The group aimed to determine the cost-effectiveness of metastasis-directed therapy (MDT) vs. systemic treatment upfront by constructing a Markov model to compare three treatment strategies:
- MDT followed by salvage Abiraterone + androgen deprivation therapy (ADT)
- Abiraterone + ADT upfront
- ADT alone upfront
At 5 years, ~ 14% of patients who received MDT upfront had not yet started systemic therapy, with ~50% still with metastatic hormone-sensitive disease. At 10 years, strategy #1 (MDT followed by salvage Abiraterone + ADT) appeared to be the most cost-effective, with an ICER of $92K/QALY when compared to strategy #3. Strategy #2, although with marginally higher effectiveness, also had a significantly higher cost compared to strategy #1, translating to ICER of $1.4M/QALY. Price of Abiraterone was found to be a sensitive model input, with a ~88% drop in Medicare pricing necessary to make strategy #2 (Abiraterone + ADT upfront) the most cost-effective strategy.
In summary, Dr. Parikh stated that MDT may serve as a treatment with tremendous value in the oligo-recurrent metastatic setting. The potential ability to defer systemic treatments may be especially beneficial in certain patients. However, future quality research is needed to answer the remaining questions:
- Does MDT cause a meaningful delay in the natural history of prostate cancer?
- Is there any benefit to combining MDT with upfront advanced hormonal therapy in the oligorecurrent setting?
Presented by: Neil Rohit Parikh, MD, MBA, Department of Radiation Oncology, University of California – Los Angeles, Los Angeles, CA
Written by: David B. Cahn, DO, MBS, @dbcahn, Fox Chase Cancer Center at the 2019 American Society of Clinical Oncology Genitourinary Cancers Symposium, (ASCO GU) #GU19, February 14-16, 2019 - San Francisco, CA