The Peer-Reviewed Forum for Real-World Evidence in Benefit Design ™ august 2013 Vol 6, No 6 I SPECIAL ISSUE
For Payers, Purchasers, Policymakers, and Other Healthcare Stakeholders
Payers’ Perspectives in Oncology Including ASCO 2013 Highlights
ASCO President Highlights Off-Label Drug Use in Oncology for 18% of Spending Bridges to Conquer Cancer Accounts Mean number of claims for unapproved indications By Wayne Kuznar
averages 11 per patient By Caroline Helwick
Photo by © ASCO/Silas Crews 2013
Chicago, IL—An examination of the Surveillance, Epidemiology and End Results (SEER)-Medicare database from 1998 to 2008 revealed that a significant number of patients with cancer receive drugs that are neither indicated by the US Food and Drug Administration (FDA) for the specific condition nor endorsed by the National Comprehensive Cancer Network (NCCN) compendia—and 18% of the spending on cancer drugs is for off-label drug use.
Chicago, IL—“Building Bridges to Conquer Cancer” was the theme of the 2013 American Society of Clinical Oncology (ASCO) annual meeting, as well as of the address of AS-
CO’s outgoing President Sandra M. Swain, MD. Dr Swain’s address focused on 3 pillars of the theme: (1) ensuring global health equity, (2) the need to
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Immunotherapies Take Center Stage in Melanoma
New drug therapies will push value questions to the forefront By Audrey Andrew Chicago, IL—Data continue to build for the application of immunotherapy for patients with metastatic melanoma. At ASCO 2013, several sessions were devoted to recent advances in melano-
ma, focusing on new ways to boost the activity of current therapies, introducing a new class of immunotherapy in development, and a new form of immunotherapy—an oncolytic vaccine.
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Cancer Drug Pipeline Is Bustling By Caroline Helwick and Wayne Kuznar Chicago, IL—Targeted therapies and immune-focused agents with novel mechanisms of action yielded impressive outcomes in the early- and late-phase studies that were reported at ASCO 2013. Melanoma The MEK inhibitor selumetinib is the first drug to prove effective in patients with metastatic uveal (ocular)
melanoma, according to phase 2 clinical trial results. In a study of 98 patients, 50% of those receiving selumetinib had tumor regression compared with 11% of the patients in the control group who received temozolomide (Temodar). The median progression-free survival (PFS) was 15.9 weeks and 7.0 weeks (P = .005), respectively, a 54% risk reduction. Lynn Mara Schuchter, MD, Program Leader,
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in th is is s u e Health Economics . . . . . . . . . . . Nearly 1 in 5 patients with cancer reports financial distress Eliminating copay increases mammography screening rates EMERGING THERAPIES. . . . . . . Pazopanib for ovarian cancer
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PERSONALIZED MEDICINE. . . . 27 Strategies to overcome the challenges of personalized medicine HEALTH POLICY. . . . . . . . . . . . . 28 Will FDA approve surrogate end point for neoadjuvant breast cancer? © 2013 Engage Healthcare Communications, LLC
“We found a lot of off-label use,” said Dawn L. Hershman, MD, MS, Associate Professor of Medicine and Epidemiology, Division of Hematology/ Oncology, Columbia University Medical Center, New York, who presented these findings at ASCO 2013. The extent of off-label use is a policy concern, because the clinical benefits of such use for patients may not outweigh the costs or the adverse health outcomes, Dr Hershman said.
BREAST CANCER. . . . . . . . . . . 34 10 years of tamoxifen prolongs survival PROSTATE CANCER. . . . . . . . . . 35 Patient lack of knowledge increases unnecessary treatment DRUG THERAPY . . . . . . . . . . . . . Sorafenib effective in metastatic thyroid cancer
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DRUG UPDATE . . . . . . . . . . . . . . Xofigo for metastatic CRPC
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PAYERS’ PERSPECTIVE. . . . . . . 39 Cancer care in 2013: hope, reality, and a call to action