A Survey of Oncologists and MCO Pharmacy and Medical Directors
Targeted small-molecule agents have emerged as key treatment options for biomarker-defined non-small-cell lung cancer (NSCLC) patient populations, namely EGFR-mutation-positive and ALK-translocation-positive, advanced/metastatic patients. Roche/Genentech/Astellas’s Tarceva (erlotinib) and Pfizer’s Xalkori (crizotinib) are entrenched in the treatment of first-line patients. Several EGFR and ALK inhibitors are in various stages of development, the most advanced of which are poised to initially gain approval for refractory patients, including AstraZeneca’s AZD-9291, similar to Novartis’s Zykadia (ceritinib), approved for the treatment of Xalkori-treated patients.
Targeted small-molecule agents will continue to have a central role in the treatment of NSCLC, not only in the first- but also in the subsequent-line settings, with the sequential administration of EGFR and ALK inhibitors expected to become standard practice. The uptake of novel therapies will be dependent on pricing and reimbursement decisions, as well as uptake, pricing, and reimbursement of companion diagnostic tests aiming to identify those patients most likely to benefit from treatment. Tissue availability for testing is a significant hurdle to test NSCLC patients, but new methodologies such as blood-based testing could lead to a greater percentage of patients being tested and treated with a targeted, biomarker-driven small-molecule agent.