Glioblastoma and Immunotherapy
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| Advanced Breast Cancer
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| Adolescents and Young Adults With Cancer
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VOLUME 6, ISSUE 14
AUGUST 10, 2015
Editor-in-Chief, James O. Armitage, MD | ASCOPost.com
ASCO Plenary Report
Value: What Do We Mean, Who Should Decide?
Bevacizumab More Cost-Effective Than Cetuximab in Metastatic Colorectal Cancer By Caroline Helwick
T
he landmark CALGB/SWOG 80405 concluded that bevacizumab (Avastin) and cetuximab (Erbitux) provide comparable benefit in the treatment of metastatic colorectal cancer. However, in terms of cost, bevacizumab was recently declared the winner. In an economic analysis presented at the 2015 ASCO Annual Meeting, researchers reported that treatment with bevacizumab cost $39,000 less per patient than cetuximab.1 “Chemotherapy plus bevacizumab costs less and achieves very similar survival and quality-adjusted survival as chemotherapy plus cetuximab for first-line treatment of KRAS wild-type metastatic colorectal cancer,” announced Deborah Schrag, MD, MPH, of Dana-Farber Cancer Institute, Boston. The results of the CALGB/SWOG 80405 headto-head comparison of the drugs were presented at the 2014 ASCO Plenary Session last year by Venook and colleagues.2 At a median follow-up of 24 months,
By John F. Smyth, MD
median overall survival was 29 months in the bevacizumab arm and 29.9 months in the cetuximab arm, and median progression-free survival was 10.8 months and 10.4 months, respectively.
From Clinical to Cost Findings
O Deborah Schrag, MD, MPH
The current analysis evaluated the regimens in terms of their cost-effectiveness, an analysis that was prospectively planned for CALGB/SWOG 80405, “given the high costs of all the study arms,” Dr. Schrag said. For the average patient, the 2014 cost for one 8-week cycle of treatment was $9,324 for bevacizu continued on page 4
Issues in Oncology
Is Proton-Beam Therapy Facing a Difficult Future? By Ronald Piana
H
ealth-care experts are questioning whether pro- in 1946.1 The first treatments were performed in the ton-beam therapy is on the verge of an economic Berkeley Radiation Laboratory in 1954. The first hosbubble—ie, a rapid surge in growth for the industry pital-based proton-beam center in the United States beyond its intrinsic value, inevitably leading to a dras- was at the Loma Linda University Medical Center, tic drop in earnings for which began operation proton centers when in 1990. Proton-beam therapy is the biggest the “bubble bursts.” A Despite the stickerproton-beam facility can shock price to build a and most expensive technology cost upward of $250 milproton center and the on the market. But is it the best? lion to construct. With high cost of treatment, 13 proton centers in In prostate cancer, there are no data to proton-beam therapy operation in the United has surged in use over sufficiently answer that question. States, 6 more centers set the past several decades, to open by the end of this and much of that growth year, and another 10 planned to open by 2018, a “pro- has been in prostate cancer. The chief selling point for ton bubble” would spell financial havoc for that sector men diagnosed with prostate cancer is the purported of the health-care system. precision dosing of proton therapy, which decreases the risk of the two most feared side effects: incontiUpswing in Usage Despite High Costs nence and impotence. The suggestion that protons could be effective in Moreover, when a hospital-based proton center treating cancers was made by the American physi- incurs a $200-plus million debt, it must amortize that continued on page 41 cist Robert R. Wilson, PhD, in a paper published Send your comments to editor@ASCOPost.com
scar Wilde famously defined a cynic as “a man who knows the price of everything and the value of nothing.” I do not think that oncologists need to be as cynical as this, but it was very appropriate that a major theme of this year’s ASCO Annual Meeting was the concept of “value.” It is clear that there are widely differing attitudes to what we mean by value in oncology, and I would suggest that all members of society need to consider this in a timely fashion—balancing the extraordinary success of medical research vs the pressure of finding the resources to translate this knowledge into practical health care. continued on page 77
Dr. Smyth is Emeritus Professor of Medical Oncology, University of Edinburgh, United Kingdom. Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO.
MORE IN THIS ISSUE Oncology Meetings Coverage ASCO Annual Meeting Metastatic Colorectal Cancer ��������������������� 1 Value in Cancer Care ���������������� 1, 5, 9–10 Glioblastoma ����������������������������������������������� 3 National Cancer Policy Forum �������52–53 High-Risk Prostate Cancer ���������������������� 12 Direct From ASCO �������������������������� 37–40 Emil J Freireich, MD, Pioneer in Oncology �����������������������������������56 In Memoriam ���������������������������������������������62 Richard J. Boxer, MD, on Cost vs Values ��������������������������������������� 66
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