Value-Based Cancer Care Issues


February 2018, Vol 9, No 1 | Payers’ Perspectives In Oncology: ASH 2017 Highlights

CAR T-Cell Therapy Makes Significant Inroads in Lymphoma: Kymriah and Yescarta Show Durable Remissions

Phoebe Starr

Immunotherapy

Atlanta, GA—CD19-directed chimeric antigen receptor (CAR) T-cell therapy continues to show excellent and durable responses in patients with lymphoma who have no other treatment options. Two studies presented at ASH 2017 provide encouraging news for 2 new drugs, including long-term follow-up of the pivotal ZUMA-1 study of the CAR T-cell therapy axicabtagene ciloleucel (Yescarta), and primary results from the JULIET study of tisagenlecleucel (Kymriah). [ Read More ]

Mogamulizumab, Anti-CCR4 Antibody, Improves Survival in Patients with Advanced Cutaneous T-Cell Lymphoma

Charles Bankhead

Emerging Therapies

Atlanta, GA—Mogamulizumab, a monoclonal antibody targeting CC chemokine receptor type 4 (CCR4), significantly reduced the risk for disease progression or death in patients with untreated cutaneous T-cell lymphoma (CTCL) compared with vorinostat (Zolinza), reported Youn H. Kim, MD, Director, Multidisciplinary Cutaneous Lymphoma Program, Stanford Medicine, California, at ASH 2017. [ Read More ]

Oral Multiple Myeloma Medication Linked to Decreased Productivity Loss

Chase Doyle

Multiple Myeloma, Value-Based Care

Atlanta, GA—A recent analysis of a commercial claims database suggests that oral therapy for multiple myeloma may help decrease the economic burden for patients and healthcare systems. According to data presented at ASH 2017, patients with multiple myeloma who received injectable therapy used significantly more disability benefits and incurred higher productivity costs than patients who received oral medications. [ Read More ]

Acute Myeloid Leukemia Treatment Episodes Linked to Significant Economic Burden

Chase Doyle

Value-Based Care

Atlanta, GA—A retrospective analysis of a large commercial payer database has demonstrated a link between various treatment episodes of acute myeloid leukemia and substantial economic burden. According to data presented at ASH 2017, healthcare resource use and direct healthcare costs were associated with high-intensity chemotherapy induction, hematopoietic stem-cell transplantation (HSCT), and episodes of relapsed or refractory disease in a US commercially insured population. [ Read More ]

Phase 2 Study of Brentuximab Vedotin plus Ibrutinib for Patients with Relapsed/Refractory Hodgkin Lymphoma

ASH 2017

Brentuximab vedotin (BV), an antibody drug conjugate, selectively delivers the antitubulin agent, monomethyl auristatin E, to CD30+ cells. In a multicenter phase 2 trial in patients with relapsed/refractory (R/R) Hodgkin lymphoma (HL), BV showed an overall response rate (ORR) of 75%, a complete response (CR) rate of 34%, and a median duration of response (DOR) of 6.7 months. [ Read More ]

Preliminary Results of Prophylactic Tocilizumab After Axicabtagene Ciloleucel (axi-cel; KTE-C19) Treatment for Patients with Relapsed/Refractory, Aggressive NHL

ASH 2017

ZUMA-1 is a pivotal, multicenter trial of axicabtagene ciloleucel (axi-cel), an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy, for the treatment of patients with refractory, aggressive non-Hodgkin lymphoma (NHL). The objective response rate (ORR) was 82% with a 54% rate of complete response (CR), and 44% of responses were ongoing at the time of the primary analysis. Grade ≥3 cytokine release syndrome (CRS) and neurologic events (NEs) occurred in 13% and 28% of patients, respectively. [ Read More ]

Median 3.5-Year Follow-Up of Ibrutinib Treatment in Patients with Relapsed/Refractory Mantle-Cell Lymphoma: A Pooled Analysis

ASH 2017

Ibrutinib (ibr) is a first-in-class oral inhibitor of Bruton’s tyrosine kinase approved for relapsed/refractory (R/R) mantle-cell lymphoma (MCL). The results of a pooled analysis of 370 patients with R/R MCL treated with ibr in the SPARK, RAY, and PCYC-1104 studies were previously reported (median follow-up, 24 months). At ASH 2017, the authors presented median 3.5-year follow-up in these patients, including additional exposure and follow-up of 87 patients across the 3 studies who enrolled in the long-term access study, CAN3001. [ Read More ]

Adverse Events, Resource Use, and Economic Burden in Patients with Mantle-Cell Lymphoma in the United States

