U.S. oncology group rates blood cancer regimens, including cost

Print 19 October 2015
Deena Beasle / Reuters

Oct 16 (Reuters) - The most influential source for U.S. oncology treatment guidelines on Friday unveiled ratings aimed at helping doctors and patients assess the costs versus benefits of current therapies for two types of blood cancer.

The National Comprehensive Cancer Network (NCCN), a nonprofit alliance of 26 leading cancer centers, said its new "Evidence Blocks" for multiple myeloma and chronic myelogenous leukemia are the first in a series that by the end of next year will encompass all oncology therapies, other than surgery or radiation. They will supplement NCCN's widely followed guidelines for oncology care.

"I have 28 regimens to choose from in relapsed myeloma," said Dr. Craig Hofmeister, a hematologist with the Ohio State University Comprehensive Cancer Center and a member of the NCCN myeloma guidelines panel. "These are crafted to provide a little bit more information about cost, effectiveness, safety - all those things that the NCCN guidelines in the past haven't provided."

The blocks give each therapy a score of between one and five in five categories: efficacy, safety, quality and consistency of evidence and affordability.

"This gives people permission to talk about cost and affordability," NCCN Chief Executive Officer Dr. Robert Carlson said on a conference call. "The patient is often embarrassed to bring up cost, and physicians hesitate to bring it up ... but that can result in a prescription not being filled because a patient can't pay for it."

Ratings for primary CML treatments - Bristol-Myers Squibb's Sprycel, and Novartis AG's Gleevec and Tasigna - are nearly identical. All three scored highly effective and very expensive.

For newly diagnosed myeloma patients eligible for a stem cell transplant, NCCN lists six "preferred" regimens, four containing Takeda Pharmaceutical Co's Velcade and various chemotherapies, one with Celgene Corp's Revlimid and another that combines Velcade and Revlimid. The Velcade/Revlimid/dexamethasone regimen is rated as the most effective and the most expensive.

NCCN lists Amgen Inc's Kyprolis, with Revlimid and dexamethasone, as another upfront myeloma therapy, but it is not "preferred" because pivotal trial results are still awaited. The Kyprolis regimen was rated highly effective, mildly toxic, average in terms of evidence, mainly consistent in terms of trial data, and very expensive.

Multiple myeloma starts in the bone marrow's plasma cells, while CML starts in certain blood-forming cells. Multiple myeloma is diagnosed in about 27,000 Americans each year, and CML is occurs in about 7,000, according to the American Cancer Society.

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