Lung Cancer 2013: The Good, the Bad, and the Ugly
Unfortunately, 2013 was also a year that highlighted some of the great challenges in effective management of lung cancer.
The costs of lung cancer care are enormous, and such evaluations are not taken into account enough when exploring the potential benefits of new agents and new treatment regimens. Dr. Kris pointed to a study that evaluated the costs related to the phase 3 trial comparing pemetrexed/carboplatin with maintenance pemetrexed vs paclitaxel/carboplatin/bevacizumab with maintenance bevacizumab. No differences were seen between the 2 regimens from a survival standpoint, but the costs of treatment on protocol were in excess of $30,000 per patient. In essence, noted Dr. Kris, we expended high resources and gained no information that advanced the field.
Dr. West noted a similar trend across oncology as a whole, with oncologists increasingly recognizing that we are spending great sums despite acquiring little clinical benefit. "There is great pressure for cancer drugs to demonstrate actual value and not to be priced so aggressively," he commented. As an example of how this has been playing out in practice, he pointed to The New York Times op-ed written last year by oncologists at the Memorial Sloan-Kettering Cancer Center, noting their refusal to use ziv-aflibercept for their patients with colon cancer because of the high cost for no incremental clinical benefit.
How do we combat this? Maybe by looking to the opposite end of the spectrum and focusing more on finding cancers when they are at the earliest, most curable stages.
One of the sad stories in 2013, Dr. Kris noted, is the sluggish adoption of CT screening to detect lung cancers. "Results of the trial proving the benefit were announced by the National Cancer Institute 3 years ago this month," he said.
The cost-effectiveness of lung cancer screening has been widely studied, and there is no question that CT screening in the absence of smoking cessation is neither cost-effective nor clinically beneficial. But considering the 20% reduction in mortality that this strategy can yield and the millions of people who could potentially benefit, efforts to identify populations most likely to benefit -- from both a cost and a clinical perspective -- are certainly worth exploring in 2014 and beyond.
The Bad and the Ugly
Unfortunately, 2013 was also a year that highlighted some of the great challenges in effective management of lung cancer.
The costs of lung cancer care are enormous, and such evaluations are not taken into account enough when exploring the potential benefits of new agents and new treatment regimens. Dr. Kris pointed to a study that evaluated the costs related to the phase 3 trial comparing pemetrexed/carboplatin with maintenance pemetrexed vs paclitaxel/carboplatin/bevacizumab with maintenance bevacizumab. No differences were seen between the 2 regimens from a survival standpoint, but the costs of treatment on protocol were in excess of $30,000 per patient. In essence, noted Dr. Kris, we expended high resources and gained no information that advanced the field.
Dr. West noted a similar trend across oncology as a whole, with oncologists increasingly recognizing that we are spending great sums despite acquiring little clinical benefit. "There is great pressure for cancer drugs to demonstrate actual value and not to be priced so aggressively," he commented. As an example of how this has been playing out in practice, he pointed to The New York Times op-ed written last year by oncologists at the Memorial Sloan-Kettering Cancer Center, noting their refusal to use ziv-aflibercept for their patients with colon cancer because of the high cost for no incremental clinical benefit.
How do we combat this? Maybe by looking to the opposite end of the spectrum and focusing more on finding cancers when they are at the earliest, most curable stages.
One of the sad stories in 2013, Dr. Kris noted, is the sluggish adoption of CT screening to detect lung cancers. "Results of the trial proving the benefit were announced by the National Cancer Institute 3 years ago this month," he said.
The cost-effectiveness of lung cancer screening has been widely studied, and there is no question that CT screening in the absence of smoking cessation is neither cost-effective nor clinically beneficial. But considering the 20% reduction in mortality that this strategy can yield and the millions of people who could potentially benefit, efforts to identify populations most likely to benefit -- from both a cost and a clinical perspective -- are certainly worth exploring in 2014 and beyond.