Value-Based Cancer Care Issues


February 2017, Vol 8, No 1

New Value Model Incorporates Long-Term Adverse Effects of Cancer Drugs

Chase Doyle

Value-Based Care

A new economic model suggests that overall survival and drug toxicity profiles are insufficient for assessing the value of a drug. According to a study that incorporated late adverse events in advanced Hodgkin lymphoma, a more comprehensive benefit-to-risk ratio of a drug requires an understanding of its long-term health implications, said Ohad Oren, MD, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, at the 2016 American Society of Hematology meeting. [ Read More ]

Obinutuzumab Prolongs Survival in Follicular Lymphoma

Phoebe Starr

Lymphoma Highlights

San Diego, CA—Obinutuzumab (Gazyva)-based induction and maintenance chemotherapy extended progression-free survival (PFS) compared with standard-of-care rituximab (Ritux­an)-based chemotherapy in patients with untreated follicular lymphoma, said Robert E. Marcus, MBBS, FRCP, FRCPath, King’s College Hospital, London, who presented the results from the phase 3 GALLIUM clinical trial at the 2016 American Society of Hematology meeting. [ Read More ]

CAR T-Cell Therapy Succeeds in Aggressive Lymphoma

Phoebe Starr

Emerging Therapies

San Diego, CA—The investigational chimeric antigen receptor (CAR) T-cell therapy KTE-C19 achieved complete responses that were durable for >1 year in more than 75% of patients with aggressive lymphomas who had no other effective treatment options, according to results from the phase 2 pivotal clinical trial ZUMA-1 that were presented by Sattva S. Neelapu, MD, Department of Lymphoma/Myeloma, M.D. Anderson Cancer Center, at the 2016 American Society of Hematology meeting. [ Read More ]

Glasdegib, a Hedgehog Inhibitor, Nearly Doubles Survival in AML or High-Risk MDS

Wayne Kuznar

Emerging Therapies

San Diego, CA—Adding the investigational smoothened (SMO) receptor inhibitor glasdegib to low-dose cytarabine (Depo­Cyt) significantly increased overall survival (OS) compared with low-dose cytarabine monotherapy in patients with acute myeloid leukemia (AML) or high-risk myelodysplastic syndrome (MDS) who were ineligible for intensive chemotherapy, according to a phase 2 study presented by Jorge E. Cortes, MD, Department of Leukemia, M.D. Anderson Cancer Center, Houston, TX, at the 2016 American Society of Hematology meeting. [ Read More ]

Novel Hypomethylating Agent Active in Patients with High-Risk Myelodysplastic Syndromes or Chronic Myelomonocytic Leukemia

Charles Bankhead

Emerging Therapies

San Diego, CA—Approximately 33% of patients with newly diagnosed, higher-risk myelodysplastic syndromes (MDS) or chronic myelomonocytic leukemia (CMML) attained complete responses with the novel hypomethylating agent guadecitabine, according to results of a phase 2 study reported by Guillermo Montalban-Bravo, MD, M.D. Anderson Cancer Center, Houston, at the 2016 American Society of Hematology meeting. [ Read More ]

R-CHOP Prevails Over Dose-Adjusted EPOCH-R as Standard of Care for Diffuse Large B-Cell Lymphoma

Phoebe Starr

Lymphoma Highlights

San Diego, CA—The CALGB/Alliance 50303 clinical trial failed to show that dose-adjusted treatment with the EPOCH-R (etoposide, phosphate, prednisone, vincristine sulfate, cyclophosphamide, doxorubicin hydrochloride, and rituximab) regimen was superior to standard therapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone) in patients with diffuse large B-cell lymphoma (DLBCL). Both treatment regimens were equally effective for event-free survival (EFS) and overall survival (OS), but dose-­adjusted EPOCH-R was associated with a higher incidence of adverse events than R-CHOP, said lead investigator Nancy L. Bartlett, MD, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, at the 2016 American Society of Hematology meeting. [ Read More ]

Pembrolizumab Produces Durable Responses in Relapsed or Refractory Cutaneous T-Cell Lymphoma

Wayne Kuznar

Lymphoma Highlights

San Diego, CA—The PD-1 inhibitor pembrolizumab (Keytruda) has good activity in patients with relapsed or refractory mycosis fungoides or Sézary syndrome, and the responses it produces are deep and durable, according to study results reported by Michael Khodadoust, MD, PhD, Medicine-Oncology, Division of Oncology, Stanford University School of Medicine, CA, at the 2016 American Society of Hematology meeting. [ Read More ]

Brentuximab Vedotin Improves Responses Lasting 4 Months in Cutaneous T-Cell Lymphoma

Wayne Kuznar

Lymphoma Highlights

San Diego, CA—Brentuximab vedotin (Adcetris) monotherapy significantly improved the objective response rate (ORR) lasting ≥4 months compared with the investigator’s choice of standard therapy in patients with cutaneous T-cell lymphoma (CTCL), reported Youn H. Kim, MD, Director, Multidisciplinary Cutaneous Lymphoma Clinic, Stanford University School of Medicine, CA, at the 2016 American Society of Hematology meeting. [ Read More ]

Pacritinib Shows Good Efficacy in Myelofibrosis: Will the FDA Release Hold on the Drug?

