Value-Based Cancer Care Issues


April 2017, Vol 8, No 2

Shifting Targets for Providers, Payers, and Patients with Cancer: Perspectives in Healthcare Reform

Gail Thompson

Value in Oncology

Las Vegas, NV—A panel discussion at the 2017 Cancer Center Business Summit revealed continuing gaps in the evolution of healthcare reform among providers, payers, and patients with cancer. Michael Kolodziej, MD, National Medical Director, Managed Care Strategy, Flatiron Health, New York, NY—an oncologist with experience on the provider and the payer sides—moderated the panel discussion, which offered perspectives from the trenches on healthcare reform. [ Read More ]

Nivolumab May Be a New Treatment Option for Patients with Advanced Gastric Cancer, Experts Suggest

Wayne Kuznar

GI Cancers Symposium

San Francisco, CA—Nivolumab (Opdivo) as salvage treatment significantly reduced the risk for death after second-line or later chemotherapy in patients with advanced gastric or gastroesophageal junction cancer. In a double-blind, randomized phase 3 trial, the median overall survival was improved by 37% in patients assigned to nivolumab versus placebo after previous treatment with at least 2 regimens, reported Yoon-Koo Kang, MD, PhD, Department of Oncology, Asan Medical Center, Seoul, South Korea, at the 2017 Gastrointestinal Cancers Symposium. [ Read More ]

Leveraging Financial Advocates to Improve Patient Care

Meg Barbor, MPH

Value in Oncology

St Louis, MO—Financial counselors can help patients find assistance with the often-prohibitive costs of cancer treatment. According to Jordan Karwedsky, a financial counselor at HSHS St Vincent Regional Cancer Center and Green Bay Oncology, Green Bay, WI, patients at these organizations saved more than $1 million on intravenous and oral chemotherapy in 2015 through copay assistance. [ Read More ]

Adding Everolimus to Antiestrogen Therapy Doubles Progression-Free Survival in Advanced Breast Cancer

Charles Bankhead

Breast Cancer

San Antonio, TX—The addition of the mTOR inhibitor everolimus (Afinitor) to the antiestrogen chemotherapy fulvestrant (Faslodex) led to a 2-fold increase in progression-free survival (PFS) in patients with advanced hormone receptor (HR)-positive breast cancer compared with fulvestrant alone, according to results of a randomized clinical trial presented at the 2016 San Antonio Breast Cancer Symposium. [ Read More ]

FDA News – April 2017

FDA News & Updates

  • Keytruda Receives Accelerated Approval for Relapsed/Refractory Classical Hodgkin Lymphoma
  • Kisqali, a New CDK4/CDK6 Inhibitor, Approved for First-Line Therapy in HR-Positive, HER2-Negative Advanced Breast Cancer
  • Xermelo First Oral Treatment Approved for Carcinoid Syndrome Diarrhea in Patients with NETs
  • Revlimid Receives New Indication for Maintenance Therapy in Multiple Myeloma After Autologous Stem-Cell Transplant
  • Opdivo a New Option for Advanced or Metastatic Bladder Cancer
  • Imbruvica First Nonchemotherapy Drug Approved for Relapsed/Refractory Marginal Zone Lymphoma
  • Rubraca Receives Accelerated Approval for Advanced Ovarian Cancer
  • Zejula a New Option for Maintenance Treatment of Recurrent Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancers
[ Read More ]

Good News for a Different Type of CDK4/CDK6 Inhibitor in Early Breast Cancer

Phoebe Starr

Breast Cancer

San Antonio, TX—Neoadjuvant therapy with the investigative CDK4/CDK6 inhibitor abemaciclib, alone or in combination with anastrozole (Arimidex), showed promising activity in postmenopausal hormone receptor (HR)-positive, HER2-negative breast cancer enrolled in the phase 2 NeoMONARCH study. Correlative tissue studies demonstrated that abemaciclib inhibited cell-cycle proliferation and activated the immune system, supporting its anticancer activity. Abemaciclib received a breakthrough therapy designation in 2015 as monotherapy for the treatment of patients with refractory HR-positive advanced breast cancer in heavily pretreated patients. [ Read More ]

Hair Preservation Improved by 50% with Investigational Scalp-Cooling Device

Charles Bankhead

Breast Cancer

San Antonio, TX—The use of an investigational electronic scalp-cooling device in patients with breast cancer who had received alopecia-inducing chemotherapy resulted in reduced or no hair loss in 50% of the patients, according to results of a randomized clinical trial reported at the 2016 San Antonio Breast Cancer Symposium. By contrast, no patient in the control group had hair preservation. [ Read More ]

