TAP Vol 2 Issue 13

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Renal cell carcinoma 11

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Oncology drug shortage 13

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VOLUME 2, ISSUE 13

Head and neck carcinoma 23

SEPTEMBER 1, 2011 ASCOPost.com

Editor-in-Chief, James O. Armitage, MD

Thoracic Oncology

Fixing the Drug Shortage: It’s About Time

World Conference on Lung Cancer: Personalized Approaches to Treatment By Caroline Helwick

T

he 14th World Conference on Lung Cancer hosted more than 7,000 attendees in Amsterdam recently, with the theme “Better Care through Personalized Medical Approaches.” The following are brief summaries of key data presented at the conference, with perspective provided by Roy S. Herbst, MD, PhD, of Yale Cancer Center in New Haven, Connecticut (see sidebar on page 3).

response rate was only 15.5% with chemotherapy, according to Gervais and colleagues from France.1 “We now have results for the use of first-line erlotinib in Asian and Western mutation-positive patients with NSCLC. I think EURTAC is a big step toward individualized lung cancer care,” said Radj Gervais, MD, of the Centre Francois Baclesse in Caen, France.

First-line Erlotinib

High EGFR Expression Predicts Survival

In EURTAC (n = 174), the first phase III study of erlotinib (Tarceva) to include Western patients with non–small cell lung cancer (NSCLC) who had epidermal growth factors receptor (EGFR) mutations, first-line treatment with the drug nearly doubled progression-free survival compared with chemotherapy. Progression-free survival was 9.4 months vs 5.2 months, respectively, and median overall survival was 22.9 months and 18.8 months, respectively. Although 54.5% paSEE PAGE 39 tients responded to erlotinib, the

High levels of EGFR expression predicted prolonged survival in patients with NSCLC who received cetuximab (Erbitux) in combination with chemotherapy in the first-line setting, according to a new analysis of the phase III FLEX trial.2 Among 1,121 patients, researchers found that individuals with high EGFR expression (200+ on a scale of 0–300) consistently benefited from the addition of cetuximab. Their median overall survival was 12 months, compared with 9.6 months for the chemotherapy-alone arm, a 27% reduction in risk (P = .011). The 1-year survival rates were 50% vs 37%, and continued on page 3

Increased Use of Hospital Services Boosts Oncology Spending

Cost of Care

or our ongoing series on the rising costs of cancer care, The ASCO Post spoke with Lee N. Newcomer, MD, Senior Vice President of Oncology for UnitedHealthcare. Dr. Newcomer is responsible for improving cost-effective cancer care at the nation’s largest health insurer. He shed light on areas of costs that are less transparent than drug prices, but are just as much a part of the problem of the untenable rise in health-care costs.

have spent the past 30 years trying to improve the results of treatment for advanced cancer. I had the privilege of working with Sir Michael Peckham when the late Professor Tim McElwain and he were evolving variants of the PVB (cisplatin, vinblastine, bleomycin) and PEB (cisplatin, etoposide, bleomycin) regimens for testicular cancer in the United Kingdom. This occurred soon after Drs. Larry Einhorn, John Donohue, Mel Samuels, and others had developed the final modifications of the vinblastine/bleomycin regimen with the addition of cisplatin, creating for the first time a regimen that achieved cure in more than 70% of patients with metastatic testicular cancer (as compared to the previous > 70% death rate). We took some missteps along the way, including attempts to reduce toxicity by the introduction of carboplatin into the regimen continued on page 2

Not Just About Drugs

High-priced cancer drugs tend to get the most press when it comes to rising cancer care costs. Are we missing something that could better inform the debate? Yes. Hospital care costs are inflating as quickly as drug costs. Our cancer costs at UnitedHealthcare are driven largely by the dramatic rise in unit costs of hospital services. Even though the hospital day census for cancer cases is dropping, our overall hospital costs are increasing in In most communities, double digits because each hospital due largely to consolidation day costs more each year. With all the attention drugs are getting, this point of the hospital industry, has been lost in the debate.

Lee N. Newcomer, MD

I

Dr. Raghavan is President, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina.

By Ronald Piana

F

By Derek Raghavan, MD, PhD

the market has become an oligopoly, which diminishes our leverage to negotiate for better, more competitive pricing.

MORE IN THIS ISSUE Oncology Meetings Coverage 14th World Conference on Lung Cancer ��� 1 2011 ASCO Annual Meeting ������������ 11, 12 Institute of Medicine National Cancer Policy Forum ������������������������������ 24 Practice Guidelines ����������������������������������������� 4 Direct from ASCO ��������������������������������������� 16 Oncology Worldwide ���������������������������������� 29 FDA Update �������������������������������������������������� 34

How does that apply to the overall debate over costs? It is a universal problem for all diseases that require hospital care. Sure, the skyrocketing prices of cancontinued on page 8

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