The challenge of paying for our targeted future

Abstract

As we enter our fourth year of production of the Women’s Oncology Review, the editorial staff would like to take this opportunity to thank our readership, sponsors and contributors. As always, we welcome your comments and feedback in order to help strengthen the Journal. Certainly 2004 has been a most interesting and challenging year, but the remainder of 2005 will likely present even more opportunities and hurdles for the caregivers of women with cancer. As we look into the immediate future, we believe that we will see continued progress in the war on cancer in women; nonetheless, the obstacles to health care delivery will continue to impose restrictions that prevent us from realizing the full potential of new treatment modalities. What shadows are cast, as we look into our crystal ball for the next academic year? Biologics and targeted therapies will continue to play an increasing role in both front-line and secondary therapies for female cancers. This past year, marked a sentinel moment in the application of biologics in colorectal cancer in which an antibody specific for the VEGF receptor was combined with chemotherapy to extend survival in patients with metastatic disease. The Gynecologic Oncology Group is currently exploring the use of targeted biologics in the treatment of ovarian cancer with two new protocols about to open: GOG 218 (bevacizumab) and GOG 213 (bevacizumab and erlotinib) for front-line and recurrent cancers respectively. Recent data based upon antibody targeting of her-2 neu in combination with chemotherapy as well as the recently expanded role of aromatase inhibitors have shown promise for prolonging life in breast cancer patients. We now have genetic profiles that predict responses and help tailor the use of potentially toxic agents for a number of malignancies. Further developments in the molecular and pharmaco-genomic arena will allow for even more specific therapies with the goal of efficacy optimization with minimization of side effects and cumulative toxicity. A great obstacle in the continued development and rational implementation of these advanced technologies and targeted agents is cost. As we struggle to make end meet even with the administration of traditional cytotoxics, we await the next round of changes, i.e. cuts from our governing bodies. In the United States, clinicians have attempted to keep pace with the changes that have been derived from the Centers for Medicaid and Medicare Services (CMS) that have provided practitioners with a peripatetic target. Over the past two years, drug prices have varied based upon average wholesale price (AWP) versus average sales price (ASP) versus increases and then decreases in the technical fees. A recent change this year has been the addition of a ‘‘Demonstration project,’’ that rewards physicians for looking at aspects of quality of care and quality-of-life measures in patients undergoing chemotherapy. The bottom line in this confusing scenario is just that. . . ‘‘the bottom line’’. All of these maneuvers are part of a larger strategy to ratchet down the available dollars for cancer patients. So then the question remains, if we are having difficulty in paying for traditional therapies, how will we be able to afford therapies that cost tens of thousands of dollars per cycle at a minimum? Furthermore, many of these new agents, while showing statistically significant survival advantages have added only a matter of several months or in some cases only a few weeks to life, but at a tremendous cost to individual patients and society. While we can hope that new technologies will continue to allow for better screening and individualized application of advanced therapies that will result in some savings, we must work together to develop effective models that will allow us to continue to develop these promising compounds, but at a cost that will not be prohibitive for the continued development of novel agents and most importantly for the utilization of these agents for our cancer patients worldwide.