Phoebe Starr

Myelofibrosis

San Diego, CA—The investigational drug pacritinib, a JAK1/JAK2 inhibitor, achieved benefits in patients with myelofibrosis, including a significant reduction in the spleen volume compared with the best available therapy that included the JAK1/JAK2 inhibitor ruxolitinib (Jakafi), according to the phase 3 PERSIST-2 clinical trial. The results were presented by John O. Mascarenhas, MD, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, at the 2016 American Society of Hematology (ASH) meeting. [ Read More ]

Venetoclax plus Bortezomib and Dexamethasone Produces High Responses in Patients with Relapsed or Refractory Multiple Myeloma

Wayne Kuznar

Multiple Myeloma

San Diego, CA—The addition of venetoclax (Venclexta) to bortezomib (Velcade) and dexamethasone yields high response rates in patients with relapsed or refractory multiple myeloma, especially in patients with disease that is not refractory to bortezomib and who received 1 to 3 previous lines of therapy, according to findings presented by Philippe Moreau, MD, Department of Hematology, Nantes University Hospital, France, at the 2016 American Society of Hematology meeting. [ Read More ]

American Society of Hematology 2016: Multiple Myeloma Highlights

Multiple Myeloma

  • Adding Daratumumab to Lenalidomide and Dexamethasone in Previously Treated Patients with Relapsed or Refractory Multiple Myeloma Improves Outcomes
  • Real-World Evidence Regarding Newer Treatment Options, Overall Survival, and Healthcare Costs in Patients with Multiple Myeloma
  • Long-Term Analysis of the CASTOR Trial: Adding Daratumumab to Bortezomib and Dexamethasone in Patients with Relapsed or Refractory Multiple Myeloma
  • The Use of Early Response Can Guide Treatment Selection in Patients with Newly Diagnosed Multiple Myeloma
  • Using Montelukast to Reduce Infusion Reactions in Patients with Relapsed or Refractory Multiple Myeloma
[ Read More ]

ASCO Value Framework Ill-Equipped to Assess Value of Therapies in Chronic Lymphocytic Leukemia

Chase Doyle

Value-Based Care

San Diego, CA—A study examining the feasibility and applicability of the American Society of Clinical Oncology (ASCO) Value Framework in chronic lymphocytic leukemia (CLL) suggests that the tool, although useful in assessing a small percentage of drug regimens, may need to be amended to be useful in CLL, reported Erlene K. Seymour, MD, Assistant Professor, Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, at the 2016 American Society of Hematology meeting. [ Read More ]

Value Frameworks Unreliable in Assessing Novel Hematologic Therapies

Chase Doyle

Value-Based Care

San Diego, CA—The American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO) developed frameworks to determine the relative value of novel therapeutic agents. These value frameworks, however, may need to be modified to assess treatments for hematologic malignancies, suggested Matthew C. Cheung, MD, SM, FRCPC, Clinical Hematologist, Odette Cancer Centre, Toronto, Ontario, Canada, at the 2016 American Society of Hematology meeting. [ Read More ]

Increased Utilization of Biosimilars in Oncology Could Save Payers Millions

Chase Doyle

Economics & Value, Value-Based Care

San Diego, CA—Filgrastim (Neupogen), a short-acting granulocyte colony-stimulating factor (G-CSF), has helped to manage chemotherapy-induced neutropenia in patients with nonmyeloid malignancies, but it comes with a hefty price tag. According to a recent study, biosimilars of filgrastim may provide a more affordable option for US payers, suggested Susan Gabriel, Director of Global Health Economics and Outcomes Research, Teva Pharmaceuticals, Frazer, PA, at the 2016 American Society of Hematology meeting. [ Read More ]

American Society of Hematology 2016: Leukemia Highlights

Leukemia

  • 5-Year Ibrutinib Therapy in Treatment-Naïve Patients with Relapsed or Refractory CLL or SLL
  • Updated Safety and Efficacy Data for Ibrutinib as First-Line Treatment in Older Patients with CLL or SLL
  • Long-Term Follow-Up of Chlorambucil plus Rituximab Combination as Frontline Therapy for Elderly and/or Unfit Patients with CLL, Including Risk Stratification
  • Reviewing the Demographics and First-Line Treatment Patterns in Patients with CLL
  • Comparing Healthcare Utilization of 2 Drug Regimens in Patients with CLL
[ Read More ]

BEACOPP Regimen Superior to ABVD in Newly Diagnosed, Advanced Hodgkin Lymphoma

Chase Doyle

Value-Based Care

San Diego, CA—In transplant-eligible patients with newly diagnosed, advanced-stage Hodgkin lymphoma, a decision-analytic model showed that chemotherapy with bleomycin, plus etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) maximized life-expectancy and quality-adjusted life expectancy compared with doxorubicin plus bleomycin, vinblastine, and dacarbazine (ABVD) therapy in the first-line setting, reported Abi Vijenthira, MD, Princess Margaret Cancer Centre, University of Toronto, Canada, at the 2016 American Society of Hematology meeting. [ Read More ]

Health Plans Must Monitor the Oncology Pipeline to Apply Appropriate Coverage Criteria, Maintain Treatment Value

James T. Kenney Jr, RPh, MBA

Payer's Perspective

The 2016 American Society of Hematology (ASH) meeting provided insight into new treatment options and mechanism of action choices for hematologic cancers. Health plans need to continue to expand their knowledge and expertise in all cancer types to maintain the ability to manage and apply coverage criteria appropriately as FDA approvals continue to increase in oncology. [ Read More ]