A panel of researchers assembled by The American Journal of Managed Care discussed the current state of immuno-oncology in the treatment of cancer.
Surabhi Dangi-Garimella, PhD, managing editor of Evidence-Based Oncology, a publication of The American Journal of Managed Care, served as moderator of the panel, which included Michael Kolodziej, MD, a medical oncologist and the national medical director for Oncology Solutions at Aetna; Kimberly Shafer-Weaver, PhD, a tumor immunologist who is program director for immunology, oncology, and metabolic disease at Health Analytics; and Jianda Yuan, MD, PhD, a tumor immunologist at the Memorial Sloan Kettering Cancer Center.
Immunotherapies have proven successful in treating several types of cancer, especially therapies like ipilimumab for the treatment of metastatic melanoma.
Nonetheless, immuno-oncology is still faced with many challenges. Many times, immunotherapy does not cure cancer in the literal sense of the word; rather it transforms it into a chronic disease.
While in some situations a patient can return to work, in other that is not an option, raising the question about policy choices when employers pay for healthcare.
The panel discussed how payers and providers are balancing these opportunities and costs, along with a review of the approved immunotherapies already on the market, such as CTLA-4, PD-1, and PD-L1 inhibitors.
An important question raised was whether there are good biomarkers to help clinicians decide if a specific drug will work in a patient, and the best way to measure patient response. This concerns multiple important aspects, one of them being the fact that if there is enough evidence to support using a particular therapy in a patient, payers will then look into how to fund it.
Dr. Yuan mentioned that technology is improving to make things more cost-effective. “It would be ideal to find good immune biomarkers (that) could predict the patient’s initial response to the immunotherapies, improving clinical response”, he said in the discussion.
Additionally, immunotherapies tend to be very expensive. “Because of the high cost, there is a lot of scrutiny in managed care to make sure that the right patient gets the treatment,” Dr.Kolodziej explained. “There is a great deal of desperation in patients with advanced malignancy. In an era when we did not have anything that worked, we wanted to try everything. Those days are over,” he added.
