OBR Daily Commentary

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Gene-Expression Profiling Raises Costs for Cancer Care without Improving Outcomes for Low-Risk Breast Cancer Patients, According to Researchers

(NCCN) Jan 23, 2019 - Researchers from Yale School of Public Health find that genetic profiling for cancer tumors is cost-effective for high- and medium-risk patients with breast cancer, but is unlikely to make a meaningful impact on treatment for low-risk patients. New research in the January 2019 issue of JNCCN—Journal of the National Comprehensive Cancer Network reports that using Oncotype DX (ODX)—the most commonly used test for predicting the benefit of adjuvant chemotherapy to reduce the risk of disease recurrence—is not cost-effective for people with breast cancer who are otherwise at low-risk of recurrence. Multigene assays to obtain a gene-expression profile are laboratory tests used to identify the function of specific genes in cancer cells.

Tomasz M. Beer, MD, FACP (Posted: January 23, 2019)

quotesThis is an excellent reminder that genomic testing is fundamentally no different from any other diagnostic intervention. The context of use matters and the authors should be applauded for their work confirming that in low risk patients, this assays should not be used. The speed with which knowledge is growing in this area will challenge us to frequently reassess the value of emerging diagnostics. New development may alter the value balance. But along the way, clinicians should embrace novel diagnostics when they make a valuable contribution and avoid them when they don't. quotes

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Association Between Reimbursement Incentives and Physician Practice in Oncology

(JAMA Oncology) Jan 3, 2019 - Question: Do the financial incentives within oncology reimbursement affect physicians’ practice patterns?

Thomas Marsland, MD (Posted: January 22, 2019)

quotesFinancial incentives have and always will drive healthcare. There is no free lunch. This report focuses on treatment practices by physicians depending on the financial incentives. First I strongly believe doctors choose what treatments to recommend depending on what is best for our patients. When efficacy and toxicities are equal then the economics definitely come into play. There are systems where using more expensive therapies are chosen as well as systems where less expensive therapies maybe chosen if there is a financial incentive to do so. Many of the newer models are based on these concepts. Also I would like to point out that that comment about financial incentive clearly applies not just to physicians. Payers also have programs that alter treatment choices due to the economics (prior auths, step therapies, fail first, and more). Gee, bet the PBMs never look at the economics of the treatments they mandate. So let us all agree patients come first and that we need to continue to work to assure that financial incentives work to the benefit of all.... quotes

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AbbVie Provides Update on Phase 3 Study of Ibrutinib (IMBRUVICA®) in Metastatic Pancreatic Cancer

(AbbVie) Jan 18, 2019 - The RESOLVE (PCYC-1137) trial evaluated ibrutinib in combination with chemotherapy agents nab-paclitaxel and gemcitabine versus placebo in combination with these chemotherapy agents. The study did not show statistically-significant progression-free or overall survival benefit with ibrutinib in combination versus the placebo combination study arm. Metastatic pancreatic cancer is one of the most aggressive and deadliest forms of cancer, with an estimated 5-year survival of less than 5 percent. IMBRUVICA is currently approved by the U.S. FDA in six disease areas with nine treatment indications and has cumulatively treated more than 135,000 patients globally in clinical practice and trials

Howard S. Hochster, MD (Posted: January 22, 2019)

quotesAnother phase 3 trial of Gem-Abraxane with or without your favorite targeted agent. No particular rationale for using BTK inhibitor, ibrutinib, or patient selection for this pathway. And another negative trial without benefit. Let's get smarter.quotes

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Meet the Editorial Board

Prostate Cancer
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Tomasz M. Beer, MD, FACP

Professor of Medicine, Division of Hematology/Medical O...

Community Oncology
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Dean Gesme, MD

FACP FACPE FASCO President, Minnesota Oncology...

Breast Cancer
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Debu Tripathy, MD

Professor and Chair, Department of Breast Medical Oncol...

Lung Cancer
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H. Jack West, MD

Medical Director, Thoracic Oncology Program, Swedish Ca...

Gastrointestinal Cancers
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Howard S. Hochster, MD

Distinguished Professor of Medicine, Rutgers Robert Woo...

Radiation Oncology
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Howard Sandler, MD, MS, FASTRO

Ronald H. Bloom Chair in Cancer Therapeutics
Pr...

Community Oncology
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Jeff Patton, M.D.

CEO Tennessee Oncology...

Precision Medicine Section Editor
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Jennifer Levin Carter, MD, MPH

Chief Medical Officer and Founder, N-of-One...

Financial Sector
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Michael G. King Jr.

Managing Director and Senior Biotechnology Analyst...

Gastrointestinal Cancers
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Richard Goldberg, MD

Director WVU Cancer Institute Director of Cancer Signa...

Editor-In-Chief
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Robert A. Figlin, MD., FACP

Professor and Director, Division of Hematology Oncology...

Health Policy
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Ted Okon

Executive Director Community Oncology Alliance...

Community Oncology
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Thomas Marsland, MD

Vice President Integrated Community Oncology Network ...

Community Oncology
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William Harwin MD

Florida Cancer Specialists President and Managing Part...

Health Policy
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William McGivney, PhD

National Health Policy Expert...

Payer
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Winston Wong, PharmD

President, W-Squared Group...