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The Peer-Reviewed Forum for Real-World Evidence in Benefit Design ™ august 2014 Vol 7 I SPECIAL ISSUE

For Payers, Purchasers, Policymakers, and Other Healthcare Stakeholders

Payers’ Perspectives in Oncology Including ASCO 2014 Highlights

Federal Spending on Cancer Research and Access to Care Woefully Inadequate By Wayne Kuznar

By Wayne Kuznar


of the Breast Medicine Service at Memorial Sloan Kettering Cancer Center, New York City, in his presidential address at ASCO 2014. He called for the achievement of “social justice in cancer care” through Continued on page 7

Ibrutinib Outperforms Ofatumumab in Patients with Relapsed/Refractory CLL By Caroline Helwick


or the second-line treatment of patients with relapsed or refractory chronic lymphocytic leukemia (CLL) or with small lymphocytic leuke-

Ezekiel J. Emanuel, MD, PhD

ncologists should become value-­based providers by eliminating unnecessary tests, prescribing cheaper alternatives when therapeutic equivalents exist, and keep calling for payment reform, said Ezekiel J. Emanuel, MD, PhD, Chair of the Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, at ASCO 2014. These measures will add value as a bridge to payment reform, which is the ultimate change that will bring value to cancer care, Dr Emanuel emphasized.

Photo by ©ASCO/Phil McCarten 2014


he impact of federal budget cuts on cancer research is threatening progress in cancer therapy and access to increasing demand for cancer services, said ASCO president Clifford Hudis, MD, Chief

Payment Reform Key to Value-Based Cancer Care

mia (SLL), ibrutinib improved progression-free survival (PFS), overall survival (OS), and overall response rate ORR compared with ofatumumab, results of

Continued on page 28

Social and Economic Costs Dr Emanuel started his discussion on value in oncology by stating that the $3 trillion that the United States

Continued on page 21

2014 Oncology Pipeline Looks Impressive By Caroline Helwick and Wayne Kuznar


he cancer drug pipeline continues to boast many new therapies, reinforcing the recent trends of new and improved monoclonal antibodies and other classes of targeted therapies for different types of tumors. At ASCO 2014, researchers presented findings for many of these drugs, with immunotherapies leading the way in current drug development in oncology.

Lung Cancer

Anti–PD-1 Antibodies The future looks particularly bright for the anti–programmed death (PD)1 monoclonal antibodies, which are being evaluated in several solid tumors. Strong results were reported for both nivolumab and pembroliz­ umab (MK-3475; formerly lambroliz­ umab) in phase 1 and 2 studies of patients with non–small-cell lung Continued on page 14

in th is is s u e VALUE IN ONCOLOGY . . . . . . . . ASCO beginning to address value What makes a treatment clinically meaningful?



2014 FDA APPROVALS. . . . . . . . Cancer drugs approved this year

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MYELOMA . . . . . . . . . . . . . . . . . . Novel drug classes in multiple myeloma

Health Economics . . . . . . . . . . . Patients with cancer not asking for costly treatments ASCO workgroup proposes consolidated payments EMERGING THERAPIES. . . . . . . Enthusiasm high for anti–PD-1 agents in cancer PROSTATE CANCER. . . . . . . . . . Upfront docetaxel markedly improves survival LUNG CANCER. . . . . . . . . . . . . . Necitumumab extends survival

© 2014 Engage Healthcare Communications, LLC

“We need to do more at a faster pace to fundamentally change the payment system,” advised Dr Emanuel. ”That and that alone—making it neutral for us whether we give more, test more, or care more for the patient—will be the important item that will change how we practice, and make sure that it is value-based.”



PAYERS’ PERSPECTIVE. . . . . . . 30 Stakeholder integration needed to fix flawed payment system

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AHDB August 2014, Payers' Perspectives in Oncology  

American Health & Drug Benefits August 2014, Payers' Perspectives in Oncology

AHDB August 2014, Payers' Perspectives in Oncology  

American Health & Drug Benefits August 2014, Payers' Perspectives in Oncology