Value-Based Cancer Care Issues


June 2012, Vol 3, No 4

Regional Cancer Care Associates: Consolidating Small Practices into a Large Consortium

Best Practices

Value-Based Cancer Care is focused on examining value within the context of healthcare stakeholder relations. Dr Pecora and his team at Regional Cancer Care Associates (RCCA) have changed the relationship between the practicing oncologist and the payer, which will have substantial effects on value. For years, the signs were clear that for oncologists to survive and be in a position to implement the great advances in treatment, they would require a new business model, and Dr Pecora and RCCA have provided one.

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FDA Expedites Approval of Pertuzumab for Metastatic HER2 Breast Cancer

FDA Approvals, News & Updates

The US Food and Drug Administration (FDA) approved pertuzumab (Perjeta; Genentech) for intravenous use in patients with HER2-positive metastatic breast cancer. Pertuzumab, a humanized monoclonal antibody, is approved for use in combination with the other anti-HER2 trastuzumab (Herceptin) and docetaxel (Taxotere) chemotherapy in patients with metastatic breast cancer who have not been treated previously with an anti-HER2 therapy or with chemotherapy. The approval was done under the expedited review process.

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Safety Warnings Added to Lenalidomide

FDA Approvals, News & Updates

The FDA has added new safety information to the label and medication guide for lenalidomide (Revlimid; Celgene), noting that lenalidomide maintenance treatment in patients with newly diagnosed multiple myeloma is associated with an increased risk for developing new primary malignancies. The decision to include this information was based on data from postapproval clinical trials in patients who previously had undergone chemotherapy, either alone or with stem-cell transplantation, before starting maintenance treatment with lenalidomide or with placebo. [ Read More ]

Understanding Genes Is Crucial to Predicting Response to Breast Cancer Therapy

Value Propositions

A study funded by the National Cancer Institute, the National Institutes of Health, a Theodore N. Law Endowment for Scientific Achievement, and a Dodie P. Hawn Fellowship in Cancer Genetics Research surprisingly showed that the presence of normal p53, a tumor suppressor gene and not the mutated gene, was making chemotherapy with doxorubicin less effective in breast cancer; it is the mutated gene that actually enhances the benefit of the drug and not the reverse. This study moves us a step closer to personalized medicine for breast cancer.

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Radium-223 Offers New Hope for Patients with Bone Metastases

Value Propositions

At the 2012 annual meeting of the Society of Nuclear Medicine, researchers presented new results for the radioisotope therapy radium-223 chloride, suggesting that these results represent a new treatment protocol for patients with advanced prostate cancer that has spread to the bone. This drug seeks out bone metastases with very potent alpha particles that are deadly to tumors. This drug has a short range of penetration, sparing healthy tissue and bone marrow. [ Read More ]

Will Merger of 2 Major Diagnostic Centers Up Access to Molecular Imaging?

Value Propositions

Two of the largest diagnostic imaging centers in the country—Insight Imaging in California and Centers for Diagnostic Imaging (CDI) in Minneapolis—have announced that they are merging forces. The combined company will have 116 fixed centers in 25 states and 90 mobile MRI and PET/CT units. The combined company will be headquartered at CDI’s current offices, with CDI’s current CEO Tom Tomlinson becoming CEO of the new company. The merger is expected in July. TriMed Media Group, Inc, June 8, 2012.

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Patients with Cancer Willing to Pay More for Unproven, but Promising, Therapies

In the Literature

Assessments of the value of cancer therapies have been based on the assumption that stakeholders care most about average or median gain in survival or quality-adjusted survival. These assessments have ignored variability or spread around the average, or in more tangible terms, a chance (albeit possibly small) at a large and highly meaningful gain in survival. A recent survey investigated hypothetical scenarios to assess the value that patients place on promising, although unproven, cancer therapies (Lakdawalla DN, et al. Health Aff [Millwood]. 2012;31:676-682).

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New Reimbursement Policies Needed to Align Payment with Cancer Care Outcomes

In the Literature

Current reimbursement policies for cancer chemotherapies do not ensure that the value and cost of therapies are commensurate with outcomes. These policies also reward the use of the most expensive drugs, in that providers’ markups are larger for these drugs than for lower-cost therapies. Lee Newcomer, MD, senior vice president of oncology services, UnitedHealth-care, proposes new reimbursement strategies to align payments with outcomes as a way of achieving best possible outcomes at the lowest cost (Newcomer LN. Health Aff [Millwood]. 2012;31:780-785).

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Phased Ipilimumab Improves PFS and OS in NSCLC

In the Literature

Ipilimumab—added in a phased regimen to paclitaxel and carboplatin chemotherapy—increased progressionfree survival (PFS) and immune-related PFS in a randomized, double-blind, international, phase 2 study of previously untreated adult patients with non–small-cell lung cancer (NSCLC). However, a concurrent regimen of ipilimumab with the chemo therapy did not differ significantly from a control (placebo plus chemo therapy) regimen (Lynch TJ, et al. J Clin Oncol. 2012; 30:2046-2054. Epub 2012 Apr 30).

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Biomarker Identifies Patients with Rare Brain Tumors Who Have a Survival Benefit from Chemotherapy Plus Radiation

Phoebe Starr

ASCO Annual Meeting

Chicago, IL—Patients with the relatively rare brain tumor anaplastic oligodendroglioma who were treated with adjuvant chemotherapy after standard radiation therapy had improved survival compared with radiation alone, especially if they had codeletion of chromosomes 1p/19q, according to long-term follow-up of the EORTC (European Organisation for Research and Treatment of Cancer) 2651 study reported at the 2012 Annual Meeting of the American Society of Clinical Oncology (ASCO).

