2027.
The jagged edge of cost and innovation was on view today during a well-attended session on the oncology drug pipeline at the Academy of Managed Care Pharmacy (AMCP) Nexus 2023 meeting in Orlando. The session was led by Kaelyn C. Boss, Pharm.D., clinical consultant pharmacist, ForHealth Consulting, University of Massachusetts Chan Medical School, and Bhavesh H. Shah, chief pharmacy officer, hematology-oncology pharmacy, Boston Medical Center.
Boss and Shah’s had some good news on the price of oncology drugs: There have been increased numbers of therapies approved in the same class for the same indication that will mean more treatment options for patients and prescribing clinicians and possibly encourage competition, perhaps on price. In addition, biosimilars are gaining acceptance in oncology and biosimilar prescriptions saved an estimated $5.5 billion in 2022.
Their not-so-good news: Biosimilars for many of the new and soon-to-come high-cost therapies are years away. Moreover, many of new treatments use complex technologies that will be difficult to replicate, creating an obstacle to competition.
Boss and Shah noted that next-generation bispecific therapeutics, which bind to both a T cell and the cancer cell, account for 28% of the hematological cancer pipeline. Bispecific antibodies increased to 7% of the hematological cancer and solid tumor pipelines.
Treatments for blood cancers, especially multiple myeloma, have been an active area of research, they noted. In August 2023, two multiple myeloma therapies, both bispecific antibodies, were approved by the FDA. Talvey (talquetamab) is priced to cost $45,000 per month, and treatment is expected to last six to eight months, bringing the total cost to between $270,000 and $360,000. Elrexfio (elranatamab) has a list price of $7,556 for the 44 mg vial and $13,051 for the 76 mg vial, or a monthly price of $41,500.
Earlier in 2023, the first two bispecific antibodies for relapsed or refractory diffuse large B-cell lymphoma (DLBCL) received FDA approval: Epkinly (epcoritamab), which is priced to cost $37,500 per month, and Columvi (glofitamab) with a price of $350,00 for a year’s worth of treatment.
Drug developers are also working on bispecific antibodies for solid tumors, although Shah noted that many are in very early stages of development. Even so, there are two in later-stage development as treatments for nonsmall cell lung cancer. Ivonescimab is being studied in a phase 3 trial compared with pembrolizumab as a first-line treatment, and izalontamab is being studied in a phase 3 trial in combination with docetaxel. It is also in a phase 2/3 trial in combination with oserimertinib.
Antibody drug conjugates (ADCs) were also heralded by Boss and Shah in their pipeline talk. ADCs are composed of a monoclonal antibody that “finds” the cancer cell and a cytotoxic drug that kills it.
There was a 65% growth in antibody drug conjugates over the last five years. There were 154 new ADCs under development in 2023. One recent approval is Padcev (enfortumab vedotin), which received accelerated approval in April in combination with Keytruda to treat metastatic urothelial cancer. Its list price is $3,828 for a 30 mg single dose vial and $2,552 per 20 mg single dose vial.
Shah said one future line of research will focus on identifying safe and efficacious combinations of ADCs with immunotherapies, PARP inhibitors and bispecific antibodies.