Value-Based Cancer Care Issues


July 2013, Vol 4, No 6

Cancer Rehabilitation: The Next Frontier in the Care Continuum

Caroline Helwick

AVBCC 2013 3rd Annual Conference

Hollywood, FL—Cancer rehabilitation is “the next frontier” in survivorship care, according to Julie K. Silver, MD, Assistant Professor of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA.

Dr Silver is the author of numerous books, including After Cancer Treatment: Heal Faster, Better, Stronger, & What Helped Get Me Through: Cancer Survivors Share Wisdom and Hope.

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Nearly 1 in 5 Patients with Cancer Reports Financial Distress

Audrey Andrews

Economics of Cancer Care

Chicago, IL—Financial distress is prevalent among insured patients with cancer, and although most patients state a desire to talk to their physicians about costs, this discussion rarely occurs, according to a study conducted at Duke University Medical Center, Durham, NC.

Of the 300 insured patients with cancer included in this study, 17% reported “high” or “overwhelming” financial distress, and only 25% of this group discussed costs with their physicians.

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Two Genetic Tests Can Prevent Overtreatment of Early Prostate Cancer

Phoebe Starr

Personalized Medicine

Chicago, IL—The management of patients with prostate cancer will be advanced by 2 new genetic tests—Oncotype DX prostate cancer test and Prolaris. Both tests generate a score that can be used to analyze biopsy specimens of men with low-risk prostate cancer (ie, Gleason score ≤6) to determine if they are truly “low risk” and appropriate for watchful waiting, or if they harbor higher-risk genes and need immediate treatment.

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How Employers Are Adapting to the New Landscape in Healthcare

Caroline Helwick

AVBCC 2013 3rd Annual Conference

Hollywood, FL—With the new landscape of healthcare delivery yet to come into sharp focus, employers are living in “the land of confusion,” wondering how they will conform to new requirements, meet the expectations of their employees, and remain profitable, said Peter Hayes, Principal, Healthcare Solutions, Duluth, GA, at the Third Annual Conference of the Association for Value-Based Cancer Care.

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The Promise of Immunotherapy in the Race to Cure Cancer

Value Propositions

Many presentations at the 2013 annual meeting of the American Society of Clinical Oncology (ASCO) focused on new research involving immunotherapy, including drugs for melanoma and lung cancer that have shown great success in prolonging life in patients with advanced disease. The number of immunotherapy drugs in development is growing, using different antibody mechanisms to identify and destroy cancer cells.

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Researchers Discover a Set of Proteins that Cause Many Cancer-Related Mutations

Value Propositions

A new study led by researchers at the National Institutes of Health shows that a set of proteins in the body produces a large number of mutations in human DNA, indicating that these naturally produced mutations are just as powerful as cancer-causing agents in producing tumors. The proteins are part of the apolipoprotein B mRNA-editing enzyme catalytic polypeptide-like (APOBEC) cytidine deaminases. The APOBEC mutations can outnumber all other mutations in some cancers. [ Read More ]

Consolidation in Cancer Care Delivery System: The Impact on Quality and Cost

Craig Deligdish, MD

From the Editor

Chief Medical Officer, Oncology Resource Networks, and Editor-in-Chief, Value-Based Cancer Care

The past several years have seen significant consolidation in the healthcare industry. The cost of healthcare in the United States is currently estimated to be 18% of the gross domestic product (GDP), and the costs are projected to increase disproportionately to the GDP during the next decade.1 Healthcare reform has accelerated consolidation and will likely continue to drive consolidation in many markets across the country.

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ASCO President Highlights Bridges to Conquer Cancer

Wayne Kuznar

Economics of Cancer Care

Chicago, IL—“Building Bridges to Conquer Cancer” was the theme of the 2013 American Society of Clinical Oncology (ASCO) annual meeting, as well as of the address of ASCO’s outgoing President Sandra M. Swain, MD.

Dr Swain’s address focused on 3 pillars of the theme: (1) ensuring global health equity, (2) the need to strengthen future generations of leaders and providers, and (3) the vision for a rapid learning system in oncology. These 3 issues “belong squarely on our personal and professional radar screens,” she said.

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Assessing the Value of New, Costly Radiation Therapies in Older Patients with Breast Cancer

Caroline Helwick

Economics of Cancer Care

Chicago, IL—For-profit hospitals are more likely than their nonprofit counterparts to treat elderly patients with breast cancer with an expensive form of radiotherapy—despite lacking evidence of its benefit, researchers from the Yale Cancer Outcomes, Public Policy and Effectiveness Research Center reported at the 2013 American Society of Clinical Oncology annual meeting.

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Payers Must Step Up Their Utilization Management Programs

Caroline Helwick

AVBCC 2013 3rd Annual Conference

Hollywood, FL—With the Affordable Care Act about to be fully enacted, and growing concerns about managing oncology costs, health plans will put simple processes in place ahead of new drug approvals to more actively manage these medications, said James T. Kenney, Jr, RPh, MBA, Pharmacy Operations Manager, Harvard Pilgrim Health Care, Wellesley, MA, at the Third Annual Conference of the Association for Value-Based Cancer Care.

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Brown Bagging versus White Bagging

Meet the Experts

At the Third Annual Conference of the Association for Value-Based Cancer Care, several Meet the Experts roundtable discussions addressed the hottest topics in oncology. James T. Kenney, Jr, RPh, MBA, Pharmacy Operations Manager at Harvard Pilgrim, and Douglas S. Burgoyne, PharmD, President and Managing Partner, VRx Pharmacy Services, discussed the topic of brown and white bagging at one of these sessions.

