Research Shows Value of Additional PET/CTscans in Follow-up of Lung Cancer Patients

The gist: New research shows that four or more PET/CT scans can help guide care for patients who have been treated for lung cancer. This is significant in the light of a recent announcement from Medicaid and Medicare Services that only three FDG PET/CT scans would be routinely covered after treatment.

“New research from Johns Hopkins School of Medicine reveals a high value of scans which could lead to future change of reimbursement policies for follow-up positron emission tomography/computed tomography (PET/CT) studies in lung cancer. The study, featured in the February 2015 issue of the Journal of Nuclear Medicine, establishes the value of fourth and subsequent follow-up PET/CT scans in clinical assessment and management change in patients with the disease.

“According to the American Lung Association, lung cancer is the leading cancer killer in both men and women in the United States. Approximately 402,326 Americans living today have been diagnosed with lung cancer. In 2014, diagnoses of an estimated 224,210 new cases of lung cancer were expected, representing about 13 percent of all cancer diagnoses.

“In the retrospective study, a total of 1,171 patients with biopsy-proven lung cancer who had positron emission tomography with a radioactive tracer (18F-FDG were identified at a single tertiary center from 2001 to 2013. Among these, 85 patients (7.3%) had four or more follow up PET/CT scans with a total of 285 fourth and subsequent follow up PET/CT scans. Median follow up from the fourth scan was 31.4 months. The follow-up PET/CT scan results were correlated with clinical assessment and treatment changes.”


Quality Cancer Care Still a Goal, Not a Reality, for Most Low-Income Americans

The American Society of Clinical Oncology (ASCO) today called for major reform of Medicaid to ensure access to life-saving screening, treatment and prevention services for low-income Americans with cancer.

“In the new ‘ASCO Policy Statement on Medicaid Reform,’ published today in the Journal of Clinical Oncology, the Society called for Medicaid expansion in all 50 states to close critical coverage gaps, to improve cancer screening and prevention services, and to end coverage restrictions that prevent Medicaid enrollees from receiving high-quality cancer care, among other recommendations.

“Currently, 67.9 million Americans — about one-fifth of the U.S. population — are enrolled in Medicaid, including those added under the Affordable Care Act expansion. Of these, an estimated 2.1 million are cancer patients or cancer survivors.* Yet studies show that Medicaid patients often do not receive the same quality of cancer care as patients with private insurance, and they are up to three times more likely to be diagnosed with cancer at a late stage, when treatment is less likely to be effective.[1]

” ‘Every patient should be able to receive high-quality cancer care, regardless of his or her financial circumstances,’ said ASCO President Peter Paul Yu, MD, FACP, FASCO. ‘Millions of Americans who rely on Medicaid won’t be able to take advantage of advances in cancer prevention and treatment unless meaningful reform occurs.’ “


Preliminary Decision by CMS to Cover Lung Cancer Screening

“The Centers for Medicare & Medicaid Services (CMS) has made a preliminary decision to cover lung cancer screening with low-dose computed tomography (LDCT) for eligible patients.

“The decision was welcomed by a number of professional societies, including the American Thoracic Society, the Lung Cancer Alliance, and the American College of Chest Physicians.

“In April, the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) voted against recommending national Medicare coverage for annual screening for lung cancer with low-dose CT in high-risk individuals. Although the MEDCAC vote isn’t binding, their ruling ignited intense pushback from healthcare professionals, patient advocates, and professional associations. More than 40 medical societies have urged CMS to provide coverage for older adults. Even politicians have entered the fray, with members of the US House and Senate asking CMS to reimburse for screening.

” ‘LDCT has been shown to reduce mortality when used to screen individuals who are at high risk for developing lung cancer because of their age and smoking history,’ Charles Powell, MD, chief of pulmonary, critical care, and sleep medicine at Mount Sinai Hospital in New York City and chair of the American Thoracic Society’s thoracic oncology assembly, said in a statement.

