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DOI: 10.1055/s-0042-1742651
Pembrolizumab weight based dosing – A call for policy change
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.
Publication History
Article published online:
21 February 2022
© 2022. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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