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Survey: Oncologists Seek Improved Symptom Control and Quality of Life for Patients With Metastatic Prostate Cancer

U.S. payers are most receptive to therapies offering significant survival benefit (June 5)

Decision Resources, a research and advisory firm located in Burlington, Mass., finds that symptom control and quality of life (QOL) are key factors influencing surveyed U.S. and European oncologists’ treatment decisions for second- and subsequent-line metastatic castrate-resistant prostate cancer (mCRPC). Moreover, the findings show that improved symptom control and improved QOL are two of the greatest unmet needs in this indication.

Interviewed thought leaders expressed optimism that cabozantinib (Cometriq; Exelixis) and radium-223 (Xofigo; Algeta/Bayer HealthCare) will have an advantage over sales-leading abiraterone (Zytiga; Johnson & Johnson/Janssen Biotech) on this attribute and will help to partially fulfill the large unmet need.

The report also finds that surveyed pharmacy directors at U.S. managed care organizations (MCOs) are most willing to grant favorable formulary status to new second- and subsequent-line mCRPC therapies that offer increased overall survival compared with currently available treatment options. Nevertheless, nearly half of the surveyed payers indicated that they would not reimburse a new therapy that is priced the same as enzalutamide (Xtandi; Medivation/Astellas Pharma) or higher that offered a 3-month improvement in median overall survival over enzalutamide. The payers most commonly stated insufficient clinical benefit to grant reimbursement.

Further, the report finds that surveyed U.S. oncologists would prescribe the emerging hormonal agent orteronel (Takeda/Millennium) to 25% of their second- and subsequent-line mCRPC patients. However, it is expected that orteronel will earn a more conservative patient share primarily because of its late launch compared with its main U.S. competitors — abiraterone and enzalutamide.

“Early-stage clinical data for orteronel are encouraging,” said analyst Dr. Karen Pomeranz. “Thought leaders are enthusiastic about hormonal therapies, in particular CYP17 inhibitors, and state that they offer high efficacy and a more manageable safety and tolerability profile compared with that associated with standard chemotherapy. However, by the time orteronel will reach the market, the current hormonal therapies, abiraterone and enzalutamide, will have become well entrenched in the treatment algorithm for second- and subsequent-line mCRPC.”

Source: Decision Resources; June 5, 2013.

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Decision supported by data from more than 4,000 patients