Mark A. Socinski, MD: We’re getting toward the end of this discussion, so I just wanted to bring up a few other issues. One of the issues that we haven’t talked about is cost. Looking at these gains that we’re seeing in survival, how are we going to think about the cost issue? I struggle in thinking about what this is going to do to the cost issue, but I also struggle with things like duration and frequency of therapy with immuno-oncology agents. These are all very expensive drugs. What are your thoughts?
Benjamin P. Levy, MD: At my former institution, I was involved with cost, with the implementation of MACRA (Medicare Access and CHIP Reauthorization Act) and the care models. This is something that community physicians and even academic physicians are going to struggle with. I will pledge that I am not fluent in cost analysis. I don’t think a lot of us are. And the other question is, should we be in the business of factoring in cost when we’re making these decisions? These decisions are secondary to the overall survival advantages that we’re seeing. I think that we are going to have to learn more about cost whether we like it or not. How to integrate that into our decision making is going to be exceptionally difficult. It really is.
We have so much that we have to digest and integrate, in terms of decision making. It will be very hard, but whether we like it or not, I think we’re going to have to do it. It may not be right now, but it may be coming in the near future.
Corey J. Langer, MD, FACP: But if we see significant survival advantages, then we have to put our collective efforts together to make sure that pharma and healthcare systems are able to make these drugs available to our patients. The head of pharma, or the CEO of any 1 of the companies that makes this agent, can change the entire cost analysis with a single keystroke on his or her laptop. We cannot change survival codes like that. Although I agree that we have to factor that in, our main responsibility is to our patients. If something is looking better, it’s incumbent of us not to deny that patient availability of that agent because of the cost but to see how we can make it globally available. There are biosimilars that are replacing some of these agents, and pharma is going to have to realize that.
In terms of cost, based on emerging data, my standard regimen has changed. Your trial is wonderful, but it wasn’t really using the regimen that I had typically used before. I would love to see a trial of carboplatin/pembrolizumab or atezolizumab with bevacizumab, but imagine the cost there. There are 3 proprietary drugs. It’s an attractive trial. Patients don’t have the neuropathy or hair loss that they typically suffer with when using taxanes, but it may just be untenable.
Transcript Edited for Clarity