Benefit of Extended Adjuvant Aromatase Inhibition in Breast Cancer Now in Question

Phoebe Starr

Breast Cancer

San Antonio, TX—Extended adjuvant endocrine therapy beyond 5 years with an aromatase inhibitor (AI) failed to improve disease-free survival (DFS) in patients with hormone receptor (HR)-positive breast cancer who were enrolled in the 3 large National Surgical Adjuvant Breast and Bowel Project (NSABP) B-52, IDEAL, and DATA studies, which were presented at the 2016 San Antonio Breast Cancer Symposium. [ Read More ]

How Washington Is Shaping a New Healthcare Reform

Gail Thompson

Value in Oncology

Former Senator Bill Frist, MD, opened the 2017 Cancer Center Business Summit in Las Vegas, NV, in early February, with a smile and a warning that we are in unfamiliar territory as the new Congress and the new administration move into 2017, territory that may occur only 2 or 3 times in a century. He said that, “For the first time since 1929, the GOP [the Republican Party] controls Congress, the White House, most governorships and state houses, as well as the Supreme Court.” [ Read More ]

Comparing the Current Value Frameworks in Oncology

Meg Barbor, MPH

Value in Oncology

Chicago, IL—Escalating drug prices have put value frameworks in the spotlight, and the identification of the key questions and the audience addressed in each value framework is vital to understanding the value landscape, said Kasia Shields, PharmD, MBA, BCOP, BCPS, Director, Medical Communications, Xcenda/AmerisourceBergen, at the 2016 Hematology/Oncology Pharmacy Association Oncology Pharmacy Practice Management Program. [ Read More ]

Reduced-Dose Sorafenib with Uptitration in Hepatocellular Carcinoma Is Cost-Saving Without Compromising Outcome

Wayne Kuznar

GI Cancers Symposium

San Francisco, CA—Starting at a low dose of sorafenib (Nexavar) and titrating up to the full dose of 800 mg, rather than starting the full dose, does not adversely affect outcomes, while improving tolerability and reducing costs in the treatment of patients with hepatocellular carcinoma (HCC). This was the conclusion from a review of 4900 veterans diagnosed with HCC who were prescribed sorafenib at Veterans Administration (VA) hospitals. [ Read More ]

Cisplatin Added to Standard Regimen Leads to Unprecedented Response Rate in Patients with Stage IV Pancreatic Cancer

Wayne Kuznar

GI Cancers Symposium

San Francisco, CA—The addition of cisplatin to standard therapy with gemci­tabine and nab-paclitaxel was associated with a median overall survival (OS) that “has not been seen in stage IV pancreatic cancer,” according to Gayle Jameson, MSN, ACNP-BC, Nurse Practitioner Investigator of Clinical Trials, HonorHealth Research Institute, Scottsdale, AZ, who reported the results from a phase 1b single-arm pilot study using the triplet at the 2017 Gastrointestinal Cancers Symposium. [ Read More ]

Urelumab Safe and Active as Monotherapy and in Combination with Nivolumab in Several Types of Cancer

Walter Alexander

Immunotherapy

National Harbor, MD—The investigational CD137 agonist urelumab, given as monotherapy and in combination with the anti–PD-1 monoclonal antibody nivolumab, demonstrated safety and, in some patients with hematologic and solid tumor malignancies, promising antitumor activity, according to results of 2 early-phase studies presented at the 2016 Society for Immunotherapy of Cancer annual meeting. [ Read More ]

Immunotherapy with Nivolumab plus Ipilimumab Improves Outcomes in Metastatic Urothelial Cancer

Walter Alexander

Immunotherapy

National Harbor, MD—Results of a phase 1/2 study that investigated 2 dosing regi­mens of 2 immunotherapies—the PD-1 inhibitor nivolumab (Opdivo) plus the CTLA-4 inhibitor ipilimumab (Yervoy)—in patients with previously treated metastatic urothelial carcinoma showed higher response rates and longer median overall survival with the regimen of nivolumab 1 mg/kg plus ipilimumab 3 mg/kg than with the dosing of nivolu­mab 3 mg/kg plus ipilimumab 1 mg/kg. [ Read More ]

