Optimizing Care for Patients With Non-metastatic CRPC

Transcript:

Alan Bryce, MD: How about Dr Zhang? Final thoughts in this space of nmCRPC [non-metastatic castration-resistant prostate cancer]? What else is coming in this space? Any other trials data that you’re excited about?

Tian Zhang, MD, MHS: It’s been a fabulous conversation and I always learn a lot when I’m on with Dr Heath, Dr [Edwin] Posadas [MD], and yourself, but in this space, I’m curious about pharmacoeconomics. So cost to our system and to our patients. I often tell patients when we have a lack of comparative treatments directly to each other, the best option to me is what they can get in their hands and in their mouths. In my practice, the biggest barrier is cost and copays, and it’s very much dictated by the insurance carrier. Even the Medicare population has a very high copay, particularly at the beginning of the year. How much our patients can afford is directly impacting how much they’re able to receive and then benefit. Unless our trial populations are getting out into real-world settings and unless these drugs are actually affordable, these benefits that we see in the trial populations will not be seen in the real-world setting. I think about how much is too much and how much are we overtreating for some of these patients. Are there patients who achieve a good PSA [prostate-specific antigen] decline, PSA undetectable for a number of years? Are those the right patient populations to de-intensify treatment? Many of these treatments were treatments until progression and there were no stops or holds along the way that was predefined. To me, that’s our biggest challenge to figure out, which patients could hold for a while, be off treatment in their intermittent ADT [androgen deprivation therapy] paradigm, and which people need to keep going and have more aggressive disease that needs further treatment pressure along the way. Those are 2 opportunities in this space that might need further research so that we can best practice for these patient populations.

Alan Bryce, MD: Great point.

Elisabeth Heath, MD, FACP: I’m just going to jump in and put a plug in for the state of Michigan that we’re 1 out of 8 states without oral chemotherapy parity. So in addition to the challenges of copay and existing insurance plans we have along with other states, there’s no guarantee and nothing in policy or law that would back that up. So the fight continues on for awareness and advocacy. That’s my plug for the evening to support that bill. Hopefully, this is the eighth year at BAT that we would be successful this April.

Transcript edited for clarity.