Payers, Providers Differ on Padcev’s Place in Regimen

The FDA recently expanded the indication of a drug for certain types of urothelial cancer, the most common form of bladder cancer. Payers and oncologists appear to be divided, however, on the drug’s place in a treatment regimen.

On July 9, the FDA gave an additional approval to Astellas Pharma US, Inc. and Seagen Inc.’s Padcev (enfortumab vedotin-ejfv) for the treatment of adults with locally advanced or metastatic urothelial cancer who are ineligible for cisplatin-containing chemotherapy and have received at least one line of therapy. The agency also converted the Nectin-4-directed antibody and microtubule inhibitor conjugate’s accelerated approval, granted Dec. 18, 2019, to regular approval for the treatment of adults with locally advanced or metastatic urothelial cancer who have received a programmed death receptor-1 (PD-1) or programmed death-ligand 1 (PD-L1) inhibitor and a platinum-containing chemotherapy before or after surgery or in a locally advanced or metastatic urothelial cancer setting.

For the Managed Care Oncology Index: Q1 2021, between Feb. 26, 2021, and April 9, 2021, Zitter Insights polled 40 commercial payers with 132.2 million covered lives. Respondents covering 36% of lives said Tecentriq (atezolizumab) from Genentech USA Inc., a member of the Roche Group, is their ideal first-line bladder cancer therapy, followed closely by Keytruda (pembrolizumab) from Merck & Co., Inc. Moreover, respondents with 31% of covered lives said that AstraZeneca’s Imfinzi (durvalumab) was their top second-line therapy, followed by those with 27% of lives who cited Opdivo (nivolumab) from Bristol Myers Squibb Co.

Zitter Insights and AIS Health are MMIT companies.

During the same time frame, Zitter Insights polled 100 oncologists about bladder cancer. While 43% of them selected Keytruda as their ideal first-line therapy, Padcev was tapped as the top second-line therapy, cited by 28% of respondents (see chart below). Among oncologists’ prescribing of bladder cancer agents over the 12 months prior to the survey, Keytruda was the top drug, prescribed by 82% of respondents. Almost half — 48% — had prescribed Padcev.

For more information on the Zitter data, contact Jill Brown Kettler at

Angela Maas

Angela has an extensive background of editing, reporting and writing for trade and consumer publications. She has written Radar on Specialty Pharmacy (formerly called Specialty Pharmacy News) since she joined AIS Health in 2005 and has broad knowledge of the various issues at play within the space. Before joining AIS Health, she was managing editor at Employee Benefit News and Employee Benefit News Canada and managing editor at HemAware (a hemophilia publication), Lupus Living and Momentum (a multiple sclerosis publication). She has a B.A. in English and an M.A. in British literature from Arizona State University.

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