Hospital Practice
ISSN: 2154-8331 (Print) 2377-1003 (Online) Journal homepage: http://www.tandfonline.com/loi/ihop20
A Urologic Oncology Roundtable Discussion: Issues to Consider in Choosing Treatment for Metastatic Castration-Resistant Prostate Cancer Mary-Ellen Taplin MD, William R. Berry MD, Alison M. Casey MSN, FNP & Angel Aslo PharmD To cite this article: Mary-Ellen Taplin MD, William R. Berry MD, Alison M. Casey MSN, FNP & Angel Aslo PharmD (2013) A Urologic Oncology Roundtable Discussion: Issues to Consider in Choosing Treatment for Metastatic Castration-Resistant Prostate Cancer, Hospital Practice, 41:4, 81-82 To link to this article: http://dx.doi.org/10.3810/hp.2013.10.1084
Published online: 13 Mar 2015.
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Date: 06 November 2015, At: 22:07
O n c o l o g y R o u n d ta b l e
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A Urologic Oncology Roundtable Discussion: Issues to Consider in Choosing Treatment for Metastatic Castration-Resistant Prostate Cancer Mary-Ellen Taplin, MD 1 William R. Berry, MD 2 Alison M. Casey, MSN, FNP 3 Angel Aslo, PharmD 4 1 Associate Professor of Medicine, Harvard Medical School, DanaFarber Cancer Institute, Boston, MA; 2Associate Chair, Genitourinary Cancer Research, US Oncology Research, Cancer Centers of North Carolina, Raleigh, NC; 3Cancer Centers of North Carolina, Raleigh, NC; 4Pharmacy Director, Zangmeister Center, Columbus, OH
DOI: 10.3810/hp.2013.10.1084
Abstract: A recent Elsevier survey of 100 urologists and 100 medical oncologists who treat patients with castration-resistant prostate cancer (CRPC) identified a knowledge gap in their understanding of the recently approved therapies and what information they wanted to know concerning how and when to properly prescribe these treatments. The survey also revealed that approximately 30% of urologists had yet to prescribe one of the newly approved therapies. In response to these findings, a panel of topic experts in the fields of oncology, nursing, and specialty pharmacy convened for a roundtable discussion and to develop a companion summary article to provide a knowledge-based perspective for physicians treating patients with metastatic CRPC (http://prostatecancer.urologiconcology.org/). These participating oncology experts discussed how CRPC is defined, how the newly approved agents should be sequenced in the management of a typical patient with CRPC, and the clinical considerations regarding the role of specialty pharmacy providers and nurse practitioners as patient advocates when selecting these therapies for treating metastatic CRPC. Keywords: drug‒drug interactions; bone metastases; monitoring issues; administrative issues
Castration-Resistant Prostate Cancer: Defining the Disease State
Recent improvements in the understanding of advanced prostate cancer have led to a clearer consensus on the clinical definition of the disease.1 Castration-resistant prostate cancer (CRPC) is currently defined by a documented testosterone level , 50 ng/ dL, despite androgen-deprivation therapy (ADT; agonist or antagonist), or removal of the testes (orchiectomy), a subsequent increase in serum levels of prostate-specific antigen (PSA; preferably 2–3 ng/mL over nadir), and/or other parameters of disease progression. Patients with CRPC may have no radiographically detectable metastases (M0) or may have bone or soft tissue sites of metastases (M1).2,3
Administrative Issues Related to Access and Payment for Therapeutic Options Correspondence: Mary-Ellen Taplin, MD, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215. Tel: 617-632-3227 Fax: 617-632-2165 E-mail: [email protected]
Although oral oncolytic agents, such as abiraterone and enzalutamide, may be more familiar to patients relative to their use of other prescription drugs, they are covered by a patient’s pharmacy benefit, and hence, additional logistics are involved when prescribing these medications compared with parenterally administered metastatic CRPC (mCRPC) agents. Oral oncolytic prescriptions will be filled by an on-site pharmacy or an independent specialty pharmacy. Depending on the proximity of the pharmacy, a delay could occur in getting the prescription to the patient. Regardless, having central
© Hospital Practice,Volume 41, Issue 4, October/November 2013, ISSN – 2154-8331 81 ResearchSHARE®: www.research-share.com • Permissions: [email protected] • Reprints: [email protected]
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10/11/13 3:14 PM
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Taplin et al
coordination (patient advocates) of all treatment-related activities by the physician practice can help decrease patient confusion and delays in medication delivery. Physicians also must be aware of large insurance copays that may be associated with a treatment prescription for an mCRPC oral agent. Although some states may require insurance companies to treat oral agents as equal to infusion therapies in terms of patient copay amounts, this is not the case in every state, and this should be taken into account as part of the decision to prescribe this therapeutic option. Patients should also understand the limitations of their copays to avoid any disruption in filling the prescription. Based on financial need, various Patient Advocacy Foundations can assist patients with the financial burden of paying for their oral medications. These foundations include the Patient Advocacy Foundation (http://www.patientadvocate.org), Patient Access Network Foundation (https:// www.panfoundation.org), Chronic Disease Fund (http:// www.cdfund.org), and HealthWell Foundation (http://www. healthwellfoundation.org).
