Confirm ultra-low-dose immunotherapy so it can be afforded where most patients live
A trial in India found that adding a very small dose of an immunotherapy drug, about a twentieth of the usual amount, to chemotherapy improved survival in head and neck cancer. If confirmed, this could make immunotherapy affordable for millions.
Randomised confirmatory trials of very-low-dose PD-1 blockade (e.g., nivolumab 20 mg every three weeks, as tested at Tata Memorial in head and neck cancer with an OS benefit versus chemotherapy alone) in additional indications and against standard-dose immunotherapy, with PK and receptor-occupancy sub-studies, and a regulatory pathway for low-dose labels or guideline recommendations in resource-limited settings. Uncertainty is substantial: the evidence base is a single-centre trial and non-inferiority to full dose has not been shown.
- Wrong doses · Most drug doses were chosen as the highest a person can tolerate, which is often more than they need.
- Most of the world has almost no cancer care · Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.
- Prices and value · New cancer drugs routinely cost over $150,000 a year, often for months of benefit. Systems cannot afford them and patients go bankrupt.
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not linked directly; found by shared links- InstitutionAdvanced Centre for Treatment, Research and Education in Cancer
Shares Vijay Patil, Kumar Prabhash, Tata Memorial Centre, Nivolumab.
- IdeaAn advance market commitment for PD-1 biosimilars for lower-income countries
Shares Prices and value, Nivolumab, Most of the world has almost no cancer care, PD-1.
- IdeaExtended-interval immunotherapy: give checkpoint inhibitors every 8-12 weeks once stable
Shares Wrong doses, Prices and value, Nivolumab, PD-1.
- IdeaRestore weight-based dosing and vial sharing for immunotherapy in the label
Shares Wrong doses, Prices and value, Nivolumab, Immune checkpoint inhibitors.
- IdeaValidate low-cost metronomic oral regimens in phase 3 and carry them into guidelines
Shares Tata Memorial Centre, Most of the world has almost no cancer care, Cervical cancer, Head and neck squamous cell carcinoma.
- IdeaSubscription pricing for checkpoint inhibitors: fixed national fee, unlimited use
Shares Prices and value, Nivolumab, Most of the world has almost no cancer care, Immune checkpoint inhibitors.
- IdeaRandomised trials of stopping immunotherapy after one year versus continuing
Shares Prices and value, Nivolumab, PD-1, Immune checkpoint inhibitors.
- IdeaPublicly funded dose-reduction trials of expensive approved drugs
Shares Wrong doses, Prices and value, Nivolumab, Immune checkpoint inhibitors.