Value-Based Cancer Care Issues


February 2014, Vol 5, No 1

Hematologic Drug Pipeline Boasts Novel Approaches

Wayne Kuznar

Emerging Therapies

New Orleans, LA—Novel options for the treatment of patients with hematologic conditions are in the pharmaceutical pipeline, with many drugs showing promising results. Here is a look at key studies presented at the 2013 American Society of Hematology annual meeting.

Chronic Lymphocytic Leukemia
Phase 3 studies of idelalisib demonstrated impressive progression-free survival (PFS) in previously treated patients with chronic lymphocytic leukemia (CLL).

[ Read More ]

Obinutuzumab Outperforms Rituximab in Older Patients with CLL

Jayson Slotnik, JD, MPH

In the Literature

The anti-CD20 antibody rituximab (Rituxan), combined with chemotherapy agents, had been shown to prolong overall survival (OS) in physically fit patients with previously untreated chronic lymphocytic leukemia (CLL), but not in those with comorbidities. In a recent head-to-head, randomized, phase 3 trial of older patients, researchers investigated the benefit of the anti-CD20 antibody obinutuz­umab (Gazyva) plus chlorambucil (Leukeran) compared with rituximab plus chlorambucil in patients with previously untreated CLL and coexisting conditions (Goede V, et al. [ Read More ]

Adverse Events Reporting Suboptimal in Oncology Publications

Jayson Slotnik, JD, MPH

In the Literature

Transparent and comprehensive reporting of AEs in published results of oncology-related clinical trials is crucial for the treatment of patients with cancer. In efforts to improve reporting of clinical trials results, the Consolidated Standards of Reporting Trials (CONSORT) extension group developed 10 recommendations in 2003 for reporting AEs. A new study of 175 publications assessed the degree to which the publication of phase 3 trials in oncology adhered with CONSORT recommendations (Sivendran S, et al. J Clin Oncol. 2014;32:83-89).

[ Read More ]

New Gene Mutation Identified in Myeloproliferative Neoplasms

Jayson Slotnik, JD, MPH

In the Literature

New research shows promise in deciphering the underlying mechanism of myeloproliferative neoplasms (MPNs), according to findings from a recently reported study (Klampfl T, et al. N Engl J Med. 2013;369:2379-2390).

The Janus kinase 2 (JAK2) gene is present in approximately 50% to 60% of patients with essential thrombocythemia or primary myelofibrosis, and an additional 5% to 10% have activating mutations in the thrombopoietin receptor gene, MPL. However, no specific molecular marker has been identified in the remaining 30% to 45% of patients.

[ Read More ]

Statin Therapy Lowers Mortality in Patients with Prostate Cancer

Jayson Slotnik, JD, MPH

In the Literature

Statin use has been shown to improve lipid profiles and to reduce cardiovascular morbidity and mortality. A 2012 study found that statins may have antitumor effects in various cancer types, including prostate cancer. Observational studies have investigated the association between statin use and different prostate cancer outcomes, but the findings were inconsistent. Also, these studies did not specifically assess whether the use of statins before the diagnosis of prostate cancer modified the association regarding the use of statins after diagnosis. [ Read More ]

NCI Pilot Trial to Assess Value of Genetic Sequencing for Improving Patient Outcomes

Jayson Slotnik, JD, MPH

Value Propositions

The National Cancer Institute (NCI) has launched a clinical trial to determine whether selecting therapies based on genetic mutations can improve outcomes in patients with metastatic solid tumors. Molecular Profiling based Assignment of Cancer Therapeutics (M-PACT) is one of the first randomized trials to assess if using genetic mutation as the basis for treatment selection can improve the rate and duration of response in patients with advanced-stage solid tumors.

[ Read More ]

ASCO Launches Value in Cancer Care Initiative

Jayson Slotnik, JD, MPH

Value Propositions

Responding to the relentless economic pressures on patients and oncologists and the ever-escalating costs of cancer care delivery, the American Society of Clinical Oncology (ASCO), in collaboration with the Value in Cancer Care Task Force, is developing a working definition of “value” in oncology, as well as identifying how to incorporate the implications of that approach into clinical decision-making in patient care.

[ Read More ]

M.D. Anderson’s Scientists Collaborate with Pfizer to Enhance Immunotherapy in Oncology

Jayson Slotnik, JD, MPH

Value Propositions

Researchers at the University of Texas M.D. Anderson Cancer Center have announces a new collaboration with Pfizer to develop immune-based approaches to new therapies for cancer. This new effort is based on M.D. Anderson’s Moon Shots Program that aims to reduce cancer deaths significantly in the future, using the 6 moon shots that target 8 types of difficult-to-treat cancer.

