Treatment for breast cancer (CaB) in the United States has matured as oncologists have formalized protocols around specific patient populations, namely HER2+, HR+/HER2-, and HR-/HER2- (also known as triple negative) CaB. Over the past decade, breakthroughs in treatment have reshaped how CaB is treated as newer therapies such as Herceptin and Tykerb were approved as monotherapy or in combination for specific patient populations. As a result, treatment of CaB is fairly standardized today with specific agents dominating patient share. However, the arrival of newer therapies and combinations of some of these agents may reshape CaB treatment as oncologists and payers seek therapies that have superior efficacy in mostly OS or PFS trial data.

Branded agents covered in this report include:

- Genentech/Roche’s Herceptin (trastuzumab)

- Genentech/Roche’s Perjeta (pertuzumab)

- Roche’s Kadcyla (trastuzumab emtansine)

- Novartis’s Afinitor (everolimus)

- GlaxoSmithKline’s Tykerb (lapatinib)

- Roche’s Avastin (bevacizumab)

- Pfizer’s palbociclib

- Novartis’s buparlisib

- Novartis’s LEE-011

- Tesaro’s niraparib

- BioMarin Pharmaceutical’s BMN-673

- Celldex’s Glembatumumab vedotin

In this report, we explore the use and formulary status of key current therapies for treating CaB and the likely reception of key emerging therapies in a survey of 101 oncologists and 30 managed care organization directors. By understanding the attitudes and expectations of prescribers and payers toward current and emerging CaB therapies, stakeholders can gain an understanding of the treatment paradigm and changing reimbursement climate for treatment of this indication.

Questions Answered in This Report:

  • Understand current treatment of breast cancer. What therapies do oncologists prescribe for breast cancer? In what populations within breast cancer (i.e., HER2+) are these therapies prescribed? How does prescribing vary based on whether the oncologist is at an office or hospital? What factors influence the selection of a therapy in the first-line setting? What drug regimen performs best for various attributes within specific breast cancer populations? What has been the impact of the launch of Perjeta + Herceptin + a taxane for breast cancer? How will prescribing of this regimen change in one year’s time? How confident are oncologists that pathologic complete response (pCR) is a reliable predictor of DFS and OS in the adjuvant setting?

  • Understand current reimbursement for breast cancer. How do MCOs reimburse for various breast cancer therapies and what restrictions do they use? How do MCOs cover Herceptin and Perjeta? How will reimbursement change in one year’s time? What are MCOs’ thoughts on the cost and efficacy of Herceptin versus Perjeta/Herceptin?

  • Understand the role of genomic assays. What genomic assays do oncologists regularly use to prescribe for HR+/HER2- breast cancer? What are the perceived benefits of genomic assays?

  • Understand the impact of emerging regimens and therapies. What do oncologists believe will be the impact of a trial examining Tykerb and Herceptin in the adjuvant treatment setting for HER2+ CaB? What do oncologists see as the greatest advantages of using Tykerb + Herceptin over Herceptin alone as an adjuvant treatment for HER2+ CaB? What percentage of their adjuvant HER2+ CaB patients do oncologists anticipate prescribing Tykerb/Herceptin and Perjeta/Herceptin for, if these agents are approved?

Scope:

This U.S. Physician & Payer Forum report contains insights from a survey of 101 oncologists and 30 managed care organization directors regarding key current therapies for CaB and the likely reception of key emerging therapies and their impact on prescribing practices for the treatment of CaB.

Markets covered: United States.

Primary research: 101 medical oncologists and 30 MCOs.

Patient populations: 2014 U.S. CaB drug-treatable populations—segmented by (neo) adjuvant, first line, second line, and third and subsequent lines.

Author(s): Niamh Buckley, Ph.D.

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