{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T09:18:18Z","timestamp":1772356698848,"version":"3.50.1"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T00:00:00Z","timestamp":1705536000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Toliparibizumab in combination with nab-paclitaxel (T+N) has excellent efficacy inmetastatic or recurrent triple-negative breast cancer (TNBC), but the optimal choice of sequence of therapy is unclear given the trade-offs between quality of life and cost. Cost-effectiveness analyses can quantify these tradeoffs, leading to more informed decisions. Our objective was to assess the societal cost-effectiveness of the T+N regimen for metastatic or recurrent TNBC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Clinical data were extracted from a multicenter, randomized, double-blind trial, TORCHLIGHT (NCT04085276). Patients were randomized into the T+N group or placebo plus nab-paclitaxel (P+N) group. 531 patients from 53 study locations were randomly assigned (T+N, n=353; P+N, n=178) into intend to treat (ITT) population; 200 and 100 patients, respectively had programmed death protein 1 (PD-L1) positive TNBC. A Markov model was established with a 21-day cycle length. Costs were acquired from local hospitals, effect parameters included quality-adjusted life year (QALY) and incremental cost-effectiveness ratio (ICER).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The cost differences were 47,538.3 CNY in ITT population (T+N, 143,725.67 CNY; P+N group, 96,187.37 CNY) and 29,258.84 CNY in PD-L1+ subgroup (T+N, 100,128.28 CNY; P+N group, 70,869.45 CNY). Meanwhile, the IEs were 0.03409 in the ITT population (T+N, 0.55323 QALY; P+N, 0.51914 QALY) and 0.03409 in the PD-L1+ subgroup (T+N, 0.42327 QALY; P+N, 0.37628 QALY). The ICERs between T+N and P+N groups were 1,394,548.41 CNY\/QALY in the ITT population and 622,663.98 CNY\/QALY in the PD-L1+ subgroup. We also analyzed the cost-effectiveness of toripalimab could be received in the Chinese medical insurance catalog. If toripalimab could be reimbursed at an 80% rate, the cost differences were changed to 16,598.99 CNY in ITT population (T+N, 112,786.36 CNY; P+N group, 96,187.37 CNY) and 7,704.58 CNY in PD-L1+ subgroup (T+N, 78,574.03 CNY; P+N group, 70,869.45 CNY). Meanwhile, the IEs remained unchanged. The ICERs between T+N and P+N groups were changed to 486,935.82 CNY\/QALY in the ITT population and 163,962.96 CNY\/QALY in the PD-L1+ subgroup. Sensitivity analyses indicated the stability of the model and the impact of utility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>At current drug prices, the T+N group is not more cost-effective than the P+N group, but after incorporating toripalimab into medical insurance, the T+N group will be more cost-effective for patients with PD-L1+ metastatic or recurrent triple-negative breast cancer.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2023.1268584","type":"journal-article","created":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T17:43:15Z","timestamp":1705599795000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Cost-effectiveness analysis of toripalimab for metastatic or recurrent triple-negative breast cancer"],"prefix":"10.3389","volume":"13","author":[{"given":"Jiangbo","family":"Shao","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cuiping","family":"Zhan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunxiang","family":"Jin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Jin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,1,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-021-00514-z","article-title":"Planning for tomorrow: global cancer incidence and the role of prevention 2020-2070","volume":"18","author":"Soerjomataram","year":"2021","journal-title":"Nat Rev Clin Oncol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3322\/caac.21763","article-title":"Cancer statistics, 2023","volume":"73","author":"Siegel","year":"2023","journal-title":"CA Cancer J Clin"},{"key":"B4","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1186\/s12943-023-01805-y","article-title":"Advancements in clinical aspects of targeted therapy and immunotherapy in breast cancer","volume":"22","author":"Ye","year":"2023","journal-title":"Mol Cancer"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.intimp.2021.107886","article-title":"Breast cancer immunotherapy: Current and novel approaches","volume":"98","author":"Barzaman","year":"2021","journal-title":"Int Immunopharmacol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.964442","article-title":"The role of PD-1\/PD-L1 and application of immune-checkpoint inhibitors in human cancers","volume":"13","author":"Tang","year":"2022","journal-title":"Front