Rituxan Treatment for 62-year-old Patient
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 an Oncology Analytics academic advisor (Dr. Lister) who specializes in hematologic malignancies. Dr. Lister concurred that a diagnosis of lymphoma was not established and that treatment was not indicated. Dr. Lister called the treating physician. After a thorough review of the case, it was agreed that no treatment was needed at this time.
Quality of Care: Rituxan is used to treat non-Hodgkin’s lymphoma or chronic lymphocytic leukemia (and rheumatoid arthritis when used in conjunction with methotrexate). It has been associated with fatal infusion reactions, kidney failure, bowel obstruction, infections, and other severe side effects. Administering Rituxan would have increased the risk of complications without any associated benefit.
Savings: Approximately $5,500 per month.
Authorization of Neulasta
Oncology Analytics received a request for authorization of Neulasta for a patient currently being treated with Taxol. Since Taxol usually does not require any treatments to boost the white blood cells, Oncology Analytics 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. Oncology Analytics contacted the treating physician to review the case. The treating physician was surprised, and he stated that he had not seen that CBC (Complete Blood Count) of the patient being treated. The request for Neulasta was withdrawn.
Quality of care: Though rare, Neulasta has been associated with splenic rupture and acute respiratory distress syndrome. Administering Neulasta to this patient would have increased the risk of complications without any associated benefit.
Savings: Approximately $4,000 per month.
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/or increased risk of tumor progression or recurrence 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.
Quality of Care: The patient did not receive a medication that may have reduced her chance of cure.
Savings: Approximately $2,500 per month, depending upon dose.
Metastatic Breast Cancer
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.
Oncology Analytics’ patient-focused mission is clearly demonstrated here. This non-compendium regimen was approved because the patient was benefitting from the treatment — the cost of the treatment was not a subject of the discussion. Treating physicians recognize Oncology Analytics’ clinical expertise and patient-focused approach. As a result, Oncology Analytics has developed a collaborative relationship with treating physicians and is recognized as a trusted advisor.
*The case studies set forth above are summaries of specific cases received by Oncology Analytics and are not medical advice nor are they Oncology Analytics’ recommendation for use or nonuse of a particular drug.