Decision Resources, one of the world's leading research and advisory firms for pharmaceutical and healthcare issues, finds that, of the many targeted cancer agents in Phase III clinical trials in the adjuvant setting, surveyed oncologists say that Genentech/Roche/Chugai's Avastin in early-stage colorectal cancer holds the most promise to achieve regulatory approval. Additionally, more than half of surveyed oncologists indicated that the minimum benefit that would persuade them to prescribe Avastin for early-stage colorectal cancer would be an 18 percent improvement in overall survival rates or a 21 percent improvement in disease-free survival rates.
The new Physician & Payer Forum report Targeted Cancer Therapies: The Shift from Metastatic to Early-Stage Disease. Clinician and Payer Attitudes finds that, in addition to Avastin, nearly all surveyed oncologists prescribe Genentech/Roche/Chugai's Herceptin, GlaxoSmithKline's Tykerb, Pfizer's Sutent and Bayer Healthcare/Onyx's Nexavar for their approved indications in cancer, which include breast cancer, non-small-cell lung cancer and renal cell carcinoma. The report finds that, while these agents have survival benefits, formulary coverage by managed care organizations (MCOs) of targeted cancer agents is inconsistent despite regulatory prescription drug plan guidelines that call for coverage of virtually all anti-tumor agents.
According to the report, MCO pharmacy directors commonly cite insufficient clinical benefit over cheaper alternatives as the reason for lack of reimbursement for targeted cancer therapies. Evidence has demonstrated that patients who have failed Herceptin in the metastatic setting should switch to Tykerb, and, according to National Cancer Institute guidelines, patients who fail Sutent could benefit from Nexavar. However, four of the MCOs that fail to cover Tykerb and six of the MCOs that fail to cover Nexavar cite the ability to negotiate a more favorable contract for a comparable drug. This suggests that some MCOs perceive Herceptin/Tykerb and Sutent/Nexavar as interchangeable agents.
"Marketers of Tykerb, Nexavar, and Sutent need to address the fact that some MCOs continue to perceive Herceptin/Tykerb, and Nexavar/Sutent as interchangeable, 'me too' agents," said Mary Argent-Katwala, Ph.D., director at Decision Resources. "Having only one from each of these pairings on a formulary leaves important clinical scenarios uncovered. We found that nearly one third of surveyed Medicare prescription drug plans carry neither Sutent nor Nexavar and one quarter fails to cover Avastin."
Targeted Cancer Therapies: The Shift from Metastatic to Early-Stage Disease. Clinician and Payer Attitudes is based on a U.S. survey of 100 oncologists and 20 MCO pharmacy directors. Their responses were compared to assess similarities and differences of opinion regarding clinical, economic and scientific factors.
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