The Role of Targeted Therapy in the Management of High-Risk Resected Kidney Cancer: What Have We Learned and How Will It Inform Future Adjuvant Trials
The primary treatment for localized renal cell carcinoma (RCC) is surgical resection with curative intent. Despite this, many patients, especially those with high-risk features, will develop recurrent or metastatic disease. Antiangiogenic therapies targeting vascular endothelial growth factor have been a mainstay of treatment of advanced RCC for more than 10 years. Evidence supporting the use of these therapies in the adjuvant setting is mixed, although one clinical trial, S-TRAC, has shown improvements in disease-free survival with 1 year of adjuvant sunitinib among patients with clear cell histology and high-risk feature...
Source: The Cancer Journal - September 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Prognostic and Predictive Factors in Metastatic Renal Cell Carcinoma: Current Perspective and a Look Into the Future
Metastatic renal cell carcinoma (mRCC) comprises a highly heterogeneous group of diseases with varied clinical outcomes. As a result, models to estimate prognosis were developed in an attempt to aid patient counseling, treatment selection, and clinical trial design. Contemporary prognostic models have been mostly generated based on clinical factors because of their ease of use. Recent advances in molecular techniques have allowed unprecedented molecular profiling of RCC and the discovery of genomic and proteotranscriptomic factors that may contribute to disease trajectory. With the advent of multiple systemic therapies in ...
Source: The Cancer Journal - September 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Introduction by the Guest Editor: Challenges and Opportunities for the Next Era of Development in Kidney Cancer
No abstract available (Source: The Cancer Journal)
Source: The Cancer Journal - September 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Time to Treat Financial Toxicity for Patients
Modern medical costs fall beyond most peoples' ability to pay and cause severe adverse effects that impact patients and families. It is time to team up with all stakeholders to provide solutions to systemic issues that thwart oncology's true goal to help patients survive their care and their cancer. Patients need realistic approaches that include (1) access to affordable treatments, (2) accountability and oversight toward patient costs and results in research, and (3) cost-effective drug supply once commercialized. Physicians play a critical role helping patients develop a plan that fits each person's medical, financial, a...
Source: The Cancer Journal - July 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Molecular Classification of Large B-Cell Non-Hodgkin Lymphoma
Large B-cell lymphomas (LBCLs) represent a frequent but clinically and morphologically heterogeneous group of tumors. Technological advances over the last 2 decades prompted the development of new classification schemas to sharpen diagnoses, dissect molecular heterogeneity, and identify rational treatment targets. Despite increased molecular understanding of these lymphomas, the clinical perspectives of patients largely remain unchanged. Recently finished comprehensive genomic studies discovered genetically defined LBCL subtypes that predict outcome, provide insight into lymphomagenesis, and suggest rational therapies with...
Source: The Cancer Journal - July 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Advances in Classification and Treatment of Non-Hodgkin Lymphoma: Mantle Cell
Mantle cell lymphoma is a rare, aggressive, and largely incurable form of non-Hodgkin lymphoma. There are a number of well-characterized prognostic features but nothing that can help guide therapy. Treatment with chemotherapy is generally effective in the short term, but relapse is inevitable and subsequent treatment is challenging. The use of Bruton tyrosine kinase inhibitors, however, has transformed practice. These agents are highly active in relapsed disease and are very well-tolerated drugs. Chemotherapy-free combinations using Bruton tyrosine kinase inhibitors look very exciting and will likely evolve to be part of f...
Source: The Cancer Journal - July 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Marginal Zone Lymphomas
There are three different marginal zone lymphoma (MZLs) entities: the extranodal MZL of mucosa- associated lymphoid tissue, the splenic MZL, and the nodal MZL. The 3 MZLs share common lesions (trisomies of chromosomes 3 and 18, deletions at 6q23), and alterations of the nuclear factor κB pathway are frequent events in all of them, but they also differ in the presence of recurrent translocations, mutations affecting the NOTCH pathway, and the transcription factor Kruppel-like factor 2 (KLF2) or the receptor-type protein tyrosine phosphatase delta (PTPRD). This review outlines the most recent and main advances in our unders...
