The proliferation of new cancer treatments has created a novel challenge for oncologists and hematologists in recent years, said Sta­cey McCullough, PharmD, the senior vice president for pharmacy at Tennes­see Oncology. For the first time, they frequently must decide which of several essentially similar medications makes the most sense for a particular patient.

Comparisons can be difficult, Mc­Cullough explained during the 4th annual meeting of Patient-Centered Oncology Care, which took place No­vember 19-20, 2015. However, careful consideration of factors such as safety, adherence, and cost can help drive good decisions. To illustrate the growth of me-too cancer medications, Mc­Cullough highlighted drug approvals that occurred between 2009 and 2013. Those years produced 51 new drugs, 24 of which featured novel mechanisms for attacking tumors. And, if anything, the trend is accelerating.

“We could look to the last few weeks, and 6 or 7 new drugs, I think, have been approved,” McCullough said. The most important criterion for choosing between similar drugs is efficacy, but it’s generally impossible to discern the most effective product in a given class. Head-to-head trials are rare, while com­paring results from one trial to another is nearly impossible. Different trials of different medications don’t even share the same endpoint.

“If we look at the cohort of these drugs that were approved over the last 5 years, the endpoints were equally dis­tributed,” McCullough said. “Progression free survival, overall survival, or overall response rates were all equal endpoints of these studies.”

The dearth of comparative evidence necessarily leads to broad guidelines. The National Comprehensive Cancer Network lists 3 tyrosine kinase inhibi­tors as first-line treatment options for chronic myelogenous leukemia (CML) and 17 sequence options (that use only 5 medications) for patients who eventu­ally need 3 lines of therapy.

There are, however, strategies for caregivers who wish to use available information to establish preferences among apparently similar medications. For example, it is sometimes possible to compare safety and side-effect profiles and use those comparisons to decide which patients should get which medi­cations. “Each of these molecules has distinctions that make them a little bit different,” she said. “They exhibit differ­ent side-effect profiles, so they can be tailored to individual patients based on their comorbid position.”

Continue Reading on AJMC.com