1 Cycle of BEP Regimen Equal to 2 Cycles in Patients with High-Risk, Stage 1 Testicular Cancer

Phoebe Starr

Genitourinary Cancers Symposium

Orlando, FL—One cycle of the bleomycin, etoposide, and cisplatin (BEP) regimen had less toxicity and was as effective as 2 cycles in patients with high-risk, nonseminomatous or germ-cell tumors of the testis (NSGCTT), according to results of a large prospective trial called 111 presented at the 2017 Genitourinary Cancers Symposium. Using 1 cycle of BEP as standard of care would reduce exposure to toxicity, and most patients with testicular cancer are relatively young. [ Read More ]

Long-Term Data Support Safety of Lanreotide in Advanced Neuroendocrine Tumors

Charles Bankhead

Neuroendocrine Tumors

San Francisco, CA—Pooled data from 2 randomized clinical trials and several open-label extension studies confirmed the safety and quality-of-life effects of long-term (>12 months) use of the somatostatin analog lanreotide (Somatulin Depot) for advanced neuroendocrine tumors (NETs), including functioning and nonfunctioning NETs, reported Alexandria T. Phan, MD, Medical Oncologist, University of New Mexico Cancer Center, Albuquerque, and colleagues, at a poster session at the 2017 Gastrointestinal (GI) Cancers Symposium. [ Read More ]

Cabozantinib, a Multitargeted TKI, Active in Advanced Neuroendocrine Tumors

Charles Bankhead

Neuroendocrine Tumors

San Francisco, CA—The multitargeted tyrosine kinase inhibitor (TKI) cabozantinib (Cabometyx) demonstrated encouraging activity in patients with advanced neuroendocrine tumors (NETs), including patients who previously received sunitinib (Sutent) or everolimus (Afinitor), according to results from a phase 2 clinical trial, reported Jennifer A. Chan, MD, MPH, Clinical Director, Program in Carcinoid and Neuroendocrine Tumors, Dana-Farber Cancer Institute, Boston, MA, at the 2017 Gastrointestinal Cancers Symposium. [ Read More ]

CAR-Targeting CD22 an Effective Salvage Therapy in Relapsed Pediatric Acute Lymphoblastic Leukemia

Wayne Kuznar

Emerging Therapies

San Diego, CA—Chimeric antigen receptor (CAR)-targeting CD22 therapy induced clinical responses and a high rate of complete remission in children and young adults with relapsed or refractory acute lymphoblastic leukemia (ALL), including patients who had received anti-CD19 CAR T-cell therapy, said Terry J. Fry, MD, Hematologic Malignancies Section, Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), at the 2016 American Society of Hematology meeting. These findings create the opportunity for bispecific or multispecific CAR T-cell targeting. [ Read More ]

New Long-Acting Interferon Effective and Safe in Polycythemia Vera

Wayne Kuznar

Emerging Therapies

San Diego, CA—Ropeginterferon alfa-2b, an investigational, long-acting, mono-pegylated interferon was noninferior to hydroxyurea in achieving complete hematologic response and with superior tolerability to hydroxyurea in the treatment of patients with polycythemia vera, according to the final results of the phase 3 PROUD-PV clinical trial presented by Heinz Gisslinger, MD, Medical University of Vienna, Austria, at the 2016 American Society of Hematology meeting. [ Read More ]

Drug Costs, and Employers as Purchasers of Care

F. Randy Vogenberg, PhD, RPh, FASHP

Employers’ Perspective

Unlike other countries around the world, the United States does not regulate or negotiate drug prices. In general, the European Union members (eg, United Kingdom, France, Germany), Australia, and other countries incorporate pricing at the time of new drug approval, and allow the use of a new drug when it provides a significant clinical benefit over existing drugs, relative to the drug price. [ Read More ]

Anti-CD19 CAR T-Cell Therapy After Stem-Cell Transplantation Effective in Advanced Multiple Myeloma

Wayne Kuznar

Emerging Therapies

San Diego, CA—Anti-CD19 chimeric antigen receptor (CAR) T-cell administration after autologous stem-cell transplant (ASCT) showed clinical activity in patients with advanced multiple myeloma, according to results of a pilot study presented at the 2016 American Society of Hematology meeting. Substantially longer progression-free survival (PFS) was seen in 2 of 10 patients who received ASCT plus CTL019 than in patients who received first-line ASCT, said Alfred L. Garfall, MD, MS, Assistant Professor of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia. [ Read More ]