[ Read More ]

Aetna Announced First Patient-Centered Medical Home in Oncology

Jayson Slotnik, JD, MPH

Value Propositions

Late last year, Aetna, together with Consultants in Medical Oncology and Hematology, launched the first patient-centered medical home for oncology. This collaborative program is based on evidence-based decision support in cancer care, using personalized medicine and realigning payment structure with the goal of increasing patient treatment coordination, improving quality outcomes, and reducing overall costs of cancer care.

[ Read More ]

Aromatase Inhibitor–Related Pain Reduced with Exercise Regimen

Charles Bankhead

SABCS 2014

San Antonio, TX—Breast cancer survivors obtained significant relief from aromatase inhibitor–associated joint pain with a prescribed exercise program, the results of a randomized clinical trial showed.

At the end of 1 year, the patients in the exercise group reported 20% to 30% less pain compared with a control group that was randomized to usual care. The benefits were consistent across subgroups, irrespective of age, disease stage, treatment regimen, or duration of aromatase inhibi­­-
t­or therapy.

[ Read More ]

Adjuvant Bisphosphonates: Winner in Postmenopausal Breast Cancer

Phoebe Starr

SABCS 2014

San Antonio, TX—Adjuvant bisphosphonates reduce the risk of bone metastases by approximately 33% and improve breast cancer–related survival by 17% in postmenopausal women with early breast cancer, according to a large meta-analysis reported at the 2013 San Antonio Breast Cancer Symposium (SABCS). Bisphosphonates had no effect on premenopausal women in the adjuvant setting.

[ Read More ]

First Drug Combination Approved for Unresectable or Metastatic Melanoma

Jayson Slotnik, JD, MPH

FDA Approvals, News & Updates

The US Food and Drug Admin­istration (FDA) approved the use of dabrafenib (Tafinlar; GlaxoSmith­Kline) plus trametinib (Mekinist; GlaxoSmithKline) as a new combination therapy for the treatment of patients with advanced melanoma that is unresectable or metastatic. The 2 drugs were individually approved by the FDA in 2013 for melanoma. Each of the 2 drugs blocks molecular signaling in different sites of the same pathway that promotes cancer-cell growth. Dabrafenib was initially approved for patients with melanoma whose tumors express the BRAF V600E mutation. [ Read More ]

Angiotensin System Inhibitors Extend Survival in Patients with Metastatic Renal-Cell Carcinoma

Phoebe Starr

Genitourinary Cancers Symposium

San Francisco, CA—The use of angiotensin system inhibitors (ASIs) improved survival in patients with metastatic renal-cell carcinoma (mRCC) by 9 months, according to a retrospective pooled analysis of several clinical trials presented at the 2014 Genitourinary Cancers Symposium. Survival was further improved if patients were also taking vascular endothelial growth factor (VEGF) receptor–targeted agents.

[ Read More ]

Adding Radiation to Antiandrogen Hormone Therapy Extends Survival in Patients with High-Risk Prostate Cancer

Phoebe Starr

Genitourinary Cancers Symposium

San Francisco, CA—Radiation added to hormone therapy with antiandrogens extended cancer-specific survival, as well as overall survival, when used as the primary treatment of patients with locally advanced or high-risk prostate cancer. In the Scandinavian Prostate Cancer Group VII study, 10- and 15-year survival improved by more than 50% in patients who received radiation plus hormone therapy versus hormone therapy alone, according to an updated analysis presented at the 2014 Genitourinary Cancers Symposium.

[ Read More ]

1 in 5 US Clinical Trials Fails to Complete

Phoebe Starr

Genitourinary Cancers Symposium

San Francisco, CA—The early termination of clinical trials is a tremendous waste of resources and can leave patients with cancer with no improved treatment options. For the first time, a comprehensive study of the clinical trial enterprise in the United States has shown that 20% of 7776 adult phase 2 and 3 clinical trials registered on ClinicalTrials.gov were terminated early. Furthermore, early terminations occurred across all cancer types, according to this retrospective study presented at the 2014 Genitourinary Cancers Symposium.

[ Read More ]

Higher Copays for Imatinib Lead to Medication Nonadherence in Patients with CML

Neil Canavan

Economics of Cancer Care

Patients with chronic myeloid leukemia (CML) and high out-of-pocket (OOP) costs for treating their disease have a 70% chance of discontinuing treatment and a 42% chance of nonadherence to treatment compared with patients with lesser copays. These conclusions, which were recently published online (Dusetzina SB, et al. J Clin Oncol. 2014;32:306-311), have dire implications for a growing population of patients with CML.
[ Read More ]

Physicians Must Consider the Financial Burden Associated with Allogeneic Transplants

Wayne Kuznar

Economics of Cancer Care

New Orleans, LA—Recipients of allogeneic hematopoietic cell transplant are at high risk for financial burden, according to survey-based data collected by Nandita Khera, MD, MPH, a medical oncologist from the Blood and Marrow Transplant Program, Mayo Clinic Arizona, Phoenix, and colleagues.
The reasons include prolonged hospital stays, living away from home, high out-of-pocket (OOP) costs, ex­tended duration of work loss for the patient and caregiver, and the occurrence of chronic medical problems, including complications from the transplant.

