Contemporary Topics in the Treatment of Non-Small-Cell Lung Cancer: Physicians, Payers, and Pathologists as Gatekeepers to Market Access

Based on a survey of 100 medical oncologists and 30 MCO pharmacy and medical directors, this report explores the market access challenges facing key current and emerging brands used in the treatment of NSCLC. The report focuses on the powerful contemporary issues that are driving the increasingly fragmented treatment of this complex disease: molecular testing, biomarker-driven prescribing, positioning of agents without biomarkers, and the role of high-cost maintenance therapy. Emerging classes covered include PD1/PD-L1 directed therapies, next-generation EGFR and ALK inhibitors, and antiangiogenics. To contextualize our survey findings, this special report will include findings from qualitative interviews with a small number of influential payers and pathologists.

NSCLC is often heralded as the “pin up” indication for personalized medicine in oncology. However, despite the recent FDA approval of another biomarker-associated agent, Boehringer Ingelheim’s Gilotrif (afatinib), adding to Roche/Genentech/Astellas’s Tarceva (erlotinib) and Pfizer’s Xalkori (crizotinib), the reality is that only a small percentage of NSCLC patients actually receive a therapy based on the molecular characteristics of their cancer as determined by a biomarker test. However, add to this the fact that Eli Lilly’s Alimta (pemetrexed) is approved only for patients with non-squamous cell histology, Roche/Genentech’s Avastin (bevacizumab) is contraindicated in patients with squamous histology, and increasingly drug selection is based on features of a patient’s tumor.