Edward Arrowsmith, MD, discussed his recent paper on the use of clinical pathways for specific cancer types and how biosimilar development can help ensure quality of care for patients with limited therapeutic options.
Edward Arrowsmith, MD, medical director of medical oncology at CHI Memorial Hospital and an oncologist at Tennessee Oncology, discussed his recent paper on the use of clinical pathways for specific cancer types and how biosimilar development can help ensure quality of care for patients with limited therapeutic options.
Transcript
You were a co-author on an article about a case study in non–small cell lung cancer (NSCLC) that addressed balancing the use of clinical pathways with specific conditions in the era of precision medicine. How does this case illustrate the issues that practices face today?
That was a piece we wrote, because we were in a variety of contexts, all of us arguing, sometimes with insurers, sometimes with others, about what we saw as a change in the role of pathways based on changes in oncology. So, maybe a little history is helpful for my view. Really, pathways started with a critical paper, which was a paper that John Schiller wrote for ECOG [Eastern Cooperative Oncology Group] in the New England Journal of Medicine comparing 4 different platinum doublets for non–small cell lung cancer, that showed that each of those 4 therapies was equivalent.
And I think that really led to a critical paper in the pathways movement, where the US Oncology Group showed that by choosing generics for situations like that—mainly generic paclitaxel instead of name brands, like Gemzar [gemcitabine] or Taxotere [docetaxel]—that you could reduce cost. What we were arguing in our paper is that that year had passed, that for the majority of patients with non–small cell lung cancer, there really was 1 best therapy. If they have an EGFR [epidermal growth factor receptor] mutation, there's an appropriate therapy. If they have a ROS1 or ALK mutation, there is an appropriate therapy. That those 4 platinum doublets for adenocarcinoma, or nonsquamous carcinomas, had been replaced with named branded pemetrexed [Alimta] and immunotherapy had entered the market. We were really arguing that in that era, there really was 1 therapy and, in particular, to think of pathways as a great tool for reducing costs was probably not the right way to think about pathways. Pathways were more a way to demonstrate high-quality clinical care.
Now, that said, since we wrote that paper, I think there has been a little bit of a shift in the oncology landscape. One huge thing is the development of biosimilars that have come on the market. And so that's an opportunity, where standardization in a practice for a biosimilar might allow continuation of excellent quality care, but the possibility of creating more value by reducing costs. There also are more and more examples where there might be 2 treatments that look very similar. So, competing immunotherapies or in some settings like BRAF-mutant melanoma, where there are some targeted therapies that appear to have the same mechanism of action and very similar outcomes. So, that era of clinical equipoise may be returning for certain disease states.
Panelists Call for Consistent Education, Support to Improve Patient Comfort With Biosimilars
May 15th 2024At the Festival of Biologics USA, panelists stressed the need for patient-centered communication and education to boost comfort with biosimilars, emphasizing consistent support from health care providers despite restrictive payer policies.
Biosimilars Policy Roundup for April 2024—Podcast Edition
May 5th 2024On this episode of Not So Different, The Center for Biosimilars® glances back at all the major biosimilar policy updates from April, including 2 FDA approvals, 1 European approval, and several insights into possible policy changes from the Festival of Biologics USA conference.
Partnering for Biosimilar Security: India's Role in US Health Care Savings, Supply Chain Stability
May 9th 2024As Indian pharmaceutical companies supplied 4 of every 10 prescriptions in the US in 2022, generating $1.3 trillion in health care savings, a new IQVIA report highlights concerns about supply chain risks and advocates for partnerships to bolster biosimilar security and overall supply chain resilience.
A New Chapter: How 2023 Will Shape the US Biosimilar Space for 2024 and Beyond
December 31st 2023On this episode of Not So Different, Cencora's Brian Biehn and Corey Ford take a look back at major policy and regulatory advancements in 2023 and how these changes will alter the space going forward.
Cencora Analysis Shows Differences in Payer Coverage Between G-CSF Biosimilars
May 2nd 2024Data from a Cencora study showed some misalignment in payer coverage of granulocyte colony-stimulating factor (G-CSF) biosimilars, highlighting that while filgrastim biosimilars are often favored over the originator, reference pegfilgrastim still dominates over its biosimilars.