ArticleESMO open2024
What constitutes meaningful benefit of cancer drugs in the context of LMICs? A mixed-methods study of oncologists' perceptions on endpoints, benefit, price, and value of cancer drugs.
Article in ESMO open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- (Neo)adjuvant approvals for solid tumors by the US Food and Drug Administration 2010-2023.Journal of the National Cancer Institute · 2026Article
- An Innovative Patient Stratification Tool Integrating Clinical and Economic Data for Benchmarking Oncology and Hematology Care: The PATONCOS System.Journal of clinical medicine · 2026Article
- What is the role of common sense oncology in the Western Pacific?The Lancet regional health. Western Pacific · 2025Review
- Article
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6 authors.
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Abstract
backgroundThe importance of surrogate endpoints, magnitude of clinical benefit of cancer drugs, and their prices have often been debated in the oncology world. No study, however, has systemically explored oncologists' perception regarding these issues.
methodsWe conducted a mixed-methods study including in-depth qualitative interviews of medical oncologists prescribing cancer drug therapy in India. Quantitative data were collected using a predetermined proforma. Qualitative in-depth interviews were audio-recorded, transcribed verbatim, anonymized, subsequently coded, and analyzed by generating basic and global themes.
resultsWe interviewed 25 medical oncologists. Twenty-eight percent of oncologists rarely used cancer drugs that improved response rate (RR) but not overall survival (OS), and an equal percentage mostly/often used such drugs. For cancer drugs that improved progression-free survival (PFS) but not OS, 20% never/rarely used them while 48% mostly/often used them. Oncologists in India considered a 4.5-month (range, 1.5-12 months) advantage in median PFS as meaningful, and considered price of ∼120 United States Dollars (USD) per month (range, 48-720 USD per month) for those PFS gains as justified. For OS, median gains of 4.5 months (range, 2-24 months) and at a monthly price of ∼360 USD (range, 48-900 USD) was considered justified. Oncologists in India were aware and concerned that RR only meant tumour shrinkage not survival benefit, but many assumed that tumour shrinkage meant better quality of life. Many oncologists acknowledged the limitations of PFS but would use a drug with PFS benefit if it was cheaper than the drug with OS benefit.
conclusionsOncologists in India showed awareness of the limited surrogacy between RR/PFS and OS but assumed that RR/PFS correlated with improved quality of life and acknowledged price as a factor in deciding treatment choices. This is the first study providing a benchmark for minimum clinical benefit (4.5 months in PFS or OS) and maximum monthly price (120 USD for PFS, 360 USD for OS) deemed justifiable by oncologists practicing in low-and-middle-income countries.
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