Onc Daily: Cancer Drug Costs vs Benefits, AML Cardioprotection

Sharon Worcester

May 13, 2020

Here are the most important stories that Medscape Oncology's editors picked for you to read today.

Cancer Drugs: Costs vs Benefits

The high cost of cancer drugs isn't necessarily justified by their clinical benefit, according to an analysis published online May 1 in Lancet Oncology.

The authors found no significant difference in monthly treatment costs for drugs with high clinical benefit and those with low clinical benefit. For example, the use of cabazitaxel (Jevtana, Sanofi-Aventis) had lower clinical benefit scores than abiraterone (Zytiga, Janssen), but had similar costs in the US and Germany and higher costs in England and Switzerland.

"Because price is not linked to value, manufacturers are incentivized to develop more drugs in an existing class or drugs with limited benefit," Yousuf Zafar, MD, MHS, FASCO, associate professor of medicine and public policy at Duke University in Durham, North Carolina, told Medscape Medical News. "If value played a role in the drug pricing and approval process, we could disincentivize the production of the tenth checkpoint inhibitor or the drug that improves survival by just weeks."

Cardioprotection in AML

The cardioprotective agent dexrazoxane (multiple brands) has been shown to reduce cardiac damage from chemotherapy in children with acute myeloid leukemia (AML). A new study suggests it also improves treatment-related mortality in this patient population; in an intent-to-treat sensitivity analysis, treatment-related mortality was 4.5% vs 12.6% (P = .024) in 96 patients who received dexrazoxane and 918 who did not, respectively.

"These patients start out as oncology patients," said Steven E. Lipshultz, MD, professor and chair of pediatrics at the University at Buffalo's Jacobs School of Medicine and Biomedical Sciences in New York, who commented on the new findings for Medscape Medical News. "But when they come back 20 years later, their hearts have been damaged, and I've been involved in probably more than 60 survivors of childhood cancer who required heart transplants," he said. "If there is one population that really needs cardioprotection, it's the children with AML."

However, the agent is not widely used; previous studies have suggested that fewer than 5% of pediatric AML patients in the US receive dexrazoxane. This is discouraging, Lipshultz commented, adding that these latest findings support its use as part of routine care in these patients.

Olaparib-Bevacizumab Combo Approved

Olaparib (Lynparza, AstraZeneca) can now be used in combination with bevacizumab for maintenance therapy in adults with advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer who responded to first-line platinum-based chemotherapy and whose cancer is homologous recombination deficiency positive, according to a new Food and Drug Administration approval.

The approval was based on findings from the phase 3 PAOLA-1 trial (NCT02477644) showing median progression-free survival of 37.2 vs 17.7 months with the olaparib-bevacizumab arm vs a placebo-bevacizumab arm (hazard ratio, 0.33).

The agency also approved the Myriad myChoice CDx test as a companion diagnostic for olaparib.

Molecular Profiling: Lessons From the UK

Real-world data suggest molecular testing is underutilized in US patients with stage IIIB or IV non-small cell lung cancer, and that even when testing is performed, it isn't adequately informing treatment decisions. In the UK, testing rates are much higher, but even that system has shortcomings.

A Medscape video features two clinicians discussing these differences, and also the efforts needed in both the US and the UK to improve current systems. Medscape contributor H. Jack West, MD, associate clinical professor and executive director of employer services of City of Hope Comprehensive Cancer Center in Duarte, California, talks to Dr. Sanjay Popat, PhD, professor of thoracic oncology at The Institute of Cancer Research and consultant in medical oncology at the Royal Marsden Hospital in London, England.

New Recommendations for Colorectal Lesions

Medscape updated its reference content with new Recommendations on Endoscopic Removal of Colorectal Lesions (USMSTF, 2020), based on information from the US Multi-Society Task Force on Colorectal Cancer. The new recommendations were published jointly in the March issues of Gastrointestinal Endoscopy, Gastroenterology, and The American Journal of Gastroenterology.

RTEL1 Protein Functions: New Discoveries, New Treatments?

Early research from the University of Copenhagen highlights the role of a protein called RTEL1 during cell division. The investigators hope that the new findings, published in Nature Structural & Molecular Biology, can be used to develop cancer treatments that involve RTEL1 inhibition.

Sharon Worcester is a reporter for MDedge, part of the Medscape Professional Network. She has more than 2 decades of experience reporting on healthcare.

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