Case Studies
Oncology Analytics in Action
Rituxan Treatment for Lymphoma
Oncology Analytics received a request for Rituxan for the treatment of lymphoma in a 62-year-old patient who presented with weakness and fatigue. After reviewing the medical records, it appeared that the available information did not clearly support the requested treatment. An Oncology Analytics medical director consulted with Dr. John Lister, a Pathologist at Johns Hopkins Hospital and a member of Oncology Analytics Distinguished Academic Advisory Board. Dr. Lister, who specializes in hematologic malignancies, concurred that a diagnosis of lymphoma was not established and that treatment was not indicated. Dr. Lister called the treating physician and after a thorough review of the case, it was agreed that treatment was not needed.
Outcome: Rituxan is used to treat a variety of lymphomas. However, this patient did not have evidence of lymphoma. Rituxan has been associated with fatal infusion reactions, kidney failure, bowel obstruction, infections, and other severe side effects. Administering Rituxan would have subjected the patient to the risk of complications without any associated benefit.
Savings: Approximately $6,200 per treatment or approximately $74,000 over 2 years.
Authorization of Neulasta
Oncology Analytics received a request for authorization of Neulasta for a patient who was being treated with paclitaxel. Since paclitxel usually does not require any treatments to boost the white blood cells, we reviewed the patient’s recent white blood cell (WBC) counts. It was found that the patient’s WBC was over 60,000, almost 6 times the upper limit of normal. A member of the Oncology Analytics Clinical Team contacted the treating physician who stated that he had not seen that result. The request for Neulasta was withdrawn.
Outcome: Neulasta often causes bone pain, which can be so severe that patients may think they are having a heart attack. It can also cause fatal splenic rupture and acute respiratory distress syndrome. Administering Neulasta to this patient would have increased the risk of complications without any possibility of benefit.
Savings: Approximately $6,000 per month or $18,000 over three months of treatment
Taxotere and Cytoxan for Stage II Breast Cancer
Oncology Analytics received a request for Taxotere and Cytoxan for stage II breast cancer in a 45-year-old female. The treating physician also requested Procrit for anemia. The treating physician was called and reminded that Procrit is associated with shortened overall survival and an increased risk of tumor progression in patients with breast cancer. In addition, there is a Black Box Warning stating that Procrit is not indicated for patients when the goal of treatment is cure. The request for Procrit was withdrawn.
Outcome: Oncology Analytics oversight improved this patient’s chance of cure.
Savings: Approximately $2,500 per month or $7,500 for three months of treatment
Metatastic Breast Cancer Treatment
A request for Pertuzumab, Trastuzumab, Docetaxel and Carboplatin (P-TCH) was received for a woman with stage IV breast cancer with skin and liver metastases. Oncology Analytics Pharmacists found no data to support P-TCH in the metastatic setting (the landmark CLEOPATRA clinical trial evaluated the P-TCH regimen without carboplatin) and the benefit of adding carboplatin in the metastatic setting of HER2+ disease is questionable given BCIRG-007. The discussion between the Oncology Analytics Medical Director and the treating oncologist revealed that the patient had been receiving this regimen and clinically benefitting from it (P-TCH, three cycles). The treating oncologist agreed completely with Oncology Analytics’ findings but did not want to alter a regimen that was beneficial to this patient. Oncology Analytics authorized the treatment and recommended that the payer allow the physician to continue this regimen for this particular patient.
Outcome: Oncology Analytics’ patient-focused mission is clearly demonstrated here. This non-compendium regimen was approved because the patient was benefitting from the treatment, therefore, the cost of the treatment was not a subject of the discussion.