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EVOLUTION IN ONCOLOGY PRACTICE MANAGEMENT™ 22 Continued from page 12
How does the medication ordering and fulfillment process work with OncoMed? Having an efficient and focused process in place is very important. We have been able to institute a process where we have someone devoted to being our liaison with OncoMed. When a patient comes in and his or her benefits are precertified, we send the person’s case information to OncoMed, and the drugs are sent to us directly, along with all the administration supplies. We get them on a next-day basis, or sooner if needed, and everything is clearly labeled with patient-specific information. That makes a huge difference to us when dealing with OncoMed versus some specialty pharmacies that some insurers have imposed upon us to use, which get the drugs wrong, ship them late, and have no idea of the correct administration supplies. How does the relationship with OncoMed allow you and your team to
focus on what is important? I will give you a “before-and-after” example. Before we worked with OncoMed, 50% or more of our time was spent on managing drug costs and reimbursement. We had 5 people managing pharmacy at the 3 locations; we have been able to reduce that number of employees to 1. Before, we had to continually make sure that we were not underwater on drugs, as reimbursement rates and times fluctuated. OncoMed has made it possible to not devote time and effort on that. Based on your experience, what would you say about OncoMed to hematologists and oncologists considering such a move? It is definitely a relationship that every infusion center or oncologist has to explore. When dealing with narrowing reimbursement margins and delayed reimbursement, ultimately it will be beneficial to switch to OncoMed.
Pharmacists filling orders at the OncoMed facility.
THE LEADERSHIP OF ONCOMED – THE ONCOLOGY PHARMACY
Burt Zweigenhaft CEO, OncoMed
Kevin Askari, RPh President and Chief Clinical Pharmacist OncoMed
Ellen Scharaga, RPh Senior Vice President OncoMed
To learn more about OncoMed or to request a presentation, contact OncoMed at 1-877-662-6633, extension 1298 or firstname.lastname@example.org, or go to www.oncomed.net.
ASCO Highlights SKIN CANCER
New Monoclonal Antibody Treatment Offers Hope for Treatment of Metastatic Melanoma By Wayne Kuznar
CHICAGO—A human monoclonal antibody that blocks a receptor that downregulates T-cell responses improves long-term survival in patients with previously treated advanced melanoma, according to the results of a phase 3 trial. “This is the first time we have shown a survival benefit in metastatic melanoma,” said Steven O’Day, MD, chief of research and director of the melanoma program at The Angeles Clinic and Research Institute in Los Angeles. “What is equally impressive is the near doubling in the 1-year and 2year landmark overall survival analyses.” The study was a head-to-head comparison of treatments in 676 patients with previously treated, unresectable stage III
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or IV melanoma. There were three treatment arms: monotherapy with ipilimumab (n = 137), gp100 peptide vaccine alone (n = 136), and the combination of these two agents (n = 403). Ipilimumab is a fully human monoclonal antibody that blocks the CTLA4 receptor (CTLA-4 is an antigen found on T cells that downregulates the T-cell response) and potentiates Tcell activation. gp100 is a vaccine that produces T-cell specific immune responses, and served as the active control arm for this study. “By blocking CTLA-4, ipilimumab keeps the T-cell potentiated and hopefully leads to antitumor immunity,” O’Day explained.
Patients in both ipilimumab arms achieved improvements in overall survival. In the gp100 vaccine plus placebo group, median overall survival was 6.4 months, which is comparable with results with placebo in previous studies. In each of the two arms receiving ipilimumab, median overall survival was 10.0 months. One-year survival was 44% in patients who received ipilimumab plus vaccine, and 46% in those treated with ipilimumab alone, compared with 25% in the gp100 vaccine group. Two-year survival was 22% and 24%, respectively, compared with 14% in patients in the vaccine group. Better disease control was also seen in both groups treated with ipilimum-
ab. After 6 months, melanoma progression was halted in approximately 30% of patients, compared with only 11% of those who received the gp100 vaccine alone. Serious adverse events were more common in both ipilimumab arms, at 17.4% and 22.9%, respectively, compared with 11.4% in the gp100 plus placebo arm. Of significance are the side effects with ipilimumab related to the immune system. These occurred in two thirds of the ipilimumab arm patients and in only one third of the gp100 vaccine group. In ipilimumab-treated patients, T cells began attacking normal tissue, the most common sites being dermatologic, gastrointestinal, endocrine, and hepatic tissue. ●
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The Oncology Pharmacist