Top 2017 Articles in AJMC®'s Evidence-Based OncologyTM

The US healthcare system has witnessed a significant upheaval over the past year, including multiple attempts to override the provisions within the Affordable Care Act. Oncology care delivery has also seen a simultaneous change, with innovative drugs, the launch of novel reimbursement models, and a push for value-based care. The American Journal of Managed Care^®’s Evidence-Based Oncology^TM (EBO^TM) covered these and other topics throughout the various issues in 2017.

Here's a look at the most popular articles published in EBO^TM this year:

5. Project ECHO: An Effective Means of Increasing Palliative Care Capacity

Researchers at the University of New Mexico have globalized their palliative care intervention model via partnerships with healthcare systems across the globe. In this article in the June issue of EBO^™ Sanjeev Arora, MD, and his colleagues and global collaborators describe the implementation of Project ECHO—Extension for Community Health Outcomes—a technology-enabled model for healthcare education that intend to address disparities in healthcare access for complex chronic conditions.

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4. Why Oncologists Need Technology to Succeed in Alternative Payment Models

The emergence of alternative payment models, as exemplified by the Oncology Care Model (OCM), is requiring oncologists to develop new solutions to meet the requirements of these programs. Technology available at the point of care offers an efficient solution to many of the most labor-intensive processes. In their article in the April issue of EBO^™, Brenton Fargnoli, MD, and his colleagues from Flatiron Health describe the major role that their company can play as a technology partner for cancer care delivery clinics transition that want to adapt the rigors of OCM and other value-based reimbursement models in daily practice.

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3. Value-Based Payment Models in Oncology: Will They Help or Hinder Patient Access to New Treatments?

In the same issue in April, Sonal Shah, PharmD, and Greg Reh, from the Deloitte Center for Health Solutions, discuss results of a survey that they conducted among representatives of health plans, providers, and clinical pathway developers that are participating, supporting, or evaluating oncology payment models to understand what approaches are perceived to be working, the early results, and the potential impact on innovation. The authors recommend early investment in data analytics to identify opportunities to reduce variability in cost and outcomes, and ultimately, to be comfortable with a downside risk payment model.

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2. Phase 3 GALLIUM Study Shows Promising Results With Obinutuzumab for Follicular Lymphoma

Results of the phase 3 GALLIUM study were presented at the 2017 annual meeting of the American Society of Hematology. The researchers set out to examine survival in 601 treatment-naïve individuals with follicular lymphoma following treatment with obinutuzumab, which has shown promising activity and manageable toxicity when combined with chemotherapy in relapsed, indolent non-Hodgkin lymphoma. At a median follow-up of 34.5 months, obinutuzumab-treated patients had a 34% reduction in the risk of progression or death.

“We are optimistic that the early adoption of obinutuzumab-based therapy will further improve the outlook for patients with follicular lymphoma,” said study author Robert Marcus, MA, FRCP, FRCPath, of the results.

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1. CAR T Cells: The Next Era in Immuno-Oncology

Will chimeric antigen receptor (CAR) T-cell treatments be as effective as other immunotherapy treatments that have been developed? A complex therapeutic process, rather than a drug, CAR T-cell treatments are operationally more similar to hematopoietic stem cell transplantation, according to Bruce Feinberg, DO, and colleagues. Based on the data available at the beginning of 2017, the authors predicted that the overall impact of this mode of treatment may not be significant, especially in the pediatric patient population, due to eligibility restrictions. Additionally, the cost of treatment is expected to add an additional barrier to CAR T access.

Two CAR T-cell treatments were approved in 2017: tisagenlecleucel (Kymriah), developed by Novartis, was the first treatment approved for B-cell precursor acute lymphoblastic leukemia in certain pediatric and young adult patients. The second intervention to be approved was Kite Pharma’s axicabtagene ciloleucel (Yescarta) for adult patients with diffuse large B-cell lymphoma. Kymriah was priced at $475,000 and Yescarta at $373,000.

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