Managing the cost of lymphoma therapy must be a priority for healthcare executives, says John Lister, MD, professor and system director, Division of Hematology and Cellular Therapy/Transplantation, at Allegheny Health Network Cancer Institute, in Pittsburgh, Pennsylvania. “Beyond cost, a rational approach to the implementation of new therapeutic strategy is required to bring exceptional value to the patient.”
Here, Lister reveals to Managed Healthcare Executive (MHE), the status of current and pipeline lymphoma treatments and the three new treatments healthcare executives need to keep on their watch list.
MHE: Why is lymphoma important for healthcare execs to focus on?
Lister: Lymphoma encompasses 70 or more distinct disease entities with variable outcome. Lymphoma can be broken down into subcategories of B-cell lymphoma, NK/T cell lymphoma, and Hodgkin lymphoma. Non-Hodgkin lymphoma groups are comprised of the first two categories. All age groups are affected with a peak incidence in the sixth and seventh decades of life. Some patients are cured with conventional therapy and more will be thanks to the many new drugs and biologics recently approved or in development. The resources needed to diagnose, treat, and follow patients with lymphoma are a significant driver of cost.
MHE: What is the status of treatments (current and in pipeline)?
Lister: Currently conventional chemotherapy combined with an anti-CD20 monoclonal antibody such as rituximab, is the treatment of choice for common types of B-cell lymphoma. Less common aggressive types of lymphoma demand more intensive chemotherapy, often requiring hospitalization for their delivery and for management of complications. Bone marrow transplantation plays an integral part of therapy for all types of lymphoma.
MHE: What are the top new lymphoma treatments to watch?
Lister: The recent approval of CAR-T cell therapy for the treatment of relapsed diffuse large B-cell lymphoma has significantly altered the treatment paradigm. CAR-T cell therapy represents a significant therapeutic advance that has only begun to impact the lives of patients. This treatment is extraordinarily expensive and thus will have a major impact upon the cost of treating patients with lymphoma. This might be partially offset by replacing bone marrow transplantation with CAR-T cell therapy. The application of CAR-T cell therapy to treatment of solid cancers is being tested in the laboratory and the clinic. Promising clinical data has emerged from treatment of ovarian cancer. Lessons learned from the treatment of lymphoma with CAR-T cell therapy will be of value to the healthcare executive in planning for future indications.
The introduction of biosimilar medications to compete with patent-protected medications such as rituximab might lower the cost of treating patients with B-cell lymphoma.
The recent introduction of targeted oral therapy with drugs such as lenalidomide, ibrutinib, acalabrutinib, idelalisib, copanlisib, among many others introduces new challenges for the creation of appropriate affordable coverage for the patient with lymphoma.
MHE: What is the status of non-Hodgkin lymphoma?
Lister: The term non-Hodgkin lymphoma should be abandoned in favor of referring directly to the biologically relevant subgroup (B-cell lymphoma, NK/T cell lymphoma, and Hodgkin lymphoma). This framework allows a more accurate connection between disease, treatment, and cost. Using this scheme of classification allows a more accurate prediction of cost and outcome in the relevant patient population.