Conclusion: The clinical improvement of Tecentriq (atezolizumab, Roche) in untreated extensive-stage small cell lung cancer is positive, but modest. New data recently announced for Imfinzi (durvalumab, AstraZeneca) looks about the same. The impact on incremental cost in this population (driven by the drugs’ prices), however, are not far outside recent historical norms, which suggests both regimens will be reimbursed by payers.
Roche’s Tecentriq won FDA approval in March 2019 as the only immuno-oncology therapy for previously untreated extensive-stage small cell lung cancer. AstraZeneca plans on introducing competition soon; in September 2019 the company reported positive results from their Imfinzi study. Each drug was trialed as an add-on to carboplatin plus etopiside. Imfinzi reported slightly higher median overall survival than Tecentriq showed (13.0 vs. 12.3 months). Unsurprisingly, its overall improvement as measured in Equinox Group’s analytical model is about the same as Tecentriq’s.
Although not negligible, Tecentriq’s and Imfinzi’s clinical innovation scores of 4.7% (shown above) and 5.4%, respectively, leave significant room for improvement in a population with high unmet medical need that includes 11% of all lung cancer patients. These clinical innovation scores are well below those recently achieved in other lung cancer populations, e.g., Keytruda in adNSCLC and sqNSCLC, and Tagrisso in EGFR+ Lung cancer (shown below).
Plotting clinical benefit against cost, the figure below confirms that both drugs offer modest innovation compared to other recent launches, but the incremental cost (prices) for both regimens are not high relative to recent historical norms for new oncology agents that have achieved favorable market access.
Our analysis incorporated data from the CASPIAN and IMpower133 clinical trials and the full prescribing information for Tecentriq and Imfinzi.