Conclusion
The clinical options that have become available to physicians in the past 3 years alone are now allowing patients with CRPC to live longer. The most appropriate sequencing and potential combination of these therapies remain an area of ongoing clinical research. Regardless of therapeutic pathway, physicians must continue to treat patients as individuals because of the heterogeneous nature of both the disease and the responses to treatments that have different methods of action. Identification of the mechanisms underlying the resistance of mCRPC to these diverse therapies will provide hope for further prolongation of life.
William R. Berry, MD, has indicated that he has been a member of a speakers bureau for Amgen, Bayer AG/Algeta ASA, Sanofi, Medivation, Inc./Astellas Pharma US, Inc., Janssen Pharmaceutical Companies, and Dendreon Corporation. He has been a member of the advisory board for Amgen, Bayer AG/Algeta ASA, Medivation, Inc./Astellas Pharma US, Inc., Janssen Pharmaceutical Companies, and Dendreon Corporation. Alison M. Casey, MSN, FNP, has no financial relationships to disclose. Angel Aslo, Pharm D, has indicated that she has been a member of a speakers bureau for Amgen, Celgene Corporation, Millennium Pharmaceuticals, Inc, and Novartis Corporation. All additional planning committee members have no financial relationships to disclose. References
1. Mostaghel EA, Page ST, Lin DW, et al. Intraprostatic androgens and androgen-regulated gene expression persist after testosterone suppression: therapeutic implications for castration-resistant prostate cancer. Cancer Res. 2007;67(10):5033–5041. 2. Mohler JL, Armstrong AJ, Bahnson RR, et al. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer. Version 2.2013. https://www. NCCN.org. Accessed March 11, 2013. 3. Cookson MS, Roth BJ, Dahm P, et al. Castration-resistant prostate cancer: AUA guideline. https://www.auanet.org/common/pdf/education/ clinical-guidance/Castration-Resistant-Prostate-Cancer.pdf. Accessed February 14, 2013.
Acknowledgments
All authors had access to all data in preparation of this multimedia activity.
Conflict of Interest Statement
The faculty members who participated in this multimedia activity have disclosed the following industry relationships: Mary-Ellen Taplin, MD, has indicated that she has received research funding from Genentech, Janssen Pharmaceutical Companies, and Medivation, Inc. She is a member of the advisory board for Janssen Pharmaceutical Companies, Medivation, Inc., Dendreon Corporation, Tokai Pharmaceuticals, and Algeta ASA. She is a consultant for Sanofi. 82
10_Taplin.indd 82
© Hospital Practice, Volume 41, Issue 4, October/November 2013, ISSN – 2154-8331 ResearchSHARE®: www.research-share.com • Permissions: [email protected] • Reprints: [email protected]
10/11/13 3:14 PM
ISSN: 2154-8331 (Print) 2377-1003 (Online) Journal homepage: http://www.tandfonline.com/loi/ihop20
A Urologic Oncology Roundtable Discussion: Issues to Consider in Choosing Treatment for Metastatic Castration-Resistant Prostate Cancer Mary-Ellen Taplin MD, William R. Berry MD, Alison M. Casey MSN, FNP & Angel Aslo PharmD To cite this article: Mary-Ellen Taplin MD, William R. Berry MD, Alison M. Casey MSN, FNP & Angel Aslo PharmD (2013) A Urologic Oncology Roundtable Discussion: Issues to Consider in Choosing Treatment for Metastatic Castration-Resistant Prostate Cancer, Hospital Practice, 41:4, 81-82 To link to this article: http://dx.doi.org/10.3810/hp.2013.10.1084
Published online: 13 Mar 2015.
