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Survey: Triple Therapy Offers Efficacy Advantages Over Current Treatments for Malignant Melanoma

Hematological toxicity influences prescribing decisions (July 9)

In a survey conducted by Decision Resources, a research and advisory firm located in Burlington, Mass., U.S. and European oncologists indicate that overall survival is the factor that most influences their prescribing decisions for unresectable malignant melanoma, and that increased overall survival is associated with the highest level of unmet need.

Interviewed thought leaders are optimistic that nivolumab (Bristol-Myers Squibb/Ono Pharmaceuticals) and dabrafenib (Tafinlar, GlaxoSmithKline) plus trametinib (Mekinist, GlaxoSmithKline), in particular, will show advantages over sales-leading ipilimumab (Yervoy, Bristol-Myers Squibb) on this attribute.

The report also finds that surveyed pharmacy directors at U.S. managed care organizations (MCOs) demand that emerging therapies provide significant improvements in overall survival over vemurafenib (Zelboraf, Roche/Genentech) to justify their cost and to secure reimbursement. Vemurafenib is the premium-priced standard-of-care in patients with unresectable malignant melanoma harboring the V600 BRAF mutation. Notably, a third of surveyed payers would not reimburse a new therapy priced the same as vemurafenib or higher that offers a 6-month improvement in overall survival over vemurafenib, citing insufficient overall clinical benefit as one of the key reasons for not granting reimbursement.

The report also finds that surveyed U.S. and European oncologists identify hematological toxicity as the safety and tolerability attribute that is most important when making prescribing decisions in unresectable malignant melanoma, thus indicating the persistent high level of unmet need for therapies with a more favorable hematological profile.

“Despite the improvements effected by vemurafenib and ipilimumab on patient overall survival in unresectable malignant melanoma, our survey results suggest that both physicians and MCO pharmacy directors have high expectations of the requirements of emerging therapies to further extend survival,” said analyst Samuel Mentzer, MSc. “Early-stage clinical data suggest that Tafinlar in combination with Mekinist and nivolumab have the potential to gain a competitive edge over ipilimumab and vemurafenib if they can replicate these promising results in their ongoing phase III trials.”

Source: Decision Resources; July 9, 2013.

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