Value-Based Cancer Care Issues


October 2013, Vol 4, No 8

Cancer Prehabilitation May Reduce Healthcare Costs and Improve Outcomes

Julie K. Silver, MD

VBCC Perspectives

Prehabilitation (or “prehab”) has a long history as an important part of the rehabilitation care continuum. For example, patients who are electing to have a total hip or knee arthroplasty may have preoperative assessments and interventions that are sometimes grouped together and called “joint camp.” Prehabilitation has also been gaining traction in the oncology community, because of the potential it may have to improve cancer care. [ Read More ]

MPDL3280A: Responses Better in Smokers than in Nonsmokers in Advanced Lung Cancer

Phoebe Starr

ESMO 2013 Conference

Amsterdam, The Netherlands—For the first time, a therapy for non–small-cell lung cancer (NSCLC) has achieved responses in smokers better than in nonsmokers. The antibody MPDL3280A also achieved good responses in squamous and adenoma histologic types of NSCLC.

These results of a phase 1 study in patients with metastatic NSCLC were so encouraging that experts suggested bypassing phase 2 studies and going on to phase 3 clinical trials directly.

Recruitment for this human monoclonal antibody is ongoing for phase 2 and 3 trials in NSCLC.

[ Read More ]

Value-Based Care Will Change the Face of Medicine

Value Propositions

In a recent guest blog on the Harvard Business Review website, Toby Cosgrove, MD, President and CEO of the Cleveland Clinic in Ohio, suggested that value-based care represents a life-saving “breakthrough,” not unlike penicillin or decoding the human genome, by focusing on lowering costs and improving quality of care and outcomes as its main goals. [ Read More ]

New Molecular Markers Can Identify Early Breast Cancer that Will Spread to the Brain

Value Propositions

Researchers have identified new molecular markers—microribonucleic acids (RNAs)—that, combined with their target genes, are believed to be able to identify which breast cancer will metastasize to the brain. “Survival rates are low once breast cancer metastasized to the brain,” said Seema Sethi, MD, lead investigator of a study presented at the 2013 American Society for Clinical Pathology (ASCP) annual meeting, and a resident at Wayne State University and Detroit Medical Center. This discovery is a new step in the evolving field of personalized medicine.

[ Read More ]

New Approach to Treating Medulloblastoma Developed at NCI-Designated Cancer Center

Value Propositions

A team of researchers at Sanford-Burnham Medical Research Institute, led by Robert Wechsler-Reya, PhD, Professor at Sanford-Burnham’s National Cancer Institute (NCI)-Designated Cancer Center and Director of the Tumor Initiation and Maintenance Program, discovered that they can block the rapid growth of cancerous brain cells by using small-molecule inhibitors. “By targeting fast-growing TPCs [tumor-propagating cells] with cell-cycle inhibitors, we have developed a new route to assault medulloblastoma. [ Read More ]

The State of Cancer Globally in 2013

Audrey Andrews

ESMO 2013 Conference

Amsterdam, The Netherlands—Although much progress has been made in cancer care over the past couple of dec­ades, a report presented at the 2013 European Cancer Congress emphasizes that on a global scale, the impact is far from equitable.
“Many parts of the world are already unable to cope with the current situation and are totally unprepared for the future growth of the cancer problem,” said Peter Boyle, PhD, DSc, President, International Prevention Research Institute, and Director, Strathclyde Institute for Global Public Health, Lyon, France.

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Kadcyla Prolongs Survival in Advanced HER2-Positive Breast Cancer

Phoebe Starr

ESMO 2013 Conference

Amsterdam, The Netherlands—The antibody-conjugate ado-trastuzumab emtansine (Kadcyla), also known as T-DM1, prolonged progression-free survival (PFS) in advanced HER2-positive breast cancer in a heavily pretreated population, according to the final results of the phase 3 clinical trial TH3RESA. The study included cancer that progressed with ≥2 previous HER2-directed therapies—trastuzumab (Herceptin) and lapatinib (Tykerb).

