Innovation takes time, especially when it comes to cancer research. However, delays in the adoption of novel oncology treatments can have a significant impact on patient health, reported Jason Shafrin, PhD, Director of Healthcare Quality and Value-Based Research Methods, and Senior Research Economist, Precision Health Economics, Los Angeles, CA, who presented the results of a geographic-based analysis of claims data at the 2017 Cancer Survivorship Symposium.
The retrospective cohort study showed that patients who lived in regions with a more rapid uptake of novel cancer therapies have longer overall survival (OS) than patients who lived in regions with a slower uptake of novel cancer therapies. In the study of 6 landmark therapies, the median OS increased by an average of 14.7 months among eligible patients who gained access to these treatments compared with patients who did not receive these treatments.
“We know ex post that these were successful treatments. We want to make sure that cancer drugs are safe and effective, of course, but faster adoption can provide an important survival benefit to patients,” said Dr Shafrin.
Study Design
Despite the potential for new oncology treatments to improve patient outcomes, it can take up to 17 years for treatments that are recognized as beneficial in randomized clinical trials to enter real-world practice. Using the SEER (Surveillance, Epidemiology, and End Results)–Medicare linked database from 1991 to 2013, Dr Shafrin and colleagues retrospectively analyzed the variability in the adoption of 6 new cancer treatments across 50 aggregated metropolitan statistical areas. After determining the percentage of patients who were eligible to receive treatment in a given area, the researchers looked at the treatment history and survival outcomes.
“We wanted to see whether regions that had access to treatments earlier saw significant advances in survival, so we assigned treatments randomly across patients, depending entirely on where they live,” explained Dr Shafrin.
This approach was applied to several cancer drugs, including trastuzumab (Herceptin) for breast cancer, bevacizumab (Avastin) for colorectal cancer, bevacizumab for lung cancer, erlotinib (Tarceva) for lung cancer, bortezomib (Velcade) for multiple myeloma, and lenalidomide (Revlimid) for multiple myeloma.
Dr Shafrin and colleagues included 92,496 patients (mean age, 76.9 years) in the baseline cohort. The 3-year survival rates were highest for patients with multiple myeloma (36.5%) and lowest for patients with lung cancer (7.5%).
The researchers observed variability in the adoption of novel cancer therapies across the 50 metropolitan areas. For example, the difference between the adoption of novel cancer therapies among eligible patients for areas at the 90th percentile versus those at the 10th percentile was 20.1%. The largest difference was seen with bevacizumab in patients with colorectal cancer (51.2% at the 90th percentile vs 20.9% at the 10th percentile); the smallest difference was seen with erlotinib (10.3% at the 90th percentile vs 2.8% at the 10th percentile), according to Dr Shafrin.
Survival improvements were seen as a result of faster adoption of new treatments. The median OS increased by an average of 14.7 months in eligible patients who gained access to these landmark therapies compared with patients who did not receive these therapies. Improvement in OS was greatest for patients who received lenalidomide (33.4 months) and smallest for patients who received bortezomib (2.9 months).
Based on these data, increasing the speed of adoption of novel agents has the potential to improve real-world survival for patients with cancer, said Dr Shafrin. Access to novel treatments could be improved by faster regulatory review, better physician education, and fewer payer-imposed barriers to access, concluded Dr Shafrin and colleagues.
