Oncology

Oncology three trends to watch in complex specialties

Keeping on top of current medical literature and monitoring industry trends are essential ways we help ensure quality, affordable care for your members. By understanding how our industry evolves, we’re better able to tailor our solutions to meet the needs of your organization, your providers, and your members.

Created for health plan executives, our Trio series spotlights compelling trends in complex medical specialties for your organization. In this edition of Trio, AIM Specialty Health clinical leaders Michael Fisch, MD, MPH, National Medical Director of Medical Oncology Programs and Genetics, Robert Zimmerman, MD, National Medical Director of Radiation Oncology, and David Lucas, MD, MBA, National Medical Director of Laboratory Medicine and Genetic Testing, present three important trends related to cancer care.

Trend 1 – Variation in oncology drug prices show little correlation to efficacy

Between 2017 and 2021, the inflation-adjusted average launch prices for cancer drugs increased by 53%.1 Despite this increase, there is little evidence of a corresponding benefit. In a recently published retrospective, cross-sectional analysis2 of all cancer drugs approved by the FDA from January 1, 2015, to December 31, 2020, the association between drug price and efficacy was disappointing. Of 224 FDA oncological drug approvals involving 119 individual drugs across all tumor types, the median annual cost for a course of an oncology drug was $196,000. Unfortunately, drug price had a weak correlation (less than 15%*) with efficacy.

By engaging with oncology practices and identifying AIM Cancer Treatment Pathways—regimens that are optimally effective, minimally toxic, and when these factors are equal, least costly—AIM helps influence your network oncologists toward high-value treatment choices for your members with cancer.

*R2 = 0.14 for overall survival, R2 = 0.16 for progression free survival, and R2 = 0.02 for overall response rate.

Trend 2 – Hypofractionation in prostate cancer supported by new clinical trial data

The trend toward hypofractionation, or treating with fewer doses of stronger radiation, began a decade ago and is still going strong. Following recommendations from Choosing Wisely and the American Society for Radiation Oncology (ASTRO), providers increasingly use hypofractionated radiotherapy for the treatment of breast cancer and bone metastases. This trend is now increasing in patients with prostate cancer, including in men with more aggressive disease.

At the 2022 ASTRO Annual Meeting, investigators presented preliminary results from the Prostate Cancer Study 5 (PCS5) trial. This clinical trial compared seven-year outcomes for patients with high-risk prostate cancer treated with conventional versus hypofractionated radiotherapy.3 A total of 329 patients were randomized between the two arms. Results at seven years confirm no difference in overall survival or biochemical disease-free survival between the two arms. Treatment was well tolerated in both groups.

Previous studies have demonstrated hypofractionated radiotherapy for prostate cancer is as effective as conventional fractionation for low-risk and intermediate-risk patients. This study expands those findings to include high-risk disease and further supports hypofractionation for most patients with prostate cancer.

AIM appropriateness guidelines address the use of hypofractionated radiotherapy for breast, lung, and prostate cancers, as well as bone metastases.

Trend 3 – The rapid pace of FDA approvals creates a challenge for evidence-based testing

In December 2022, the U.S. Department of Health and Human Services reported a Medicare Part B spend of $9.3 billion on laboratory tests, a 17-percent increase from 2020.4 This growth, in part, is due to the rapid pace at which the FDA continues to approve new proprietary tests to assist in improving the delivery of precision cancer care. As of June 2022, the FDA cleared companion-diagnostic tests for approximately 27 molecular biomarkers that guide therapy selection for an excess of 40 FDA-approved drugs in 16 tumor types.5 Although innovation like this is imperative, it can also lead to inappropriate utilization, including off-label testing and treatments.

Challenges associated with new, complex tests can stem from provider confusion about current evidenced-based practices (e.g., appropriate use of next-generation sequencing in cancer care), discordance in professional society guidelines, and lack of provider access to specialty resources (e.g., oncologists, geneticists, multidisciplined tumor boards, etc.).6

Through our robust surveillance program, AIM guideline research and development specialists, physician leaders, and genetic counselors stay abreast of newly developed tests and professional society evidence-based guidelines to assist health plans and their providers in this quickly evolving environment.


References

  1. Office of (California) Rep. Katie Porter, How Big Pharma Exploits Launch Prices to Cash in on Cancer, November 22, 2022, https://porter.house.gov/uploadedfiles/skyrocketing__how_big_pharma_exploits_launch_prices_to_cash_in_on_cancer.pdf (accessed January 6, 2023).
  2. Miljkovic MD, Tuia JE, Olivier T, Haslam A, Prasad V. Association Between US Drug Price and Measures of Efficacy for Oncology Drugs Approved by the US Food and Drug Administration From 2015 to 2020. JAMA Intern Med. 2022;182(12):1319-1320.
  3. The ASCO Post, PCS5 Trial: Long-Term Outcomes of Moderately Shortened Radiation Course for High-Risk Prostate Cancer, October 24, 2022, https://ascopost.com/news/october-2022/pcs5-trial-long-term-outcomes-of-moderately-shortened-radiation-course-for-high-risk-prostate-cancer/ (accessed January 6, 2023).
  4. U.S. Department of Health and Human Services Office of Inspector General Data Brief, Medicare Part B Spending on Lab Tests Increased in 2021, Driven By Higher Volume of COVID-19 Tests, Genetic Tests, and Chemistry Tests, December 2022, https://oig.hhs.gov/oei/reports/OEI-09-22-00400.pdf (accessed January 6, 2023).
  5. Schilsky RL, Longo DL. Closing the Gap in Cancer Genomic Testing. N Engl J Med. 2022;387(23):2107-2110.
  6. Roberts MC, Spees LP, Freedman AN, et al. Oncologist-Reported Reasons for Not Ordering Multimarker Tumor Panels: Results From a Nationally Representative Survey. JCO Precis Oncol. 2021;5:PO.20.00431. Published 2021 April 2022.

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