News in Brief: Interim PET interval predicts R-CHOP treatment failure in DLBCL; Four myeloma drugs make bid for PBS listing; Call for Medicare review of procedural specialist incomes

Interim PET interval predicts R-CHOP treatment failure in DLBCL

Australian haematologists have identified an interim FDG-PET method for predicting response to R-CHOP chemotherapy in DLBCL that’s been shown to improve on existing scoring systems.

The findings have bolstered evidence for the prognostic relevance of iPET, which has been controversial without consensus on the most appropriate timing and method of scanning.

In an analysis of  iPET results and outcomes of 200 DLBCL patients, Deauville 5 (D5) after two cycles of R-CHOP and a delta SUVmax of <66% after four cycles of R-CHOP was shown to reliably predict failure of treatment.

Investigators from Melbourne and Townsville said interim PET scanning was the only factor that added prognostic value to the NCCN-IPI, with relevant findings at both iPET2 and iPET4 among the large cohort of patients from Melbourne and Townsville centres.

Haematologist Dr Joel Wight and colleagues from Austin Health in Heidelberg and the Olivia Newton John Cancer Research Institute said DS5 (but not DS4) at iPET2 was strongly associated with poor EFS and OS, independent of NCCN-IPI and biological factors.

The group also report that patients with DS5 at iPET2 and/or ΔSUVmax of <66% at iPET4 were highly likely to have early failure of primary therapy.

Investigators suggest it may be appropriate to target these subgroups for clinical trials of novel therapies. But patients who do not meet these iPET criteria should not have their primary therapy inappropriately changed, the group adds.

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Four myeloma drugs make bid for PBS listing

The PBAC will consider making four anti myeloma drugs accessible under the PBS during its July meeting.

Following an unsuccessful submission in the November 2020 meeting, the monoclonal antibody elotuzumab in combination with lenalidomide and dexamethasone will be reconsidered for those whose myeloma has returned.

The committee will also review two submissions for the selective inhibitor of nuclear transport (SINE), Selinexor – one in combination with bortezomib and dexamethasone for treatment of those whose myeloma has returned and a second in combination with dexamethasone in a select group of people who have received at least four prior therapies.

Meanwhile a new subcutaneous dosing regime for the already listed Daratumumab is on the table. The  monoclonal antibody is currently available for those at first relapse as an intravenous infusion in combination with bortezomib and dexamethasone. The new subcutaneous dosing application will be for the same combination and indication as already approved.

Finally two new brands of Bortezomib are under review with no change to the current indications or combinations available.

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Call for Medicare review of procedural specialist incomes

Procedural specialists are overpaid compared to other specialists and there needs to be a review of the inequities in the Medicare Benefits Schedule, according to two senior physicians.

The high incomes for procedural specialists are not justified by their long years of training, level of skill or the hours worked compared to other physicians or GPs, according to Dr Kerry Breen and Dr Kerry Goulston.

Writing in Pearls and Irritations, they say the imbalance in incomes between specialties has become wider and more distorted in recent years because of a flaw in the original MBS when Medicare was set up favoured procedural work over consultations.

The distortion is now deterring medical graduates from working in low income specialities, and there is an urgent need for the federal health department to commission a new study to review the 2005 Productivity Commission report on how to address  the income bias.

“Such a study should also be invited to examine whether the earning differentials between various groups of doctors are justifiable and are in the best interests of the health care system and patients,” they suggest.

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