Thursday, June 11, 2015

ASCO Knowledge Part III: Value Concepts in the Management of OC

This education session at ASCO covered a number of important topics early detection, personalized medicine, treatment choices and treatment costs. 

Early Ovarian Cancer : Can we find it, Can we stop it, Cane we afford it?

Usha Menon

Dr Menon practices in London , England. She  explained that ovarian cancer screening is a process . She noted that:

  • picking up low grade Ovarian Cancer (OC) is different that picking up high grade OC
  • 50% of OC  cancer arises in the fallopian tubes
  • OC takes an average of 4 years to develop, stage 1&2 disease size is < 1cm
  • Focus should be on finding low volume disease 
Her suggestions for following low risk women include:

  • CA-125 over time
  • Autofluorescense high resolution imaging
  • Ultrasound with microbubbles
  • ctDNA (circulating tumor DNA)
For high risk women Dr Menon recommended CA-125 every 4 months. In the ROCA
(Risk of Ovarian Cancer Algorithm) study 53% of the women had a CA-125 < 35 yet had invasive ovarian cancer. 

Personalized Treatment in OC:Fancy Science or Expensive Hype

Douglas Levine

There is a broad applicability of personalized medicine.

We have developed treatments for BRCA mutations so we know what to do with those but we are not too sure what to do when we learn about these other mutations. 
Some points Dr Levine made include:

  • Genomic scarring may occur. It is a mechanism of DNA repair which leaves a scar or signature . Those signatures can be used to classify tumors . 
  • Chemoresistant tumors contain an extensive number of alterations – including BRCA1& BRCA 2
  • There are other mutations (6% of the women have a pTen mutation) but we few to date are clinically actionable. In other words we know about mutations but there are no treatments currently available for that mutation.
  • Tumor tissue will change and evolve over time so it is important to profile the tumor in the time it needs to be treated.
  • ctDNA ( circulating tumor DNA) can be found in blood plasma. It may be able to be used to monitor for recurrence and response .

Crossroads in Treatment :Primary Treatment Choices , Consolidation, and Postplatinum Endgame

David Spriggs

Value is patient centric. It drives care during primary treatment. Treatment cost for patients is heavily loaded in 1st year (hospital / treatment /diagnostic /drugs) . The actual amount the physician charges is a very low percentage of that total cost.Primary surgery done by a gynecologic  oncologist increases  5 year survival of women with OC. (gynecologic -oncologist 38% , non gynecologist 30% )

Dr Spriggs presented a few new terms that I was unfamiliar with so I want to share them with you. The quality-adjusted life-year (QALY) measures the value of health outcomes. QALY combines the value of the length of life and quality of life in one number. Researchers are evaluating the cost of drugs using the ICER(incremental cost-effectiveness ratio) . From the ASCO DAILY NEWS article “Cost of Cancer Drugs Should be a part of Treatment Decisions” The estimated ICER range for the US is between $50,000/QALY and $200,000/QALY. Dr Spriggs in his presentation mentioned that the ICER for Olaparib a newly FDA Approved Parp inhibitor was $193,000 .

 Dr Spriggs noted that IP ( interperitoneal ) treatment continues to show an survival advantage and that consolidation treatment for OC using paclitaxel is more cost effective than bevaciszumab (Avastin)( Lesnock) .

Tomorrow’s post will report on ASCO’s CancerLINQ  a health information technology platform.

Every Day is a Blessing!

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