Epidermal growth factor inhibitors in first-line for metastatic colorectal cancer with ras wild-type: a perspective based on pharmacological costs.

INTRODUCTION: In light of the relevant expenses of pharmacological interventions it might be interesting to make a balance between the cost of the new drugs administered, such as EGFRIs (cetuximab and panitunumab) and the added value represented by the improvement of the clinical parameters of interest such as progression free survival (PFS). Areas covered: The analysis was conducted to assess the effect of front-line chemotherapy on the PFS, separately, on each arm of the evaluated trials. Only phase III randomized controlled trials (RCTs) were considered. We calculated the pharmacological costs necessary to get the benefit in PFS, for each trial. We have subsequently applied the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) to the above phase III RCTs. Our analysis evaluated 9 phase III RCTs, including 7199 patients. ESMO-MCBS reached high scores (grade 4) for the CRYSTAL and PRIME trials. The combination of FOLFOX and panitunumab is associated with low difference per month-PFS gained (15 821.9 €) instead of FOLFIRI plus cetuximab (21 854.6 €) in KRAS wild-type patients. Expert commentary: Our data demonstrate a huge difference in cost per month of PFS gained in modern front-line treatments in mCRC with RAS wild-type.