By Dr. David Hewitt, inVentiv Health Clinical Division
The world’s leading cancer experts gather today in Chicago for the American Society of Clinical Oncology 51st meeting to explore topics in one of healthcare’s most complex and rapidly evolving therapeutic areas.
It’s too early to say if there will be any big surprises this year, but looking over the weekend’s schedule, it is obvious that the conference discussion will largely center around pharmaceutical companies developing and launching novel immunotherapies that are changing the landscape in cancer care. This year’s conference also will highlight the companion topics of precision medicine and predictive diagnostics for finding the right patients for these advanced and costly treatments.
The underlying question for many of the sessions scheduled this year is one of value: How can we as a society afford these new, advanced treatments? Of the 25,000 people registered for this year’s meeting in Chicago, about 80% are clinicians who will attend sessions that both illustrate cause for excitement around scientific advances and concern over cost. Doctors are asking how they can both provide optimal care and optimize spending of both individuals and healthcare systems.
Sessions ranging from “Expediting the Curve for Applied Cancer Genomics” today to Saturday morning’s opening session on “Immunotherapy for Every Patient: Check Your Enthusiasm” will explore the issues of patient selection through molecular diagnosis, maximizing value and using the new therapies most effectively. On Sunday, the Plenary Session ends with Dr. Leonard Saltz, chief of gastrointestinal oncology at Memorial Sloan Kettering, exploring “The Value Proposition in Oncology: Different Approaches to Understanding the Value of Cancer Care.”
Innovation – in Science and Study Design
On the positive side of the equation is efficacy and enormous progress researchers are making in understanding and treating cancer, particularly in the area of immunotherapies. About 1,400 of the 5,000 abstracts to be presented this year are related to IOs, an indication of the level of excitement within the oncology community. At the same time, innovative research within conventional therapies also are yielding new and exciting results.
Four studies highlighted as the conference open give an indication of what attendees will be hearing between now and conference close on June 2:
•A large Australian trial showing that daily use of nicotinamide, a form of vitamin B3, for 12 months reduced the incidence of new non-melanoma skin cancers by 23% in patients at high risk for skin cancer
•A randomized phase III trial finding that a new monoclonal antibody, elotuzumab, added to standard therapy, extended the duration of remission for patients with relapsed multiple myeloma by about five months.
•Findings from two phase III studies showing that children with Wilms tumor who have a specific chromosomal abnormality do better with a more intensive, augmented chemotherapy regimen
•A large trial showing that men with newly diagnosed, advanced prostate cancer lived ten months longer, on average, when they received docetaxel chemotherapy along with standard hormone therapy
“We’re in an era of cutting-edge precision medicine, yet we can still achieve meaningful progress with conventional treatments,” Gregory A. Masters, MD, FACP, FASCO, Chair of ASCO’s Cancer Communications Committee said in a news release issued at the start of the conference.
“Thanks to a deeper understanding of cancer biology, we have a potential new targeted therapy for multiple myeloma, and can better tailor treatment for kids with Wilms tumor. At the same time, a simple vitamin pill and a long-available chemotherapy are being put to work in different ways to improve the lives of patients,” he said.
Innovation being showcased at the conferences goes beyond the science. The docetaxel study is an example of the kind of innovative public-private partnerships that will be needed more and more in creating adaptable study designs that can accommodate changes in standards of care to continue providing valuable data to policy makers and physicians.
The ongoing study has an innovative multi-stage, multi-arm design, which was developed with and run from the Medical Research Council Clinical Trials Unit at University College London. The study can be modified to both assess new therapies and adapt to changes in the standard of care (SOC) in the continuously recruiting control arm.
Funding for STAMPEDE came from Cancer Research UK, UK Medical Research Council, the UK National Cancer Research Institute, the UK Department of Health, Sanofi-Aventis, Novartis, Pfizer, Janssen, Astellas, University of Birmingham, and University of Warwick.
The buzz around the positive data is tempered by concerns over money, with the World Health Organization this month urging pharmaceutical companies to lower their prices. In releasing its influential “Model List of Essential Medicines,” WHO warned that pricing had made drugs for cancer, tuberculosis and hepatitis C unaffordable to most people who need them.
And two days before the start of ASCO, Express Scripts Holding Co., one of the largest managers of prescription-drug benefits for U.S. employers and insurers, said it was seeking deals with pharmaceutical companies that would set pricing for some cancer drugs based on how well they work. The effort is part of a growing push for so-called pay-for-performance deals faced with the rising price of medications, some of which cost more than $100,000 per patient a year.
Express Scripts told clients it is seeking deals with drug makers for differentiated pricing for certain cancer drugs based on how well they work against different types of tumors, Express Scripts Chief Medical Officer Steve Miller said in an interview this week. Currently, Express Scripts and most insurers pay the same per-unit rate for a cancer drug regardless of the type of cancer it is being used to treat.
ASCO will see physicians, public and private insurers and PBMs both excited about the multiple scientific advances, but also deep into debate over innovative ways to pay for them. Stay tuned.