[ Read More ]

Second-Generation ALK Inhibitor Regresses Brain Metastases in Patients with Lung Cancer

Phoebe Starr

ESMO 2013 Conference

Amsterdam, The Netherlands—The novel ALK/EGFR inhibitor known as AP26113 achieved good responses in reducing brain metastases in patients with crizotinib (Xalkori)-resistant and crizotinib-naïve non–small-cell lung cancer (NSCLC), as well as radiographic regression of central nervous system (CNS) metastases. These results of the first-in-human phase 1/2 dose-finding study of AP26113 were presented at the 2013 European Cancer Congress by David R. Camidge, MD, PhD, Director, Thoracic Oncology Clinical Program, University of Colorado Denver, Aurora.

[ Read More ]

For Oncologists, Some Food for Thought in the New Era of Healthcare Reform

Audrey Andrews

Breast Cancer Symposium

San Francisco, CA—At the 2013 Breast Cancer Symposium, Lawrence N. Shulman, MD, Senior Vice President for Medical Affairs, Dana-Farber Cancer Institute, Boston, told oncologists that in the current era of healthcare reform, they will need to think beyond treatment outcomes, toxicities, and personal preferences.

Dr Shulman told oncologists they will need to “factor in” cost considerations and payment reform. “Ideally, our treatment decisions would be the same, but several factors cause us to rethink our approaches to cancer care,” he said.

[ Read More ]

Comparative Effectiveness Research Should Reap Benefits for Oncology Care

Audrey Andrews

Breast Cancer Symposium

San Francisco, CA—Comparative effectiveness research (CER) is an important construct for identifying and summarizing the evidence on the effectiveness, safety, and overall value of alternative strategies in oncology care, said Gary H. Lyman, MD, MPH, Professor of Medicine, Duke University and the Duke Cancer Research Institute, Durham, NC, during the 2013 Breast Cancer Symposium.

“The big challenge is deciding what treatment works in whom, under what circumstances, and whether we can afford it,” Dr Lyman said.

[ Read More ]

Large-Scale Oncology Pathways Program Reduces Drug and Hospitalization Costs

In the Literature

The cost of cancer care continues to rise, and especially the cost of cancer drugs. Since their introduction in the 1990s, clinical pathways have demonstrated an improvement in the quality of care, while lowering costs in numerous clinical settings. Data, however, are limited regarding the role of clinical pathways in cancer care. CareFirst BlueCross BlueShield in partnership with P4 Pathways implemented a multistate oncology pathways program in 2008. [ Read More ]

PD-1 Inhibitor Lambrolizumab Is Safe, Shows Durable Responses in Patients with Advanced Melanoma

In the Literature

Lambrolizumab (previously known as MK-3475) is a humanized monoclonal immunoglobulin G4 antibody that blocks the programmed death 1 (PD-1) receptor and reactivates an immune response to the cancer cells. The PD-1 receptor limits the body’s immune response against cancer. Researchers have set out to investigate the safety and antitumor activity of 3 dosing regimens of lambrolizumab in a cohort of patients with advanced melanoma (Hamid O, et al. N Engl J Med. 2013;369:134-144).

[ Read More ]

Community Oncology Practices Trying to Keep Afloat

Caroline Helwick

AVBCC 2013 3rd Annual Conference

Hollywood, FL—There are perplexing considerations for community oncology practices under sequestration, but adapting to future practice models poses even bigger questions, according to Leonard H. Natelson, Chief Executive Officer of Hematology/Oncology Associates of Rockland, NY. Mr Natelson has a good track record of improving the profitability of community oncology practices, and he shared his insights at the 3rd Annual Conference of the Association for Value-Based Cancer Care.

[ Read More ]

Seeking Value in Oncology Care

Caroline Helwick

AVBCC 2013 3rd Annual Conference

Hollywood, FL—“How do different stakeholders define value in oncology? This is a complex question, and definitely a mainstream, though at times controversial, issue,” according to Pamela Morris, Director, Syndicated Research, Zitter Health Insights. Ms Morris discussed the search for value in oncology care, informed by results from the Zitter Group’s research, at the 3rd Annual Conference of the Association for Value-Based Cancer Care.