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New Drug Application for Ibrutinib Submitted to FDA for B-Cell Malignancies

FDA Approvals, News & Updates

A New Drug Application for the oral Bruton’s tyrosine kinase (BTK) inhibitor ibrutinib (Janssen Biotech/Pharmacyclics) was submitted to the US Food and Drug Administration (FDA) for the treatment of patients with B-cell malignancies, specifically for previously treated patients with chronic lymphocytic leukemia (CLL) or with small lymphocytic lymphoma (SLL), and for previously treated patients with mantle-cell lymphoma (MCL).

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Neoadjuvant Lapatinib and Trastuzumab with Hormonal Therapy for HER2 Breast Cancer

In the Literature

A new phase 2 clinical trial is one of the first to investigate the use of hormonal therapy without chemotherapy as a neoadjuvant strategy for patients with HER2-positive breast cancer (Rimawi MF, et al. J Clin Oncol. 2013;31:1726-1731). Of patients with overexpressed HER2, 50% are also estrogen receptor (ER)-positive. The HER2 receptor is an ideal target for monoclonal antibody therapy. Trastuzumab is an effective inhibitor of HER2 but is a weak inhibitor of HER2 heterodimers with HER1 and HER3, which lead to the downstream inhibition of the PI3K/PTEN pathway. [ Read More ]

Combination Therapy with Nivolumab and Ipilimumab Superior to Monotherapy in Advanced Melanoma

In the Literature

Immune blockade has been shown to induce tumor regression in various types of cancer. Ipilimumab is a fully human, immunoglobulin (Ig) G1 monoclonal antibody that blocks cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4); nivolumab is a fully human IgG4 antibody that blocks the programmed death-1 (PD-1) receptor. A new study investigated whether combined immune blockade with ipilimumab and nivolumab would increase survival in patients with advanced melanoma (Wolchok JD, et al. N Engl J Med. 2013;369:122-133).

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A PBM Perspective on Biosimilars

Caroline Helwick

AVBCC 2013 3rd Annual Conference

Hollywood, FL—Pharmacy benefit managers (PBMs) will soon have the new challenge of dealing with the confusion of biosimilars, according to Douglas S. Burgoyne, PharmD, President and Managing Partner, VRx Pharmacy Services, Salt Lake City, UT, a full-service PBM company that provides medication therapy management, case management, and other clinical services to employer group waiver plans and commercial payers.

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340B Program

Meet the Experts

At the Third Annual Conference of the Association for Value-Based Cancer Care, several Meet the Experts roundtable discussions addressed the hottest topics in oncology. TonyZappa, PharmD, MBA, Vice President, Contract Pharmacy Services Operations, Wellpartner, moderated this discussion.

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Genomic Sequencing Uncovers the Genetic Landscape of Primary CNS Lymphoma

Dalia Buffery, MA, ABD

Personalized Medicine

Lugano, Switzerland—The genomic basis of primary central nervous system lymphoma (PCNSL), a very aggressive and incurable type of lymphoma, has not been understood until now. At the 2013 International Con­ference on Malignant Lymphoma, a team of researchers from the Mayo Clinic and from the University of Virginia presented its recent findings at a poster session involving the most comprehensive study to date of the genomic landscape of PCNSL.

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Comparing the Impact of ADT Agents on Cardiovascular Events and Death in Men with Prostate Cancer

Rosemary Frei, MSc

Prostate Cancer

Niagara Falls, Ontario—Among men with prostate cancer and preexisting cardiovascular (CV) disease, the risk of CV events or CV-related death is cut in half when they receive androgen-deprivation therapy (ADT) with degarelix (Firmagon) instead of the luetinizing hormone–releasing hormone (LHRH) agonists goserelin (Zoladex) or leuprolide (Lupron), according to results of a new analysis presented at the 2013 Canadian Urological Association annual meeting.

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The Leucovorin Shortage: A Tangled Web of Similar Isomers and Huge Cost Differences

William Shimp, MD; Laura R. Bobolts, PharmD, BCOP; Valerie Fishman, RN; Marc Fishman, MD; Jurgen Kogler, MD; Dinah Huff, MD; William Hrushesky, MD

Drug Updates

Dr Shimp is Associate Medical Director, Dr Bobolts is Director, Oncology Pharmaceutical Affairs, Ms V. Fishman is Chief Oncology Nurse, Dr M. Fishman is Chief Executive Officer and Chief Medical Officer, Dr Kogler is Associate Medical Director, Dr Huff is Research Program Manager, and Dr Hrushesky is Senior Executive Medical Director and Chief Scientific Officer, Oncology Analytics, Inc, Plantation, FL

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Xofigo (Radium Ra 223 Dichloride): The First Alpha Particle–Emitting Radioactive Agent for the Treatment of Castration-Resistant Prostate Cancer with Symptomatic Bone Metastases

Lisa A. Raedler, PhD, RPh

Drug Updates

Prostate cancer is the second leading cause of cancer-related death in the United States among men and the most frequently diagnosed cancer in American males. Among patients with metastatic prostate cancer, up to approximately 90% have bone metastases.1 The median survival after the diagnosis of bone metastasis associated with prostate cancer is approximately 3 years.2

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