Original Title: Pembrolizumab en cáncer de pulmón no células pequeñas

Authors' recommendations: High-quality evidence shows that pembrolizumab as monotherapy versus platinum-based py as first-line therapy in patients with EGFR/ALK-negative metastatic squamous and non-squamous non-small-cell lung cancer (NSCLC) with PD-L1≥50% tumor expression shows a higher net benefit because it improves overall survival (OS), progression-free survival (PFS) and objective response rate (ORR) and reduces the incidence of adverse effects greater or equal to Grade III by approximately 67%; consequently the benefits of monotherapy would be higher since platinum-related treatment toxicity is minimized. High-quality evidence shows that pembrolizumab in combination with platinum-based chemotherapy versus platinum-based chemotherapy as first-line therapy in patients with EGFR/ALK-negative metastatic squamous and non-squamous NSCLC with PD-L1 1%-49% tumor expression results in a significant net benefit since it improves OS and PFS; however, it also increases the occurrence of adverse effects. The benefits of combination therapy may be maximized when there is a need for quick response and to prevent rapid disease progression. High-quality evidence shows that pembrolizumab as monotherapy versus doxetacel as secondline therapy in patients with EGFR/ALK-negative metastatic squamous and non-squamous NSCLC with PD-L1≥1% tumor expression results in a higher benefit since it improves OS, PFS and ORR. There is consensus among the clinical practice guidelines identified on recommending pembrolizumab monotherapy as first-line therapy win patients with PD-L1≥50% tumor expression. Similarly, they consider the use of pembrolizumab in combination with standard chemotherapy in patients with PD-L1 1% - 49% tumor expression. The coverage policies from most high-income countries consider it for these indications, in contrast with Latin American countries. In Argentina, pembrolizumab is not included in the Mandatory Medical Plan and is not reimbursed by the Unique Reimbursement System of the Superintendence of Health Services. In addition, in 2019, the National Health Technology Assessment Committee concluded that in patients with metastatic NSCLC and PD-L1≥50% tumor expression, the incremental budget impact that covering pembrolizumab would mean for the Argentine public system would be unfavorable both as monotherapy and in combination therapy. Finally, in 2020, the Peruvian Health Technology and Research Institute reached similar conclusions.

Project Status: Completed

Year Published: 2022

URL for published report: https://www.iecs.org.ar/publicacion/?id=22852

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)