” ‘While there is some risk of overdiagnosis, it is outweighed by the mortality benefit that has been demonstrated with screening targeted groups of high-risk patients,’ he said.”


Commentary: CMS Should Use Caution When Implementing Lung Cancer Screening

“A strategy that limits CMS [Centers for Medicare and Medicaid Services] coverage of lung cancer screening to certified and comprehensive centers may be preferable to widespread coverage due to the potential harms associated with screening and a lack of data specific to the Medicare population, according to a commentary published today in Annals of Internal Medicine.

“ ‘It is essential that low-dose CT screening programs have the proper infrastructure in place to ensure standardized interpretation and reporting of CT results, a protocolized evaluation process for screen-detected nodules, and a coordinator to ensure patients receive evaluation in a timely and appropriate fashion,’ Renda Soylemez Wiener, MD, MPH, assistant professor of medicine in The Pulmonary Center of the Boston University School of Medicine, told HemOnc Today. ‘Through a process of certification of screening programs, CMS can ensure that Medicare beneficiaries undergoing low-dose CT screening have it done in a way that maximizes benefits and minimizes harms from lung cancer screening.’ “


Dabrafenib Bests Chemotherapy and May be Safer than Vemurafenib

A clinical trial found that dabrafenib, a BRAF inhibitor, was far more effective in treating melanomas that have BRAF mutations than the chemotherapy drug dacarbazine, according to a report at an American Society of Clinical Oncology meeting. Patients treated with this drug lived without getting worse for 70% longer than those treated with dacarbazine (5.1 vs. 2.7 months, respectively). Moreover, compared to those treated with vemurafenib in other studies, dabrafenib-treated patients had less risk of another kind of skin cancer called squamous cell carcinoma. This suggests that dabrafenib, which is experimental, could be safer than vemurafenib, which is FDA approved.


Vemurafenib Benefits People Previously Treated for Melanoma

A New England Journal of Medicine study found that vemurafenib, which was approved by the FDA in 2011, controlled melanomas in about half of people who had been previously treated for this disease. The trial included 132 repeat patients; tumors shrank in 47% of the patients and were not evident in 6% during the course of the trial. Vemurafenib is a BRAF inhibitor and about half of melanoma patients have BRAF mutations. While 26% of patients developed another kind of skin cancer called squamous cell carcinoma, these lesions were successfully removed surgically.

Primary source: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1112302


Scans May Reveal Early Drug Resistance in Melanomas

Preliminary results suggest that an imaging technique can give early signs of drug resistance in melanomas. A Journal of Clinical Oncology study found that positron-emission tomography (PET)/computed tomography (CT) scans correlated with standard measures of tumor response in seven melanoma patients treated with vemurafenib. The scans also showed that during the third and fourth weeks of treatment, tumors in three patients began to take up and metabolize more of a sugar. This is a sign of cell activity, suggesting that these tumors were starting to resist the drug.


Vemurafenib Boosts Immunotherapy Against Melanoma in Mice

Vemurafenib increases the effectiveness of a treatment that uses immune system cells modified to target cancer cells, according to a study in Cancer Research. When combined with vemurafenib, which targets melanomas with the most common BRAF mutations (V600), this immunotherapy treatment killed more melanoma cells in mice. The combination treatment was also more successful than vemurafenib alone. The researchers conclude that their work supports testing this combination treatment in people with melanomas that have BRAF V600 mutations.


Combining Dabrafenib and Trametinib Increases Melanoma Patient Survival

People with melanoma lived longer when treated with a combination of dabrafenib (a BRAF inhibitor) and trametinib (a MEK inhibitor) than with dabrafenib alone, according to research in The New England Journal of Medicine. The study included 247 people with melanomas that had BRAF V600E mutations. Treatment with both drugs increased survival to 9.4 months, compared to 5.8 months with dabrafenib alone. In addition, tumors were not evident or shrank considerably in 76% of people treated with both drugs compared to 54% of those treated with dabrafenib alone.

Primary source: http://www.nejm.org/doi/full/10.1056/NEJMoa1210093