A physician pointing out a tumour on a lung x-ray.

Gilotrif for lung cancer: Pay less without compromising efficacy?

  • Gilotrif (afatinib) is a treatment for a common type of lung cancer.
  • A study found that taking Gilotrif at a lower dose appeared to lead to fewer side effects without compromising efficacy.
  • 25% dose reduction = 25% lower cost of treatment. I.e., potential savings of $16,000 /year.

Gilotrif is a treatment indicated for people with a common type of lung cancer called non-small-cell lung cancer (NSCLC), who are also positive for a mutation in the EGFR gene.

When Gilotrif launched in 2013 in the US, it was priced at $66,000 per year for 40 mg/day. The potential to start Gilotrif at a lower dose without compromising efficacy or safety would no doubt lead to considerable savings.

Can we go below 40 mg/day?

It’s possible, according to a study recently published in the journal Annals of Oncology by Dr. Yang and colleagues. Here, they looked at records of nearly 470 patients with lung cancer taking Gilotrif as part of two Phase III studies.

Dr. Yang and colleagues found that as expected, reducing the dose of Gilotrif by 25% led to fewer side effects that were grade 3 or higher (on a scale of 5 where a grade 5 side effect is death).

What surprised me though, was that even when patients took 25% less Gilotrif, the amount of drug in their blood didn’t seem to change much.

In translation: The actual amount of drug that’s killing the cancer was the same whether patients took 40 mg/day or 30 mg/day.

Further supporting the possibility of lowering the dose without compromising efficacy is that patients who took Gilotrif at the lower dose had similar progression-free survival (PFS) as other patients on the full dose.

Bottom line

  • Common sense suggests that taking more drug means better efficacy, but that’s not always true.
  • In the case of Gilotrif, reducing the dose by 25% appeared to lead to lower risk of side effects without compromising efficacy.
  • Taken altogether with potential cost savings of $16,000 /year, it’s definitely worth a discussion with your oncologist.

Source study: Yang JC-H, et al. Ann Oncol 2016. Published ahead of print September 6, 2016. A paid subscription may be required.

References: 1. Afatinib Prescribing Information, 2016. 2. Yang JC-H, et al. Ann Oncol 2016. Published ahead of print September 6, 2016. 3. United Biosource Corporation. Boehringer launches its first cancer drug Gilotrif at competitive rate. Available at: http://www.ubc.com. Accessed on September 30, 2016.

Photo adapted from original by Lee Memorial Health System, used under license.

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