ASH 2017

In patients with mantle-cell lymphoma (MCL), adverse events (AEs) can impair patient adherence to planned therapeutic regimens, and moderate-to-severe AEs generally require medical attention and are often associated with increased healthcare resource use (HRU) and costs. At ASH 2017, the authors presented the results of a retrospective cohort analysis designed to assess HRU and direct costs of MCL, examine variation in costs across treatment types, and document the economic burden associated with MCL treatment-related AEs. [ Read More ]

Ibrutinib, Fludarabine, Cyclophosphamide, and Obinutuzumab (GA101) for First-Line Treatment of Patients with CLL with Mutated IGHV and without TP53 Aberrations

ASH 2017

The combination of fludarabine, cyclophosphamide, and rituximab (FCR) has been the standard first-line treatment for young patients with chronic lymphocytic leukemia (CLL), with a complete remission (CR) rate after 6 cycles of 40% to 72%, and an undetectable bone marrow (BM) minimal residual disease (MRD) rate after 6 cycles of 43% to 58%. [ Read More ]

Profound Symptom Burden of Myeloproliferative Neoplasms Highlighted in New Studies

Chase Doyle

ASH 2017, Conference Correspondent

Atlanta, GA—A pair of recent studies from the Mayo Clinic underscore the serious symptom burden experienced by patients diagnosed with myeloproliferative neoplasms (MPNs), according to data presented at ASH 2017. Specifically, patients with MPNs are at high risk for depression, and those with Philadelphia chromosome–negative disease are afflicted with sleep and psychiatric disturbance as well. [ Read More ]

Ibrutinib plus Venetoclax Combo Elicits Impressive Responses in Relapsed Chronic Lymphocytic Leukemia

Wayne Kuznar

Leukemia

Atlanta, GA—Ibrutinib (Imbruvica) plus venetoclax (Venclexta) led to an objective response rate of 100% in patients with relapsed or refractory chronic lymphocytic leukemia (CLL), with 47% in complete remission at 6 months. These high response rates were achieved with only 1 case of laboratory tumor lysis syndrome, said Peter Hillmen, MBChB, PhD, FRCP, FRCPath, Leader, Section of Experimental Haematology, Leeds Institute of Cancer and Pathology, United Kingdom, at ASH 2017. [ Read More ]

Recent FDA Approvals for ALL a “Watershed” Moment

Chase Doyle

Leukemia

Atlanta, GA—The past few years have witnessed significant progress in the treatment of several hematologic malignancies, and truly paradigm-changing therapies have recently emerged in acute lymphoblastic leukemia (ALL). At ASH 2017, Crystal L. Mackall, MD, Co-Director, Immunology & Immunotherapy of Cancer Program, Stanford University, CA, discussed the FDA approvals of 2 important treatments for patients with B-cell precursor ALL. [ Read More ]

New BTK Inhibitor Leads to Durable Responses in Relapsed or Refractory Chronic Lymphocytic Leukemia

Charles Bankhead

Leukemia

Atlanta, GA—More than 90% of patients with relapsed or refractory chronic lymphocytic leukemia (CLL) achieved objective responses with the new Bruton’s tyrosine kinase (BTK) inhibitor acalabrutinib (Calquence), updated data from an ongoing study showed. In most cases, the responses were durable, reported John C. Byrd, MD, Director, Division of Hematology, the Ohio State University Comprehensive Cancer Center, Columbus, at ASH 2017. [ Read More ]

Venetoclax plus Rituximab New Chemotherapy-Free Option for Chronic Lymphocytic Leukemia

Phoebe Starr

Leukemia

Atlanta, GA—Venetoclax (Venclexta) plus rituximab (Rituxan) achieved superior progression-free survival (PFS) and overall survival (OS) compared with standard-of-care bendamustine (Treanda/Bendeka) plus rituximab in patients with relapsed or refractory chronic lymphocytic leukemia (CLL). PFS improved by 81% and OS by 52% with venetoclax plus rituximab, and the depth of response was impressive—complete response and complete response with incomplete platelet recovery was 26.8%, and minimal residual disease negativity in peripheral blood was 83.5%. [ Read More ]

Daratumumab Therapy for Smoldering Myeloma Extends Progression-Free Survival

Wayne Kuznar

Multiple Myeloma

Atlanta, GA—Single-agent daratum­umab (Darzalex) shows significant activity in smoldering multiple myeloma (SMM). The 12-month progression-free survival (PFS) rate with a long dosing schedule of daratumumab was 95%, and the median PFS was not yet reached in any of the 3 dosing schedules studied, announced Craig C. Hofmeister, MD, MPH, Associate Professor, Division of Hematology, the Ohio State University, Columbus, at ASH 2017. [ Read More ]

A New Combination as First-Line Regimen in Advanced Hodgkin Lymphoma?

