I recently had the pleasure of reviewing a fascinating book, Miracle Medicines, written by Robert Shook. Coming from my managed care background, I expected another biased and colorful account of the history of the seven pharmaceutical companies and their respective drugs that they developed and released. These companies and the drugs have truly changed the face of health care for both physicians and patients who use these drugs.

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As many regular readers of P&T know, I often scan the literature  of reports from the private sector and select some of these for my editorials. Recently, a report from the national BlueCross BlueShield Association (BCBSA) crossed my desk and appears to have important implications for P&T committee members in different sectors.

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Indolent NHL is a slow-growing form of lymphoma. It encompasses what had been called low-grade NHL and some categories of intermediate-grade NHL. Depending on the type of cancer, patients today often live years without a lot of treatment. The usual strategy had been to wait until symptoms were manifested to a large degree before treatment was ordered.

However, with newer immunotherapies now available, the era of watching and waiting may be over, because effective treatment may begin as soon as the lymphoma is detected.

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The practice of treating patients with relatively nonspecific cytotoxic compounds, such as chemotherapy, is now being complemented by a new era of targeted lymphoma drug development. Researchers are now able to identify a wide array of molecular targets and agents. The new agents include several broad classes of drugs that:

• modulate or change the expression of important genes in the cancer cell.
• intercept the messages generated by detrimental gene expression.
• represent repackaged or reformulated derivatives of tried-and-true favorites.

Several newly available drugs have a unique effect on DNA. In normal cells, DNA exists in two states: condensed and open.

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Standard Therapy

At its most fundamental level, cancer has emerged as a disease of genes and DNA, and the entire message can now be interpreted with the aid of sophisticated techniques in molecular and cellular biology.

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OVERVIEW

Lymphomas represent about 4% of the new cases of cancer diagnosed in the U.S. each year. They constitute the fifth most common cancer diagnosis and the fifth leading cause of cancer deaths. In fact, although the incidence of most cancers is decreasing, lymphoma is one of only two tumors that are increasing in frequency. The cause of this increase is unknown.

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Median durations of response in the overall population were 5.7 months in the combination arm and 4.2 months in the monotherapy arm. Compared with patients receiving cetuximab alone, the cetuximab/irinotecan patients experienced a significantly longer median time to disease progression.

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