When the American Society of Clinical Oncology unveiled its scheme for assessing the value of cancer drugs, it included some less-than-flattering drug ratings. One of those was for Eli Lilly's ($LLY) Alimta, a lung cancer drug that's been a blockbuster performer for the U.S.-based company.
Now, at Lilly's urging, ASCO has re-analyzed the data on Alimta (pemetrexed) to focus in on the drug's target population, rather than the broader group of study patients.
The original assessment of the drug's benefits depended on a head-to-head study pitting the chemo drug cisplatin and Gemzar (gemcitabine) against cisplatin and Alimta. In the overall group--which included patients with squamous and non-squamous forms of lung cancer--Alimta fell short. That's how ASCO's framework delivered a zero-benefit verdict on Alimta, compared with standard therapy.
But in the non-squamous patients, Alimta did deliver. When combined with cisplatin, the Lilly drug extended patients' lives by a larger margin than the cisplatin/Gemzar combo did. That variation in response, in fact, is why Alimta's FDA-approved label specifies that the drug be used in patients with non-squamous disease.
Using those numbers, Alimta scored a 16 for its advantage over the standard regimen, ASCO now says in an addendum to the framework first published in the Journal for Clinical Oncology last month. The drug-evaluation proposal comes amid rapidly rising prices for cancer treatment, with the latest drugs reaching $150,000 or more.
Understandably, Lilly prefers the updated version. The original, broad assessment "resulted in a net health benefit score that does not reflect the value Alimta offers nonsquamous non-small cell lung cancer patients," Lilly said in a statement. "We contacted ASCO to ensure physicians and patients have the most accurate information when making treatment decisions. ASCO was open to our concerns and we worked together to find a solution."
This sort of back-and-forth is what ASCO invited when publishing the framework. Just as cost-effectiveness agencies in other countries open preliminary drug evaluations for discussion before making final judgments, the journal article asked for comments on its proposal. Lilly is unlikely to be the only company with suggestions as ASCO applies its analytics to additional meds.
Once the scorecard is finalized, the idea is for doctors to review it with patients when deciding how to approach treatment. Oncologists "must have the knowledge and tools necessary" to compare different therapies "for specific clinical scenarios," the journal article said. Doctors and patients both need to think about costs, too; patients need to understand "the relative financial consequences" of various treatments, while each doctor "also has a responsibility to be a good steward of health care resources," the framework authors state.
- check out the updated framework
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Editor's note: This story was updated to clarify ASCO's re-analysis of Alimta data.