In 11 years (2008–2019) immuno-oncology in Italy has significantly reduced cancer deaths. Approximately 4,000 deaths were avoided in our country: 2,109 in lung cancer, 1,344 in melanoma and 588 in kidney cancer. For the first time, the reduction in mortality with the introduction of immuno-oncology drugs has been quantified, thanks to the LIOn Project. (Leadership In Oncology), promoted by Bristol Myers Squibb together with oncologists and health economics experts. The results of the LIOn Project. were presented at the XXV National Congress of the Italian Association of Medical Oncology (AIOM) and at the ISPOR Europe 2023 Congress, which took place recently, highlighting the value of immuno-oncology as an investment in health, both in clinical terms for avoided deaths and economic, linked to the reduction of indirect costs from premature mortality”.
by Irma D’Aria
The objective of the initiative is to generate evidence to demonstrate and communicate the value of immuno-oncology as an investment in health, evaluating the impact of this treatment approach on mortality from melanoma, lung cancer and kidney cancer and quantifying its positive effect on the entire country system in terms of reduction of premature mortality, productivity and tax return. From 2008 to 2019, an overall saving in Italy of approximately 120 million euros in indirect costs from premature mortality has been estimated: 61 million euros for lung cancer, 48.8 million for melanoma, and 10.9 million for kidney cancer.
by Elisa Manacorda
The reduction of mortality
The Italian Medicines Agency (AIFA) approved the reimbursement of the first immuno-oncology drug, ipilimumab, in our country in 2013, in previously treated metastatic melanoma and, subsequently, reimbursed other immunotherapeutics that brought innovation to the treatment of these pathologies. The trials included many patients even in the previous 5 years, hence the choice to start the evaluation of the LIOn Project. starting from 2008. “If we consider the period before the introduction of immuno-oncology compared to the subsequent one, a statistically significant reduction in mortality is observed in all three types of tumors – he explains Cosimo Paga, Executive Country Medical Director, Bristol Myers Squibb Italy -. The immune system can be stimulated from the outside to react more strongly against cancer. This frontier of medicine is called immuno-oncology. The identification of immune checkpoints, molecules involved in the mechanisms that allow the tumor to escape the control of the immune system, has represented the key element for the clinical use of immuno-oncology. The immuno-oncology drugs available today are checkpoint inhibitors, which allow the immune system to return to a decisive level of activity to fight the disease.”
by Irma D’Aria
Melanoma leading the way for immunotherapy
“Immuno-oncology is capable of significantly improving survival with a good quality of life and, in some cases, leading to recovery, a term that was previously unthinkable when compared to tumors that are very difficult to treat – continues Cosimo Paga -. The way was opened by melanoma. Before the arrival of this innovative approach, the life expectancy of patients with metastatic melanoma was approximately 6 months and less than 10% were alive at 5 years. Today the history of this skin cancer has changed. Thanks to the combination of two immuno-oncological molecules, nivolumab and ipilimumab, in the first line of metastatic disease, almost half of the patients (48%) are alive at 7 and a half years. The immune system is very complex and there is more and more research demonstrating how limited the understanding of its mechanisms still is. This is why the potential of immuno-oncology is very important.”
by Anna Lisa Bonfranceschi
The clinicians of the scientific committee
The Scientific Committee of the LIOn Project. is composed of Giovanni Apolone (Scientific Director of the IRCCS National Cancer Institute Foundation of Milan), Paolo Ascierto (Director of the Melanoma Oncology, Oncological Immunotherapy and Innovative Therapies Unit of the National Cancer Institute ‘Pascale’ Foundation of Naples), Filippo de Braud (Full Professor of Medical Oncology at the University of Milan and Director of the Department and Division of Medical Oncology of the IRCCS Foundation National Cancer Institute of Milan), Francesco Grossi (Full Professor and Director of the Medical Oncology Division at the University of Insubria, Varese ), Francesco Perrone (Director of the Complex Clinical Trials Structure of the National Cancer Institute ‘Pascale’ Foundation of Naples) and Massimo Riccaboni (Director of the AXES Research Unit at the IMT School of Advanced Studies in Lucca).
Indirect cost savings
The LIOn Project. also estimated the reduction in deaths and the related savings for indirect costs from premature mortality in the three cancers in the next few years, between 2020 and 2028. In this period, more than 30 thousand deaths are expected to be avoided (19,490 in lung cancer, 11,202 in melanoma and 1,829 in kidney cancer), with savings of over 750 million euros (407 million euros for melanoma, 332 million for lung cancer and 27 million for kidney).