[ Read More ]

Rituximab Infusions Costlier When Given in the Hospital than in the Office Setting

Wayne Kuznar

Economics of Cancer Care

New Orleans, LA—More patients with diffuse large B-cell lymphoma (DLBCL) are receiving rituximab infusions in the hospital setting, incurring greater costs than those receiving infusions in the office or clinic, an examination of medical and pharmacy claims has shown.

Rituximab in combination with CHOP (cyclophosphamide, doxorubi­cin, vincristine, and prednisone) is the recommended first-line therapy for DLBCL, improving overall survival compared with CHOP alone.

[ Read More ]

Significant Hospital Costs Tied to 30-Day Readmissions for Allogeneic Transplants

Wayne Kuznar

Economics of Cancer Care

New Orleans, LA—New research has confirmed that 30-day readmission for reduced-toxicity conditioning allogeneic hematopoietic-cell transplantation (allo-HCT) is linked to greater 100-day posttransplant hospital charges.

The finding justifies 30-day readmission as a significant marker of quality of care, said lead investigator Sherri Rauenzahn, MD, a palliative care fellow at West Virginia University in Morgantown, who presented her data at ASH 2013.

[ Read More ]

Peripheral T-Cell Lymphoma Associated with High Clinical Burden, Resource Utilization, and Costs

Wayne Kuznar

Economics of Cancer Care

New Orleans, LA—Peripheral T-cell lymphoma (PTCL) is associated with high resource utilization rates and high overall costs, according to a multicenter study presented at ASH 2013. Hospitalizations, in particular, represent a major clinical and economic burden, indicating the need for treatments requiring lower resource utilization with better PTCL management.

[ Read More ]

PIK3CA Mutation Thwarts Neoadjuvant Anti-HER2 Therapy in Breast Cancer

Charles Bankhead

Personalized Medicine

San Antonio, TX—Patients with HER2-­positive breast cancer harboring a PIK3CA mutation had a significantly lower likelihood of achieving a pathologic complete response (pCR) to neoadjuvant anti-HER2 therapy, the results of 2 large clinical trials presented at the 2013 San Antonio Breast Cancer Symposium (SABCS) showed.

Patients without the mutation had a pCR rate of 37% versus 17% for those with a mutation. The pCR rate for mutated tumors was 17% to 18%, whether patients received a single anti-HER2 agent or a combination.

[ Read More ]

Genetics Providing New Insights into Signaling Pathways and Treatment Targets in ALL

Wayne Kuznar

Personalized Medicine

New Orleans, LA—Those frustrated with low long-term remission rates in adult patients with acute lymphocytic leukemia (ALL) can find hope in the superior outcomes associated with treatment for pediatric ALL. Overall survival (OS) with therapy reaches 85% in children but lags in adults at 45%. Targeting specific pathways and adding novel agents to standard therapy should improve outcomes in adult patients.

[ Read More ]

Dual-Vaccine Combination Improves Survival in Patients with Metastatic Pancreatic Cancer

Jayson Slotnik, JD, MPH

GI Cancers Symposium

San Francisco, CA—A dual-vaccine strategy improved survival more than single vaccination of patients with metastatic pancreatic ductal adenocarcinoma (PDAC). Data from a randomized phase 2 trial were reported by Dung T. Le, MD, Assistant Professor of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, at the 2014 Gastrointestinal Cancers Symposium.

[ Read More ]

Task Force Recommends Annual Screening for Lung Cancer in High-Risk Populations

Neil Canavan

Lung Cancer

The US Preventive Services Task Force (USPSTF) is recommending that individuals aged >55 years who have a history of heavy smoking be screened annually for lung cancer.

If adopted, this initiative will bring an estimated 14% reduction in lung cancer–related mortality as a result of early disease detection, according to the USPSTF position paper, which was recently published online (Moyer VA. Ann Intern Med. 2014 January 14. Epub ahead of print).

[ Read More ]

Abraxane Receives a New Indication for the Treatment of Patients with Metastatic Pancreatic Cancer

Lisa A. Raedler, PhD, RPh

Drug Updates

The American Cancer Society has estimated that approximately 45,220 new cases of pancreatic cancer would be diagnosed in the United States in 2013 and approximately 38,460 patients would die of pancreatic cancer in 2013.1 Despite being the tenth most common cancer, pancreatic cancer is the fourth most common cause of cancer deaths, in part because a large majority of patients present with nonresectable advanced disease.2,3

[ Read More ]