Extended indication

Enhertu as monotherapy is indicated for the treatment of adult patients with unresectable or metasta

Therapeutic value

Possible added value

Registration phase

Registered

Product

Active substance

Trastuzumab deruxtecan

Domain

Oncology

Reason of inclusion

Indication extension

Main indication

Breast cancer

Extended indication

Enhertu as monotherapy is indicated for the treatment of adult patients with unresectable or metastatic HER2‑low breast cancer who have received prior chemotherapy in the metastatic setting or developed disease recurrence during or within 6 months of completing adjuvant chemotherapy

Proprietary name

Enhertu

Manufacturer

AstraZeneca

Mechanism of action

Antibody-drug conjugate

Route of administration

Intravenous

Therapeutical formulation

Injection / infusion solution

Budgetting framework

Intermural (MSZ)

Additional remarks
HER2-low population in this trial including tumors with IHC 1+ and IHC 2+/ISH- HER2 expression Patients in study progressed on, and would no longer benefit from endocrine therapy and have been treated with 1 or 2 prior chemotherapy/ adjuvant in the metastatic setting.

Registration

Registration route

Centralised (EMA)

Type of trajectory

Normal trajectory

ATMP

No

Submission date

June 2022

Expected Registration

January 2023

Orphan drug

No

Registration phase

Registered

Additional remarks
Fabrikant verwacht indiening in de eerste helft van 2022 en registratie in de eerste helft van 2023. Positieve CHMP opinie in december 2022. 
Dit geneesmiddel is in de sluis geplaatst voor zover verstrekt in het kader van geneeskundige behandelingen.

Therapeutic value

Current treatment options

SoC chemotherapie

Therapeutic value

Possible added value

Substantiation

In het hormoon receptor-positieve cohort, was de mediane progressie-vrije survival 10,1 maanden in de trastuzumab deruxtecan groep en 5,4 maanden in de 'keuze van de arts groep' (hazard ratio for disease progression or death, 0.51; P<0.001), de overall survival was 23,9 maanden en 17,5 maanden, (hazard ratio for death, 0.64; P = 0.003). De verwachting is dat de paskwil-criteria gehaald zullen worden.

Frequency of administration

1 times every 3 weeks

Dosage per administration

5,4mg/kg

References
DB-04 (NCT03734029). Modi et al. N Engl J Med 2022; 387:9-20.

Expected patient volume per year

Additional remarks
Het is op dit moment nog niet mogelijk in te schatten hoeveel patiënten van deze nieuwe populatie er in aanmerking zullen komen.

Expected cost per patient per year

Cost

125,143.00

References
CBS; fabrikant
Additional remarks
Trastuzumab-deruxtecan is beschikbaar in flacons van 100mg. De apotheekinkoopprijs (AIP) bedraag €1.800 per flacon. De aanbevolen dosering is 5,4mg per kg per behandelcyclus van 21 dagen. Op basis van een gemiddeld gewicht van 72kg bedragen de kosten van trastuzumab-deruxtecan €7.200 per behandelcyclus (4 flacons van €1.800). De kosten per maand zijn dan €10.428,57 ((365/12)*(7.200/21)). De kosten per patiënt per jaar zijn dan €125.143.

Potential total cost per year

There is currently nothing known about the possible total cost.

Off label use

There is currently nothing known about off label use.

Indication extension

Indication extension

Yes

Indication extensions

Treatment of adult patients with unresectable or metastatic HER2 positive breast cancer who have received two or more prior anti HER2 based regimens (NCT03248492). Treatment of adult patients with unresectable or metastatic HER2-positive breast cancer who have received one or more prior anti-HER2therapies (2L) (NCT03529110). Treatment of HER2-overexpressing advanced gastric or gastroesophageal junction adenocarcinoma patients who have progressed on two prior treatment regimens (NCT03329690). Treatment of adult patients with HER2-mutated, Unresectable and/or Metastatic non-small cell lung cancer (NSCLC) (NCT03505710).

References
Fabrikant

Other information

There is currently no futher information available.