Value vs affordability: highlights from ASCO 2019
The American Society of Clinical Oncology (ASCO) annual meeting (31 May–4 June, Chicago, IL, USA) convened almost 40,000 healthcare professionals to discuss the latest in cancer prevention, diagnosis and treatment.
The American Society of Clinical Oncology (ASCO) annual meeting (31 May–4 June, Chicago, IL, USA) is the largest cancer conference in the world, covering the latest research in the prevention, diagnosis and treatment of the second leading cause of death worldwide. If you missed the chance to attend this exciting meeting, we’ve collated the meeting’s real-world evidence (RWE) highlights below. We also spoke to clinicians from Istituto Nazionale Tumori IRCCS Fondazione G. Pascale (Napoli, Italy) who were at the meeting to get their feedback and key takeaways.
Affordable Care Act has positive effects on patients with cancer
In a number of presented studies, the 2010 Affordable Care Act (ACA) was found to have increased access to care and subsequent chances of survival in patient populations with cancer. Anna Jo Smith, a resident in the Johns Hopkins Department of Gynecology and Obstetrics (MD, USA), and colleagues, assessed National Cancer Database data on 132,000 women diagnosed and treated for ovarian cancer and found that women who received public insurance post-ACA saw relative gains of 2.5% in early-stage diagnosis and timely treatment.
“Detecting and treating ovarian cancer at an early stage saves lives and lowers health-care costs compared to treatment of cancer at a more advanced, incurable stage….Having health insurance plays a major role in whether or not a woman has access to care providers who can monitor symptoms and act on those symptoms if necessary.” - Anna Jo Smith, Johns Hopkins Department of Gynecology and Obstetrics (press release)
@asco plenary: “Affordable Care Act (ACA) Medicaid expansion impact on racial disparities in time to cancer treatment.” Great, important work deserving of this forum and in keeping with @asco19 theme. Every patient. #diversity @ASCOPres #policy #data #CancerLinQ
— Vanessa Johnson, MD,MPH,HMDC (@Darklyte) June 2, 2019
In a Yale School of Medicine study (CT, USA) of 34,000 patients, Blythe J.S. Adamson et al found that the ACA had improved African American cancer patients’ receipt of timely treatment, reducing racial disparities in access to care. Cost-related medication non-compliance (CRN) was also found to have decreased in non-elderly patients who survived cancer, especially patients on a lower income, in a joint study by researchers at Saint Louis University School of Medicine, Washington University in St. Louis (both MO, USA), Southern Illinois University School of Medicine (IL, USA) and Harvard Medical School (MA, USA).
Important points raised by Dr Zafar @yzafar, “need to use real-world evidence to impact the patient care” thanks #ASCOHealthEquity #asco2019 to select this unconventional trial reported by Amy Davidoff,PhD group #disparities pic.twitter.com/EsO1UBAcrE
— Carolina (@BernabeCarolina) June 2, 2019
RWE shows potential to fill knowledge gaps in rare populations
As indications become increasingly differentiated and patient populations become ever smaller, decision makers are turning to RWE to fill in gaps left by disparate clinical trials and enable more accurate comparisons of efficacy. Roche (Basel, Switzerland) researchers turned to RWE to define a control population to demonstrate efficacy of their investigational non-small cell lung cancer (NSCLC) drug entrectinib, when patient rarity meant that a prospective randomized trial wasn’t possible.
As an oncologist who also sees pts at Bellevue @NYCHealthSystem with a predominantly minority population, I see the real-world evidence at each clinic day of the challenges that my pts face. Thank you to the #asco2019 plenary to bringing some of these issues to a greater stage
— Elaine Shum (@ElaineShumMD) June 2, 2019
Researchers from the US Department of Veterans Affairs (VA; MD, USA) also utilized RWE collected from Electronic Health Records to build a model of 1-year survival in NSCLC patients at the VA. They plan to validate this model and eventually use it to inform individualized patient care and improve outcomes.
“Real-world data is really important because data from clinical trials is from selected patients, whereas the real-world data is from the worst patients, which are the majority of patients that we treat in clinical practice.” Paolo A. Ascierto, Director, Unit of Melanoma, Cancer Immunotherapy and Innovative therapy, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale
Precision medicine is the future of decision making
“With the rise of immunotherapy, and new drugs in general, we have so many more opportunities to help patients, but we have to better understand what is the best choice for the patient. We need to start using biomarkers and other data to decide the best choice for the single patient: this is the future of oncology.” Vito Vanella, oncology specialist, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale
Immunotherapies, including CAR-T therapies, have had some incredible successes and are poised to revolutionize the field of cancer treatment. However, there are a number of challenges to overcome before this novel treatment modality can reach its full potential. Key current obstacles include unpredictable efficacy and toxicity. Ohio State University Wexner Medical Center (OH, USA) researchers presented a retrospective study of older adults to address the lack of evidence of how incidence of toxicity can affect overall survival, concluding that “caution” should be used when considering this relationship, and Bianca Santomasso, Memorial Sloan Kettering Cancer Center (NY, USA) discussed the cause and management of neurotoxicity in CAR-T therapies.
“At ASCO, I expected to see new data on the management of toxicity for immunotherapy and CAR-T cells. It’s important to understand how this data can be applied to clinical practice because there are many sides to toxicity management and it’s important for us to be able to diffuse new information and strategies back home.” Curvietto Marcello, Clinical Trials Coordinator, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale
Want more news from ASCO 2019? Check out the daily coverage from our sister site, Oncology Central, include the latest news, opinions and more.
“It’s important to attend ASCO to get the latest news on the best choice for patients.” Claudia Trojaniello, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale