February 2013 Vol 6, No 1, Special Issue

With the fiscal cliff in the rear-view mirror, the next economic pressure is the impending spending cuts and debt ceiling crisis in the coming months. Although cuts to the budget of the National Institutes of Health (NIH) have not been mentioned so far, the American Society of Hematology (ASH) is voicing its support of NIH funding at levels at least as high as the current levels to support hematology research, while ASH also initiates a program of funding bridge grants.

Atlanta, GA—The use of azacitidine (Vidaza) in patients with high-risk myelodysplastic syndrome (MDS) is associated with the reduced need for red blood cell (RBC) transfusion and transfusion dependence, a report from the 2012 ASH meeting showed.

“At 12 and 18 months after azaci­tidine treatment, there were 26% and 38% reductions in RBC transfusion costs, respectively, per patient compared with the 6 months before therapy,” said Eric Tseng, MD, Department of Hematology, University of Toronto, Ontario, Canada.

Targeted therapies, immunomodulatory agents, and monoclonal antibodies with impressive response rates for the treatment of various hematologic malignancies were among the agents in late-stage development that were featured during oral and poster sessions at the ASH 2012 meeting. Success with some of these therapies was groundbreaking.

A new selective inhibitor of the FLT3 gene, quizartinib, produced complete remission in more than 33% of patients with an aggressive form of acute myeloid leukemia (AML). The treatment allowed these patients to bridge to potential­ly curative allogeneic stem-cell transplant, said principal investigator, Mark Levis, MD, PhD, Associate Professor of Oncology and Medicine, Johns Hopkins Kimmel Can­­­cer Center, Baltimore, MD, at ASH 2012.

Beneficial treatment options for patients with myelofibrosis are significantly lacking, although 1 drug, ruxolitinib (Jakafi), has proved effective in clinical trials. Compared with best available therapy, ruxolitinib proved to be a cost-effective option for patients with myelofibrosis, according to the findings from a cost-effectiveness study that was presented by Khalid El Ouagari, PhD, of Novartis Pharmaceuticals Canada, and colleagues.

In the treatment of non-Hodgkin lymphoma, faster infusion of ri­tuximab (Rituxan) results in direct cost-savings for providers and for patients, reported John Hornberger, MD, of Cedar Associates, Menlo Park, CA, and a consultant to Genentech, at the 2012 ASH meeting.

This is especially important “in an era of landmark legislation designed to address concerns about rising costs of healthcare and place more emphasis on patient-centered research,” noted Dr Hornberger.

An online tool may increase the number of oncologists who make optimal treatment decisions for patients with chronic myeloid leukemia (CML) based on their response to first-line tyrosine kinase inhibitor (TKI) therapy, according to Kevin L. Obholz, PhD, Senior Managing Editor, Clinical Care Options, Reston, VA.

The tool is designed to provide customized, patient-specific expert advice similar to one developed for the adjuvant treatment of breast cancer. The breast cancer tool had a positive impact on treatment decisions, notes Dr Obholz.

A study using real-world data for patients with tumor lysis syndrome (TLS) showed that treatment with rasburicase (Elitek) was associated with significantly greater reductions in uric acid, length of hospital stay, and total hospitalization costs per patient compared with allopurinol (Zyloprim).

TLS, which is a consequence of either tumor treatment or spontaneous tumor death, is an oncologic emergency. TLS can lead to renal failure, seizures, severe muscle weakness, tetany, cardiac arrhythmias, and death. The treatment options for TLS include allopurinol and rasburicase.

A cost-effective analysis shows that combined-modality therapy (CMT) is the preferred induction strategy over chemotherapy alone for younger patients with primary central nervous system (CNS) lymphoma.

“This strategy minimizes cost, while maximizing life expectancy and quality-adjusted life-years,” said lead investigator Anca Prica, MD, a hematology/oncology fellow at Sunnybrook Health Sciences Centre, Toronto, Canada.

Meanwhile, the preferred strategy for older patients is chemotherapy alone, Dr Prica said.

San Francisco, CA—For the second- line treatment of patients with metastatic colorectal cancer (CRC), the total costs were 14% lower with bevacizu­mab (Avastin) than with cetuximab (Erbitux), according to an analysis presented at the 2013 Gastrointestinal Cancers Symposium.

The study was presented by Elaine Yu, PharmD, of Genentech. The analysis was conducted using the UnitedHealthcare claims database and Medicare Advantage plan of patients who had 2 claims for CRC at least 30 days apart between 2007 and 2011, and evidence of 2 lines of therapy.

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