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We welcome the position paper by the European Society for Medical Oncology on issues surrounding biosimilars.1 After recent approval of the first biosimilars of monoclonal antibodies (mAbs) in oncology, the input of medical oncology societies to an open discussion of medical opinion and provision of guidance regarding the introduction of these drugs into clinical practice are urgently needed.
As pointed out by Tabernero et al, safety and efficacy of biosimilars are the shared responsibility of manufacturers and regulatory bodies. We agree that a robust regulatory framework for authorisation of biosimilars is in place in Europe, and properly developed and approved biosimilars can be considered a valid treatment option.2
In line with the authors and the whole pharmaceutical industry,3 we advocate that the decision whether a reference product or biosimilar is dispensed to a patient has to be retained by the prescribing physician and based on clinical judgement. Patients should be engaged in these decisions and must know which biologic they receive. Transparency across all levels and prescription by brand name are critical factors to ensure adequate pharmacovigilance.
What is currently missing from a regulatory perspective are formal, evidence-based standards and guidelines to ensure patient safety in the context of switching between a reference product and its biosimilar(s). National healthcare systems may encourage such a switch to reduce costs.
mAbs are a highly complex class of biologics, and mAb biosimilars have only just started to become available in oncology. Tabernero et al urge physicians to be well informed about the products prior to making a decision on switching. At present, the consequences of switching a patient with cancer stable on an mAb reference product to a biosimilar are unknown. There is no clinically relevant evidence available yet from any studies investigating such a switch in an oncology indication (table 1).
Current evidence on the impact of switching between reference product mAbs and their biosimilar(s) is limited mainly to studies in inflammatory diseases.4 Importantly, results of switching studies with individual products cannot be generalised to other biologics and their biosimilars.
As more biosimilars become available, more complex switching scenarios might be possible, such as switching between biosimilars (these products have not been directly compared with each other in clinical studies) and switching back and forth between products. Such switching scenarios are associated with an even higher level of residual uncertainty.
Patients deserve the best available treatment for better outcomes and potential cure. The introduction of biosimilars can improve oncology patients’ access to potentially life-saving biologics. However, safety considerations and the potential for cure should remain first priority and not be outweighed by potential cost reduction aspects.
We support physicians’ ability to prescribe based on their assessment of the totality of data available, their personal experience and in consultation with the patient.
To enable proper decision-making and ensure that a switch does not negatively impact safety and efficacy of treatment, relevant clinical evidence is needed, including appropriate data from switching studies with biosimilars in the oncology setting and guidance from medical societies.
The authors thank Bettina Barton (SFL Regulatory Affairs & Scientific Communication, Switzerland) for providing medical writing support.
Contributors Both authors contributed equally to this correspondence.
Funding Funded by Hoffmann-La Roche.
Competing interests GB and TS are the employees of Hoffmann-La Roche.
Provenance and peer review Not commissioned; internally peer reviewed.
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