Bruce Feinberg, DO: Let’s go down the therapeutics that are available. There are trastuzumab-dkst and trastuzumab-anns, so you’re converting those using those biosimilars?
Michael Diaz, MD: Yes.
Bruce Feinberg, DO: You are taking active patients who are on them and making the conversion?
Michael Diaz, MD: Correct—after we talk about it with the patient. We want their approval. We want their buy-in, and we want to make sure they feel comfortable. We want to make sure they understand they’re not getting an inferior product, and we also want them to be aware so that they can help us. They can help us and notify us if they notice any differences or changes.
Once again, these are biosimilars are highly similar, but we can still see unique differences in patient to patient. It is very rare, but it can happen. When I say unique differences, sometimes a patient may have an adverse effect with 1 that they did not have with the other, and that’s why we want to make sure the patient is aware. We want to get their buy-in. We want them to be aware to look out for adverse effects, and we want them to notify us if they’re having any issues or problems that are unique.
Bruce Feinberg, DO: And bevacizumab-awwb?
Michael Diaz, MD: Yes, we are using that where clinically indicated. It has most of the indications that the reference product does, so yes, we are trying to use it where we can.
Bruce Feinberg, DO: Bhavesh, go ahead.
Bhavesh Shah, RPh, BCOP: One of the reasons why we would see this hindrance in adoption rates with some of the biosimilars in oncology is that they do not carry all the indications that the reference product has. A lot of the time, providers do not know that it is because it is an orphan indication and not because there is a difference in mechanism for ovarian cancer versus lung cancer that the FDA didn’t grant this biosimilar an indication in that setting. If you go into the NCCN [National Comprehensive Cancer Network] Guidelines, they actually recommend indications besides those that are already approved on the label. That is important to understand because as we see more indications that the reference product may be getting, the biosimilar may not have those indications. The difference is because it’s an IP [intellectual property]—related issue and not because of efficacy or mechanism of action of the drug.