OBJECTIVESTo examine ultraorphan drugs in terms of incremental health, costs, and cost-effectiveness compared with more prevalent disease drugs.METHODSWe identified Food and Drug Administration drug approvals from 1999 to 2019. For drugs approved for multiple indications, we considered each drug-indication pair separately. Utilizing Food and Drug Administration's orphan drug designation and US disease prevalence, we categorized drug-indication pairs as: ultraorphan (<10 000 patients), "other" orphan (≥10 000 and <200 000), and nonorphan (≥200 000). We searched the PubMed database for cost-effectiveness analyses and comparative effectiveness studies. We excluded manufacturer-funded studies. We extracted estimates of incremental health gains in terms of quality-adjusted life-years (QALYs) and incremental costs associated with drug-indication pairs compared with the standard of care at the time of their approval. We compared QALY gains, added costs, and incremental cost-effectiveness ratios (ICERs) using the Kruskal-Wallis, Mann-Whitney U (MWU), and Kolmogorov-Smirnov (KS) tests.RESULTSMedian incremental QALYs, costs, and ICERs differed across nonorphan, "other" orphan, and ultraorphan categories (Kruskal-Wallis P < .01). Compared with nonorphan drugs, ultraorphan drugs had larger QALY gains (0.700 vs 0.050, MWU P < .01, KS P < .01), larger costs ($172 231 vs $3360, MWU P < .01, KS P < .01), and larger ICERs ($1 216 184/QALY vs $114 061/QALY, MWU P < .01, KS P <.01). Compared with "other" orphan drugs, ultraorphan drugs had larger QALY gains (0.700 vs 0.310, MWU P =.65, KS P =.32), larger costs ($172 231 vs $69 308, MWU P = .03, KS P = .03), and larger ICERs ($1 216 184/QALY vs $223 472/QALY, MWU P <.01, KS P <.01).CONCLUSIONSNovel ultraorphan drugs typically offer larger incremental health gains than drugs for more prevalent diseases, but because of their substantial added costs, are typically less cost-effective.

2019-07-01·The Prostate3区 · 医学

Targeting prostate cancer cells with enzalutamide‐HDAC inhibitor hybrid drug 2‐75

3区 · 医学

Article

作者: Li, Ye ; Vander Griend, Donald J. ; Yang, Zhe ; Xu, Liping ; Muzzarelli, Kendall M. ; Hu, Dan‐Ping ; Prins, Gail S. ; Qin, Zhihui ; Ou, Siyu ; Hu, Wen‐Yang ; Chen, Bailing

AbstractBackgroundThe progression of castration‐resistant prostate cancer (CRPC) still relies on the function of androgen receptor (AR), achieved by evolving mechanisms to reactivate AR signaling under hormonal therapy. Histone deacetylase inhibitors (HDACis) disrupt cytoplasmic AR chaperone heat shock protein 90 (Hsp90) via HDAC6 inhibition, leading to AR degradation and growth suppression of prostate cancer (PCa) cells. However, current HDACis are not effective in clinical trials treating CRPC.MethodsWe designed hybrid molecules containing partial chemical scaffolds of AR antagonist enzalutamide (Enz) and HDACi suberoylanilide hydroxamic acid (SAHA) as new anti‐PCa agents. We previously demonstrated that Enz‐HDACi hybrid drug 2‐75 targets both AR and Hsp90, which inhibits the growth of Enz‐resistant C4‐2 cells. In the current study, we further investigate the molecular and cellular actions of 2‐75 and test its anti‐PCa effects in vivo.ResultsCompared with Enz, 2‐75 had greater AR antagonistic effects by decreasing the stability, transcriptional activity, and nuclear translocation of intracellular AR. In addition to inhibition of full‐length AR (FL AR), 2‐75 downregulated the AR‐V7 variant in multiple PCa cell lines. Mechanistic studies indicated that the AR affinity of 2‐75 retains the drug in the cytoplasm of AR + PCa cells and further directs 2‐75 to the AR‐associated protein complex, which permits localized effects on AR‐associated Hsp90. Further, unlike pan‐HDACi SAHA, the cytoplasm‐retaining property allows 2‐75 to significantly inhibit cytoplasmic HDAC6 with limited impact on nuclear HDACs. These selective cytoplasmic actions of 2‐75 overcome the unfavorable resistance and toxicity properties associated with classical AR antagonists, HDACis, and Hsp90 inhibitors. Finally, 2‐75 showed greater antitumor activities than Enz in vivo on SQ xenografts derived from LNCaP cells.ConclusionsNovel therapeutic strategy using newly designed 2‐75 and related AR antagonist‐HDACi hybrid drugs has great potential for effective treatment of CRPC.

Clinical and Translational Oncology

Access to systemic treatment of non-melanoma skin cancer in Spain: a survey analysis

Article

作者: Marquez-Rodas, Ivan ; Drozdowskyj, Ana ; Gonzalez-Cao, Maria ; Berciano-Guerrero, Miguel A ; Berrocal, Alfonso ; Maldonado, Cayetana ; Muñoz-Couselo, Eva ; Manzano, Jose Luis ; Martin-Algarra, Salvador ; Yelamos, Oriol ; Espinosa, Enrique ; Cerezuela-Fuentes, Pablo ; Puig, Susana ; Puertolas, Teresa ; Martin-Liberal, Juan ; Soria, Ainara ; Quindos, Maria

BACKGROUNDNovel and highly effective drugs for non-melanoma skin cancer (NMSC) improve patient outcomes, but their high cost strains healthcare systems. Spain's decentralized public health system, managed by 17 autonomous communities (AaCc), raises concerns about equitable access.METHODSA cross-sectional survey (July-September 2023) was sent to Spanish Multidisciplinary Melanoma Group (GEM Group) members to assess access to new drugs.FINDINGSFifty physicians from 15 Spanish AaCc responded to the survey. Access for drug with approved public reimbursement, Hedgehog inhibitors in basal-cell carcinoma and anti PD-L1 antibody in Merkel carcinoma, was observed in 84% and 86% of centers, respectively. For other EMA-approved treatments, but without reimbursement in Spain access decreased to 78% of centers. Heterogeneity in access was mainly observed intra regions.CONCLUSIONUnequal financial support for drugs for NMSC with creates a patchwork of access across Spanish hospitals, with variations even within the same AaCc.

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