Target Therapy vs the Immune Check Point Inhibitors in Lung Cancer: Costs and Caps Platform

Main Article Content

Helmy M. Guirgis


The immune check point inhibitors (ICI) and target therapy (TT) Osimertinib (Osi) prolonged survival in advanced/metastatic non-small cell lung cancer (a/m-NSCLC). Costs of ICI were previously investigated (ESMED, July 2022) while TT being overlooked. In 2022, insulin monthly cost was capped at $35 for Medicare patients. We aimed to 1- Attach a $ amount to results of the major relevant TT and ICI clinical studies and weigh their relative costs 2- Reason that utilization threshold caps are necessary to contain cost of extended therapy

Methods: In this prospective observational study, annual costs of the approved and widely used TT were calculated as the monthly optimal dose x 12.  Costs of the 5-approved ICI in 1-st-line a/m NSCLC were calculated as mg/m2 or per 80 kg x price x number of cycles.

Results: Median annual 5-TT cost was $228,000 vs 5-ICI of $134,786 at 1.69 ratio. At 10%, estimated coverage of pharmacy and nursing costs, ratio dropped to 1.52. The 1-3-year Osi costs were $248,372-$745,116, Crizotinib $226,308 -$678,924 and Larotrectinib $399,372-$1,198,116. Pembrolizumab were $134,796-$404,388, Atezolizumab $124,761-$374,283 and Cemiplimab $125,108-$375,324.

Applying $500,000 caps, the ICI 3-year costs were all below threshold. TT medium 3-year cost was $684,000, exceeding cap by $184,000, Osi by $245,116 and Crizotinib by $178,924. Larotrectinib 2-3-year costs were higher by $298,744 - $698,116. We reasoned that if 1,000 US patients treated with TT at the annual median, cost mounts to $684,000,000. In Europe, 2,000 patients’ cost would be $1,368,000,000.

Conclusions: The median TT/ICI was more costly at 1.52 ratio. Drug costs were determined by the number of re-purchases, the 1st-buy, if followed, was considered a down payment. Cap implementations are necessary to contain costs of extended therapy.

Keywords: Costs, non-small lung cell cancer, Immune check point inhibitors, Osimertinib, Targeted Therapy

Article Details

How to Cite
GUIRGIS, Helmy M.. Target Therapy vs the Immune Check Point Inhibitors in Lung Cancer: Costs and Caps Platform. Medical Research Archives, [S.l.], v. 11, n. 2, feb. 2023. ISSN 2375-1924. Available at: <>. Date accessed: 21 apr. 2024. doi:
Research Articles


1-Guirgis HM. The Impact of The Immune Check Point on Cost in Lung Cancer: Duration of use. ESMED, July 200, v10i7.2859
2-Garon EB, Rizvi NA, Hui R, et al. Pembrolizumab for the treatment of non-small cell lung cancer. N Engl J Med. 2015; 372:2018–28.
3-Garon EB, et al. Pembrolizumab monotherapy 5-year data from KEYNOTE-001 in patients with advanced non–small cell lung cancer (NSCLC), ASCO annual meeting, Chicago, May 2019 (Abstract LBA9015)
4- Reck M, Rodriguez-Abreu D, Robinson AG, et al. Pembrolizumab versus chemotherapy for PD-L1-positive non-small lung cancer. N Engl J med. 2016: 375:823-833.
5- Reck M, Rodriguez-Abreu D. Updated analysis of KEYNOTE-024: Pembrolizumab vs. platinum-based chemotherapy for advanced non-small-cell lung cancer with PD-L1 tumor proportion score of 50% or greater. JCO 37, 7, 537-546, 2019.
6-Herbst RS, Gluseppe G, de Marinis F, et al, Atezolizumab for First-Line Treatment of PD-L1–Selected Patients with NSCLC. NEJM. 2020, 383,1328-1339.
7-Sezer A, Kilickap S, Gümüş M, et al. Cemiplimab monotherapy for first-line treatment of advanced non-small-cell lung cancer with PD-L1 of at least 50%: a multicentre, open-label, global, phase 3, randomised, controlled trial. Lancet. 397(10274):592-604, 2021
8- Chihara Y, Takeda T, Goto Y, et al. Osimertinib as first-line treatment for EGFR mutation-positive advanced NSCLC in elderly patients. The oncologist. 27, no 11, November 2022
9- Wu Yi-L, Tsuboi M, He J, et al. Osimertinib as adjuvant therapy in patients with resected EGFRm stage IB-IIIA NSCLC: updated results from ADAURA. Presented at: ESMO Congress 2022; September 9-13, 2022; Paris, France.
10- Li M, Liao K, Pan I-Wen et al. Growing Financial burden from high cost targeted oral anticancer medicines among Medicare beneficiaries with cancer. JCO oncology practice ,18,11,759, 2022
11- OU Si, Zhu VW. CNS metastasis in ROS1 +NSCLC: an urgent call to action, to understand, and to overcome lung cancer. 130, 201-207; 2019
12- World Health Organization- International Agency for Research on Cancer. World Fact Sheet. Available at Accessed May 2020.
13-Hartman M, et al. Health Aff. (Millwood). 2021; doi:10.1377/hlthaff.2021.01763. The Centers for Medicare & Medicaid Services ( CMS). National Health Care Spending In 2020: Growth Driven By Federal Spending In Response To The COVID-19 Pandemic.
14-Schnipper LE, Davidson NE, Wollins DS, et al. Updating the American Society of Clinical Oncology Value Framework: Revisions and reflections in response to comments Received. J Clin Oncol. May 31,2016. 18-
15-Cherny NI, Dafni U, Bogaerts J, et al. ESMO- Magnitude of Clinical Benefit Scale version 1.1. Ann Oncol. 2017;28(10):2340- 2366. doi:10.1093/annonc/mdx310PubMedGoogle
16-Siegel JE, Weinstein MC, Russell LB, et al. Panel on cost-effectiveness in health and medicine. Recommendations for reporting cost effectiveness analyses. JAMA. 1996;276(16):1339–1341
17-Subbiah V et al. Prevalence of RET fusion in cancer. J Clin Onc 2020,38: 1209-1221
18- Guirgis, HM. Drug Costs vs. Probability of Survival in Lung Cancer, Impact of Dosage, Duration, and Immune Check Point Inhibitors Combinations. JCP 5, 32-36, 2019. Doi:10.25270/jcp.2019.06.00083
19-Guirgis, HM. Costs of extended immune check point inhibitors treatment in advanced/metastatic lung cancer: Bundling of cost proposal. ASCO May-June 2020 annual meeting, Chicago, abstract 291815
20-Kline RK. Bundled Payment Models in Oncology: Learning to Think in New Ways DOI: 10.1200/OP.20.00735 JCO Oncology Practice, Published online February 04, 2021, PMID: 33539197
21-Peters S, Camidge DR, Shaw AT, et al. Alectinib versus crizotinib in untreated ALK-positive non-small-cell lung cancer. N Eng/ J Med. 2017; 377:829-838.
22-Solomon BJ, Besse B, Bauer TM, et al: Lorlatinib in patients with ALK-positive non-small-cell lung cancer: Results from a global phase 2 study. Lancet Oncol 19:
1654-1667, 2018