The Pharmacological Costs of First-Line Therapies in Unselected Patients With Advanced Colorectal Cancer: A Review of Published Phase III Trials

In light of the relevant expenses of pharmacologic interventions, it might be interesting to make a balance between the cost of the new drugs administered and the difference in progression-free survival in first-line treatments for advanced colorectal cancer. We calculated the pharmacologic costs necessary to get the benefit in progression-free survival for each trial. The costs are from the pharmacy of our hospital in Legnago, Italy. We evaluated 28 phase III randomized controlled trials that included 19,958 patients. The treatment with oxaliplatin with fluorouracil and folinic acid (FOLFOX) was the most cost-effective. The addition of irinotecan to FOLFOX (FOLFOXIRI) increased the costs only marginally. The increase is bigger for combinations that include biologic agents. The pharmacologic costs of commonly used first-line regimens for the treatment of advanced colorectal cancer are highly variable, and the performance of the published chemotherapy schemes depends on the selection of patients, the tumor characteristics, and the type of the scheme.