Source: The Cancer Journal - July 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Special Statement
No abstract available (Source: The Cancer Journal)
Source: The Cancer Journal - July 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Interventional Pharmacoeconomics
We describe this approach of interventional pharmacoeconomics and provide multiple individual examples. (Source: The Cancer Journal)
Source: The Cancer Journal - July 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Cancer Drugs in Asian Populations: Availability, Accessibility, and Affordability
Accessibility to effective cancer treatments is a goal of Universal Health Coverage; yet, achieving this in the context of escalating costs in a diversity of Asian nations with different socioeconomic development is extremely challenging. Value-based assessments within the context of each health care system, financing infrastructure that will facilitate appropriate prioritization of high-cost medications, transparency in international pricing and reducing out-of-pocket costs through national insurance programs are measures that Asian countries should take toward Universal Health Coverage for cancer care. Encouraging sharin...
Source: The Cancer Journal - July 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Incorporating Value-Based Care Into Oncology
Value-based care within insurance design utilizes evidence-based medicine as a means of defining high-value versus low-value diagnostics and treatments. The goals of value-based care are to shift spending and coverage toward high-value care and reduce the use of low-value practices. Within oncology, several value-based methods have been proposed and implemented. We review value-based care being used within oncology, including defining the value of oncology drugs through frameworks, clinical care pathways, alternative payment models including the Oncology Care Model, value-based insurance design, and reducing low-value care...
Source: The Cancer Journal - July 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Bending Versus Transforming the Drug Cost Curve: A Matter of Political Will
There is increasing consensus that comprehensive reforms are needed to curb the rising costs of specialty drugs and growing bipartisan agreement on the basic principles that these reforms must address (1) constraints on yearly inflation of drug prices, (2) limits on practices to extend patents and restrict generic competition, (3) increased transparency of rebates provided by pharmaceutical companies to pharmacy benefit managers and insurance companies, and (4) caps on the total yearly out-of-pocket costs for Medicare patients. While such reforms will improve the current system, they are unlikely to be truly transformative...
Source: The Cancer Journal - July 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
Pricing and Paying for Cancer Drugs: Policy Options for Fixing A Broken System
The US system for pricing and paying for cancer drugs is badly broken. The evidence is all around us—whether we focus on total spending, the breathtakingly high prices for chimeric antigen receptor T-cell therapy, the exceedingly high prices for many recently introduced drugs that offer only marginal improvements over existing treatments, or the increasing unaffordability of patient copayments. These problems are compounded by the distortions created by our payment policies, which do not take account of the value of competing treatment options and are structured in ways that distort physicians' incentives. We review the ...
Source: The Cancer Journal - July 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
The Cancer Journal Article for Theme Issue: The Problem of Cancer Drug Costs
Modern medical costs fall beyond most peoples' ability to pay and cause severe adverse effects that impact patients and families. It is time to team up with all stakeholders to provide solutions to systemic issues that thwart oncology's true goal to help patients survive their care and their cancer. Patients need realistic approaches that include (1) access to affordable treatments, (2) accountability and oversight toward patient costs and results in research, and (3) cost-effective drug supply once commercialized. Physicians play a critical role helping patients develop a plan that fits each person's medical, financial, a...
Source: The Cancer Journal - July 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
The Problem of Cancer Drugs Costs: A Payer Perspective
Chemotherapy and supportive drugs constitute 70% of a cancer patient’s medical costs during active therapy. Payers use several approaches to keep those costs affordable including paying lower margins for “buy and bill” oncologists, prior authorization, pathways, or performance-based compensation. Payers also utilize financial tools such as deductibles, copayments, or coinsurance to shift more of the cost of health care coverage to employees or the insured. The strengths and weaknesses of those approaches are reviewed in this article. Policy changes that address drug protection from competition or negotiation, monopol...
Source: The Cancer Journal - July 1, 2020 Category: Cancer & Oncology Tags: Review Articles Source Type: research
