Ali McBride, PharmD, MS, BCOP, FAzPA, FASHP: Looking at the current areas of development for biosimilars, you can utilize these in the up-front setting or relapsed-refractory setting. When that preference occurs is still an unknown area. I think that when we’re continuing therapy, we’ll probably continue these brand-name therapies based on continualization in the curative setting. Again, the key question here is curative. There will be a preference early on to continue with that brand-name biologic therapy. As time goes on, in a year or 2, we’ll see more and more uptake of the biosimilarization.
Even though the preference is there—by a physician team, by team members—the payers will actually define what we use, because we have to get prior authorization of biosimilars up front or biologics. Based on the current utilization or integration of what those policies are developed as, then in these cases—even though they may have a preference or they may say “I trust one biologic rather than the biosimilar”—we’ll see a payer define that early on. There’s a consistent communication based on the payer and institutions defining what that actual pathway is.
When the next step evolves, that will be a discussion on when to integrate that in the institution and also how familiar you feel with those drug therapies as well. That next step is part of that educational piece, which is truly a lack of integrating those biosimilars into the next-step pathway. When we start taking a look at biosimilar integration, over time, we’ll see more familiarity because of use and adverse-event profiles, which should be different, becoming a mainstay of those discussions. That familiarity will bring about increased utilization for physician and team members as well.
Kashyap Patel, MD: Biologics and biosimilars—let me go back to biologics first. Biologics have really revolutionized the treatment of cancer patients. Until 15 years back, all we had were some highly toxic chemotherapy that was almost, like, the bomb that you would use in a large dose and then hope that the cancer tissue dies and the normal tissue recovers.
The biologics target the specific cell, getting a specific marker on the surface. Biologics have revolutionized the management of cancer patients. But they’re really expensive, and the biosimilars have allowed us to replace expensive biologic drugs with relatively less expensive ones—not a whole lot of difference, maybe 15%, 20%, 30% less, but any savings to the system is savings. That’s why biosimilars have been very promising for continuing the accessibility and affordability for cancer patients in our country.