Value-Based Cancer Care Issues


September 2016, Vol 7, No 8

ASCO Develops First-Ever Guidelines for Pain Management in Cancer Survivors

Charles Bankhead

Cancer Pain

Every patient with cancer and cancer survivors should undergo screening for pain at each follow-up visit, and clinicians should individualize the recommendations for intervention as indicated by each patient’s self-reported pain, according to the first-ever clinical guidelines for managing pain in cancer survivors recently published by a panel of experts convened by the American Society of Clinical Oncology (ASCO). [ Read More ]

NCI’s Acting Director: Data-Sharing, Immunotherapy, and the Cancer Moonshot Initiative

Laura Morgan

Cancer Moonshot

The national Cancer Moonshot initiative, led by Vice President Joe Biden, was established to accelerate the progress in cancer outcomes, including prevention, diagnosis, and treatment. First introduced in January 2016, the initiative is focused on moving cancer research forward in a meaningful way by encouraging greater cooperation between cancer research institutions and increasing data-sharing for that purpose, said Douglas R. Lowy, MD, Acting Director, National Cancer Institute (NCI), at the 2016 American Association of Physicists in Medicine annual meeting in Washington, DC. [ Read More ]

Concurrent Radiation and Temozolomide Lowers Risk for Death in Elderly Patients with Glioblastoma

Walter Alexander

Brain Cancer

The first study to assess the addition of temozolomide (Temodar) chemotherapy during short-course radiation therapy, followed by monthly maintenance of temozolomide in elderly patients with glioblastoma showed a significantly reduced risk for death, said the study co-author James R. Perry, MD, FRCPC, The Crolla Family Endowed Chair in Brain Tumour Research, Odette Cancer and Sunnybrook Health Sciences Centres, Toronto, Canada, in a plenary session at the 2016 American Society of Clinical Oncology annual meeting. [ Read More ]

Assessing the Cost–Benefit of Immune Checkpoint Inhibitors

Chase Doyle

Value in Oncology

Although immune checkpoint inhibitors can significantly extend survival of patients with metastatic disease, more than 50% of the patients who use them have serious, grade 3 to grade 5 adverse events. These toxicities comprise a considerable proportion of the total number of immune checkpoint inhibitors, especially those that target PD-1, said Neil T. Mason, MBA, Personalized Medicine Strategist, Moffitt Cancer Center, Tampa, FL, who presented his study results at a poster session at the 2016 American Society of Clinical Oncology annual meeting. [ Read More ]

Referring Radical Prostatectomies to High-Volume Providers Could Save Millions

Chase Doyle

Value in Oncology

A new study of the geographic distribution of cancer surgeries in the Medicare population has shown that performing radical prostatectomies in high-volume centers leads to improved outcomes and reduced costs of care. Referring patients to a high-volume provider within 100 miles could save >$20 million annually, according to data presented at the 2016 American Society of Clinical Oncology annual meeting and published just before the meeting. [ Read More ]

Guidelines and Pathway: Link to Benefit Design by Employers

Kristin Jarrell, PharmD; Michael Toscani, PharmD

Employers’ Perspective

In today’s changing oncology landscape, the quality and value of cancer care have become increasingly integrated. With the rising costs of cancer treatment, payers and policymakers aim to better define value, as well as to educate patients about their therapeutic options. Insurers and payers have implemented a variety of strategies to control costs at the behest of employer plan sponsors, including utilizing oncology clinical pathways. [ Read More ]

In the Literature – September 2016

In the Literature

  • Enzalutamide Superior to Bicalutamide in Patients with Prostate Cancer
  • Two-Drug Combination Shows Promise for Recurrent Small-Cell Lung Cancer
  • Olanzapine Helps Prevent Chemotherapy-Related Nausea and Vomiting
  • Neratinib Demonstrates Efficacy for a Subgroup of Patients with Breast Cancer
[ Read More ]

FDA News – September 2016

FDA Approvals, News & Updates

  • Sustol, First Extended-Release 5-HT3 Approved for the Prevention of CINV
  • Keytruda Receives New Indication for Head and Neck Squamous-Cell Carcinoma
  • Cabometyx Approved for Patients with Advanced Renal-Cell Carcinoma
  • DiviTum, Noninvasive Blood Test, Receives Expanded US Patent
[ Read More ]

Clinical Pathways in Payment Reform Should Address Risk Adjustment

Chase Doyle

Clinical Pathways

It does not take a crystal ball, or even an economist, to foretell that disaster is imminent in the healthcare system if premiums and out-of-pocket costs continue to rise, along with the cost of cancer drugs. Although the government attempts to rectify the situation with Medicare payment reform, new payment and care delivery models, such as the Oncology Care Model (OCM) pilot, and laws, such as the 2015 Medicare Access and CHIP Reauthorization Act (MACRA), present financial challenges for oncologists. [ Read More ]

Changes in Patient-Reported Outcomes Linked to Better Survival in Metastatic Prostate Cancer

Charles Bankhead

Prostate Cancer

Patient-reported outcomes had significant associations with survival in metastatic castration-resistant prostate cancer (mCRPC), suggesting potential implications for clinical management, reported Tomasz M. Beer, MD, Oregon Health & Science University, Knight Cancer Institute, Portland, and colleagues, at the 2016 International Society for Pharmacoeconomics and Outcomes Research annual meeting. [ Read More ]

