Zitter Pulse Check: Prostate Cancer (December 2023)
Coverage
Prostate cancer is a high-cost category with an increasing number of therapies that treat different subtypes of the condition. To help stakeholders absorb datapoints and perceptions from all directions and synthesize those insights into a tangible strategy for prostate cancer, Zitter Insights surveys a leading panel of pharmacy and therapeutics (P&T) decision makers at payers and integrated delivery networks. The Managed Care Oncology Index: Prostate Cancer combines deep payer insights with the industry standard in market access information to produce quarterly reports and insights summaries on leading oncology brands.
Payer Management
Payers with half of commercial lives said that managing branded prostate cancer therapies is a high priority, while payers representing more than two-fifths of Medicare beneficiaries consider it a very high priority. Payers with around two-thirds of all lives, however, say they are only slightly aggressive in managing the treatments. More than three-fifths of payers said they have an average level of satisfaction with available agents, and most payers and oncologists said there is moderate to high unmet need in treating the condition.
More than half of oncologists and payers with more than half of all lives say there is an average disease burden for people with the condition. One-third of payers said that there is an average level of contracting for prostate cancer treatments.
Key Findings
Talzenna Plus Xtandi
On June 20, 2023, the FDA expanded the approval of Pfizer Inc.’s poly (ADP-ribose) polymerase (PARP) inhibitor Talzenna (talazoparib) in combination with the company’s Xtandi (enzalutamide) for the treatment of adults with homologous recombination repair (HRR) gene-mutated metastatic castration-resistant prostate cancer (mCRPC). Payers with almost two-thirds of Medicare lives said they were moderately aware of the treatment, while those with almost half of commercial beneficiaries said they were extremely aware of it. Dosing for Talzenna capsules is 0.5 mg once daily, and Xtandi is 160 mg once daily via either tablet or capsule. Drugs.com lists the price of 30 0.5 mg of Talzenna as more than $18,451 and the price of 60 80 mg tablets of Xtandi as more than $14,382. Half of oncologists said that patients’ out-of-pocket costs for the regimen are in line with what they expected.
Combination Therapies
The FDA has approved multiple combinations of drugs for the treatment of prostate cancer. Payers with almost two-thirds of commercial lives and those with almost all Medicare beneficiaries said they manage each agent of a combination therapy independently. Most payers said they do not expect to implement strategies controlling the use of combination agents, with many saying that they follow National Comprehensive Cancer Network (NCCN) guidelines. Less than one-quarter of payers, however, said they will take measures to control the use of combination treatments. Among those respondents, the top strategies cited were increasing the use of prior authorization and requiring adherence to clinical treatment pathways.
Akeega
On Aug. 11, 2023, the FDA approved the Janssen Pharmaceutical Companies of Johnson & Johnson’s Akeega (niraparib/abiraterone acetate) in combination with prednisone for the treatment of adults with deleterious or suspected deleterious breast cancer gene (BRCA)-positive metastatic castration-resistant prostate cancer. It was the first dual action tablet combining a poly (ADP-ribose) polymerase (PARP) inhibitor — GSK’s Zejula (niraparib) — with abiraterone acetate, an androgen biosynthesis inhibitor. Most oncologists said they expect the agent to have at least some impact on their treatment of people with prostate cancer. More than one-third of all payers were somewhat aware of the product, and the same amount of oncologists were moderately aware of it.
Trends
PARP Inhibitors
Message: “New discussion this week surrounding use of PARP inhibitors for mCRPC. Several manufacturers are stakeholders, including AstraZeneca with Lynparza. There is also potential for new combo treatments with abiraterone and enzalutamide.”
Payer Thoughts: “This is a big deal potentially, since we have only begun to see PARPi use within late-stage prostate cancer. The use of combos with abiraterone is somewhat known with Lynparza and Rubraca, but now we are hearing about enzalutamide combos that could greatly increase net cost of combo regimen.”
FDA Approves Akeega
On Aug. 11, 2023, the FDA approved the Janssen Pharmaceutical Companies of Johnson & Johnson’s Akeega (niraparib/abiraterone acetate) in combination with prednisone for the treatment of adults with deleterious or suspected deleterious breast cancer gene (BRCA)-positive metastatic castration-resistant prostate cancer (mCRPC). It is the first dual action tablet combining a poly (ADP-ribose) polymerase (PARP) inhibitor — GSK’s Zejula (niraparib) — with abiraterone acetate, an androgen biosynthesis inhibitor. The agency granted the application priority review and used the Assessment Aid. Recommended dosing is 200 mg niraparib/1,000 mg abiraterone acetate and 10 mg prednisone once daily. The agent’s list price for a 30-day supply is $18,750.
Subscribers to AIS’s RADAR on Specialty Pharmacy may read the in-depth article online
FDA Approves Talzenna/Xtandi Combination Use
On June 20, 2023, the FDA expanded the approval of Pfizer Inc.’s Talzenna (talazoparib) in combination with the company’s Xtandi (enzalutamide) for the treatment of adults with homologous recombination repair (HRR) gene-mutated metastatic castration-resistant prostate cancer. The agency initially approved the poly (ADP-ribose) polymerase (PARP) inhibitor on Oct. 16, 2018. The newest use had priority review, and the review used the Assessment Aid. Dosing for Talzenna capsules is 0.5 mg once daily, and Xtandi is 160 mg once daily via either tablet or capsule. Drugs.com lists the price of 30 0.5 mg of Talzenna as more than $18,451 and the price of 60 80 mg tablets and 120 40 mg tablets of Xtandi as more than $14,382.
Subscribers to AIS’s RADAR on Specialty Pharmacy may read the in-depth article online
