Cancer care in 2017: the promise of more cures with the challenges of an unstable health care system

Abstract

This past year will likely be remembered as one of breakthrough advances in reducing the burden of cancer, with some landmark “rsts” coming out of the US Food and Drug Administration (FDA). Among the notable approvals were the rst CART [chimeric antigen receptor T-cell] immunotherapies – tisagenlecleucel (Kymriah) for B-cell precursor acute lymphoblastic leukemia, and axicabtagene ciloleucel (Yescarta) for relapsed or refractory large B-cell lymphoma; the rst US-approved biosimilar for cancer, bevacizumab-awwb (Mvasi) for multiple types of cancer; and rst-time approvals for neratinib (Nerlynx) as an extended adjuvant therapy for early-stage human epidermal growth factor receptor 2 (HER2)-overexpressed/amplied breast cancer, and avelumab (Bavencio) for the treatment of metastatic Merkel cell carcinoma. But our excitement about those advances will undoubtedly be tempered by the continued challenges in expanding access to better quality health care, piloting more e™ective payment models, and consolidating delivery systems. Our excitement has also been tempered by the rapid rise in the cost of e™ective biologic, immunologic, and targeted therapies. With the approval of trastuzumab-dkst (Ogivri), the rst targeted biosimilar for HER2-positive breast and gastrointestinal cancers, we can look forward to price decreases possibly in the 20%-30% range over time from a targeted therapy with remarkable clinical eŸcacy. We know that approved biosimilars have demonstrated clinical eŸcacy along with similar minor biologic diversity that is also seen in the reference biologic.1 We can also hope that increasing competition among biosimilar and reference compounds will lead to improvements in production methodologies that can allow further price reductions so that even more patients can gain access to these highly e™ective therapies. In addition, the rst FDA approval for the next-generation sequencing (NGS) FoundationOne proling test and the rapid announcement by the Centers for Medicare & Medicaid Services (CMS) that it will cover the cost of that testing brings us a step closer to knowing which patients most likely will or won’t benet from costly and toxic targeted therapies. Along with the many clinical trials studying which mutations predict which eŸcacies of individual or combinations of targeted agents, the approval and CMS coverage policy will help us improve value to our patients; when we can recommend the most benecial therapies and avoid futile ones. Finally, the approval for the DigniCap Scalp Cooling System for patients on chemotherapy for all solid tumors is of great importance. Pending coverage availability, it may in¦uence some patients to get chemotherapy they might otherwise have forgone to avoid hair loss (see also pp. e346-e348).