Nearly Half of Pancreatic Cancer Surgery Candidates Are Not Offered that Option

Charles Bankhead

Pancreatic Cancer

Pancreatic cancer is the third leading cause of cancer-related death in the United States. Nearly half of patients with locoregional pancreatic cancer do not undergo potentially curative surgery, primarily because of nonclinical factors, according to the results of an analysis of data from the National Cancer Institute database by Amy T. Cunningham, MPH, a doctoral candidate at Thomas Jefferson University in Philadelphia, and colleagues. [ Read More ]

Adding Capecitabine to Gemcitabine Chemotherapy After Pancreatic Cancer Surgery Improves Survival

Walter Alexander

Pancreatic Cancer

Adding capecitabine chemotherapy to gemcitabine after pancreatic cancer resection was associated with longer overall survival (OS) than gemcitabine chemotherapy alone, according to results from the European Study Group for Pancreatic Cancer (ESPAC)-4 clinical trial. For the small proportion of patients with pancreatic cancer who are candidates for surgery, adjuvant gemcitabine chemotherapy is the current standard of care worldwide, said John P. Neoptolemos, MD, Chair of Surgery, University of Liverpool, United Kingdom, during an oral abstract session at the 2016 American Society of Clinical Oncology annual meeting. “We thought that the combination of gemcitabine plus capecitabine…may be better than gemcitabine alone, and launched the phase 3 ESPAC-4 trial,” he stated. [ Read More ]

Venetoclax Shows Promising Efficacy in Relapsed or Refractory Acute Myelogenous Leukemia

Wayne Kuznar

Hematologic Cancers

Venetoclax (Venclexta) monotherapy has significant clinical activity in patients with acute myelogenous leukemia (AML) whose disease has relapsed or is resistant to chemotherapy and in those deemed unable to tolerate chemotherapy, according to a new study. The overall response rate (ORR) for venetoclax in the phase 2 single-arm study was 19%, with complete remissions in some patients. This was the first study to examine venetoclax monotherapy in patients with relapsed or refractory AML or untreated AML who are unfit for intensive therapy. [ Read More ]

Lenalidomide Maintenance Therapy After ASCT Shows Survival Benefit in Patients with Multiple Myeloma

Walter Alexander

Hematologic Cancers

A meta-analysis of overall survival (OS) in 3 clinical trials of lenalidomide (Revlimid) maintenance therapy after high-dose melphalan (Alkeran) and autologous stem-cell transplantation (ASCT) for multiple myeloma showed long-term disease control and prolonged OS. A slightly increased risk for a secondary primary malignancy is outweighed by the OS benefit, said lead investigator Philip McCarthy, MD, Roswell Park Cancer Institute, Buffalo, NY, in an oral presentation at the 2016 American Society of Clinical Oncology annual meeting. [ Read More ]

Collaborative Oncology Care Requires Good Mentoring, Self-Study

Alice Goodman

Collaborative Care

Collaborative oncology care, which involves incorporating an advanced practitioner (AP) into an oncology practice, will help meet the growing burden of complex care and improve patient satisfaction. Collaborative care is also cost-effective, and oncologists report increased professional satisfaction when an AP is part of their practice, said Wendy H. Vogel, MSN, FNP, AOCNP, Wellmont Cancer Institute, Kingsport, TN, at the 2016 American Society of Clinical Oncology (ASCO) annual meeting. Ms Vogel discussed the role of the AP in providing advanced oncology care to the community. [ Read More ]

HF10 plus Ipilimumab Increases Response Rates in Metastatic Melanoma

Walter Alexander

Melanoma

When combined with systemic ipilimumab (Yervoy), the investigational oncolytic viral immunotherapy HF10, a mutation of the HF strain of the herpes simplex virus type 1 (HSV-1), has local and systemic activity in patients with metastatic melanoma, said Robert Andtbacka, MD, CM, Huntsman Cancer Institute, Salt Lake City, during a poster presentation at the 2016 American Society of Clinical Oncology meeting. He added that HF10 substantially improves the response rate of ipilimumab alone and does not exacerbate ipilimumab toxicity. [ Read More ]

Gene Signature May Identify Nonresponders to Nivolumab

Alice Goodman

Personalized Medicine

Immunotherapies have changed the way many patients with cancers, including patients with renal-cell carcinoma (RCC), are treated. Although some patients have a dramatic response to immunotherapies that appears to be sustained over the long-term, a large proportion of patients do not respond to treatment with programmed death (PD)-1 or PD ligand 1 (PD-L1) inhibitors. Therefore, the search continues for biomarkers that can help to determine which patients will likely respond to available checkpoint inhibitors, optimizing treatment selection. [ Read More ]

Increase in Drug Spending Largely Attributed to Rebates Pocketed by Pharmacy Benefit Managers

Robert Goldberg, PhD

Patient Advocacy

Total drug spending in the United States, based on invoice prices, reached $425 billion in 2015, according to the IMS Institute for Healthcare Informatics report, “Medicines Use and Spending in the U.S.: A Review of 2015 and Outlook to 2020.” When adjusted for net price spending, $310 billion went to drug and biotech companies, but where the other $115 billion went is often omitted from media coverage. [ Read More ]

Tecentriq (Atezolizumab) First PD-L1 Inhibitor Approved for Patients with Advanced or Metastatic Urothelial Carcinoma

Lisa A. Raedler, PhD, RPh

Drug Updates

Urothelial carcinoma (also known as transitional-cell carcinoma) is the most common subtype of bladder cancer, accounting for more than 90% of bladder cancer diagnoses in the United States. In 2016, nearly 77,000 cases of bladder cancer are expected to be diagnosed in the United States, and more than 16,000 people will die from this disease. The incidence of bladder cancer increases with age, with a median age of 73 years at diagnosis. [ Read More ]