Robust NHL drug pipeline calls for comparative trials

Non-Hodgkin's lymphoma (NHL) has several subtypes, with subtle variations, which leads to reduced effectiveness of standardized therapies. The introduction of rituximab, which targets B-cells, has had a positive effect on the management of NHL, but much still needs to be accomplished.

Key Points

Non-Hodgkin's lymphoma (NHL) is the most common hematological cancer in the United States, causing the most deaths among these types of cancer. This disease has several subtypes, with subtle variations, which leads to reduced effectiveness of standardized therapies. The introduction of rituximab, which targets B-cells, has had a positive effect on the management of NHL, but much still needs to be accomplished.

COMMENTARY: A HEALTH PLAN PERSPECTIVE

The area is rich with potential new products and new applications of existing products for the treatment of NHL. Agents such as bortezomib, lenalinamide, and bevacizumab are undergoing late-stage trials for NHL. Inotuzumab ozogamicin, an anti-CD22 monoclonal antibody, is in phase 2 clinical trials. Its different mechanism of action from rituximab makes it a likely candidate for combination therapy for NHL, including those with rituximab. In addition, a patient-specific vaccine for NHL is under development.

For health plans, these trials mean that the treatment options for both untreated and refractory NHL are likely to expand significantly. One issue is the possibility of significant regional variation of NHL treatment with the expansion of potential therapies. To avoid wasted resources on less-than-optimal treatments, direct comparative trials of multiple treatment options are essential to establish clinical effectiveness and then cost-effectiveness. Without the development of this critical evidence, health plans are likely to be faced with the need to accept and pay for all treatment regimens that have FDA approval, which can only serve to potentiate acceleration in cost of care for this relatively common malignancy.
-Gary Owens, MD, president,Gary Owens Associates, Glen Mills, PA

REFERENCES

1. Jemal A, Siegel R, Ward E, et al: Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71–96.

2. Knight C, Hind D, Brewer N, et al: Rituximab (MabThera) for aggressive non-Hodgkin's lymphoma: Systematic review and economic evaluation. Health Technol Assess. 2004 Sep;8(37):iii, ix-xi, 1–82.

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