One of 8 patients with metastatic colon cancer receives therapy with antineoplastic agents not supported by evidence-based medicine or outside of clinical practice guidelines from the National Com prehensive Cancer Net work (NCCN), found Jonas A. de Souza, MD, an oncology/hematology fellow at the University of Chicago, and colleagues.
As a result, patients are unnecessarily exposed to the potential side effects associated with such drugs, despite current practice guidelines, and at a cost of >$2 million for these drugs alone.
These findings were obtained from reimbursement data from United Healthcare on 1041 insured patients with metastatic colon cancer who received treatment between January 2007 and June 2010. The researchers evaluated the use of 3 agents in the following clinical settings that do not reflect current NCCN clinical guidelines recommendations:
- Bevacizumab (Avastin), which has insufficient data to support its use in patients whose cancer had progressed despite a combination regimen of bevacizumab and chemo - therapy
- Monotherapy with capecitabine (Xeloda), which has been shown to be ineffective as a salvage therapy after failure with a fluoropyrimidine- containing regimen
- Panitumumab (Vectibix), which is not supported by any data or compelling reason to be administered after progression occurs in patients who had previously received an epidermal growth factor receptor antibody; this also applies to cetuximab (Erbitux).
Cost of Non–Evidence-Based Therapy
Among the 884 patients with metastatic colon cancer who received bevacizumab, 90 patients (10%) had received it beyond disease progression, resulting in 636 claims for reimbursement at a cost of $1,326,696.
Capecitabine was administered to 121 patients, 49 (40%) of whom received it without evidence-based support, resulting in 281 claims, at a total cost of $621,463.
Among 38 patients who received panitumumab, non–evidence-based use was found in 6 patients (16%), at a total cost of $69,665. The cost of the non–evidence-based use of these drugs totaled $2,009,480, which did not include infusion ex - penses, diagnostics, hospitalizations, and management of adverse effects, said Dr de Souza.
The goals of practice guidelines are well established, commented Marcelo Blaya, MD, Assistant Professor of Medicine, Section of Hematology and Medical Oncology, Tulane University Health Sciences Center, New Orleans. He listed these goals as aiming to:
- Reduce unwanted variation in practice
- Bring clinical practice in line with the best available evidence
- Improve quality care • Provide decision support.
Dr Blaya added that patients with advanced cancer who receive non– evidence-based treatment are receiving better treatment in the context of clinical trials; otherwise, providers should shift their focus to palliative care.