Immunol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1101\/gr.165985.113","article-title":"Neo-antigens predicted by tumor genome meta-analysis correlate with increased patient survival","volume":"24","author":"Brown","year":"2014","journal-title":"Genome Res"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1158\/2326-6066.CIR-13-0127","article-title":"PD-L1 expression in triple-negative breast cancer","volume":"2","author":"Mittendorf","year":"2014","journal-title":"Cancer Immunol Res"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-023-06972-6","article-title":"Efficacy relevance of PD-L1 expression on circulating tumor cells in metastatic breast cancer patients treated with anti-PD-1 immunotherapy","volume":"200","author":"Zhou","year":"2023","journal-title":"Breast Cancer Res Treat"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.2217\/imt-2023-0023","article-title":"A meta-analysis of application of PD-1\/PD-L1 inhibitor-based immunotherapy in unresectable locally advanced triple-negative breast cancer","volume":"15","author":"Zhang","year":"2023","journal-title":"Immunotherapy"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32454-0","article-title":"Molecular alterations in triple-negative breast cancer-the road to new treatment strategies","volume":"389","author":"Denkert","year":"2017","journal-title":"Lancet"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2023.03.006","article-title":"Immune checkpoint therapy-current perspectives and future directions","volume":"186","author":"Sharma","year":"2023","journal-title":"Cell"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15112933","article-title":"Hope and hype around immunotherapy in triple-negative breast cancer","volume":"15","author":"Jacobs","year":"2023","journal-title":"Cancers (Basel)"},{"key":"B14","article-title":"TORCHLIGHT: A randomised, double-blind, phase III clinical study of teraplizumab combined with albumin paclitaxel versus placebo combined with albumin paclitaxel in patients with metastatic or recurrent triple-negative breast cancer","author":"Jiang","year":"2023"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.58.4904","article-title":"First- and second-line bevacizumab in addition to chemotherapy for metastatic colorectal cancer: a United States-based cost-effectiveness analysis","volume":"33","author":"Goldstein","year":"2015","journal-title":"J Clin Oncol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.699781","article-title":"First-line chemo-immunotherapy for extensive-stage small-cell lung cancer: A United States-based cost-effectiveness analysis","volume":"11","author":"Liu","year":"2021","journal-title":"Front Oncol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.12195","article-title":"Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine","volume":"316","author":"Sanders","year":"2016","journal-title":"JAMA"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-11-139","article-title":"Improved curve fits to summary survival data: application to economic evaluation of health technologies","volume":"11","author":"Hoyle","year":"2011","journal-title":"BMC Med Res Methodol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1038\/s41523-022-00468-0","article-title":"Triple negative breast cancer: Pitfalls and progress","volume":"8","author":"Zagami","year":"2022","journal-title":"NPJ Breast Cancer"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1080\/13543784.2022.2049232","article-title":"Progress and pitfalls in the use of immunotherapy for patients with triple negative breast cancer","volume":"31","author":"Agostinetto","year":"2022","journal-title":"Expert Opin Investig Drugs"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)32531-9","article-title":"Pembrolizumab plus chemotherapy versus placebo plus chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer (KEYNOTE-355): a randomised, placebo-controlled, double-blind, phase 3 clinical trial","volume":"396","author":"Cortes","year":"2020","journal-title":"Lancet"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1910549","article-title":"Pembrolizumab for early triple-negative breast cancer","volume":"382","author":"Schmid","year":"2020","journal-title":"N Engl J Med"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2023.1268584\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T17:43:17Z","timestamp":1705599797000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2023.1268584\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,18]]},"references-count":22,"alternative-id":["10.3389\/fonc.2023.1268584"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2023.1268584","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,18]]},"article-number":"1268584"}}