Event

In oncology, sequential use of treatments with different mechanisms of action is common practice to overcome cross-resistance  . Over the past decade, treatment sequencing with novel immunotherapy and targeted agents has contributed to substantial improvement in clinical outcomes in cancer patients. However, such clinical practice introduces methodology challenges for HTA. 

There are two main reasons why assessing causal treatment effects can be complex during treatment sequencing. First, the effectiveness of a specific treatment is often dependent on prior lines of treatments and their failures. Specifically, effectiveness of a treatment can be diminished if a patient had disease progression with a previous treatment with similar mechanisms of action. 

Second, overall survival is jointly determined by effectiveness of all lines of treatments. If a patient in a clinical trial has disease progression while receiving a treatment, the patient will likely switch to another treatment or receive a subsequent line of therapy. Essentially, it is challenging to evaluate the effectiveness of treatment B when one group of patients receives treatments A, B, and C sequentially and another group of patients receives treatment D, B, and E.

In recent appraisals from The National Institute for Health and Care Excellence (NICE), UK, the inability to adjust for prior and subsequent lines of treatment in cancer patients has been criticized. The webinar aims to introduce challenges associated with assessing causal treatment effect for treatment sequencing in oncology in layman’s terms and discuss potential approaches to address such challenges.