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New Research from Texas Oncology Uncovers Key to More Targeted Use of High-Cost Cancer Drug

Study Examined Use of Injections That Help Patients Reduce Infections During Chemotherapy Treatment 

In new research from Texas Oncology that examined the drug pegfilgrastim and the most commonly used chemotherapy regimens for breast cancer, including TC (docetaxel, cyclophosphamide) and TCH (docetaxel, carboplatin, trastuzumab), results showed that pegfilgrastim is the major cost driver of all drug costs for the most common breast cancer treatment protocols. Pegfilgrastim, also known as Neulasta®, is a white blood cell stimulator – commonly used to combat low white blood cell counts which is one of the most common chemotherapy side effects. Understanding practice patterns and cost drivers of treatment gives oncologists greater insight in how to provide the most effective cancer care while reducing toxicity and cost.

The Texas Oncology research, which included a review of the most common treatment regimens of more than 40,000 breast cancer cases, focused on the clinical and cost implications for use of the drug pegfilgrastim. The research results help physicians plan treatments that are highly effective while reducing toxicity and cost. 

“These chemotherapy treatments are more expensive if pegfilgrastim is used. However, pegfilgrastim helps reduce the occurrence of infections and is necessary among certain chemotherapy regimens that have greater risk of toxicity. When used appropriately, pegfilgrastim reduces febrile neutropenia, infections, hospitalizations and expensive hospital-related costs,” said Dr. Debra Patt, medical oncologist at Texas Oncology–Austin Central. “Patients who do not have infections are more likely to maintain their chemotherapy dosages, rather than reducing the dosage, which helps the patient more effectively fight cancer.”

As cost of cancer treatment continues to be an important issue, further studies will be needed to best determine the optimal approach in early breast cancer.

“The study highlights Texas Oncology’s ability to access vast patient data through its affiliation with US Oncology’s industry-leading iKnowMed electronic health records database as a strategic comparative effectiveness research resource that benefits all of our Austin area patients,” said Dr. Patt.

Physicians from Texas Oncology will present the study’s findings this week at the annual Cancer Prevention & Research Institute of Texas Conference in Austin. The study is an example of Texas Oncology’s robust commitment to comprehensive research including participation by its patients in numerous clinical trials through US Oncology Research. These trials have involved all stages of cancer, and have helped to develop 43 FDA approved cancer therapies.

Other studies presented at the CPRIT conference include an evaluation of an Advance Care Planning Program and a research study to evaluate patients at risk for an inherited breast cancer syndrome. The Advance Care Planning Program serves to engage patients in informed decision making in order to respect their values and recognize their goals of treatment with advanced malignancy. Texas Oncology reports the implementation of that program across its Austin practices.

Dr. John Sandbach, practice director of Texas Oncology–Austin Central and co-director of the Hereditary Cancer Risk Assessment Program, and colleagues report on a study evaluating genetic predisposition to breast cancer among women who have a type of high risk breast cancer, triple negative breast cancer. Understanding heritable risk has been a long-term focus of Texas Oncology as demonstrated by its robust Hereditary Cancer Risk Assessment Program to identify patients at risk of developing cancer. 

“The best way to cure cancer is to prevent it from happening in the first place,” said Dr. Sandbach.

Since 1999, Texas Oncology patients in the Austin area have participated in more than 200 research studies, including an average of 36 open trials at any given time for bladder, brain, breast, colorectal, endometrial, head and neck, liver, lung, melanoma, ovarian, pancreatic, prostate, renal, and uterine cancers, as well as lymphomas, leukemia, and advanced solid tumors. Other recent research projects involving Austin patients include:

• Clinical trials of a breast cancer “smart bomb” treatment, which targets tumors cells while avoiding harming healthy cells
• A study that evaluated the risk of secondary malignancy after breast cancer treatment, which showed that cancer patients can receive appropriate therapy without increased risk of developing acute myeloid leukemia and myelodysplastic syndrome in the first three years after completion of therapy
• Participation in a large scale quality improvement program that examined data from more than 42,000 patients to identify clinical evidence based treatment adherence and cost management benefits from increased standardization of treatment regimens (evidence-based pathways)
• Implementation and ongoing review of a focused, weekly outpatient clinic specifically concerned with advising patients and families regarding palliative care solutions
• A program to improve advance care planning opportunities through seamless, proactive engagement of oncology advanced practice nurses in cancer patient discussions, and incorporating a review of more than 2,500 stage four cancer cases
• A phase I clinical research trial program
• Investigator initiated clinical cancer research trials
• Participation in regional collaborative research trial networks through Clinical Trials Network of Texas (CTNeT) and SWOG
• The only open brain cancer vaccine trials opened in the Austin region to treat glioblastoma multiforme, which is the most malignant type of brain tumor.

“With 80 percent of cancer treatment now delivered on an outpatient basis, the advantages of Texas Oncology’s community-based approach to cancer treatment include significant cost containment, as compared to hospital-based care, along with convenience that improves quality of life for patients and their families,” said Dr. Sandbach. “We also leverage our network strengths – the combined experience of hundreds of doctors, and thousands of patient treatments – to stay on the forefront of research and discovering innovations in all facets of cancer treatment and care.”