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Report: Breast Cancer Treatment Will Become More Dynamic as Companies Launch Targeted Agents, Regimens

Perjeta and Kadcyla reshape treatment algorithm

Decision Resources Group, a health care research firm located in Burlington, Mass., finds that efficacy more than any other factors drives oncologists’ prescribing of targeted therapies for breast cancer. In addition, according to the majority of surveyed oncologists, the escalating overall cost of drug treatment for breast cancer has little or no effect on their treatment decisions.

The new findings indicate that the landscape for breast cancer therapies will become more dynamic as newer targeted agents and drug combinations launch over the next few years.

The results of a survey of 101 oncologists and 30 medical directors and pharmacy directors of managed care organizations (MCOs), reveals that MCOs, through reimbursement and restrictions, have only a limited influence on the prescribing of approved agents.

The report also finds that first-line treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer will become increasingly fragmented. First-line treatment is currently dominated by trastuzumab (Herceptin, Roche/Genentech) and to a lesser extent by pertuzumab/trastuzumab (Perjeta/Herceptin, Roche/Genentech). However, the approval of everolimus/trastuzumab (Afinitor/Herceptin, Novartis) and ado-trastuzumab emtansine/pertuzumab (Kadcyla/Perjeta, Roche/Genentech) will recast patient share within the first-line.

Dual HER2-targeted therapies lapatinib/trastuzumab (Tykerb/Herceptin, GlaxoSmithKline) and pertuzumab/trastuzumab could obtain significant patient share in the adjuvant setting, the report predicts. If the FDA approves pertuzumab/trastuzumab in 2016, surveyed office- and hospital-based oncologists estimate they would prescribe this therapy to more half of their adjuvant HER2-positive breast cancer patients 1 year after launch.

Among surveyed oncologists who do not currently prescribe everolimus/exemestane to their eligible HR-positive patients, the high cost compared with that of generically available treatments and the lack of familiarity with everolimus/exemestane are the most common reasons cited for not prescribing this treatment.

“More than one-half of hospital-based oncologists and almost one-third of office-based oncologists consider the PI3K/Akt/mTOR signaling pathway to be a validated target in hormone-resistant breast cancer following the approval of Afinitor in this population,” said analyst Niamh Buckley, PhD. “This finding is encouraging for Novartis’ emerging pan-class I PI3K inhibitor buparlisib.”

“If approved, poly-ADP ribose polymerase [PARP] inhibitors will be mostly prescribed to triple-negative patients in the first-line setting,” Buckley added. “Many oncologists, however, anticipate reserving the PARP inhibitors for later lines of treatment because they believe that currently available chemotherapy options are more efficacious.”

Source: Decision Resources Group; March 25, 2014.

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