Ruth O'Regan, MD
As biosimilars inch closer to the market, conversations around cost have taken center stage. In other markets across the world, biosimilars have reduced costs in oncology—both for payers and patients.
Ruth O’Regan, MD, professor of medicine at University of Wisconsin School of Medicine and Carbone Cancer Center, discussed the excitement with biosimilars, and the potential impact they could have on the US drug market.
OncLive: Can you share your thoughts on biosimilars in breast cancer?
: Biosimilars really are beginning to take off in oncology. For breast cancer, we have seen data on trastuzumab biosimilars. We have randomized studies where they have been compared with trastuzumab, showing similar safety and immunogenicity. They are pretty much ready for primetime. It is going to be interesting because the data suggest that they are identical, but whether patients who have been on trastuzumab for metastatic disease for years will be accepting of this change—we don't know at this time.
Other things [to consider] are modes for administration. There is a subcutaneous form of trastuzumab, which is very useful outside the United States, but we don't have it yet.
How can those in the field become more familiar with the concept of biosimilars?
For biosimilars, we need to get them out there at continuing medical education meetings and national conferences so people know about them. Really, talking to pharmacists, institutions, and nurses to make sure they know about it would be the key thing.
At the University of Wisconsin School of Medicine and Carbone Cancer Center, we look at the formulary and whether there is a cheaper option than the original drug. We would definitely consider using the biosimilar. It needs to be done at the institution level, but there also needs to be information given out at meetings.
In what ways can the cost of therapy be brought down?
It is hard because they all show some efficacy; the question is, “How much efficacy do they show?” In certain countries, where there is universal healthcare, there are very strict criteria in terms of what they approve and what they do not approve. It is all related to survival. When drugs are approved, we need to think about who they are indicated for, and how they will be used; those are very important. If you have 3 drugs that are very similar, like the CDK4/6 inhibitors, what are the differences? Are there cross-differences that we can use to help our patients? The bottom line is that we have to try to bring the cost down at the pharmaceutical company level.
One of the issues is that [cancer] drugs are incredibly expensive to develop. That is why they are costly. The cost of these drugs is lower outside of the United States, so there are things we could do in terms of legislation to do that, as well.
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