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by Angela Maas |
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Breast cancer is the most common
cancer diagnosed in American women
and the most common cancer globally. Estimates show that more than 300,000
people in the U.S. are expected to be diagnosed this year alone. When the FDA
first approved Genentech, Inc.’s Herceptin in 1998 for the treatment of
people with breast cancer whose tumors overexpress the human epidermal growth
factor receptor-2 (HER2) protein, the drug offered a new targeted approach to
treating the disease. In the years since, researchers have identified other
subtypes of the cancer and developed newer agents indicated for specific
types and stages of the disease. According to oncologist Andrew
Hertler, M.D., chief medical officer at specialty care management company New
Century Health, three of those treatments represent the biggest blockbuster
advances in breast cancer care: Gilead Sciences, Inc.’s Trodelvy,
a Trop-2-directed antibody and topoisomerase inhibitor conjugate; Enhertu, a
HER2-directed antibody and topoisomerase inhibitor conjugate from Daiichi
Sankyo, Inc. and AstraZeneca; and Merck & Co., Inc.’s Keytruda, a
programmed death receptor-1 (PD-1) blocking antibody. AIS Health spoke with
Hertler about these agents and other factors impacting breast cancer
care. AIS Health: What is
important for payers to know about these three therapies? Hertler: In Trodelvy, we expect to see as much as a five-fold increase
in utilization, as 74% of breast cancer is ER [i.e., estrogen
receptor]-positive and HER2-negative. In Enhertu, we expect (and have now
seen) a three-fold increased use of Enhertu, given that 50% to 60% of
patients are HER2-low breast cancer patients. This is good news for patients,
but payers need to get ready for an increased expense. AIS Health: What agents
are their main competitors? Hertler: There are no direct competitors to these three drugs. The
control arms in the...trials would be considered the previous standard of
care. AIS Health: Are there any
pipeline drugs that could pose stiff competition to those three? Hertler: There is no competition in sight. Breast cancer segregates
into very distinct groups, and there are no specific competitor drugs in the
pipeline likely to come to market in the next several years for each of the
distinct subgroups these three drugs are targeted at. AIS Health: With
lower-cost Herceptin biosimilars available, will oncologists feel somewhat
obligated to use these over Enhertu? Are payers preferring the
biosimilars? Hertler: Herceptin biosimilars would not be an option for patients
with HER2-low breast cancer. There is no evidence to support efficacy. AIS Health: Among
different breast cancer subtypes, where is the greatest need for effective
therapies? Hertler: The greatest need for effective therapies is in the
triple-negative group. Despite the addition of Keytruda to the armamentarium,
there is still a poor prognosis in breast cancer. There is a particular need
for improved therapy in the metastatic setting for this subtype. This is the
area where we most need new therapies. |
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