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Survey: Emerging Lung Cancer Treatments Expected to Offer Efficacy Benefits

Payers most receptive to therapies that improve overall survival

Decision Resources Group, a health-care research firm located in Burlington, Mass., finds that, according to surveyed U.S. and European oncologists, improvements in efficacy endpoints are the most influential factors in prescribing decisions for patients with previously treated EGFR wild-type/untested non–small-cell lung cancer (NSCLC).

The company also finds that improved median overall survival (OS) and increased progression-free survival (PFS) are the greatest unmet needs in this indication.

Surveyed oncologists expressed enthusiasm for programmed cell death-1 (PD-1) monoclonal antibody inhibitors and anticipated that nivolumab (Bristol-Myers Squibb) and pembrolizumab (Merck) will demonstrate efficacy advantages over currently available therapies.

Interviewed thought leaders also expressed enthusiasm for the MEK protein inhibitor selumetinib (AstraZeneca) in combination with docetaxel (generics) for the treatment of KRAS-mutant patients.

Improvements in OS were identified as an area of highest unmet need by surveyed oncologists, and surveyed payers indicated that emerging therapies that offer a significant benefit in this regard are highly desirable and would be readily reimbursed.

OS and PFS had the most influence over surveyed U.S. and European oncologists’ prescribing decisions for patients with previously treated EGFR wild-type/untested NSCLC.

“Although improvement in median overall survival is associated with increases in physician preference share and prescribing likelihood, there appears to be a pricing threshold at which efficacy benefits no longer justify price premiums over current therapies,” said analyst Kirsha Naicker, PhD, MSc.

She added: “A therapy’s toxicity profile is an important consideration for prescribing therapies for previously treated EGFR wild-type/untested NSCLC. Regardless, a therapy with a poor side effect profile that is highly efficacious and targets an area of high unmet need, such as selumetinib, is viewed favorably by physicians.”

According to the survey, the treatment of NSCLC patients continues to evolve and is driven by the development of novel agents, such as therapies with associated biomarkers that can predict a response (e.g., selumetinib and pembrolizumab). Surveyed payers regarded the availability of a predictive biomarker as one of the key factors for granting favorable formulary status to novel therapies.

The need for more efficacious medications to treat patients with NSCLC who have KRAS mutations will be addressed to some extent by the approval of selumetinib, the report says. However, a significant unmet need remains for this underserved patient population.

Source: Decision Resources Group; June 19, 2014.

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