As steady improvements continue in the treatment of multiple myeloma, it’s important for managed care executives to get out in front of the changes on the horizon.
“Several exciting new drugs are in the market or on the verge,” says Jeffrey Scott, MD, an oncologist and chief medical officer of Integra Connect. “This means that more patients are living longer and better, and treatment increasingly resembles chronic care.”
He adds that treatment improvements across all care settings are leading to fewer complications and fewer unnecessary costs. “This trend is accelerating in the wake of CMS value-based care programs such as the Oncology Care Model.”
Several classes of therapies are available for treating relapsed multiple myeloma, says Sam Santhosh, founder, chairman and global CEO of MedGenome. They include:
• Immunomodulatory drugs (thalidomide, lenalidomide)
• Proteasome inhibitors (bortezomib, carfilzomib)
• Histone deacetylase inhibitors (panobinostat)
• Monoclonal antibodies (daratumumab, elotuzumab)
• Alkylating agents (cyclophosphamide)
“Combination therapies, specifically synergistic combinations result in deep responses of longer duration,” Santhosh says.
With so much going on in multiple myeloma treatment, it can be difficult to keep track of the major developments. Here are 10 things experts say healthcare executives should know.
1. Over the last decade, there’s been unprecedented outcomes improvements
“New therapies in myeloma are being approved and brought into investigation at an ever-increasing rate,” says Gerry Messerschmidt, MD, FACP, chief medical officer of Precision Oncology. “These are no longer just new drugs but new biologics/immune therapies and cellular therapies such as CAR T-cell infusions. Combinations of drugs and immune and cellular therapies theoretically have the ability to dramatically impact myeloma outcomes, e.g., potential longer-term disease-free survival. The costs of these many element therapies will be ever increasing but if they result in significant fractions of patients developing long-term disease-free survival, overall healthcare costs could decrease.”
Binod Dhakal MD, MS, assistant professor of medicine, Division of Hematology/Oncology, Medical College of Wisconsin, says promising new immunology methods include antibody-based therapy, cellular therapy including CAR-T cell therapy, and vaccine-based approaches. He adds that lenalidomide maintenance after stem cell transplantation results in improved overall and progression-free survival.
Mary Kwok, MD, FACP, USA, Hematology-Oncology, Murtha Cancer Center, Walter Reed National Military Medical Center, adds that the FDA approved indications for currently available drugs were expanded to include new combinations of medications, and promising clinical trials are ongoing, particularly studies investigating CAR T-cells to treat myeloma.
2. Improved outcomes and more treatments may mean higher costs
As patients live longer and treatment options expand, payers need to find ways to partner more closely with oncology practices and accelerate the design of value-based care models, says Scott. “The goal should be to prevent avoidable costs and reduce complications associated with treatment. That means equipping oncologists to better manage these patient populations holistically across all settings of care and elements of their health and well-being.”
3. Relapse remains an issue
“Despite the vast improvement, there remains a proportion of patients who relapse and are more likely to have aggressive disease that is refractory to therapy,” says Gareth Morgan, MD, PhD, director, University of Arkansas for Medical Sciences Myeloma Institute.
Identifying these high-risk patients at diagnosis and implementing therapeutic approaches that can overcome treatment resistance is crucial, he says. “This requires a change that focuses on the use of genetic analyses to segment myeloma at the molecular level to enhance risk segmentation and develop biologically-stratified, in addition to targeted- and precision-immunotherapy treatment approaches,” he says.