Clinicians generally follow NCCN treatment guidelines carefully when the intent of therapy is curative, notes Andrew L. Pecora, MD. There is very high concordance with the guidelines in the treatment of adjuvant breast cancer, adjuvant colon cancer, and metastatic testicular cancer where the therapeutic approach is well established. However, this is not the case when treating non-small cell lung cancer with an immuno-oncology agent, he says.
When considering whether to incorporate an immuno-oncology drug, it is important to first ensure that it is FDA-approved for the indication, states Pecora. Another important consideration is the rate of disease progression, because these agents can take some time to have an effect. CTLA4 inhibitors take longer to produce an effect than PD-1 inhibitors, he adds. In some more aggressive cases, the delay in response can allow the disease to progress to a point that is detrimental for the patient.
Immunotherapies can also cause pseudoprogression, initially increasing the size of the tumor. Because of this effect, oncologists have had to change their way of thinking when it comes to measuring response. When treating with an immuno-oncologic, time to response is much less important than overall survival, Pecora says. It is important to let patients know that tumor growth is not necessarily bad.
New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
April 22nd 2025On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
Listen
Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
Listen