A Drug’s Label and Reimbursement Barriers are Factors that Impact Medical Oncologists’ Sequential Prescribing of Targeted Agents, According to a New Report from Decision Resources
June 26, 2013—Burlington, Mass. —Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that, for metastatic colorectal cancer (mCRC), a majority of surveyed oncologists most frequently prescribe a regimen containing Roche/Genentech/Chugai’s Avastin in the first-line setting, regardless of tumor KRAS status. Surveyed oncologists consider a therapy’s efficacy benefit, the ability to combine the targeted agent with the chemotherapy of choice, and regulatory approval in the first-line setting as factors that most strongly influence their first-line prescribing decisions. Over 30 percent of surveyed oncologists indicate that the approval of Bristol-Myers Squibb/Eli Lilly/Merck Serono’s Erbitux in combination with FOLFIRI limits their first-line prescribing of this agent and similarly, a majority of surveyed oncologists indicate that Zaltrap’s (Regeneron/Sanofi) label currently limits or prevents prescribing of this agent in the first-line setting.
The U.S. Physician & Payer Forum report entitled Defining Optimal Sequential Treatment with Targeted Agents in Colorectal Cancer: How Are U.S. Physicians and Payers Responding to New Treatment Options in the Metastatic Setting? finds that almost one year after Zaltrap’s launch in the United States, about only 15 percent of surveyed oncologists currently prescribe Zaltrap in the second-line setting for mCRC, considering both wild-type and mutated KRAS disease, compared with over 60 percent for Avastin. However, the report finds that second-line prescribing of Zaltrap is positively impacted by KRAS mutational status and patient ineligibility for oxaliplatin. The latest targeted agent to gain approval in mCRC, Bayer HealthCare’s Stivarga, is frequently prescribed in the third- and fourth-line setting and over 70 percent of surveyed oncologists anticipate their prescribing of Stivarga to increase in two years’ time.
The findings also reveal that approximately half of surveyed managed care organizations indicate that Avastin is reimbursed to any mCRC patient at the clinician’s discretion, compared with 21 percent for Zaltrap and Stivarga. The greater prescribing freedom given to Avastin likely strengthens its patient share lead and allows for it to be prescribed off-label, whereas other therapies are restricted to specific patient populations.
“Avastin dominates first-line treatment in metastatic colorectal cancer, and with the agent’s label expansion for use beyond disease progression this strengthens Avastin’s position in the second-line setting,” said Decision Resources Analyst Gemma McConnell, Ph.D. “It is essential for current and emerging therapies to offer advantages in efficacy, tolerability, cost and/or formulary coverage to differentiate themselves in this increasingly competitive environment.”
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