SEATTLE — May 24, 2018 — Fred Hutchinson Cancer Research Center’s latest findings will be featured at the annual meeting of the American Society of Clinical Oncology, “Delivering Discoveries: Expanding the Reach of Precision Medicine,” to be held June 1–5 in Chicago.
Here are several highlights:
This year’s ASCO annual meeting showcases the cost-analysis work of Hutch researchers, including comparisons between single and multipayer systems of care, combined versus stand-alone therapies and industry affordability ratings.
Comparison of systemic therapy use, cost, and survival in patients with metastatic colorectal cancer in Western Washington, U.S., and British Columbia, Canada. How does treatment for metastatic colorectal cancer differ between a single-payer health care system (British Columbia, Canada) and a multipayer system (western Washington)? Drs. Todd Yezefski and Veena Shankaran from the Hutchinson Institute for Cancer Outcomes Research, or HICOR, with colleagues at the British Columbia Cancer Agency compared chemotherapy use, cost and survival outcomes using cancer registry and claims data from colorectal cancer patients in British Columbia and western Washington. Study to be featured in an ASCO press release available in advance to registered reporters at MediaHQ.asco.org and to be posted on the ASCO media site after the embargo lifts Friday, June 1 at 1 p.m. CT.
The potential cost-effectiveness of first-line immunotherapy + chemotherapy for advanced non-squamous non-small cell lung cancer (NSCLC). In May 2017, the U.S. Food and Drug Administration granted accelerated approval for pembrolizumab and a chemotherapy regimen for non-squamous, non-small cell lung cancer patients. HICOR researcher Dr. Joshua Roth and team studied the value of the combination treatment compared with the stand-alone chemotherapy regimen to evaluate comparative effectiveness and cost-effectiveness. In preliminary results, the authors concluded that the combination regimen is expected to increase survival, but does so at an additional cost that is unlikely to be considered cost-effective relative to contemporary standards of value in cancer treatment in the United States.
Are National Comprehensive Cancer Network (NCCN) Evidence Blocks (EB) Affordability Ratings (AR) representative of real-world costs? An evaluation of advanced non-small cell lung cancer (aNSCLC). The NCCN “evidence blocks” were developed to summarize the value of oncology treatments based on five key measures: efficacy, safety, quality/quantity of evidence, consistency of evidence and affordability. HICOR’s Dr. Scott Ramsey and colleagues compared “real-world costs” and the NCCN’s affordability ratings for chemotherapy in advanced non-small cell lung cancer patients. The median cost per patient per month was $16,412 with mean cost per regimen ranging from $12,000 to $67,000 per month. Therefore, the researchers have ascertained that the NCCN’s affordability ratings do not provide reliable information regarding the total costs for NCCN-approved regimens for advanced non-small lung cancer.
Fred Hutch researchers address why CAR T immunotherapy has led to durable remissions in some blood cancer patients, how another immunotherapy approach (checkpoint inhibitors) is gaining traction in a rare skin cancer, and ways immunotherapies could be used in sarcomas.
CAR T-cell therapy has led to durable remissions for many —but not all — patients with certain advanced, highly treatment-resistant cancers. Members of the laboratory of Dr. Cameron Turtle, a CAR T-cell expert, will reveal factors associated with durable remissions with a CD19 CAR T-cell product currently in clinical trials:
- Factors associated with durable remissions after CD19-specific CAR-T cell therapy for refractory/relapsed B-cell non-Hodgkin lymphoma. Dr. Jordan Gauthier will discuss the disease-related and CAR T cell-related factors that are linked to longer survival among 57 trial participants with lymphoma.
- Factors impacting disease-free survival in adult B cell B-ALL patients achieving MRD-negative CR after CD19 CAR-T cells. Dr. Kevin Hay will present data on how a blood biomarker, disease-related factors and pre-CAR T cell conditioning are linked to survival after complete remission in 56 leukemia patients.
Merkel cell carcinoma, or MCC, kills one in every three people who develop it. Treatment options have been few and ineffective, especially for advanced MCC, or aMCC. But two ongoing immunotherapy trials have significantly shifted the needle. Dr. Paul Nghiem, a leading expert on MCC, is presenting the updated results of these two pivotal trials:
- Durable tumor regression and overall survival (OS) in patients with advanced Merkel cell carcinoma (aMCC) receiving pembrolizumab as first-line therapy. Early data from this trial, released in 2015, made Keytruda a standard of care for advanced MCC, and further results continue to show immunotherapy’s advantage over chemotherapy. At 18 months post-treatment, 68 percent of trial participants are alive, more than double the historical survival rate with chemo.
