Value-Based Cancer Care Issues


December 2019, Vol 10, No 6

Value-Based Care Management Medicare Program Changes for 2020 and Beyond

Joe Bailes, MD; Gena Cook

Online First, Value-Based Care

Medicare models for value-based care in oncology started with the Oncology Care Model (OCM), which was launched in July 2016 and will run until June 2021. Value-based care is here to stay, as the Centers for Medicare & Medicaid Services (CMS) continues to develop and test more value-based models and tools through the Center for Medicare & Medicaid Innovation. CMS recently released an informal Request for Information on a proposed Oncology Care First model to succeed the first OCM. Commercial payers and state governments are also introducing their own value-based agreements with community oncology practices, hospitals, and health systems. [ Read More ]

Real-World Applications of Value-Based Care in Oncology

AVBCC 2019 Highlights

New York, NY—With cancer drugs representing some of the most expensive pharmaceuticals on the market, conversations abound around value in oncology and proposed solutions for achieving it. At the 2019 AVBCC Summit, experts on the topic of drug pricing hashed out which frameworks are best suited for real-world applications in cancer care. [ Read More ]

Paradigm Shift: PARP Inhibitors Should Be Offered to All Patients with Ovarian Cancer

Phoebe Starr

ESMO 2019

Barcelona, Spain—Poly (ADP-ribose) polymerase (PARP) inhibition has an established role as maintenance therapy in women with newly diagnosed high-grade advanced ovarian cancer and a BRCA mutation. At the ESMO Congress 2019, results of 3 clinical trials expand the use of PARP inhibition in ovarian cancer to all patients. The 3 studies had different enrollment criteria, used a different PARP inhibitor, and 2 of them used PARP inhibitor plus bevacizumab (Avastin); however, taken together, all 3 trials show that the PARP inhibition era is here. [ Read More ]

Targeted Therapy with Olaparib Beneficial in Metastatic Prostate Cancer with Gene Mutations

Phoebe Starr

ESMO 2019

Barcelona, Spain—The poly (ADP-ribose) polymerase (PARP) inhibitor olaparib (Lynparza) delayed disease progression and showed a trend toward improved survival compared with newer hormonal agents in men with pretreated metastatic castrate-resistant prostate cancer (CRPC) and homologous recombinant repair (HRR) gene mutations or with BRCA1, BRCA2, and ATM mutations. Results of this late-breaker were reported at the ESMO Congress 2019 during the presidential session. [ Read More ]

Postsurgery Observation Better Than Radiotherapy in Men with Prostate Cancer

ESMO 2019

Barcelona, Spain—Results of the new clinical trial RADICALS-RT indicate that using salvage radiotherapy immediately after surgery leads to equivalent outcomes in terms of progression-free survival (PFS) versus adjuvant radiotherapy in men with prostate cancer undergoing radical prostatectomy. These late-breaking results were presented at the ESMO Congress 2019 by lead investigator Chris Parker, MD, FRCR, MRCP, Consultant Clinical Oncologist, Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, England. [ Read More ]

FDA Approves Calquence for Adults with CLL or SLL

FDA Approvals, News & Updates

On November 21, 2019, the FDA accelerated the approval of acalabrutinib (Calquence; AstraZeneca) for adults with chronic lymphocytic leukemia (CLL) or with small lymphocytic lymphoma. This drug was approved 4 months earlier than the FDA PDUFA date. The FDA used its priority review for these 2 indications and granted ­acalabrutinib a breakthrough therapy designation for these indications. [ Read More ]

Zejula Receives FDA Approval for HRD-Positive Advanced Ovarian Cancer

FDA Approvals, News & Updates

On October 23, 2019, the FDA approved a new indication for the PARP inhibitor niraparib (Zejula; ­Tesaro) for the treatment of patients with homologous recombination deficiency repair (HRD)-positive advanced ovarian, fallopian tube, or primary peritoneal cancer, after receiving ≥3 chemotherapy regimens. HRD is defined by a deleterious or suspected deleterious BRCA mutation, or a genomic instability associated with disease progression more than 6 months after the ­tumor’s response to the last platinum-­based chemotherapy. On the same day, the FDA also approved the Myriad myChoice CDx test to select patients for niraparib therapy based on the HRD tumor status. [ Read More ]

Osimertinib Superior TKI as First-Line Treatment of Advanced NSCLC with EGFR Mutation

Phoebe Starr

Lung Cancer

Barcelona, Spain—Osimertinib (Tagrisso), a third-generation EGFR tyrosine kinase inhibitor (TKI), extended overall survival (OS) compared with older TKI EGFR inhibitors, including gefitinib (Iressa) or erlotinib (Tarceva), as first-line treatment for patients with advanced non–small-cell lung cancer (NSCLC) and EGFR mutation in the phase 3 clinical trial called FLAURA. [ Read More ]

Nivolumab plus Ipilimumab Combination Improves Survival in Patients with Metastatic NSCLC

