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Supplements Clinical Advance in the Management of Febrile Neutropenia

Perspectives in Febrile Neutropenia: Q&A With Gary Lyman, MD, MPH

Finally, I think the issue of interchangeability, and patient and physician notification, is important. Although at the federal level there may be rules that say that the brand name drug and the biosimilar can be switched without notifying the physician, I think clinicians and health systems and managed care organizations should still notify physicians if they build in the use of agents that mandate a switching from the brand name to a biosimilar. In other words, I think it would behoove us all to know what product the patient will actually be receiving and, if that has changed, there needs to be a notification of that change. I think we need to gain some experience over the next several years to make sure that the interchangeability is safe and that no unexpected or rare complications occur because of the switch from one agent to another. I think that’s an area where transparency and accountability will be important, [but it won’t] inhibit the introduction of biosimilars, which can reduce cost and improve access to treatment to patients who are desperately in need of treatment. But I think it will be important that we all be on the same page in terms of notification. The introduction of these new agents in the guidelines will lead to better-informed clinicians and patients. If we can ensure greater adherence to these guidelines, everyone will be better off.

AJMC®: What would be the No. 1 takeaway about FN for high-level individuals in a managed care company?

Lyman: Clearly, FN remains the most serious, life-threatening, and dose-limiting toxicity associated with cancer chemotherapy. We’re all excited about the novel targeted cancer therapies that have come along. We’ll now have biosimilars of those targeted therapies, and they do tend to have less effect on the bone marrow, in terms of FN. For the foreseeable future, in most instances, these new agents will not be given by themselves, but will be administered along with or in sequence with traditional chemotherapy, where FN remains the major limiting toxicity. So, FN is here for a long time to come. It is a big reason why patients end up in the hospital and the emergency department (ED), and there are considerable costs associated with these complications. While these drugs reduce the risk of hospitalization and ED visits, G-CSFs are also pricey, and that’s why guidelines are so important, to find that appropriate point between not using expensive drugs unnecessarily, but using them to reduce complications, hospitalizations, and even mortality in patients who should be receiving these drugs. In addition, the introduction to biosimilars will, in the long run, improve access and our ability to tailor treatments to the right patients, when these agents are needed, improving long-term outcomes and the quality of life of patients receiving cancer treatment. 

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