International Journal of Colorectal Disease

, Volume 33, Issue 11, pp 1505–1516 | Cite as

First-line therapies in metastatic colorectal cancer: integrating clinical benefit with the costs of drugs

  • Jacopo GiulianiEmail author
  • Andrea Bonetti



In light of the relevant expenses of pharmacological interventions, it might be interesting to make a balance between the cost of the new drugs administered and the added value represented by the improvement in progression free survival (PFS) in first-line for metastatic colorectal cancer CRC (mCRC).


Phase III randomized controlled trials (RCTs) that compared at least two first-line chemotherapy regimens for mCRC patients were evaluated. Differences in PFS between the different arms were compared with the pharmacological costs (at the pharmacy of our hospital). The European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) was applied to the above RCTs.


Overall 28 phase III RCTs, including 19,958 patients, were analyzed. The FOLFOX resulted the least expensive (56 € per month of PFS gained) while the addition of irinotecan to FOLFOX (FOLFOXIRI) increased only marginally the costs (90 € per month of PFS gained). Treatments including the monoclonal antibodies showed a cost per month of PFS gained of 2823 € (FOLFIRI with cetuximab in KRAS wild-type patients and liver-only metastases), of € 15,822 (FOLFOX with panitumumab in KRAS wild type), and of 13,383 € (FOLFOX with bevacizumab). According to the ESMO-MCBS, the treatments including an EGFR-inhibitor (cetuximab or panitumumab) were associated with a score of 4, while the inclusion of bevacizumab reached a score of 3.


Our data demonstrate a huge difference in cost per month of PFS gained in modern first-line treatments in mCRC.


Metastatic colorectal cancer Randomized phase III trials First-line therapy Costs of drugs ESMO-MCBS 



Jacopo Giuliani and Andrea Bonetti contributed equally in the conception and design, acquisition of data, or analysis and interpretation of data; drafting the article and revising it critically for important intellectual content; and final approval of the version to be published.

Compliance with ethical standards

Conflict of interest statement

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. In particular:

• Jacopo Giuliani, M.D., has no conflict of interest.

• Andrea Bonetti, M.D., has no conflict of interest.


No founds were received to support this article.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of OncologyMater Salutis Hospital—Az. ULSS 9 ScaligeraLegnagoItaly

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