Breast cancer research and treatment · 2026
The value of innovation in breast cancer treatment: real option value of olaparib for first-line treatment of gBRCA-mutated HER2 negative metastatic breast cancer.
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Gong Cynthia L, Chavez-MacGregor Mariana, Xu Xiaoqing, Park Leah, Elsea David, Katsandres Sarah, Migliaccio-Walle Kristen, Veenstra David L
Аннотация
PURPOSE: Novel drugs for metastatic breast cancer (mBC) can provide patients not only with improved survival but also the opportunity to benefit from future treatment innovations, a concept referred to as real option value (ROV). Quantifying the ROV of first-line (1L) olaparib may help clinicians and patients better understand the additional value increased survival provides through access to future innovative therapies.
METHODS: We developed a Markov model with progression-free, progression, and death states to estimate long-term survival gain of 1L olaparib versus treatment of physician's choice (TPC; chemotherapy) among patients with HER2-negative mBC. To derive ROV, a scenario without future drug innovation was compared to one including anticipated innovations as of January 2023. ROV parameters were informed by literature, trial data, ongoing studies, and mBC treatment patterns. Clinician expert-reviewed assumptions generated high-, mid-, and low-ROV scenarios. The primary outcome was aggregated life expectancy, weighted between HR+ and TNBC per OlympiAD trial characteristics.
RESULTS: Without innovation, modeled aggregate survival was 3.16 years with olaparib versus 1.81 years with TPC (Δ1.35 LYs). With innovation, survival increased to 3.91 vs. 2.42 LYs in the high scenario (Δ1.49 LYs; +0.139 LYs vs. no innovation), 3.44 vs. 2.02 LYs in the mid-scenario (Δ1.42 LYs; +0.069 LYs), and 3.24 vs. 1.87 LYs in the low-scenario (Δ1.37 LYs; +0.022 LYs), for olaparib vs. TPC respectively. This corresponded to relative survival increases of 10.3%, 5.1%, and 1.6%, respectively.
CONCLUSIONS: First-line olaparib directly improves survival and can further extend survival by providing access to future innovations. These findings may guide early treatment selection to optimize sequencing and support further evaluation of ROV for additional guideline-recommended treatments in mBC.
METHODS: We developed a Markov model with progression-free, progression, and death states to estimate long-term survival gain of 1L olaparib versus treatment of physician's choice (TPC; chemotherapy) among patients with HER2-negative mBC. To derive ROV, a scenario without future drug innovation was compared to one including anticipated innovations as of January 2023. ROV parameters were informed by literature, trial data, ongoing studies, and mBC treatment patterns. Clinician expert-reviewed assumptions generated high-, mid-, and low-ROV scenarios. The primary outcome was aggregated life expectancy, weighted between HR+ and TNBC per OlympiAD trial characteristics.
RESULTS: Without innovation, modeled aggregate survival was 3.16 years with olaparib versus 1.81 years with TPC (Δ1.35 LYs). With innovation, survival increased to 3.91 vs. 2.42 LYs in the high scenario (Δ1.49 LYs; +0.139 LYs vs. no innovation), 3.44 vs. 2.02 LYs in the mid-scenario (Δ1.42 LYs; +0.069 LYs), and 3.24 vs. 1.87 LYs in the low-scenario (Δ1.37 LYs; +0.022 LYs), for olaparib vs. TPC respectively. This corresponded to relative survival increases of 10.3%, 5.1%, and 1.6%, respectively.
CONCLUSIONS: First-line olaparib directly improves survival and can further extend survival by providing access to future innovations. These findings may guide early treatment selection to optimize sequencing and support further evaluation of ROV for additional guideline-recommended treatments in mBC.