EFFICACY, EFFECTIVENESS, SAFETY AND COST-EFFECTIVENESS OF THE USE OF SORAFENIB IN DIFFERENTIATED THYROID CANCER. A SYSTEMATIC REVIEW

• Published in: Value in health 2017-05, Vol.20 (5), p.A90
• Main Authors: Machado, P Miranda, Carrasquilla-Sotomayor, M, Alvis-Zakzuk, NJ, Alvis-Zakzuk, JS, de la Rosa, F Gomez, Guzman, N Alvis
• Format: Article
• Language: English
• Subjects: Clinical research; Clinical trials; Cost analysis; Critical incidents; Diarrhea; Disability adjusted life years; Drug therapy; Drugs; Economic analysis; Efficacy; Epidemiology; Fatigue; Health care expenditures; Hypertension; Iodine; Medical screening; Metastases; Patients; Quality adjusted life years; Safety; Survival; Systematic review; Targeted cancer therapy; Thyroid cancer; Weight loss
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.05.005

OBJECTIVES: Treatment options for patients with differentiated thyroid cancer (DTC) locally advanced or metastatic refractory to radioactive iodine (RAI) are limited. The aim of this study was to review the evidence on efficacy, effectiveness, safety and cost-effectiveness of sorafenib administered in radioiodine-refractory DTC patients. METHODS: A systematic review was conducted through a systematic search of indexed scientific literature in the main databases (PubMed and Embase). The search terms "thyroid cancer", "differentiated" and "sorafenib" were used to identify the relevant literature. Full-text articles published in the last 10 years that included patients >18 years were selected. No language restriction was performed. Clinical response (partial response, disease progression in patients with stable disease) and survival (mean progression-free survival and/ or overall long-term survival) were the outcomes analyzed in the efficacy and effectiveness epidemiological analysis. For safety analysis, adverse events associated to sorafenib were evaluated. Treatment costs, years of life gained (YLG), incremental cost per year of life earned, incremental cost per disability adjusted life years (DALY), and quality-adjusted life-year (QALY) were analyzed in the economic analysis. RESULTS: We identified 597 studies (PubMed=133, Embase= 464). 427 were excluded after screening. We full-text reviewed 54 studies (PubMed= 17, Embase= 37) after reviewing titles and abstracts. A total of four studies met the inclusion criteria and were included in the analysis (systematic reviews= 2, meta-analysis=l and clinical trials=l). In the analyzed studies, sorafenib resulted to significantly increase the progression-free survival between 10-35 months in radioiodine-refractory DTC patients. Hand-foot syndrome (4-66%), fatigue (5.3-16%), hypertension (7.3-9.7%), diarrhea (5.8-6.8%), rash (4.8-6.8%) and weight loss (5.2-5.8%) were the most frequently reported severe adverse events caused by sorafenib. No cost-effectiveness studies related to DTC were found in the review. CONCLUSIONS: Our results suggest that sorafenib represents a new and effective treatment option for patients with progressive RAI-refractory DTC.