Submit your article to this journal
Article views: 3
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ihop20 Download by: [University of Lethbridge]
Date: 06 November 2015, At: 22:07
O n c o l o g y R o u n d ta b l e
Downloaded by [University of Lethbridge] at 22:07 06 November 2015
A Urologic Oncology Roundtable Discussion: Issues to Consider in Choosing Treatment for Metastatic Castration-Resistant Prostate Cancer Mary-Ellen Taplin, MD 1 William R. Berry, MD 2 Alison M. Casey, MSN, FNP 3 Angel Aslo, PharmD 4 1 Associate Professor of Medicine, Harvard Medical School, DanaFarber Cancer Institute, Boston, MA; 2Associate Chair, Genitourinary Cancer Research, US Oncology Research, Cancer Centers of North Carolina, Raleigh, NC; 3Cancer Centers of North Carolina, Raleigh, NC; 4Pharmacy Director, Zangmeister Center, Columbus, OH
DOI: 10.3810/hp.2013.10.1084
Abstract: A recent Elsevier survey of 100 urologists and 100 medical oncologists who treat patients with castration-resistant prostate cancer (CRPC) identified a knowledge gap in their understanding of the recently approved therapies and what information they wanted to know concerning how and when to properly prescribe these treatments. The survey also revealed that approximately 30% of urologists had yet to prescribe one of the newly approved therapies. In response to these findings, a panel of topic experts in the fields of oncology, nursing, and specialty pharmacy convened for a roundtable discussion and to develop a companion summary article to provide a knowledge-based perspective for physicians treating patients with metastatic CRPC (http://prostatecancer.urologiconcology.org/). These participating oncology experts discussed how CRPC is defined, how the newly approved agents should be sequenced in the management of a typical patient with CRPC, and the clinical considerations regarding the role of specialty pharmacy providers and nurse practitioners as patient advocates when selecting these therapies for treating metastatic CRPC. Keywords: drug‒drug interactions; bone metastases; monitoring issues; administrative issues
Castration-Resistant Prostate Cancer: Defining the Disease State
Recent improvements in the understanding of advanced prostate cancer have led to a clearer consensus on the clinical definition of the disease.1 Castration-resistant prostate cancer (CRPC) is currently defined by a documented testosterone level , 50 ng/ dL, despite androgen-deprivation therapy (ADT; agonist or antagonist), or removal of the testes (orchiectomy), a subsequent increase in serum levels of prostate-specific antigen (PSA; preferably 2–3 ng/mL over nadir), and/or other parameters of disease progression. Patients with CRPC may have no radiographically detectable metastases (M0) or may have bone or soft tissue sites of metastases (M1).2,3
Administrative Issues Related to Access and Payment for Therapeutic Options Correspondence: Mary-Ellen Taplin, MD, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215. Tel: 617-632-3227 Fax: 617-632-2165 E-mail: [email protected]
Although oral oncolytic agents, such as abiraterone and enzalutamide, may be more familiar to patients relative to their use of other prescription drugs, they are covered by a patient’s pharmacy benefit, and hence, additional logistics are involved when prescribing these medications compared with parenterally administered metastatic CRPC (mCRPC) agents. Oral oncolytic prescriptions will be filled by an on-site pharmacy or an independent specialty pharmacy. Depending on the proximity of the pharmacy, a delay could occur in getting the prescription to the patient. Regardless, having central
© Hospital Practice,Volume 41, Issue 4, October/November 2013, ISSN – 2154-8331 81 ResearchSHARE®: www.research-share.com • Permissions: [email protected] • Reprints: [email protected]
10_Taplin.indd 81
10/11/13 3:14 PM
Downloaded by [University of Lethbridge] at 22:07 06 November 2015
