Urology Practice and Specialty Pharmacy Meet at a Crossroads

OncLive Chairman,

Mike Hennessy

In the oncology realm, specialty pharmacy has become a mainstay, but its role in urology practice is starting to trend upwards. Defined as a market space of products that have a significant per dose or per monthly expense associated with them, specialty pharmacy may offer urologists a way to manage their prostate cancer patients before referring them to a medical oncologist, according to our article, “Specialty Pharmacy Makes Inroad in Pharmacy Practice.”

Eric Sredzinski, PharmD, RPh, would agree. “Specialty pharmacy and urology are at a crossroads,” says the executive vice president of Clinical Affairs and Quality Assurance for Avella Specialty Pharmacy.

Incorporating specialty pharmacy is not an easy endeavor, however. As with any investment, time and capital are required, and a urology practice has to start with an understanding of the current volume of prescriptions being written and filled. Ultimately, specialty pharmacy can be useful to maintain the continuity of care for the patient—something that all urologists want.

We also report on a recent “OncLive Insights Expert Perspectives” panel, moderated by Daniel P. Petrylak, MD, director of the Genitourinary Oncology Research Program at the Yale Comprehensive Cancer Center. He was joined by Dean F. Bajorin, MD, an attending physician at Memorial Sloan Kettering Cancer Center and Evan Y. Yu, MD, professor in the Department of Medicine at the University of Washington and the Seattle Cancer Care Alliance.

The panel discussed the growing and exciting emergence of immunotherapy in bladder cancer, highlighting the checkpoint blockade inhibitor MPDL3280A. The FDA has designated the agent as a breakthrough therapy in bladder cancer.

The panelists discussed ongoing clinical trials, including a phase II, multicenter, single-arm study of MPDL3280A in patients with locally advanced or metastatic urothelial bladder cancer (NCT02108652).

In that trial, researchers are evaluating MPDL3280A (1200 mg) every 21 days for up to 16 cycles in 300 cisplatin-refractory patients and 100 treatment-naïve and platinum-ineligible patients.

“It’s going to be interesting to see whether platinum in-eligible patients who are chemotherapy naïve will respond or not,” said Petrylak during the discussion.

The Large Urology Group Practice Association, or LUGPA, has a new president-elect—Neal Shore, MD, of Atlantic Urology Clinics, an affiliate of 21st Century Oncology. Shore joined us in our studios at the OncLive News Network and discussed his new responsibilities at the organization and talked briefly about the role of radium-223 in urology practice.

Rounding out this issue are highlights from the 110th Annual Scientific Meeting of the American Urological Association (AUA) and the 2015 ASCO (American Society of Clinical Oncology) Annual Meeting.

At the AUA, some of the broad subjects covered include improved and smarter screening techniques, active surveillance, and biomarkers. In particular, the use of biomarkers may aid urologists in smarter screening techniques by better identifying higher-grade cancers and minimizing overall biopsy rates.

Overtreatment was a strong theme emphasized during the AUA meeting, especially findings that revealed a 50% drop in PSA testing after the USPSTF (United States Preventive Services Task Force) gave the screening test a grade of “D,” back in 2012 and did not recommend its use by primary care physicians. The recommendation is slowly sending prostate cancer diagnosis backward 20 years, according to some experts.

We also highlight the growing use in the United States of active surveillance. The strategy has become a viable option for many men with low-risk prostate cancer who choose not to undergo active treatment—including surgery or radiotherapy.

At ASCO, the role of docetaxel in prostate cancer was highlighted in two studies. We noted the first ever study of adjuvant chemotherapy use in high-risk, localized prostate cancer. In the study by Sandler et al, the 4-year overall survival rates were 89% for men who received androgen deprivation therapy and radiation therapy versus 93% for men treated with androgen deprivation therapy, radiation therapy, and docetaxel. In another study from ASCO, the addition of docetaxel to standard hormonal therapy significantly improved survival among men with newly diagnosed, hormone-naïve advanced prostate cancer.