Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Dec;23(12):e552-e561.
doi: 10.1016/S1470-2045(22)00554-X.

Alternative dosing strategies for immune checkpoint inhibitors to improve cost-effectiveness: a special focus on nivolumab and pembrolizumab

Ruben Malmberg  1 , Michiel Zietse  2 , Daphne W Dumoulin  3 , Jeroen J M A Hendrikx  4 , Joachim G J V Aerts  3 , Astrid A M van der Veldt  5 , Birgit C P Koch  2 , Stefan Sleijfer  5 , Roelof W F van Leeuwen  6
Affiliations
Review

Alternative dosing strategies for immune checkpoint inhibitors to improve cost-effectiveness: a special focus on nivolumab and pembrolizumab

Ruben Malmberg et al. Lancet Oncol. 2022 Dec.

Abstract

Immune checkpoint inhibitors have revolutionised cancer treatment by offering durable responses to many patients with solid and haematological cancers. The high prices and increasing use of immune checkpoint inhibitors put considerable strain on health-care budgets globally. This financial strain could jeopardise patients' access to these anti-cancer therapies. However, substantial evidence suggests that immune checkpoint inhibitors are being administered at doses that exceed the minimum dose required for maximum anti-tumour efficacy. Therefore, investigating and implementing the most cost-effective dosing strategies for immune checkpoint inhibitors are urgently necessary. This Personal View provides an overview of existing data on immune checkpoint inhibitor pharmacology and (novel) dosing strategies for anti-PD-1 therapy with nivolumab and pembrolizumab, with a special focus on cost-effectiveness and saving potential. Furthermore, specific recommendations to guide health-care professionals are provided, through the process of prescribing, rounding, preparing, and administering nivolumab and pembrolizumab in the most practical and cost-effective way possible.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests DWD reports speakers fees from Roche, Bristol Myers Squibb, Merck Sharp & Dohme, Pfizer, and AstraZeneca, all outside the submitted work. JJMAH reports an unconditional grant for patient benefit program from Merck, outside the submitted work and paid to the institution. JGJVA reports speaker fees from Eli Lilly, Merck Sharp & Dohme, and BIOCAD; patents issued on allogenic tumour cell lysate and on combination immuno-oncology, owned by the Erasmus Medical Center Cancer Institute; participation on a data safety monitoring board or advisory board for Eli Lilly, Biocad, Amphera, and Merck Sharp & Dohme; unpaid leadership role for the International Association for the Study of Lung Cancer; stock or stock options for Amphera; and present participation in more than 60 clinical trials related to oncology (all compensation paid to the institution), all outside the submitted work. AAMvdV reports consulting fees from Bristol Myers Squibb, Merck Sharp & Dohme, Sanofi, Pierre-Fabre, Ipsen, Eisai, Pfizer, Roche, and Novartis outside the submitted work. RWFvL reports consulting fees from Bristol Myers Squibb, Pierre Fabre, Merck Sharp & Dohme, Bayer, and Sanofi; and speaker's fees from Bristol Myers Squibb, Pfizer and Astellas, all outside the submitted work. All other authors declare no competing interests. This Personal View was not supported by external funding.

LinkOut - more resources