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Surveyed EU5 Medical Oncologists Prescribe Iressa or Tarceva as a First-Line Treatment to an Average of 70 Percent of Their Confirmed EGFR-Mutation Positive NSCLC Patients

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Interviewed payers say biomarker-driven prescribing is a non-small-cell lung cancer  (NSCLC) market access lever, but optimal pivotal trial design is also key, according to a new report from Decision Resources.

Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that surveyed medical oncologists across the EU5 (France, Germany, Italy, Spain, and the United Kingdom) currently prescribe the reversible epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors Tarceva (Roche) or Iressa (AstraZeneca) as first-line treatment to an average of 70 percent of their drug-treated non-small-cell lung cancer (NSCLC) patients with non-squamous tumors confirmed to be harboring an activating EGFR mutation. Coupled with first-line prescribing of Pfizer’s Xalkori to 36 percent of respondents’ ALK translocation-positive NSCLC patients, on average–despite health technology assessment (HTA) complexities in some countries–this demonstrates the increasing importance of biomarker-driven prescribing in NSCLC in the EU5.

The new European Physician and Payer Forum report entitled Non-Small-Cell Lung Cancer: Drivers of European Prescribing and Reimbursement in an Indication with High Unmet Need at a Time of Increasing Austerity also finds that while interviewed payers confirm that a strongly predictive biomarker and highly predefined target population are key tools for access to the highly competitive NSCLC market, manufacturers seeking to penetrate this space must optimize pivotal trial design and value dossier preparation. Head-to-head studies incorporating strong biomarkers that show robust survival benefits over suitable comparators are increasingly vital in all EU5 countries as cost-constrained healthcare authorities strive to draw out value for money.

The findings also reveal that while all or almost all surveyed oncologists currently test some tumors for EGFR mutation and ALK translocation, the rate of testing is constrained by the need to treat before results are obtained and the lack of tissue for testing and healthcare authority restrictions on patient criteria. In addition, definitive results of ALK testing especially are not always obtained.

“Companion diagnostic tests that use surrogate samples, such as serum, plasma, bronchial alveolar lavage and fine needle aspirates, could improve uptake of targeted agents,” said Decision Resources Business Insights Analyst Sam Mentzer. “Furthermore, well-designed, easily administered cost-sharing schemes can be a key prescribing differentiator for NSCLC, especially in Italy and the United Kingdom, and increasingly in Spain. As cost-sharing schemes become more prevalent, funding of diagnostic testing could be an additional leveraging tool, country-specific legalities permitting.”

Source: Decision Resources