John L. Fox, MD, MHA: It’s interesting. Three decades ago, there was a significant shift from hospital-based chemotherapy to outpatient-based chemotherapy, from infusion in hospitals to infusion in offices. In the last decade or so, there have been a couple more paradigm shifts: one from IV-administered therapies now to oral therapies and from general chemotherapy to targeted chemotherapy or targeted agents, not just simply chemotherapy or immunotherapy. And so what impact has that had on managed care? I think it really depends on what viewpoint you’re coming from. As a health plan that’s at risk for both the medical benefit and the pharmacy benefit, these paradigm shifts from IV to oral really haven’t had an impact other than on the cost, and the shift from chemotherapy to targeted therapy again hasn’t had a major impact on how we reimburse care. It certainly changed the cost of care, although I would say that we’re certainly in favor of molecularly-targeted therapies or targeted therapies because they increase the likelihood that someone’s going to get a therapy that’s going to work and reduce the waste. In other words, the patients who get therapy don’t respond and get the side effects as their only consequence of that therapy.
Chronic lymphocytic leukemia is an interesting space because now we have at least 2 oral therapies that are rated highly, category I or category IIa, by the National Comprehensive Cancer Network; whereas before, all we had was IV therapies. I would say, though, that the changing environment here reflects greater diagnostic accuracy around what stage therapy or what stage of CLL patients have and, as a consequence, what therapy is most appropriate. And from our vantage point as a payer, whether or not IV therapy or oral therapy is most appropriate, we’re really indifferent to.
There are a number of unmet needs in CLL that probably aren’t dramatically different than any other cancer type. We need drugs or drug regimens that increase the likelihood of an early, deep, and durable remission with prolonged survival; not only progression-free survival, but long-term survival. And then for patients who do relapse, we need the same things: drugs that can induce, rather rapidly, long-term and durable remissions. But that’s true not only for CLL; it’s true for all hematologic malignancies, and it’s true for metastatic cancer or stage 4 cancer in general.
But just as important to that long-term and durable remission are drugs that are more convenient to take and, in particular, have lower toxicities. One of the oral agents in particular, in this space, has significant toxicities and increased risk of death. And while it has certain benefits in the relapse space, there are some challenges, and they’re not just specific to that drug. All drugs have toxicities. I think there is this notion that oral therapies would be safer and less toxic, and it’s not necessarily true, as this example shows.
Real-World Study Reveals Key Insights into DLBCL Treatment Patterns, Outcomes
April 18th 2024A recent study offers valuable insights into the characteristics, treatment patterns, and outcomes of diffuse large B-cell lymphoma (DLBCL) in patients across different lines of therapy, providing a look into the landscape of DLBCL management.
Read More
Pegcetacoplan for PNH More Cost-Effective Than Anti-C5 Monoclonal Antibodies
April 18th 2024A cost-utility analysis conducted from the perspective of the Italian health system found that pegcetacoplan was more effective and less costly than 2 complement 5 (C5) inhibitors for the treatment of paroxysmal nocturnal hemoglobinuria (PNH).
Read More
Oncology Onward: A Conversation With Penn Medicine's Dr Justin Bekelman
December 19th 2023Justin Bekelman, MD, director of the Penn Center for Cancer Care Innovation, sat with our hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, for our final episode of 2023 to discuss the importance of collaboration between academic medicine and community oncology and testing innovative cancer care delivery in these settings.
Listen
Many Patients With Psoriasis in Clinical Trials Experience Nocebo Effects, Study Finds
April 18th 2024Half of patients exposed to placebo in clinical trials experienced adverse events (AEs), which may be partially explainable by nocebo effects, according to a recent review and meta-analysis.
Read More
Low-Volume Hospitals Had Higher Reoperation Rate, Postoperative Complications in CRC
April 18th 2024Patients opting for elective colorectal surgery to address colorectal cancer (CRC) could have different rates of reoperation and postoperative complications based on the size of the hospital.
Read More