OBR Daily Commentary

forumImage

Cancer Costs: Expensive Drugs, Abandoned Prescriptions

(WSJ Health blog) May 20, 2011 - As we gear up for the annual meeting of the American Society of Clinical Oncology — and its flood of studies on drugs and other treatments — let’s take a moment to consider the cost of those often life-saving therapies.

Thomas Marsland, MD (Posted: May 24, 2011)

quotesThe growing use of oral anti cancer therapies raises a number of interesting and complex questions. As demonstrated by the JOP article the cost is a significant factor for the patients. Their out of pocket expense is usually much greated when they take oral medications covered under the pharmacy benefits rather than intravenous therapy covered by medical benefits. We need to do a better job of helping these patients with financial assistance (which often is available through co-pay foundations) and also in actively monitoring for compliance. These types of activities put additional financial stresses on the practice also. We often employ individuals solely to help patients with financial assistance. Oral anti cancer drugs also require close patient monitoring not only for compliance but also for managing toxicities with no real mechanism to capture these costs. Going forward it is critical that the payer community recognize the value that is being provided by the practice and find some novel way to compensate them for the work that is being done. Finally, the cost of the drugs themselves needs to be closely watched. Hopefully many, if not most, of the newer oral oncolytic will be targeted and use of the "right drug for the right patient" will help to control some of these expenses.quotes

Read Article arrow
Add Comment 1 Comment
forumImage

Data Published in Journal of Clinical Oncology Highlights Significant Activity of Micromet’s Blinatumomab in Patients with Acute Lymphoblastic Leukemia

(Yahoo! Finance) May 17, 2011 - Micromet, Inc. today announced that data from a Phase 2 clinical trial of the Company's lead product candidate blinatumomab in patients with minimal residual disease positive (MRD) acute lymphoblastic leukemia (ALL) were published in the May 16th on-line edition of the Journal of Clinical Oncology (JCO).

(Posted: May 19, 2011)

quotesThis is a very interesting new molecule which is a bispecific single-chain antibody. That bispecificity enables it to target two cells at the same time. In this case it targets CD19, a B-cell antigen present on the ALL cells; it also binds to T-cells which activate them to kill the ALL cells. Twenty-one patients with MRD positivity (strongly correlated with subsequent relapse) were treated and a whopping 16 became MRD negative. Relapse-free survival probability is 78% at a median follow-up of over a year. This is very encouraging data as relapsed ALL is a dismal disease, probably partly because most frontline regimens use a rotating cocktail of almost every active agent for this disease. Other than the FDA approval of nelarabine a few years ago, which is only approved for the smaller subset of patients with T-ALL, there have been no drugs approved for adult ALL in over 20 years. This drug is also going to be tested in relapsed ALL and would potentially be amenable to the treatment of any CD19 positive malignancy. Lymphoma and CLL would be other reasonable diseases to investigate, although the current schedule of a 4-week continuous infusion is not too user friendly for more indolent diseases. The company is also working on an alternative formulation that might be easier to administer. quotes

Read Article arrow
Add Comment 1 Comment
forumImage

Editorial: The Value of Comparison

(New York Times) May 16, 2011 - Before you take a drug or undergo a medical procedure, wouldn’t you want to be sure it is the most effective and, if possible, the least costly available?

Thomas Marsland, MD (Posted: May 17, 2011)

quotesComparative effectiveness research is something oncologists have done forever. We are constantly comparing one protocol to another to determine which therapy is most effective and least toxic. What has complicated the picture is when cost has been entered into the equation. The health reform currently doesn't allow cost to be included in treatment decision making. Most of us would agree that for truly equal treatments in terms of effectiveness and side effects that using cost to make a treatment decision is not unreasonable. Where again sometime the waters are muddied is when the issue of off label usage is factored into the equation. The Lucentis-Avastin debate does some of this - raising the question of whether Avastin off label would be covered for macular degeration. I would just hope that the whole question of value (benefit for cost) is ultimately decided by the patients and the physicians. quotes

Read Article arrow
Add Comment 1 Comment

Meet the Editorial Board

Prostate Cancer
member photo
Tomasz M. Beer, MD, FACP

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

Community Oncology
member photo
Dean Gesme, MD

FACP FACPE FASCO President, Minnesota Oncology...

Breast Cancer
member photo
Debu Tripathy, MD

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

Lung Cancer
member photo
H. Jack West, MD

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

Gastrointestinal Cancers
member photo
Howard S. Hochster, MD

Distinguished Professor of Medicine, Rutgers Robert Woo...

Radiation Oncology
member photo
Howard Sandler, MD, MS, FASTRO

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

Community Oncology
member photo
Jeff Patton, M.D.

CEO Tennessee Oncology...

Precision Medicine Section Editor
member photo
Jennifer Levin Carter, MD, MPH

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

Financial Sector
member photo
Michael G. King Jr.

Managing Director and Senior Biotechnology Analyst...

Gastrointestinal Cancers
member photo
Richard Goldberg, MD

Director WVU Cancer Institute Director of Cancer Signa...

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

Professor and Director, Division of Hematology Oncology...

Health Policy
member photo
Ted Okon

Executive Director Community Oncology Alliance...

Community Oncology
member photo
Thomas Marsland, MD

Vice President Integrated Community Oncology Network ...

Community Oncology
member photo
William Harwin MD

Florida Cancer Specialists President and Managing Part...

Health Policy
member photo
William McGivney, PhD

National Health Policy Expert...

Payer
member photo
Winston Wong, PharmD

President, W-Squared Group...