PD-L1 Testing Improves Nivolumab’s Cost-Effectiveness for Metastatic Nonsquamous Lung Cancers

Docetaxel is more cost-effective than nivolumab (Opdivo, Bristol-Myers Squibb) for treating pretreated metastatic nonsquamous non-small cell lung cancer (NSCLC), but prescribing nivolumab only to patients with programmed cell death ligand 1-positive (PD-L1+) tumors improves its cost-effectiveness, according to a Swiss study published in the Journal of Thoracic Oncology.

“PD-L1 testing should be considered in patients with nonsquamous NSCLC who are candidates for PD-L1 checkpoint inhibitor therapy,” concluded Klazien Matter-Walstra, PhD, of the Swiss Group for Clinical Cancer Research Coordinating Centre in Bern, Switzerland, and coauthors, in an International Association for the Study of Lung Cancer (IASLC) news release. “Price reduction or PD-L1 testing and selection of patients for nivolumab on the basis of test positivity improves cost-effectiveness compared with docetaxel.”

The findings are not “directly generalizable” to other countries, the authors cautioned. But the Swiss cancer care system is “comparable to the US system and to many European countries in terms of patient care and cost,” they noted.

Nivolumab is a fully-human immunoglobulin (Ig) G4 anti-PD1 monoclonal antibody that was approved by the US Food and Drug Administration in 2015, for patients with platinum therapy-refractory, metastatic squamous and nonsquamous NSCLC. Previous studies have shown that nivolumab is not cost-effective compared to docetaxel chemotherapy for the treatment of squamous NSCLC.

The researchers used data from the CheckMate 057 clinical trial to compare incremental cost-effectiveness ratios for nivolumab and docetaxel, and to test the impact of PD-L1 testing and patient selection on treatment cost-effectiveness. Using Markov models, the authors compared the cost-effectiveness of three treatment algorithms: treating all patients with nonsquamous NSCLC with docetaxel; treating all patients with nivolumab; or using PD-L1 testing to assign patients to receive docetaxel or nivolumab, using two thresholds for tumor PD-L1 positivity (at least 1% or at least 10%). Patients with PD-L1+ tumors were administered nivolumab, while patients with PD-L1-negative tumors received docetaxel.

“In our analysis, both PD-L1 test strategies (nivolumab only for those patients reaching the ≥ 1% or ≥ 10% positive thresholds) resulted in higher mean costs but also better effectiveness than treating all patients with nivolumab,” the researchers reported.

“The easiest way to improve cost-effectiveness is to lower drug prices,” the authors noted.

The research team did not have access to supportive care used in the CheckMate 057 trial, and could not model supportive-care costs, they cautioned.

The study was funded by “industry-independent grants” from the Swiss Group for Clinical Cancer Research and the Cantonal Hospital Lucerne. Study coauthor Roger von Moos, MD, of the Swiss Group for Clinical Cancer Research Coordinating Centre and Cantonal Hospital Graubünden in Chur, Switzerland, is a Bristol-Myers Squibb advisory board member, according to disclosures in the published paper.