Access Barriers Limit Community Adoption of Novel Therapies: Biagio Ricciuti, MD

Accessibility remains one of the largest barriers to translating academic best practices into a community oncology setting, according to several panelists at the Boston Regional Institute for Value-Based Medicine^® event on February 5, including Biagio Ricciuti, MD, a medical thoracic oncologist at the Dana-Farber Cancer Institute.

In one example, Ricciuti explained that newer T-cell engager therapies, like terlotinib used in small cell lung cancer, initially required the first 3 doses to be administered as an inpatient therapy. However, as treatment protocols progressed, his institution reduced it to only 1 dose.

“When we are giving this as an inpatient medication overnight in the Brigham and Women's Hospital, for example, that was certainly something that was challenging to implement locally,” Ricciuti said in an interview with The American Journal of Managed Care^®. “And that's because we had to centralize patients to our site to deliver, safely and effectively, this new medication.”

Ricciuti also said that drugs like terlotinib, with a unique safety profile, are often accompanied by new toxicities and therefore should be administered as an inpatient therapy. However, when community institutions first adopted these therapies, patients in community hospitals were centralized to academic centers that were better equipped to manage the new toxicities.

“We have made progress by fixing some of these toxicities using precise protocols,” Ricciuti explained, noting that adoption of these therapies in a community setting takes longer to adapt protocols that ensure patient safety. “Now, this can be more easily given in the community setting, and I've seen more and more colleagues in those specific settings delivering those therapies safely to their patients.”

In contrast, another service that is easy to translate from an academic setting into the community is genetic testing, he said.

“That's something that people are already doing, and so just identifying the right mutation for the right new therapeutic is easy to implement,” Ricciuti said.