Increase in Oral Cancer Drugs Raises Thorny Issues for Oncology Practices

Extract

The recent announcement of the prestigious 2009 Lasker clinical research award to the developers of imatinib (Gleevec) recognizes the advent of a new generation of targeted therapies, many of them taken as pills, that have transformed cancer treatment for many patients. In the last 5–10 years, oral agents such as gefitinib, erlotinib, lapatinib, and capecitabine have followed imatinib. And more are on the way. According to a 2008 National Comprehensive Cancer Network task force report, at least one-fourth of all chemotherapy agents now in development are expected to be delivered orally.

For some patients, oral agents have replaced the long sessions in doctors’ offices where intravenous (i.v.) chemotherapy drugs are administered in specially equipped and staffed infusion rooms. And for oncology practices, the agents have raised a series of management issues, including strained finances and new demands on staff time. Systems to ensure patient safety and adherence to oral chemotherapy have yet to be implemented in many practices. And the complexity of reimbursement from both Medicare and private insurers has stretched many oncology clinics, particularly smaller private practices, nearly to the breaking point.