- Two-year efficacy and safety update from JAVELIN Merkel 200 part A: A registrational study of avelumab in metastatic Merkel cell carcinoma progressed on chemotherapy. Bavencio became the first FDA-approved drug for MCC based on the early results of this trial, released in 2017. The latest results continue to show the remarkable durability of this therapy: Over one-third of participants with chemotherapy-resistant metastatic MCC are alive at two years. In comparison, historical data has shown that such patients have experienced a survival rate of only a few months with additional chemotherapy.
Novel approaches in bone and soft tissue sarcomas: The emerging role of precision medicine. Dr. Seth Pollack will speak in an education session on the role of immunotherapy in sarcomas. Pollack treats sarcoma patients, and his research focuses on adapting immunotherapy approaches for the disease.
Patient comorbid conditions and cancer clinical trial participation. ASCO recently recommended modernizing criteria related to comorbid conditions routinely used to exclude patients from clinical trials. Dr. Joe Unger and colleagues investigated how comorbidities influence patient decision-making about clinical trial participation. Patients with one or more comorbid conditions were 24 percent less likely to participate in a trial. The modernization of trial eligibility criteria could provide the opportunity for several thousand more patients to participate in cancer clinical trials each year.
Geographic distribution and survival outcomes for rural cancer patients treated in clinical trials. Studies show that rural cancer patients have worse outcomes than urban patients. But studies relying on cancer population data are unable to account for differences in access to care. In contrast, clinical trial patients receive standardized care by design, so large clinical trial databases are ideal for examining the impact of residency on outcomes. Dr. Joe Unger and colleagues found that rural and urban cancer patients with the same access to care through clinical trial participation experienced similar outcomes, which suggests that improving access to uniform treatment strategies for cancer patients may help resolve the rural/urban disparity in cancer outcomes.
Our researchers evaluate cost issues related to new therapeutics and genetic-testing technologies that have the potential to offer more precise care for patients.
The emergence of cancer biosimilars in the United States: A clinician’s guide. In an education session, Dr. Gary Lyman will reference insights from his May 23 paper in the New England Journal of Medicine on “Rationale, Opportunities, and Reality of Biosimilar Medications.” New biological therapeutics —like Herceptin (trastuzumab) and Neupogen (filgrastim) —have revolutionized the practice of clinical medicine but they also have contributed to the rise in health care costs. As patents on these biologic therapies expire, it should be possible to reduce cost and improve access by creating biosimilars of these agents. However, that would require medical providers to relentlessly monitor efficacy data and address reimbursement and coverage issues.
Cost-effectiveness of multi-gene panel sequencing (MGPS) for advanced non-small cell lung cancer (aNSCLC) patients. Genetic testing for various cancer mutations can connect patients with targeted therapies and potentially extend their lives. But is it more cost effective to do multi-gene panel sequencing (testing for various mutations simultaneously) or single-marker genetic testing (testing one gene at a time)? Dr. Lotte Steuten and colleagues examined the data of approximately 5,700 advanced lung cancer patients who had received either type of testing (though most received single-marker testing). Multi-gene sequencing identified an additional 8 percent of patients with mutations and enabled 2 percent more patients to receive targeted therapies. Steuten’s team determined that although lifetime total costs were higher for those who had undergone multi-gene sequencing, expected life years also increased, making multi-gene sequencing moderately cost-effective.
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At Fred Hutchinson Cancer Research Center, home to three Nobel laureates, interdisciplinary teams of world-renowned scientists seek new and innovative ways to prevent, diagnose and treat cancer, HIV/AIDS and other life-threatening diseases. Fred Hutch’s pioneering work in bone marrow transplantation led to the development of immunotherapy, which harnesses the power of the immune system to treat cancer. An independent, nonprofit research institute based in Seattle, Fred Hutch houses the nation’s first National Cancer Institute-funded cancer prevention research program, as well as the clinical coordinating center of the Women’s Health Initiative and the international headquarters of the HIV Vaccine Trials Network.