Live Virtual Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2020

Fixed dosing of immunotherapy - profit ahead of sustainability?  (#7)

Jim Siderov 1
  1. Austin Health, Heidelberg, Vic, Australia


The cost of cancer care is rising to unsustainable levels, partly driven by increases in expenditures for newer therapies. In 2016, the direct costs of cancer care in the US was $74billion1 with predictions of doubling in a decade. In Australia, the PBS subsidised over $4.3billion in 2018/19 for antineoplastic and immunomodulating agents.2 Practitioners bemoan the soaring costs of cancer treatment, offering suggestions to assist with financial toxicity.1,3-4 This is especially true with newer, more expensive immunotherapy treatment. 

Fixed dosing of immunotherapy has been justified by arguing improved efficiency in compounding, reduced drug wastage, and reduced errors.5 However, is this approach financially sustainable? Personalized rather than fixed-dosing of pembrolizumab for advanced lung cancer has the potential to save $0.825billion annually in the US.6 In a Canadian review of 6 regional cancer centres, personalised dosing of pembrolizumab decreased costs by around $225,000 whereas fixed dosing increased costs by $6million. 


Medicines play an important role in sustainability in cancer care. The use of personalised dosing places sustainability ahead of profit. 

  1. Lien K, et al. Adjusting for drug wastage in economic evaluations of new therapies for haematological malignancies. A systematic review. J Oncol Pract 2016;12:369-79
  2. PBS expenditure report. Available at Accessed August 2020
  3. Gross C, Gluck A. Soaring cost of cancer treatment: Moving beyond sticker shock. J Clin Oncol 2018;36;305-7
  4. Leung C, et al. Financial impact of cancer drug wastage and potential cost savings from mitigation strategies. J Oncol Pract 2017;13:e646-52
  5. Hendrikx J, et al. Fixed dosing of monoclonal antibodies in oncology. The Oncologist 2017;22:1212-21
  6. Goldstein D, et al. A pharmacoeconomic analysis of personalized dosing vs fixed dosing of pembrolizumab in firstline PD-L1-positive non-small cell lung cancer. J Natl Cancer Inst 2017;109:1-6
  7. Jang A, et al. A real-world data approach to determine the optimal dosing strategy for pembrolizumab. J Oncol Pharm Pract 2020; in press