Among patients with previously untreated diffuse large B cell lymphoma (DLBCL), combination polatuzumab vedotin, rituximab, cyclophosphamide, doxorubicin, and prednisone (pola-R-CHP) may be cost-effective, but only where 5-year progression-free survival is greater than 66.1%, according to research published in Blood.

DLBCL is the most frequently diagnosed non-Hodgkin lymphoma subtype. Combination rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is the standard-of-care regimen in the setting of previously untreated disease, and although several targeted therapies have aimed to improve this combination treatment, none have proven more effective than the current standard.

Polatuzumab vedotin, an anti-CD79b monoclonal antibody, has previously shown promising safety and efficacy in both the relapsed/refractory and previously untreated DLBCL setting. The phase 3 POLARIX study (ClinicalTrials.gov Identifier: NCT03274492) suggested that pola-R-CHP may improve PFS outcomes compared with R-CHOP among patients with intermediate- or high-risk disease.


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There is, however, concern about the long-term financial toxicity associated with DLBCL treatments. For this study, researchers compared the cost-effectiveness of pola-R-CHP with that of R-CHOP in the previously untreated DLBCL setting.

The authors created a hypothetical model of a cohort of patients with a mean age of 65 years diagnosed with DLBCL; PFS and overall survival data were estimated using outcomes from the POLARIX study. Using state-transition Markov modelling methods, the researchers analyzed cost-effectiveness in the cohort based on expected outcomes. A willingness-to-pay (WTP) threshold of $150,000 per quality-adjusted life-year (QALY) was assumed based on analogous research into chimeric antigen receptor T cell therapy in the relapsed/refractory DLBCL setting.

Based on previous data, the researchers also assumed 5-year PFS rates of 69.6% vs 62.7% with pola-R-CHP vs R-CHOP, respectively. With these expectations, analysis suggested that pola-R-CHP was cost-effective at a WTP threshold of $150,000 (incremental cost-effectiveness ratio, $84,308 per QALY).

Where, however, 5-year PFS was 66.1% or lower, pola-R-CHP was no longer considered cost-effective at the WTP threshold. At the WTP threshold of $150,000, analysis suggested that pola-R-CHP is cost-effective up to a cost of $276,312.

“Widespread adoption of pola-R-CHP in the frontline setting will lead to substantial increased direct healthcare costs,” the authors wrote. “Further efforts are needed to reduce the cost of pola and other novel therapies in the first and second-line setting for DLBCL.”

Disclosure: The study author(s) declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Kambhampati S, Saumoy M, Schneider Y, et al. Cost effectiveness of polatuzumab vedotin combined with chemoimmunotherapy in untreated diffuse large B-cell lymphoma. Blood. Published online June 13, 2022. doi:10.1182/blood.2022016624

This article originally appeared on Hematology Advisor