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Clinical benefit of cancer drugs approved in Switzerland 2010–2019
cancer drug approval clinical benefit criteria ESMO-MCBS ASCO-VF OLUtool Switzerland oncology drugs

Clinical benefit of cancer drugs approved in Switzerland 2010–2019


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Summary

  • The study evaluates the clinical benefit of cancer drugs approved in Switzerland between 2010 and 2019 using three different frameworks: ESMO-MCBS, ASCO-VF, and OLUtool.
  • A total of 48 drugs for 92 indications were assessed based on 100 studies, with each study evaluated according to the criteria set by ESMO-MCBS, ASCO-VF, and OLUtool.
  • Only 39% of studies showed substantial clinical benefit according to ESMO-MCBS, 51% according to ASCO-VF, and 46% according to OLUtool.
  • There was fair concordance between ESMO-MCBS and ASCO-VF in the palliative setting and moderate concordance between ESMO-MCBS and OLUtool. However, there was no significant concordance between ASCO-VF and OLUtool.
  • Factors associated with substantial clinical benefit included HRQoL benefit reported as a secondary outcome for ESMO-MCBS and ASCO-VF, and blinded studies for OLUtool.
  • The study concludes that only around half of the trials supporting the marketing authorization of recent cancer drugs in Switzerland meet the criteria for substantial clinical benefit, with at best moderate agreement between the different grading systems.

Over time, the number of cancer drugs approved by the Food and Drug Administration (FDA) has increased. This has been attributed to advances in cancer drug research but also to faster approvals which are often based on preliminary data and intermediate primary endpoints instead of overall survival (OS). While it is desirable to make treatments available on the market in a shorter time, this should not happen at the expense of effectiveness or safety of the approved substances and must therefore be approached with caution. There are concerns that faster drug approval may be associated with lower drug efficacy and worse patient safety, possibly also partly due to the high amount of approvals based on intermediate endpoints whose correlation to long-term outcomes like OS and Health related quality of life (HRQoL) was low in studies.

Effective treatments should prolong survival time and/or improve HRQoL. Previous studies have argued that certain cancer drugs approved by the FDA and the European Medicines Agency (EMA) show questionable clinical benefit. In Switzerland, approval for new drugs is granted by the Swiss national authorisation and supervisory authority Swissmedic. In the authorisation process of medical products, Swissmedic takes into account pharmacological and clinical data on efficacy and safety as well as HRQoL. The price of a medicinal product is not assessed by Swissmedic and is determined after authorisation either by the authorisation holder or, in th e case of an application for health insurance coverage, by the Swiss Federal Office of Public Health.

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cancer drug approval, clinical benefit criteria, ESMO-MCBS, ASCO-VF, OLUtool, Switzerland oncology drugs

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