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Invited Commentary
March 2018

Are Value Frameworks Missing the Mark When Considering Long-term Benefits From Immuno-oncology Drugs?

Author Affiliations
  • 1Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
  • 2American Society of Clinical Oncology, Alexandria, Virginia
JAMA Oncol. 2018;4(3):333-334. doi:10.1001/jamaoncol.2017.4339

Translating the fundamentals of cancer biology into useful antineoplastic agents has led to a number of highly effective drugs for cancers that previously had few or no effective therapies. Among these are inhibitors of signal transduction pathways, monoclonal antibodies used alone or coupled with classical cytotoxic agents, and immune checkpoint inhibitors. With these advances in developmental therapeutics have come several sobering realizations: these novel therapies often provide a clinically meaningful benefit for a small number of patients with advanced cancers; benefits for most are short lived, typically measured in months; and treatments are costly. The cost is substantial enough to result in financial strain to patients and their families, and at a national level there is concern that state-of-the-art cancer care will not be accessible and affordable to all citizens. To address this dilemma, several professional societies and pharmaco-economists have developed value frameworks as tools with which to assess the clinical benefit of new agents when compared with the standard of care and in relationship to cost (ie, are patients [as consumers] getting a “bang for their buck?”).

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