Atezolizumab Lowers Extensive-Stage Small Cell Lung Cancer Costs

ATEZOLIZUMAB lowered monthly medical costs while delivering similar survival to durvalumab in extensive-stage small cell lung cancer.

Comparing Atezolizumab for ES-SCLC With Durvalumab

Platinum and etoposide combined with a PD-L1 inhibitor, either atezolizumab or durvalumab, represents standard first-line treatment for extensive-stage small cell lung cancer (ES-SCLC). Although Phase III trials have shown similar efficacy for the two regimens, no direct comparison has established whether their costs and clinical outcomes differ in routine practice.

Researchers conducted a multicenter retrospective study using data from eight Japanese institutions. The analysis included patients with ES-SCLC who received platinum and etoposide with atezolizumab or durvalumab between August 2018 and December 2022.

Medical costs were calculated using individual health insurance claims linked with electronic medical records. Following propensity score matching and the exclusion of patients treated with cisplatin, the analysis comprised 128 patients. Their mean age was 74 years, and 85% were male.

Monthly Costs Differ by More Than $4,000

Mean monthly medical costs during immunotherapy were significantly lower with atezolizumab for ES-SCLC than with durvalumab. Monthly costs averaged ¥1,003,922, equivalent to $7,183, with atezolizumab compared with ¥1,596,511, or $11,422, with durvalumab. This represented a monthly difference of $4,239.

Despite this cost difference, median overall survival was comparable between the treatment groups. Median survival reached 13.9 months with atezolizumab and 14.8 months with durvalumab, with no statistically significant difference.

Poor performance status was associated with worse overall survival. Treatment selection itself was not identified as a prognostic factor.

Immune-Related Events Favor Atezolizumab

Grade 2 or higher immune-related adverse events occurred in 11% of patients receiving atezolizumab and 31% receiving durvalumab. Interstitial lung disease was also less frequent with atezolizumab, affecting 3% of patients compared with 20% in the durvalumab group.

The findings suggest that atezolizumab may provide a clinically comparable option with lower associated medical costs in Japanese real-world practice. However, the retrospective design and geographically specific population should be considered when interpreting the findings for U.S. clinical practice.

Reference
Hirano K et al. Atezolizumab vs durvalumab for extensive-stage small cell lung cancer in Japan: a real-world comparative analysis of costs and clinical outcomes. Jpn J Clin Oncol. 2026;doi:10.1093/jjco/hyag128.

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