Personalized medicine and economic evaluation in oncology: all theory and no practice?

Abstract

The clinical definition of personalized medicine (PM) is closely related to that of pharmacogenomics. Ideally, PM could lead the pharmaceutical industry to differentiate products by subgroups of patients with the same pathology and find new gene targets for drug discovery. Here, we focus on the potential impact of PM on the design of clinical trials and economic evaluations limited to oncology (its first and main field of application). Then, we assess the European economic evaluations focused on trastuzumab and cetuximab, the two drugs usually mentioned as emblematic examples of targeted therapies. Clinical results of PM in oncology have not been as encouraging as hoped so far. Of course, economic evaluations on targeted therapies cannot help overcome the lack of clinical evidence for most of them. The two paradigmatic examples of cetuximab and trastuzumab indicate that the methodological implications on economic evaluations debated in the literature are more theoretical than practical.

Keywords:

• cetuximab
• economic evaluation
• oncology
• personalized medicine
• targeted therapy
• trastuzumab

Financial & competing interests disclosure

N Freemantle has received funding for research and consulting from a number of companies that may be currently developing personalized medicine strategies. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Notes

¹83 articles were excluded, being: focused on clinical issues or other subjects not related to our aim(50); reviews or comments (13); partial economic evaluations (11); and full economic evaluations not focused on TR for treatment in metastatic cancer (9).

²47 articles were excluded, being: focused on clinical issues or other subjects not related to our aim (27); reviews or comments (11); partial economic evaluations (8) and one full economic evaluation not focused on CX.