Original Title: Ipilimumab más nivolumab en mesotelioma no resecable

Authors' recommendations: "Conclusions Moderate quality evidence shows that nivolumab in combination with ipilimumab as first-line therapy in patients with unresectable malignant pleural mesothelioma probably yields a higher net benefit since it extends overall survival when compared to standard platinum-based chemotherapy plus pemetrexed. Although it has been observed that nivolumab plus ipilimumab has modestly improved quality of life, the progression-free survival and objective response rate were similar between both groups. Moreover, similar rates of adverse events and serious adverse events have been registered in both groups. Benefits on overall survival have been shown both in patients with epithelioid and non-epithelioid malignant pleural mesothelioma, with a month and a half survival increase in the first group and nine months in the second group of patients. No evidence comparing nivolumab plus ipilimumab with the standard platinum-based chemotherapy plus pemetrexed and bevacizumab regimen has been found. Clinical practice guidelines, including the one from Argentina, recommend the use of nivolumab plus ipilimumab as first-line therapy in patients with unresectable malignant pleural mesothelioma. In most of them, this therapy regimen is mentioned as the preferred first-line therapy regimen, even when classified by epithelioid and non-epithelioid type. Also, the platinum-based chemotherapy plus pemetrexed regimen, and the regimen that adds bevacizumab, are shown as alternative therapies. The use of nivolumab plus ipilimumab in this group of patients is not explicitly covered in Latin-American health policies. However, public and private funders from the United States of America, France, Canada, Germany and the United Kingdom do provide coverage for nivolumab plus ipilimumab in this group of patients. The cost-effectiveness studies identified evidence that the use of nivolumab plus ipilimumab when compared with the standard platinum-based chemotherapy plus pemetrexed as first-line therapy in patients with malignant pleural mesothelioma would not be cost effective according to funders from the United States of America, China and Switzerland. It would require more than a 50% cost reduction in order to be cost-effective. No economic studies conducted in countries from the region evaluating cost-effectiveness or budget impact have been found. Moreover, it has been considered that its cost is higher than standard platinum-based chemotherapy plus pemetrexed. For this reason, it has been concluded that the economic aspect is not favorable."

Project Status: Completed

Year Published: 2023

URL for published report: https://ets.iecs.org.ar/publication/2169

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: <p>Institute for Clinical Effectiveness and Health Policy (IECS)</p>