Open Access

ARTICLE

An oncology perspective on the benefits and cost of combined androgen blockade in advanced prostate cancer

Armen G Aprikian¹, Neil Fleshner², Adrian Langleben³, Jeffrey Hames⁴

1 Department of Surgery, McGill University, MUHC — Montréal General Hospital, Montréal, Québec, Canada
2 Division of Urology, Department of Surgery, University of Toronto, University of Toronto Health Network Toronto, Ontario, Canada
3 Departments of Medicine and Oncology, McGill University, Montréal, Québec, Canada
4 Michael G. DeGroote, McMaster University, Hamilton, Ontario, Canada
Address correspondence to Armen G Aprikian, MD, MUHC — Montréal General Hospital, 1650 avenue Cedar, Montréal, Québec, H3G 1A4 Canada

Canadian Journal of Urology 2003, 10(5), 1986-1994.

Abstract

Objectives: To provide context in oncology for the significance of the benefits and cost of combined androgen blockade (CAB) in the treatment of advanced prostate cancer.
Methods: Canadian drug costs for the survival benefit with CAB in advanced prostate cancer were compared with the costs of benefit with new treatments in advanced non-small-cell lung cancer (NSCLC), metastatic colorectal cancer, and metastatic breast cancer. Clinical toxicities were also compared.
Results: The survival benefit with CAB in advanced prostate cancer appears to be approximately 3 months. The survival benefit with the addition of vinorelbine to cisplatin for the treatment of advanced NSCLC is approximately 2 months, and the survival benefit with the addition of irinotecan to fluorouracil (and leucovorin) for the treatment of metastatic colorectal cancer is approximately 2 to 3 months. The survival benefit with anastrozole or exemestane in advanced breast cancer, or with the addition of trastuzumab to standard chemotherapy in metastatic breast cancer that overexpresses human epidermal growth factor receptor 2 (HER2), is approximately 4 to 5 months. The calculated cost per month of survival benefit with bicalutamide in CAB for prostate cancer is $437 to $1107. The cost per month of survival benefit with vinorelbine for NSCLC is $1241 and with irinotecan for colorectal cancer is $6812 to $11,214. The calculated cost per month of survival benefit with anastrozole for breast cancer is $170, for exemestane is $185, and the cost per month with the addition of trastuzumab is $5230. Vinorelbine and irinotecan are associated with severe grade 3 or 4 clinical toxicities, and an increased frequency of heart failure has been observed when trastuzumab is added to anthracyclines. Anastrozole, exemestane and nonsteroidal antiandrogens are associated with mild to moderate side effects.
Conclusions: The advantages offered by CAB (including the cost per month of survival benefit and minimal associated clinical toxicities) are comparable to the reported advantages of new treatments for other common cancers such as NSCLC, colorectal cancer, and breast cancer.

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