[ Read More ]

Addressing Medication Nonadherence: A Patient–Provider Perspective

Caroline Helwick

AVBCC 2013 3rd Annual Conference

Hollywood, FL—Adherence to medications is critical for effective cancer treatment. Oncologists must understand the reasons for nonadherence and help patients to keep taking their medications, said Lillie D. Shockney, RN, BS, MAS, Associate Professor, Johns Hopkins University School of Medicine and School of Nursing, Baltimore, at the 3rd Annual Conference of the Association for Value-Based Cancer Care.

[ Read More ]

Patient Assistance Programs

Caroline Helwick

AVBCC 2013 3rd Annual Conference

Hollywood, FL—“Patient assistance is not an option but a very important part of the fabric of our healthcare system,” said Patrick McKercher, RPh, PhD, President of the Patient Access Network Foundation, at the 3rd Annual Conference of the Association for Value-Based Cancer Care. “While some predict that when the donut hole squeezes shut there will be no need for patient assistance programs, this could not be further from the truth.”

[ Read More ]

Genomics of Acute Myeloid Leukemia Explored

Phoebe Starr

Personalized Medicine

New York, NY—To paraphrase Winston Churchill, “we are at the end of the beginning” of the era of clinical genomics in acute myeloid leukemia (AML), said Richard M. Stone, MD, Clinical Director, Adult Leukemia Program, Dana-Farber Cancer Insti­tute, Boston, at the 2013 National Comprehensive Cancer Network congress on hematologic malignancies.

[ Read More ]

Panitumumab-FOLFOX4 Therapy Extends Survival in Patients with CRC without RAS Mutations

Eileen Koutnik-Fotopoulos

Personalized Medicine

Testing for KRAS mutations is recommended to guide treatment decisions in patients with metastatic colorectal cancer (CRC) by pointing to the patients who would most likely benefit from anti–epidermal growth factor receptor (EGFR) therapies. The KRAS mutation is a predictive biomarker of resistance to anti-EGFR therapy in this patient population. Specifically, patients with KRAS mutations in exon 2 do not benefit from this therapy and may have poor outcomes if an anti-EGFR is combined with an oxaliplatin (Eloxatin)-containing chemotherapy regimen. [ Read More ]

Redesigning Clinical Trials Necessary to Enhance Discovery of Effective Targeted Drugs in the Genomic Era

Wayne Kuznar

Personalized Medicine

Boston, MA—Defining optimal therapeutic efficacy in the genomic era will require that clinical trial design in oncology move from a drug-centric approach to a patient-centric one. Retrofitting current knowledge into old paradigms will slow the progress in discovering effective targeted agents, said Razelle Kurzrock, MD, Director, Center for Personalized Therapy and Clinical Trials, Moores Cancer Center, University of California, San Diego, at the Global Biomarkers Consortium Second Annual Conference.

[ Read More ]

Revlimid Receives a New Indication for the Treatment of Patients with Relapsed or Progressing Mantle-Cell Lymphoma

Lisa A. Raedler, PhD, RPh

Drug Updates

Mantle-cell lymphoma (MCL), which accounts for approximately 6% of new non–Hodgkin lymphoma diagnoses, is a rare and often aggressive cancer.1,2 MCL is most often diagnosed in older white adults (typically patients are in their mid-60s) and is usually in advanced stages.1,2 Splenomegaly and lymph node enlargement are typically present, in addition to bone marrow, liver, and gastrointestinal tract involvement.2

[ Read More ]

Idelalisib and Ibrutinib 2 Promising B-Cell Receptor–Signaling Inhibitors for B-Cell Malignancies

Phoebe Starr

Emerging Therapies

New York, NY—Targeted therapy to the B-cell receptor signaling is paying off in chronic lymphocytic leukemia (CLL) and in other B-cell lymphomas. Two novel oral agents—the PI3K inhibitor idelalisib and the Bruton’s tyrosine kinase (BTK) inhibitor ibrutinib—show great promise for these malignancies. These drugs have been studied in phase 3 trials, and current studies are focusing on combination strategies and new schedules to improve outcomes. In addition, both drugs have recently been submitted for review by the US Food and Drug Administration (FDA).

[ Read More ]