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Interventional pharmacoeconomics for immune checkpoint inhibitors through alternative dosing strategies

British Journal of Cancer volume 129, pages 1389–1396 (2023)Cite this article

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Abstract

Immune checkpoint inhibitors (ICIs) are approved for the treatment of a variety of cancer types. The doses of these drugs, though approved by the Food and Drug Administration (FDA), have never been optimised, likely leading to significantly higher doses than required for optimal efficacy. Dose optimisation would hypothetically decrease the risk, severity, and duration of immune-related adverse events, as well as provide an opportunity to reduce costs through interventional pharmacoeconomic strategies such as off-label dose reductions or less frequent dosing. We summarise existing evidence for ICI dose optimisation to advocate for the role of interventional pharmacoeconomics.

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Funding

AW is funded by training grant T32CA009566 from the National Cancer Institute. KP is funded by the Clinical Therapeutics Training Grant (T32GM007019).

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Authors and Affiliations

  1. Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA

    Austin Wesevich, Koosha Paydary & Mark J. Ratain

  2. Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Daniel A. Goldstein

  3. Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel

    Daniel A. Goldstein

  4. Clalit Health Service, Tel Aviv, Israel

    Daniel A. Goldstein

  5. Optimal Cancer Care Alliance, Chicago, IL, USA

    Daniel A. Goldstein & Mark J. Ratain

  6. Clinical Pharmacology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    Cody J. Peer & William D. Figg

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AW performed the literature review and drafted the manuscript. DAG, KP, CJP, and WDF contributed to the review design and revised the manuscript. MJR conceived the review design and revised the manuscript. All authors approved of the final manuscript and are accountable for all aspects of the work.

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Correspondence to Mark J. Ratain.

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AW, KP, CJP and WDF declare no competing interests. DAG declares the following interests: institutional research funding (Merck, Bristol-Myers Squibb, and Jennsen); consulting fees (VIVIO Health); and stock ownership (VIVIO Health and TailorMed). MJR is co-founder, director and treasurer of the Optimal Cancer Care Alliance, is an inventor on pending patent applications for low-dose tocilizumab, and has testified as an expert witness on behalf of multiple generic companies regarding the optimal dosing of anticancer agents.

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Wesevich, A., Goldstein, D.A., Paydary, K. et al. Interventional pharmacoeconomics for immune checkpoint inhibitors through alternative dosing strategies. Br J Cancer 129, 1389–1396 (2023). https://doi.org/10.1038/s41416-023-02367-y

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