Taplin et al
coordination (patient advocates) of all treatment-related activities by the physician practice can help decrease patient confusion and delays in medication delivery. Physicians also must be aware of large insurance copays that may be associated with a treatment prescription for an mCRPC oral agent. Although some states may require insurance companies to treat oral agents as equal to infusion therapies in terms of patient copay amounts, this is not the case in every state, and this should be taken into account as part of the decision to prescribe this therapeutic option. Patients should also understand the limitations of their copays to avoid any disruption in filling the prescription. Based on financial need, various Patient Advocacy Foundations can assist patients with the financial burden of paying for their oral medications. These foundations include the Patient Advocacy Foundation (http://www.patientadvocate.org), Patient Access Network Foundation (https:// www.panfoundation.org), Chronic Disease Fund (http:// www.cdfund.org), and HealthWell Foundation (http://www. healthwellfoundation.org).
Conclusion
The clinical options that have become available to physicians in the past 3 years alone are now allowing patients with CRPC to live longer. The most appropriate sequencing and potential combination of these therapies remain an area of ongoing clinical research. Regardless of therapeutic pathway, physicians must continue to treat patients as individuals because of the heterogeneous nature of both the disease and the responses to treatments that have different methods of action. Identification of the mechanisms underlying the resistance of mCRPC to these diverse therapies will provide hope for further prolongation of life.
William R. Berry, MD, has indicated that he has been a member of a speakers bureau for Amgen, Bayer AG/Algeta ASA, Sanofi, Medivation, Inc./Astellas Pharma US, Inc., Janssen Pharmaceutical Companies, and Dendreon Corporation. He has been a member of the advisory board for Amgen, Bayer AG/Algeta ASA, Medivation, Inc./Astellas Pharma US, Inc., Janssen Pharmaceutical Companies, and Dendreon Corporation. Alison M. Casey, MSN, FNP, has no financial relationships to disclose. Angel Aslo, Pharm D, has indicated that she has been a member of a speakers bureau for Amgen, Celgene Corporation, Millennium Pharmaceuticals, Inc, and Novartis Corporation. All additional planning committee members have no financial relationships to disclose. References
1. Mostaghel EA, Page ST, Lin DW, et al. Intraprostatic androgens and androgen-regulated gene expression persist after testosterone suppression: therapeutic implications for castration-resistant prostate cancer. Cancer Res. 2007;67(10):5033–5041. 2. Mohler JL, Armstrong AJ, Bahnson RR, et al. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer. Version 2.2013. https://www. NCCN.org. Accessed March 11, 2013. 3. Cookson MS, Roth BJ, Dahm P, et al. Castration-resistant prostate cancer: AUA guideline. https://www.auanet.org/common/pdf/education/ clinical-guidance/Castration-Resistant-Prostate-Cancer.pdf. Accessed February 14, 2013.
Acknowledgments
All authors had access to all data in preparation of this multimedia activity.
Conflict of Interest Statement
The faculty members who participated in this multimedia activity have disclosed the following industry relationships: Mary-Ellen Taplin, MD, has indicated that she has received research funding from Genentech, Janssen Pharmaceutical Companies, and Medivation, Inc. She is a member of the advisory board for Janssen Pharmaceutical Companies, Medivation, Inc., Dendreon Corporation, Tokai Pharmaceuticals, and Algeta ASA. She is a consultant for Sanofi. 82
10_Taplin.indd 82
© Hospital Practice, Volume 41, Issue 4, October/November 2013, ISSN – 2154-8331 ResearchSHARE®: www.research-share.com • Permissions: [email protected] • Reprints: [email protected]
10/11/13 3:14 PM
