SEPTEMBER 2014 VOL 5 NO 7
INTEGRATING COST, QUALITY, ACCESS INTO CLINICAL DECISION-MAKING IN ONCOLOGY www.ValueBasedCancerCare.com VBCC PERSPECTIVE
Oncologists Can Become Value- Financial Toxicity: Based Providers Using Evidence The Elephant in the to Guide Patient Care (Side Effect) Room By Wayne Kuznar
Chicago, IL—Oncologists should become value-based providers by eliminating unnecessary tests, prescribing cheaper alternatives when therapeutic equivalents exist, and keep calling for payment reform, said Ezekiel J. Emanuel, MD, PhD, Chair, Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, at the 2014 American Society of Clinical Oncology meeting, during a session Ezekiel J. Emanuel, MD, PhD on defining value from different stakeholder perspectives. “We need to do more at a faster pace to fundamentally change the payment system,” advised Dr Emanuel. ”That and that alone—making it neutral for us whether we give more, test more, or care more for the patient—will be the important item that will change how we practice, and make sure that it is value-based.” Costs of Care a Key Concern The $3 trillion that the United States spent on healthcare in 2013 is more Continued on page 10
PD-1 Monoclonal Antibodies Usher in the Era of Immunotherapy in Oncology Oncologists’ enthusiasm echoed by FDA approval of pembrolizumab By Dana Butler
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ncologists’ excitement about the promise of immunotherapy is about to be tested in clinical practice, with the recent FDA approval of pembrolizumab (Kytruda; Merck), the first anti–programmed death receptor-1 (PD-1) monoclonal antibody (see article, page 16). New data were presented for the monoclonal PD-1 antibodies, especial-
© 2014 Engage Healthcare Communications, LLC
ly for nivolumab and pembrolizumab, at the 2014 American Society of Clinical Oncology (ASCO) meeting and in subsequent publications. Early Pembrolizumab Data Used by FDA Data presented at ASCO 2014 for pembrolizumab came from the phase 1b KEYNOTE-001 dose-finding study Continued on page 27
Barry D. Brooks, MD Chair, US Oncology P&T Committee McKesson Specialty Health, Texas Oncology
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e have all had that patient— the patient who is prescribed a new targeted therapy and cannot comply with it because it is just too expensive. When asked directly about the reasoning for the noncompliance, the patient suggests that taking the treatment is just
too expensive and, in fact, it is cheaper to die. Financial Toxicity Is a Medical Side Effect In 2013, Zafar, Ubel, and their Duke colleagues, introduced a new term for an important, frequently undisclosed
Continued on page 8
FOURTH CONFERENCE
Next-Generation Sequencing Provides Value to Multiple Stakeholders By Wayne Kuznar
Los Angeles, CA—An understanding of the genomic drivers of cancer and linking therapy to these genetic alterations provides value to all stakeholders, including oncologists,
payers, researchers, and patients, said Gary Palmer, MD, JD, MBA, MPH, Senior Vice President of Medical Affairs at Foundation Medicine. Nextgeneration sequencing is the best way Continued on page 30
INSIDE VALUE PROPOSITIONS . . . . . . . . . . 2 new mutations causing lung cancer resistance identified Kaiser implements value-based care
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DEFINING VALUE IN ONCOLOGY . . Should oncologists weigh society’s interests in patient care? Involving patients in value discussions
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FDA DRUG APPROVALS . . . . . . . . . 16 Pembrolizumab first anti–PD-1 approved ECONOMICS OF CANCER CARE . . 19 Cost burden follows patients into survivorship
IN THE LITERATURE . . . . . . . . . . . . . . . . . . 21 Enzalutamide extends survival in mCRPC PERSONALIZED MEDICINE . . . . . . 28 Oncologists show low confidence in genomic testing 4TH CONFERENCE . . . 30 Predictive versus prognostic testing CER helps define value in cancer care MELANOMA . . . . . . . . . . . . . . . . . . . 37 BRAF protein marker for mortality risk? DRUG UPDATE . . . . . . . . . . . . . . . . 40 Arzerra receives FDA approval for CLL