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 ]
October 2013, Vol 4, No 8
An evolving crisis in cancer care will reach a critical mass over the next 15 to 20 years without a transition to a more patient-centered, evidence-based delivery system, warn the authors of a report from the Institute of Medicine (IOM).[ Read More ]
Hollywood, FL—Oncology growth for the next couple of years will be driven by several strong trends, according to Doug Long, Vice President of Industry Relations, IMS Health, who described these trends at the 3rd Annual Conference of the Association for Value-Based Cancer Care.
IMS analyses of the oncology landscape indicate the following trends:[ Read More ]
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 ]
On September 10, 2013, the Institute of Medicine (IOM), part of the National Academy of Sciences, published a 315-page report, titled “Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis”. [ Read More ]
The US Food and Drug Administration (FDA) granted accelerated approval to pertuzumab (Perjeta; Genentech) as part of a treatment regimen for the neoadjuvant setting (ie, before surgery) for patients with HER2-positive early-stage breast cancer. This is the first time that the FDA approved a drug for the neoadjuvant treatment of patients with breast cancer.[ Read More ]
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 ]
Mandate to Demonstrate Value in Cancer Care Is Growing: Oncologists Urged to Be Part of the Solution
The cost of cancer care has become a frequent topic of conversation in oncology conferences and publications, as well as among other stakeholders, including patients and payers. In a recent editorial published in the Journal of Clinical Oncology, David G. [ Read More ]
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 ]
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 ]
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.
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 ]
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 ]
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 ]
San Francisco, CA—In a population of patients with metastatic breast cancer and Medicare Part D claims, the mean lifetime cost of treatment was approximately $102,000, according to a study presented at the 2013 Breast Cancer Symposium by Hope S. Rugo, MD, Director, Breast Oncology Clinical Trials Program, University of California, San Francisco.[ Read More ]
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 ]
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 ]
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 ]
The availability of a test that would be able to improve the risk versus benefit assessment of long-term adjuvant endocrine therapy for late recurrence in patients with estrogen receptor (ER)-positive breast cancer would be a valuable tool for enhancing the treatment decision-making of oncologists. [ Read More ]
Niagara Falls, Ontario—Researchers have determined that 18F-fluorodeoxyglucose (FDG) positron emission tomography (FDG-PET), a widely available and relatively inexpensive imaging modality, could be used to shape treatment plans for patients who have been diagnosed with high Gleason score prostate cancer.[ Read More ]
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 ]
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 ]
Hollywood, FL—Contracting in oncology has become a more complicated process, now that it involves many entities beyond physicians and payers. Dawn G. Holcombe, MBA, Vice President, Strategic Relationships, Florida Cancer Specialists, Sarasota, FL, described the scenario at the 3rd Annual Conference of the Association for Value-Based Cancer Care.[ Read More ]
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 ]
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 ]
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 ]
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
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
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 ]
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 ]
Costs to Medicare Nearly Twice as High for Hospital Outpatient versus Community-Based Oncology Services
A new analysis of Medicare claims between 2009 and 2011 has revealed that patients with cancer receiving chemotherapy in hospital outpatient settings are billed at rates that are 25% to 47% higher than for equivalent oncology services rendered at community-based physicians’ offices.[ Read More ]