CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2022; 43(03): 306-310
DOI: 10.1055/s-0042-1742651
Policy Brief

Pembrolizumab weight based dosing – A call for policy change

1   Department of Medicine, Oncology Centre, INHS, ASVINI, Mumbai
,
Amol Akhade
2   Department of Medical Oncology, Topiwala National Medical College and Nair Hospital, Mumbai, Maharashtra, India
,
Purvish Parikh
3   Department of Medical Oncology, Mumbai Oncocare Centers, Mumbai, Maharashtra, India
,
Atul Sharma
4   Department of Medical Oncology, AIIMS, New Delhi, India
,
5   Department of Medical Oncology, Mahatmma Gandhi Medical College Hospital, Jaipur, Rajasthan, India
,
Kumar Prabhash
6   Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
7   Department of Medical Oncology, HCG and St John’s Medical College Hospital, Bengaluru, Karnataka, India
,
Vanita Noronha
6   Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Ullas Batra
8   Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
,
Prashant Mehta
9   Department of Medical Oncology, Asian Institute of Medical Sciences, Faridabad, Haryana, India
,
Vineet Govinda Gupta
10   Department of Medical Oncology, Artemis Hospital, Gurugram, Haryana, India
,
Venkatraman Radhakrishnan
11   Department of Medical Oncology, Cancer Institute, Chennai, Tamil Nadu, India
,
Rakesh Reddy Boya
12   Department of Medical Oncology, Mahatma Gandhi Cancer Hospital, Vishakhapatnam, Andhra Pradesh, India
,
13   Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
› Institutsangaben

Introduction

Immuno-oncology (IO) drugs are now approved for use in metastatic, adjuvant, and/or neoadjuvant setting for a growing list of cancers including non-small cell lung cancer, small cell lung cancer, melanoma, urothelial cancer, renal cell carcinoma, head and neck squamous cell carcinoma, esophageal cancer, gastric cancer, cervical cancer, endometrial cancer, hepatocellular cancer, Merkel cell carcinoma, microsatellite instability-high or mismatch repair deficient colorectal cancer and other cancers, tumor mutational burden-high cancer, cutaneous squamous cell carcinoma, triple-negative breast cancer, classical Hodgkin lymphoma, and primary mediastinal large B cell lymphoma. This list continues to expand at an impressive speed. The benefits in improving progression-free survival (PFS) and overall survival are a welcome advance beyond the plateau that we seem to have reached with conventional chemotherapy treatment. The biggest challenge is to identify biomarkers that would help select the 20 to 40% patients who respond to immunotherapy drugs, thereby limiting treatment to those most likely to benefit, avoiding toxicity among the patients unlikely to respond. This has very important pharmacoeconomic implications, especially because immunotherapy drugs are very expensive.

The important question is whether we can do something substantial to address unnecessary wastage of expensive medicines. The answer is yes. It is based on a long established principle of using dose according to the individual's weight/surface area. It is based on avoiding “flat” dosing—a flawed strategy that leads to unnecessary wastage of expensive medicines and subjects our patients to avoidable toxicity. There is a strong rationale to integrate the concepts of pharmacoeconomics.[1] We present here our policy brief on rational use of pembrolizumab that optimizes patient benefit as well as utilization of resources.



Publikationsverlauf

Artikel online veröffentlicht:
21. Februar 2022

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