Lung Cancer

Barcelona, Spain—The immunotherapy combination of nivolumab (Opdivo) plus ipilimumab (Yervoy) improved overall survival (OS) compared with chemotherapy as first-line treatment in patients with advanced non–small-cell lung cancer (NSCLC) and PD-L1 expression ≥1%, according to results of CheckMate 227. The OS was also improved with nivolumab plus ipilimu­mab compared with chemotherapy in the total study population and in patients whose tumors had low (<1%) PD-L1 expression. [ Read More ]

Practice-Changing Results: Ivosidenib First Targeted Therapy to Show Benefits in Patients with Cholangiocarcinoma and IDH1 Mutation

Wayne Kuznar

Cholangiocarcinoma

Barcelona, Spain—Ivosidenib (Tib­sovo), an oral therapy that targets isocitrate dehydrogenase-1 (IDH1) mutation, significantly improved progression-free survival (PFS) in patients with advanced cholangiocarcinoma (CCA) and an IDH1 mutation, in a phase 3 clinical trial reported lead investigator Ghassan K. Abou-Alfa, MD, Medical Oncologist, Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York City, at the ESMO Congress 2019. [ Read More ]

Pemigatinib Effective in Patients with Cholangiocarcinoma and FGFR2 Fusion or Rearrangement

Wayne Kuznar

Cholangiocarcinoma

Barcelona, Spain—Alterations in the fibroblast growth factor receptor (FGFR)2 gene have been identified as driver mutations in cholangiocarcinoma (CCA). Durable objective responses were observed in >33% of patients with locally advanced or metastatic CCA and FGFR2 rearrangements or fusions who received treatment with pemigatinib, a selective oral inhibitor of FGFR1, FGFR2, and FGFR3. Data from the single-arm, open-label phase 2 clinical trial FIGHT-202, which was presented at the ESMO Congress 2019, revealed that investigational pemigatinib induced a response in 35.5% of the 107 patients with FGFR2 fusions or rearrangements (cohort A), with a median duration of response of 7.5 months. [ Read More ]

Ensuring Patient Access to Cancer Care Must Be a Priority

AVBCC 2019 Highlights

New York, NY—Patients with cancer are not just faced with a terrifying disease; they must also surmount an uphill climb when it comes to accessing care. Advocates—some of whom have shared in their experiences as patients—are hard at work to ensure access is a reality. A roundtable discussion of patient advocates at the 2019 AVBCC Summit focused on identifying the major obstacles to care and what can be done to improve patient access. [ Read More ]

Barriers to Value-Based Contracting in Oncology

AVBCC 2019 Highlights

New York, NY—With drug-pricing legislations currently before the House and the Senate, the issue of demonstrating value in high-cost drug therapies has become the front and center of the healthcare conversation. Moderator Roger Longman, MA, Co-Founder and Chairman, Real Endpoints LLC, a reimbursement-focused analytics and advisory firm, engaged an expert panel on the topic of value-based agreements during the 2019 AVBCC Summit. [ Read More ]

Payers’ Perspectives on Value in Cancer Care

AVBCC 2019 Highlights

New York, NY—At the 2019 AVBCC Summit, a panel of payers, moderated by Mike Kolodziej, MD, Vice President, Chief Innovation Officer, ADVI Health, discussed strategies for improving the delivery of value-based cancer care, along with changes on the horizon as payers and providers strive to maximize access to high-quality oncology drugs. [ Read More ]

The Future of Cancer Care: Change Is the Only Certainty

AVBCC 2019 Highlights

New York, NY—By its very nature, oncology is rife with change, with new research resulting in treatment advances at a rapid pace. Pending federal legislation aimed at reining in prescription drug prices and an upcoming presidential election may introduce yet further changes in oncology. A discussion on these issues was presented at the 2019 AVBCC Summit in October, with a look at the oncology landscape. [ Read More ]

Biosimilars Are Key Components of Oncology Today: Brush Up on the Basics

Meg Barbor, MPH

NCCN 2019 Hematologic Malignancies

San Francisco, CA—An increasing number of biosimilars have been approved in the United States, but many clinicians are still poorly informed about what constitutes a biosimilar, and what is involved in their unique pathway to approval, said Andrew D. Zelenetz, MD, PhD, Medical Oncologist, Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York City. He discussed this topic at the NCCN 2019 Hematologic Malignancies meeting. [ Read More ]

Genetic Profiling and Personalized Medicine in Myelodysplastic Syndromes

Meg Barbor, MPH

NCCN 2019 Hematologic Malignancies

San Francisco, CA—Personalization of therapy in the treatment of patients with myelodysplastic syndrome (MDS) is focused primarily on risk classification of patients. Once clinical risk has been established, treatment considerations should be informed by features such as disease subtype, prognostic somatic mutations, chromosomal abnormalities, targetable somatic mutations, immunologic features, and patient factors, according to Rafael Bejar, MD, PhD, Assistant Professor of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA. [ Read More ]