Modeling Study Projects Vitrakvi (Larotrectinib) to Extend Life Expectancy in Certain Lung and Thyroid Cancers

A recent study published in the Journal of Managed Care & Specialty Pharmacy analyzed the long-term effectiveness of Vitrakvi (larotrectinib) compared with immune checkpoint inhibitors in patients with metastatic non-small cell lung cancer (NSCLC) and differentiated thyroid cancer (DTC).

The objective of the study was to project the life-years (LYs) and quality-adjusted LYs (QALYs) for patients eligible for Vitrakvi compared to those receiving a checkpoint inhibitor, Opdivo (nivolumab) or Keytruda (pembrolizumab).

Vitrakvi is a prescription medicine used to treat adults and children with solid tumor cancer that are caused by certain abnormal NTRK genes and has either spread or cannot be safely removed with surgery. Vitrakvi may be prescribed when there is no other acceptable treatment option or if the cancer has progressed on other treatments. Vitrakvi received accelerated approval for this indication in 2018; full approval will be determined pending the verification of clinical benefit in ongoing trials.

The study was conducted by a group of researchers, including first author Kangho Suh, Pharm.D., Ph.D., assistant professor at the University of Pittsburgh School of Pharmacy, who developed survival models to help predict long-term comparative effectiveness between the medications. The researchers analyzed data from 21 adults with NTRK gene fusion-positive NSCLC and 21 adults with DTC. Survival data for Opdivo and Keytruda were obtained from published clinical trials, and progression-free and overall survival were estimated using survival distributions.

The results of this modeling study showed that patients treated with Vitrakvi are projected to have significant gains in LYs and QALYs compared to those receiving Opdivo or Keytruda. In people with metastatic NSCLC, Vitrakvi resulted in gains of 5.87 LYs (3.53 QALYs) compared to Opdivo and gains of 5.91 LYs (3.56 QALYs) compared to Keytruda. In DTC patients, Vitrakvi showed a life expectancy gain of 5.23 LYs (4.24 QALYs) compared to Keytruda.

The study's findings indicate that Vitrakvi may provide substantial gains in life for patients with NTRK gene fusion-positive tumors compared to immune checkpoint inhibitors. While the study provided important projections on the comparative effectiveness of Vitrakvi and immune checkpoint inhibitors, there were limitations. The study did not include real-world data, and some uncertainty remained in the results due to the reliance on previous clinical trial data.

Overall, the study's findings highlight the potential of Vitrakvi as a promising treatment option for patients with certain types of solid tumors. Further studies are needed to validate these results and confirm that Vitrakvi provides better clinical and health outcomes than immune checkpoint inhibitors.