Phoebe Starr

Lymphoma

Atlanta, GA—Adding brentuximab vedotin (Adcetris) to doxorubicin, vinblastine, and dacarbazine (A+AVD) instead of the standard regimen with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) as frontline treatment for advanced Hodgkin lymphoma reduced the risk for disease progression, death, or the need for additional therapy by 23%, according to new data presented at ASH 2017. [ Read More ]

Brentuximab Vedotin plus Nivolumab Yields High Complete Responses in Relapsed or Refractory Hodgkin Lymphoma

Chase Doyle

Lymphoma

Atlanta, GA—Interim results from a phase 1/2 study of the combination of brentuximab vedotin (Adcetris) and nivolumab (Opdivo) have demonstrated a high overall response rate (ORR) in patients with relapsed or refractory Hodgkin lymphoma. According to data presented at ASH 2017, 83% of patients responded to the combination, which included a 62% rate among efficacy-evaluable patients. [ Read More ]

PET-Directed Approach Can Guide Radiation Therapy in Diffuse Large B-Cell Lymphoma

Phoebe Starr

Lymphoma

Atlanta, GA—A positron emission tomography (PET)-directed approach after standard chemotherapy can guide the need for consolidation radiation therapy in patients with diffuse large B-cell lymphoma (DLBCL). This approach can spare patients from further treatments, such as salvage chemotherapy and stem-cell transplant, as well as unnecessary radiation therapy, according to a study presented at ASH 2017. [ Read More ]

Nivolumab plus Azacitidine Shows Encouraging Activity in R/R AML or as Frontline Therapy in Elderly Patients with AML

ASH 2017

Available preclinical and clinical evidence suggests that inhibition of PD-1/PD-L1 pathways increases antileukemic responses in acute myeloid leukemia (AML). Moreover, azacitidine treatment results in upregulation of PD-1 signaling, which is associated with azacitidine resistance. Based on this rationale, the current study evaluated the safety and efficacy of combination nivolumab plus azacitidine treatment in 2 patient cohorts: those with relapsed or refractory (R/R) AML with poor-risk features, and in elderly patients with untreated AML. [ Read More ]

Enasidenib Monotherapy Is Well-Tolerated and Active in Older Patients with Untreated mIDH2 AML

ASH 2017

Enasidenib (AG-221) is a novel, small-molecule oral inhibitor of mutated IDH2 (mIDH2) proteins that is currently indicated for the treatment of adult patients with mIDH-positive relapsed or refractory (R/R) acute myeloid leukemia (AML). The phase 1 AG221-C-001 study demonstrated the clinical efficacy of enasidenib in patients with mIDH2 R/R AML. Given the limited treatment options for older patients with untreated AML, the current analysis sought to evaluate the clinical outcomes for older patients with previously untreated mIDH2 AML who received enasidenib monotherapy in the AG221-C-001 study. [ Read More ]

Safety and Tolerability of Midostaurin from Expanded Treatment Protocol in Patients with FLT3 Mutation–Positive, Newly Diagnosed AML

ASH 2017

Midostaurin, a multikinase inhibitor targeting FLT3 and KIT, is indicated for the treatment of patients with newly diagnosed, FLT3 mutation–positive acute myeloid leukemia (AML) in combination with standard induction and consolidation chemotherapy, based on demonstrations of superior survival outcomes versus placebo in the randomized, double-blind, phase 3 RATIFY trial. The Radius-X open-label expanded treatment protocol (ETP) was designed to provide access to midostaurin and obtain additional insights into the safety and tolerability profile of midostaurin in adult patients with newly diagnosed, FLT3 mutation–positive AML. [ Read More ]

Encouraging Efficacy and Safety with Enasidenib or Ivosidenib plus Azacitidine in Patients with Newly Diagnosed AML

ASH 2017

Enasidenib and ivosidenib monotherapy have demonstrated induction of clinical responses in patients with mutant IDH (mIDH) relapsed/refractory acute myeloid leukemia (AML), whereas azacitidine (AZA) monotherapy prolongs survival in older patients with the newly diagnosed (ND) AML. Based on these results and coupled with preclinical evidence of synergy with combination of mIDH inhibitors plus AZA, an ongoing phase 1b/2 study evaluated the efficacy and safety of this combination in ND AML; results of the phase 1b portion were reported at ASH 2017. [ Read More ]