IPILIMUMAB FOR THE TREATMENT OF ADVANCED MELANOMA.

Running Head: IPILIMUMAB FOR THE TREATMENT OF ADVANCED MELANOMA
IPILIMUMAB FOR THE TREATMENT OF ADVANCED MELANOMA
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IPILIMUMAB FOR THE TREATMENT OF ADVANCED MELANOMA
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Abstract:
Cancer has been a disease of major concern today. Skin cancers are one of the most prevalent
cancers throughout the world. Various treatment strategies have been devised to treat
melanoma. This project aims to examine the applicability and the cost-effectiveness of using
Ipilimumab. This drug is administered to improve the survivability of the patients suffering
from advanced melanoma. Cost-effectiveness becomes a matter of concern when a particular
strategy or technique is higher in cost. Ipilimumab is defined to be a monoclonal antibody
that activates the immune system by targeting CTLA-4. CTLA-4 is a protein receptor that
downregulates the immune system. Melanoma is a type of cancer associated with the skin.
Melanocytes (melanin-producing cells), become mutated and become cancerous. There are
many comparators which are highly effective in treating this disease and in this particular
study, the selected comparator is gp100. GP 100 stands for glycoprotein 100. Glycoproteins
are combinations of carbohydrate and protein. The protein content is present in the form of
long polypeptides with attached glycoprotein side chains. These glycoproteins are used in
preparing immune vaccines for the treatment of melanoma in patients. Immune vaccines are
certain vaccines which boost or down-regulates the immune system of the human body. The
study was done to check the strengths of Ipilimumab (a drug used to treat melanoma) in
various methods by using Ipilimumab individually (monotherapy), Ipilimumab+gp100 (bi-
therapy) and simply with gp100. It was found that the survivability rate in case of using
Ipilimumab is comparatively higher than others. Melanoma proceeds through five stages. The
severity of the disease ascends through the stages. Ipilimumab is administered only at the late
stages of melanoma. The Grade 3 and Grade 4 patients were treated with Ipilimumab, and it
was found that the average survivability rate for the Ipilimumab is 10.1 months higher than
gp100. The dose of the Ipilimumab recommended by the physicians is 3mg/kg. This dose has
been standardized and then decide by the doctors as a standard dose. Markov model is a

IPILIMUMAB FOR THE TREATMENT OF ADVANCED MELANOMA
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model used to frame randomly changing processes. In this paper, the economic evaluation
has been done by introducing the Markov model, where three factors are associated with the
clinical outcomes, quality of life and resources related to healthcare. Markov model is used
here since the economy is a factor which changes always. Some parameters control the
economic models, but in this case, the payers’ interest plays a significant role. Indeed the use
of Ipilimumab is 95% cost-effective as compared to others. The policy practice and the
Australian government subsidization is under consideration based on the results. The schemes
are designed after analyzing the data and the survivability rate after the drug administration in
over two years. The investment and the sponsorship are certainly needed from the
government side to counter the treatment cost. Thus after analyzing the budget structure and
the cost-effectiveness, it is recommended to the government to implement the policies that
are conducive to encounter the heavy burden of the treatment.

IPILIMUMAB FOR THE TREATMENT OF ADVANCED MELANOMA
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Appraisal Checklists:
Appraisal checklist 1:
Question Yes No Referenced from
Did the article describe
an important clinical
problem addressed via
a clearly formulated
question?

Menzies, A.M., Johnson, D.B.,
Ramanujam, S., Atkinson, V.G., Wong,
A.N.M., Park, J.J., McQuade, J.L.,
Shoushtari, A.N., Tsai, K.K., Eroglu, Z.
and Klein, O., 2016. Anti-PD-1 therapy in
patients with advanced melanoma and
preexisting autoimmune disorders or
major toxicity with Ipilimumab. Annals of
Oncology, 28(2), pp.368-376.
Wolchok, J.D., Hodi, F.S., Weber, J.S.,
Allison, J.P., Urba, W.J., Robert, C.,
O'Day, S.J., Hoos, A., Humphrey, R.,
Berman, D.M. and Lonberg, N., 2013.
Development of Ipilimumab: a novel
immunotherapeutic approach for the
treatment of advanced melanoma. Annals
of the New York Academy of
Sciences, 1291(1), p.1.
Yang, J.C., Hughes, M., Kammula, U.,
Royal, R., Sherry, R.M., Topalian, S.L.,
Suri, K.B., Levy, C., Allen, T.,
Mavroukakis, S. and Lowy, I., 2017.
Ipilimumab (anti-CTLA4 antibody) causes
regression of metastatic renal cell cancer
associated with enteritis and
hypophysitis. Journal of immunotherapy
(Hagerstown, Md.: 1997), 30(8), p.825.
Was a qualitative
approach appropriate? 
Was the sampling
strategy clearly defined
and justified? In
particular
