Patrick Brown, MD
With the recent publication of an inaugural set of guidelines for treatment of pediatric acute lymphoblastic leukemia (ALL), the National Comprehensive Cancer Network (NCCN) seeks to introduce standards to a branch of care long dominated by clinical trial protocols. These new standards are intended for managing different age groups and risk levels, youths with Philadelphia chromosome (Ph)-positive ALL, and toxicities, with an eye toward current and long-term risks of care.1
An additional reason for the NCCN’s release of the guidelines was the need for authoritative pediatric ALL treatment pathways that would help ensure payer concurrence with treatment methodologies that physicians were selecting, Wui-Jin Koh, MD, chief medical officer of the NCCN, explained.
Table. Key Trials and Agents in Evolution of Therapy for Pediatric ALL2-7
In the adult [ALL] cancer population, where NCCN guidelines [are well established], systemic therapies are covered by payers based on their inclusion in NCCN guidelines. We had heard from many pediatric oncologists who said that because NCCN guidelines did not include pediatric tumors, they would have to then go back to the insurance companies to justify the use [of certain drugs] and essentially spend time dealing with all those insurance/regulatory issues. [The] NCCN is so well accepted that if it is in NCCN guidelines, in general it is used for coverage determinations by multiple payers,” Koh said.
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