Tagawa on Balancing Cost and Clinical Benefits of Antibody-Drug Conjugates

Scott T. Tagawa, MD, MS, FACP, FASCO, professor of medicine and Urology at Weill Cornell Medicine, and an attending physician at NewYork-Presbyterian – Weill Cornell Medical Center, discusses the importance of considering a drug's overall value beyond just its initial price per mg.

Tagawa recently joined Targeted OncologyTM in an interview to discuss the landscape of antibody-drug conjugates (ADCs) for the treatment of bladder cancer. Here, he discussed how the affordability of ADCs for this patient population should continue to be addressed.

Transcription:

0:09 | As a broad statement, I would say that cost-effectiveness is probably more important than the actual cost of a drug per mg, or however it is being measured. Those that are more efficacious and improve progression-free survival, quality of life, and overall survival, in particular, that quality of life and the overall survival part that allows people to be, let's say, part of the workforce for longer and live longer, I think those are huge trade offs, even if the first course is double, triple, quadruple, 10x, i mean some of these combinations may be 1000x over some of the old generic drugs, so that I think is more important.

1:09 | One of the nice things is that some of the older drugs still have efficacy and might look interesting for combinations, and some of the current generation drugs are becoming older. Some of the antibodies against PD-1 or PD-L1, it is not so long unitl they are generic, and they may be part of this, and that will decrease cost, at least kind of somewhat. Clearly, these are expensive drugs, and this is a conversation about antibody-drug conjugates, but at the same [ESMO meeting] was the presentation of the first time we saw the addition of a PD-1 to cytotoxic chemotherapy. That is not an ADC in advanced urothelial carcinoma, so the addition of PD-1 to cytoxic chemotherapy was eddective.

2:10 | Cross trials are not statistically appropriate, but the magnitude or benefit of EV/pembro beating cisplatin, I think in most people's minds, is a bigger difference than just adding PD-1 alone to cisplatin-based chemotherapy. But for places where a patient, hopefully it doesn't happen in the United States, places that cannot afford an ADC plus PD-1, cisplatin chemotherapy plus PD-1, that is where it has a major place, at least today in countries where that is not available. And the availability is part regulatory, but also partly a cost issue. So anyway, the nice thing is that there are multiple options.