Most Cost-Effective Sequence of TKIs for Treatment of GISTs Identified

The best potential strategy involving tyrosine kinase inhibitors (TKIs) for the treatment of gastrointestinal stromal tumors (GISTs) has been identified, according to new research published in Clinical Drug Investigation.

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Advanced GISTs, a type of sarcoma, have been increasingly managed and treated using TKIs. However, despite the relative accessibility of these drugs, they tend to be quite costly. Clinicians generally agree that TKIs for patients with GISTs are an effective first-line treatment, but the best therapeutic sequence in terms of cost-effectiveness is a topic for debate.

Researchers led by Virginie Nerich, PhD, PharmD, University Hospital (Besançon Cedex, France), sought to identify the most cost-effective therapeutic sequence involving TKIs for the treatment of GISTs. The study compared four strategies, each of which included the TKI imatinib (400 mg/day) as a first-line treatment. The strategies were imatinib (400 mg/day) with best supportive care; imatinib (400 mg/day) plus imatinib (800 mg/day) with best supportive care; imatinib (400 mg/day) plus sunitinib with best supportive care; and imatinib (400 mg/day) plus imatinib (800 mg/day) plus sunitinib with best supportive care.

Researchers used a Markov model with a hypothetical cohort of patients and a lifetime horizon to test the strategies. Results of the study showed the first strategy, involving imatinib with best supportive care, to be the most cost-effective strategy ($69,688 per 32.9 life-months) for employing TKIs for the treatment of GISTs. However, when taking into account a price reduction of 80% for imatinib, the imatinib (400 mg/day) plus imatinib (800mg/day) with best supportive care strategy, as well as the imatinib (400 mg/day) plus imatinib (800 mg/day) plus sunitinib with best supportive care, became the most cost-effective strategies.

Researchers concluded that a price reduction of imatinib impacts the cost-effectiveness of the TKI, depending on the dosage. However, researchers maintain that their approach of testing sequential strategies must continue as new drugs become available for patients with advanced GISTs in order to improve their care and quality of life.