“A group of doctors and other healthcare industry professionals have set out to develop a more efficient tool for assessing the true value of immuno-oncology (I/O) drugs. They note that these drugs often come with high prices that may distract from their advantages over other types of therapy. For example, Kroger Pharmacy is selling the checkpoint inhibitor ipilimumab (Yervoy) for $140 per mg. At the recommended dose of 3 mg/kg for melanoma patients, the total expense can be high. However, ipilimumab is one of the class of I/O drugs that have improved expectations on supportive care costs and survival benefit. The old measures of value may not apply. Therefore, how does one determine whether $140/mg is a fair price for the drug?”
“A growing number of patients with cancer are benefitting from research advances in immunotherapy, leading the American Society of Clinical Oncology (ASCO) to name immunotherapy as the Society’s advance of the year for a second year in a row. Released today, this year’s report, Clinical Cancer Advances 2017: ASCO’s Annual Report on Progress Against Cancer highlights the expanding role of immunotherapy. Evolving research findings are providing new insights on how to get the optimal results from these relatively new treatments.”
“A few weeks ago, I was watching veg-out TV, quietly wondering to myself how a show called ‘Pure Genius’ could be so darned dumb.
“Then a commercial break added a new sort of mystification: A long, vivid ad touted the cancer drug Opdivo, a form of immunotherapy — an exciting new type of treatment that harnesses the body’s own immune system — for lung cancer.
“Lung cancer is the biggest cancer killer, so, in this anomalous country that allows direct-to-consumer drug ads, it was no surprise to see a lung cancer ad on network TV.”
“In a single-arm phase II study, cabozantinib demonstrated clinical activity in patients with advanced carcinoid and pancreatic neuroendocrine tumors (pNETs). Partial responses (PRs) were observed in 15% of each cohort treated with cabozantinib and stable disease was the best response in about two-thirds of patients.
“Median progression-free survival (PFS) exceeded 20 months in the pNET cohort and was >30 months in the carcinoid tumor cohort, said Jennifer A. Chan, MD, at the 2017 Gastrointestinal (GI) Cancers Symposium.”
“Patients with small intestine neuroendocrine tumors often have mesenteric tumor deposits (MTDs) in the abdomen – discrete tumor nodules that are not connected to the primary tumor. The clinical significance of these tumor deposits has not been thoroughly investigated, and they are not included in the American Joint Committee on Cancer (AJCC) staging system for midgut neuroendocrine tumors.
“Chanjuan Shi, M.D., Ph.D., and colleagues examined the prognostic significance of MTDs associated with midgut neuroendocrine tumors in 132 patients. Using pathologic slides from resected tumors and electronic medical records, the researchers reviewed AJCC tumor stage, lymph node and liver metastasis, presence of MTDs and survival data.”
“A new therapy in development for the treatment of midgut neuroendocrine tumors, a rare type of cancer that occurs in the small intestine and colon, shows improved progression-free survival and response rates for patients with advanced disease. Results of the international phase 3 clinical trial of lutetium-177 (177Lu)-Dotatate compared to high-dose octreotide LAR were published in the Jan. 12 issue of the New England Journal of Medicine.
” ‘Patients diagnosed with midgut neuroendocrine tumors often have advanced disease that has spread to other sites. Treatment options are limited. 177Lu-Dotatate is an effective option to delay tumor progression for patients with this disease,’ says Jonathan R. Strosberg, head of the Neuroendocrine Tumor Program at Moffitt Cancer Center. ‘There is also preliminary evidence of survival benefit that requires confirmation on final survival analysis, expected in several years.’ ”
“Who might benefit from a clinical trial for an experimental cancer treatment?
“A common misperception is that such trials are strictly for patients who have reached the end of the road and have no more hope of being helped by standard treatments.
” ‘But it’s not last-ditch,’ said Dina G. Lansey, the assistant director for diversity and inclusion in clinical research at the Johns Hopkins Kimmel Cancer Center. New forms of immunotherapy are being tested in many types of cancer, and not just at late stages.”
“More than ten years of published clinical data and personal experience using PRRT-based targeted therapy of neuroendocrine tumors supports the effectiveness of this novel treatment approach and the ability to minimize and manage potential toxic side effects. A comprehensive review of somatostatin analog peptide receptor radionuclide therapy (PRRT) is published in Cancer Biotherapy and Radiopharmaceuticals.”
“Since its FDA approval in 2014, the somatostatin analog lanreotide (Somatuline Depot) has been creating fresh options for select patients with gastroenteropancreatic neuroendocrine tumors (NETs), given the significant improvement in progression-free survival (PFS) demonstrated in this population.
“Now, investigators are examining the potential that the agent could have in patients with lung NETs—an area that is greatly lacking in research— in a potentially practice-changing clinical trial that seeks to determine the role of the synthetic growth inhibitory hormone in patients with the rare tumor type. Thus far, no prospective trials specifically for patients with lung NETs have been reported, researchers have noted.”