Perspectives
Oncology Insights: Cancer medications top global drug sales
Increased utilization is a major driver of oncology drug sales. Here are some strategies that help improve value.
August 20, 2024Oncology Insights
Cancer medications top global drug sales
Pembrolizumab (Keytruda®), is a checkpoint inhibitor that binds programmed death 1 (PD-1) receptor.1 This action blocks the ability of cancer cells to turn off immune system cells and avoid elimination.1 Pembrolizumab (Keytruda®) is projected to be the number-one selling drug worldwide with sales of about $25 billion in 2024.2 The United State (U.S.) Food and Drug Administration (FDA) granted the first pembrolizumab (Keytruda®) indication in 2015 for second-line treatment for unresectable, metastatic melanoma.3 To date, pembrolizumab (Keytruda®) is FDA approved for 39 indications across multiple tumor types and hematologic cancers.1 Nivolumab (Opdivo®) and daratumumab and hyaluronidase-fihj (Darzalex Faspro®) are two additional targeted cancer drugs that also rank in the top 10 best-selling drug list. 2, 4, 5
Targeted cancer medications have enhanced clinical outcomes and changed treatment management.6, 7 The annual wholesale acquisition cost (WAC) for the three cancer drugs in the best-selling drug list are $192,735 (pembrolizumab [Keytruda®], $198,500 nivolumab [Opdivo®], and $222,941 daratumumab and hyaluronidase-fihj [Darzalex Faspro®].8 With continued indication expansions in earlier cancer stages, incremental price increases and projected increases in cancer rates, it is unlikely that the current sales trend will change soon.8, 9
Another event that will likely maintain the demand for two of the top sellers is reformulation from intravenous (IV) to subcutaneous (SC) preparations.2, 10
The redesign of IV daratumumab (Darzalex®) to a SC injection daratumumab and hyaluronidase-fihj (Darzalex Faspro®) resulted in simplified administration and decreased adverse events which helped to drive up utilization.5 SC checkpoint inhibitor dosage forms may improve administration efficiencies and, in some cases, offer a reference drug option when patent exclusivity begins to expire for the IV preparation. Medical professional will continue to administer SC injections, and the WAC price will likely align with the price of the IV form.10
PD1/PD-L1, CTLA-4 Subcutaneous formulation development:2, 8, 10
Drug | Anticipated FDA review date | IV formulation annual WAC |
Atezolizumab (Tecentriq®) | Sept. 14, 2024 | $185,710 |
Nivolumab (Opdivo®) | Dec. 29, 2024 | $198,500 |
Pembrolizumab (Keytruda®) | To be determined (TBD) | $192,735 |
Nivolumab/Relatlimab-rmbw (Opdualag™) | TBD | $385,400 |
Durvalumab (Imfinzi®)* | TBD | $171,721 |
Ipilimumab (Yervoy®)* | TBD | $118,362 |
*Studies have been terminated
As payers seek opportunities to manage high-cost cancer drugs, considerations may include dosing strategies, evaluation of evidence established in published literature and transition to lower cost administration sites.
Cancer drug development has improved patient outcomes. As drug prices continue to rise and top the world sales list, an assessment of value and identification of methods to optimize treatment benefit is vital to ensure resources are available to provide quality care.
References
- Keytruda [package insert]. Rahway, NJ; Merck; August 2024.
- Bean M. 10 Drugs poised to be best-sellers in 2024. Retrieved August 1, 2024 from https://www.beckershospitalreview.com/pharmacy/10-drugs-poised-to-be-best-sellers-in-2024.html.
- US Food and Drug Administration. Retrieved Aug 1, 2024 from https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=BasicSearch.process
- OPDIVO [package insert]. Princeton, NJ; Merck; Bristol-Myers Squibb 2024.
- DARZALEX FASPRO® [package insert]. Horsham, PA; Janssen; July 2024.
- Zhou Z, Li M. Targeted therapies for cancer. BMC Med. 2022 Mar 11;20(1):90. doi: 10.1186/s12916-022-02287-3. Retrieved August 15, 2024 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8915534/
- Aguilar A, Mas L, Enríquez D, Vallejos C, Gutarra R, Flores CJ. Impact of Targeted Therapy on the Survival of Patients With Advanced-Stage Non-small Cell Lung Cancer in Oncosalud – AUNA. Cancer Control. 2022 Jan-Dec;29:10732748211068637. doi: 10.1177/10732748211068637. Retrieved August 15, 2024 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8777330/
- IPD payer and Provider Insights August 15, 2024
- Rosenberg PS, Miranda-Filho A. Cancer Incidence Trends in Successive Social Generations in the US. JAMA Netw Open. 2024 Jun 3;7(6):e doi: 10.1001/jamanetworkopen.2024.15731. Retrieved July 23, 2024 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11165384/
- Inoue Y. Subcutaneous delivery of immune checkpoint inhibitors: new route replacing intravenous administration? Transl Lung Cancer Res. 2024 Apr 29;13(4):947-951. doi: 10.21037/tlcr-24-63. Retrieved August 1, 2024 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11082710/
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