Introduction
Endometrial cancer (EC) remains one of the most common gynecological malignancies in the United States, with an estimated 67,800 new cases and 13,250 deaths projected for 2024. Advanced or recurrent EC presents a particularly poor prognosis, with a five-year survival rate of only 15-17%. Traditional chemotherapy regimens have offered limited success, underscoring the urgent need for more effective treatment strategies.
The DUO-E Trial: A New Hope
In response to this need, the Phase III DUO-E trial (NCT04269200) explored the efficacy of combining durvalumab, a PD-L1 inhibitor, with chemotherapy, followed by maintenance therapy with or without olaparib, a PARP inhibitor. The trial revealed significant improvements in progression-free survival (PFS) and overall survival (OS) compared to standard chemotherapy alone, particularly in patients with deficient mismatch repair (dMMR) EC.
Key Findings
- Risk Reduction: The risk of disease progression or death was reduced by 45% in the DOCT group (durvalumab + chemotherapy + olaparib) and by 29% in the DCT group (durvalumab + chemotherapy) compared to the control group.
- FDA Approval: Based on these outcomes, the FDA approved durvalumab in combination with chemotherapy as a new standard for treating dMMR primary advanced or recurrent EC in June 2024.
Cost-Effectiveness Analysis
Despite the clinical benefits, the high costs of durvalumab and the variability in patient responses pose significant challenges to its cost-effectiveness. This study conducted a comprehensive economic analysis from the perspective of U.S. healthcare payers, comparing the cost-effectiveness of durvalumab-based regimens to standard chemotherapy.
Economic Implications
- Incremental Cost-Effectiveness Ratio (ICER): Both DOCT and DCT regimens showed ICERs exceeding the willingness-to-pay (WTP) threshold of $150,000 per quality-adjusted life year (QALY), indicating that these treatments are not cost-effective compared to standard chemotherapy.
- Scenario Analysis: Even with adjustments such as reducing the price of durvalumab or limiting treatment duration, the regimens failed to achieve cost-effectiveness within the dMMR EC population.
Conclusion
While durvalumab combined with chemotherapy and maintenance therapy offers promising clinical outcomes for patients with advanced or recurrent EC, its high cost remains a significant barrier to widespread adoption. The findings underscore the need for price reductions and policy interventions to improve the accessibility of these innovative therapies. As the management of EC continues to evolve, incorporating molecular and immunohistochemical markers into treatment strategies may offer new avenues for enhancing both clinical and economic outcomes.
This study provides valuable insights for clinicians, policymakers, and pharmaceutical companies, highlighting the importance of balancing clinical efficacy with cost-effectiveness in the development and implementation of new cancer therapies.
