Focus on Oncology Among Managed Care Advisors

Council of Strategic Healthcare Advisors, Princeton

August 7, 2017

Inside Edge has conducted a brief survey among our standing managed care expert panel, the Council of Strategic Healthcare Advisors (CSHA), about the disease areas driving the market. The 56 advisors who responded to the survey represent MCOs, IDNs, PBMs, retail pharmacy, and specialty pharmacy. Oncology is the therapeutic area receiving the most attention, followed by diabetes and other metabolic disorders. Oncology comes to the top because of its rich pipeline, growth in FDA approved indications, involvement of specialty pharmacy, and cost.

Biotechnology has yielded new types of medicines that are precise and tackle cancer in a more sophisticated way. The main immunotherapy agents that are likely to be the future of cancer treatments are:
• Chimeric antigen receptor (CAR) T-cell therapy
• Monoclonal antibodies (mAbs)
• Checkpoint Inhibitors
• Oncolytic viral immunotherapy

CAR-T agents supports the removal of T cells from the patient’s blood and then alters them with CARs to be infused back into the patient. The technique has shown promising results in trials for some forms of leukemia and lymphomas. CAR T-cell therapy is only available in clinical trials at this time, but the FDA has recommended approval in mid-July for an Acute Lymphoblastic Leukemia drug.

Monoclonal antibodies (mAbs) have already become an important treatment in many cancers. There are about a dozen FDA approved mAbs treating breast cancer, melanoma, leukemia and still many in the pipeline being tested. Researchers are studying ways of making mAbs safer and more effective such as combining parts of two antibodies together.

Checkpoint inhibitors are a type of monoclonal antibody that targets specific checkpoints such as PD-1 and PD-L1. These inhibitors essentially take the brakes off of immune cells so that they can fully defend against cancerous cells. There are many agents on the market with indications for melanoma, NSCLC, bladder cancer, and more. Many other drugs that target checkpoints are now being tested in clinical trials as well, both as single drugs and combination treatments.

Oncolytic viruses are altered viruses that infect and kill mainly cancer cells. Preclinical and clinical trials have shown encouraging results on a range of genetically engineered oncolytic viruses including Reovirus, Adenovirus, Herpes Simplex Virus, Coxsackievirus, and Vaccinia Virus. These viruses alone can cause some serious symptoms, but when engineered they can hone in on cancer cells. Several studies have shown possibilities for combination treatments, synergistic effects with chemotherapy, and therapies for head and neck cancers.

Payers note it is important to continue to manage these very expensive but effective treatment options.

For more information about some of these therapies, read here:

Sarah Lincoln
Associate Director

CSHA, Healthcare, Healthcare outlook, Healthcare trends, Managed care, Oncology, Targeted therapy