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NCI’s Recovery Act Web site also features a list of the clinical trials supported by NCI’s Accelerating Clinical Trials of Novel Oncologic PathWays (ACTNOW) initiative. The ACTNOW trials are high-priority, early-phase clinical trials of new cancer treatments being studied on an accelerated timeline in a variety of cancer types. The accelerated timeline is intended to shorten the time between drug discovery and approval and safe use of these treatments by cancer patients. The trials include a significant number of correlative studies, including studies of biologic and imaging tests.
The Web page lists the ACTNOW trials by cancer type and contains links to descriptions of the trials, including the objectives, patient enrollment criteria, and current trial locations.
I think one good recent example of Comparative Effectiveness Research in cancer medicine was a Duke University cost savings study on the impact of a chemoresponse assay (which I advocate) on treatment costs for recurrent ovarian cancer. They sought to estimate mean costs of chemotherapy treatment with or without use of a chemoresponse assay.
ReplyDeleteThey estimated mean costs for 3 groups: (1) assay assisted: 75 women who received oncologist's choice of chemotherapy following chemoresponse testing (65% adherence to test results), (2) assay adherent: modeled group assuming 100% adherence to assay results, and (3) empiric: modeled from market share data on most frequently utilized chemotherapy regimens. Cost estimates were based on commercial claims database reimbursements.
The most common chemotherapy regimens used were topotecan, doxorubicin, and carboplatin/paclitaxel. Mean chemotherapy costs for 6 cycles were $48,758 (empiric), $33,187 (assay assisted), and $23,986 (assay adherent). The cost savings related to the assay were associated with a shift from higher- to lower-cost chemotherapy regimens and lower use of supportive drugs such as hematopoiesis-stimulating agents.
Conclusion of the study was that assay-assisted chemotherapy for recurrent ovarian cancer may result in reduced costs compared to empiric therapy. What most medical oncologists do now (PMID: 20417480).