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An analysis presented at the 2014 GI Cancers Symposium explored the cost-effectiveness of nab-paclitaxel plus gemcitabine versus erlotinib plus gemcitabine in metastatic pancreatic cancer. The total cost of therapy for nab-paclitaxel plus gemcitabine was approximately $24,000, explains the lead author E. Gabriela Chiorean, MD. These costs were based on 4 months of therapy, as utilized in the pivotal MPACT study that explored the combination.
The costs related to treatment administration and supportive care should be considered, in order to compare the full costs associated with FOLFIRINOX and nab-paclitaxel plus gemcitabine, Chiorean believes. Gemcitabine, 5-fluorouracil, irinotecan, and oxaliplatin are available generically, making them inherently cheaper. As a result, upfront treatment with FOLFIRINOX is approximately 20% cheaper than gemcitabine plus nab-paclitaxel. However, when considering the need for growth factor support, infusion costs, hydration, and the management of additional side effects, the cost associated with FOLFIRINOX are similar to nab-paclitaxel plus gemcitabine, adds Chiorean.
Patients with a poor performance status, multiple comorbidities, CHF, diabetes, and a previous stroke may not be able to tolerate combination therapy, suggests Ramesh K. Ramanathan, MD. For these patients, supportive care or single-agent gemcitabine or capecitabine are reasonable options. For patients with rapid weight loss who are deteriorating fast due to tumor bulk, nab-paclitaxel plus gemcitabine with a focus on supportive care may reverse or slow down progression, believes Ramanathan.