Articles

Background: Healthcare costs are a continued concern among employers and other purchasers, and extend especially to biologics that are being increasingly scrutinized to demonstrate value over time. A significant cost challenge to employers, these drugs create logistical issues for patients, physicians, pharmacies, and manufacturers owing to their unique approval requirements, dosing, side effects, and distribution methods. The costs of biologics are also hard to track, because they show up in medical as well as pharmacy expenditures.

Background: According to the National Institutes of Health, medical expenditures are projected to reach $158 billion by the year 2020. This represents a 27% increase from 2010 costs. Prostate cancer is in the top 5 contributors of this cost, and is projected to reach $12 billion. Advancements in drugs, surgery, and radiation therapy have all contributed to an increase in costs. Payers are feeling increased pressure to make cost-effective choices among these agents.

A new meta-analysis confirmed that patients with breast cancer who achieve a pathologic complete response (pCR) to neoadjuvant therapy have a more favorable outcome than those who do not.

Observational studies have sug­gested that the antidiabetes agent metformin (Glucophage) may have anticancer effects. New studies have attempted to confirm this, but the results and their meaning still remain unclear.

More evidence is accumulating that vitamin D levels play a role in breast cancer outcomes. Investigators from the United Kingdom reported that postmenopausal women with sufficient vitamin D levels were significantly less likely to develop bone metastases when taking zoledronic acid (Zometa) compared with women with lower vitamin D levels.

The antidepressant venlafaxine (Effexor) is often prescribed to patients with breast cancer who are taking tamoxifen (Nolvadex) to help reduce the side effect of hot flashes. But according to research presented at the meeting, venlafaxine may reduce the effectiveness of tamoxifen.

Histone deacetylase (HDAC) inhibitors may have a future in the targeted treatment of triple-negative breast cancer, if the results of in vitro studies can be replicated clinically.

Although many clinicians are already prescribing fulvestrant (Faslodex) at a dose of 500 mg, a phase 3 study presented at the meeting confirmed the superiority of this dose over 250 mg.

A comparison of letrozole (Fem­ara) with tamoxifen (Nolva­dex) demonstrated that the former may be superior for the treatment of postmenopausal estrogen receptor (ER)-positive patients who have lobular carcinoma, according to a subanalysis of patients in the phase 3 BIG 1-98 trial.

Black women and other racial minorities are less likely than white women to receive sentinel lymph node (SLN) dissection as the standard of care for clinically node-negative breast cancer, and this has negative consequences, an analysis of the Surveillance, Epidemiology and End Results (SEER)/Medicare database suggested.