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Abiraterone Merits Consideration as New Standard Before Chemotherapy for Treatment of Prostate Cancer

ASCO Annual Meeting

Chicago, IL—Abiraterone acetate (Zytiga) delays disease progression when used with prednisone before chemotherapy in men with metastatic castration-resistant prostate cancer, said Charles J. Ryan, MD, Associate Professor of Clinical Med icine, Helen Diller Family Comprehensive Cancer Center at the University of California, San Francisco, who reported a planned interim analysis of a phase 3 study at the 2012 meeting of the American Society of Clinical Oncology.

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BRAF and MEK Inhibitors Make News at ASCO

Audrey Andrews

ASCO Annual Meeting

Chicago, IL—At the 2012 American Society of Clinical Oncology meeting, attendees flocked to sessions on the treatment of melanoma to hear about the next generation of agents that are building on the success achieved with the BRAF inhibitor vemurafenib (Zelboraf), and the immunotherapy drug ipilimumab (Yervoy), which have added new treatment options where, not long ago, none existed.

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Reimbursement Strategies Must Be Patient-Centered

AVBCC Annual Conference

In an interview with the Association for Value-Based Cancer Care (AVBCC), Jennifer Malin, MD, PhD, Medical Director of Oncology at WellPoint, emphasized that patients should remain the central focus in novel or innovative reimbursement models.

AVBCC: Dr Malin, you have talked about the importance of keeping patient-centered care the focus of reimbursement strategies. How can this be done while still controlling cost?

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The Value of Level I Pathways at US Oncology

Caroline Helwick

AVBCC Annual Conference

Houston, TX—The use of the Level I Pathways Program at McKesson Specialty Health/US Oncology Network over the past 5 years has reduced treatment variability and resulting costs, according to Roy A. Beveridge, MD, chief medical officer, McKesson Specialty Health/US Oncology Network.

“We fundamentally believe that the use of these pathways significantly reduces the variation in patient care, and we have been able to demonstrate this,” Dr Beveridge said at the Second Annual Conference of the Association for Value-Based Cancer Care.

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CareFirst Oncology Management Program Aims to Manage the “Entire Oncology Patient”

Caroline Helwick

AVBCC Annual Conference

Houston, TX—The Oncology Management Program at CareFirst Blue Cross Blue Shield (BCBS) continues to evolve, producing nearly 10% in cost-savings over prepathways practice, and ensuring that patients get more appropriate care, said Winston Wong, PharmD, Associate Vice President of Pharmacy Management at CareFirst BCBS, who described the program at the Second Annual Conference of the Association for Value-Based Cancer Care.

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Integrating Digital Patient Engagement into Your Care Model

Gena Cook

Practice Management

The Health Information Technology for Economic and Clinical Health (HITECH) Act has set aside $19 billion in incentives to encourage healthcare providers to adopt and meaningfully use electronic medical record (EMR) technology in an effort to provide more patient-centered care. This unprecedented investment in health information technology (HIT) will digitize the medical industry and connect patients to their providers electronically for the first time so they (and their families) can be more engaged in their own care.

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More Revenue, Less Waste: Tips for Optimizing Financial Performance

Neil Canavan

ACCC Annual Meeting

Baltimore, MD—Belt tightening is the order of the day. To succeed, you are going to need a stern resolve, a sturdy belt, and a steady pull—not just by the bean counters in the back office, but by everyone: administrators, doctors, and mid-level employees alike. At the 2012 Association of Community Cancer Centers meeting, several presenters offered practical tips to help in the new climate of healthcare reform.

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Ipilimumab-GVAX Combination Safe for Metastatic Castration-Resistant Prostate Cancer

In the Literature

A combination of ipilimumab and the granulocyte-macrophage colonystimulating factor-transduced allogeneic prostate cancer cells vaccine (GVAX) was feasible and tolerable in an openlabel phase 1 study in men with metastatic castration-resistant prostate cancer (van den Eertwegh AJM, et al. Lancet Oncol. 2012;13:509-517). Based on the toxicity profile and clinical activity, the authors recommended further clinical evaluation of ipilimumab and tumor vaccines in combination.

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Brain, Breast, and Liver Cancers All Respond to Immunotherapy

Richard Hyer

AACR Annual Meeting

Chicago, IL—Immunotherapy is nontoxic, tumor-specific, long-term therapy with a long-term memory. The expectation is that once the patient has been treated with immunotherapy, the therapeutic effect will remain and safeguard the patient for life by provoking the immune system to attack any return of the cancer.

There is progress in at least 4 areas: pediatric brain tumors, breast cancer, hepatocellular carcinoma, and generally advanced cancers, according to 4 current studies described at the 2012 American Association for Cancer Research meeting.

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Late-Breaking Clinical Trials: Potential New Therapies for Lymphoma, Prostate, and Other Cancers

AACR Annual Meeting

Chicago, IL—Several presentations featured at a news conference at the 2012 American Association for Cancer Research meeting highlighted new therapies showing promising results in the early stage of research, potentially charting new options for patients with cancer.

Ibrutinib for B-Cell Lymphoma

Diffuse large B-cell lymphoma (DLBCL) represents 40% of all non- Hodgkin lymphoma. Some 23,000 new cases are diagnosed and 10,000 deaths occur annually in the United States, with a 50% cure rate at best, using chemotherapy and radiation therapy.

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