The most obvious advantage to the expanded 2008 list of compendia is a greater breadth of data. “The risk of not having adequate variation in review resources is that you don’t have enough information overlap to fill holes in the decision-making process,” Dr. Abernethy said. “By having greater distribution of the task of evidence synthesis across a greater number of compendia, there might actually be a beneficial result that reaches down into patient care.”
Peter Yu, MD, agreed that giving physician’s the leeway to choose the right drugs is important. Dr. Yu serves as the representative for community oncology on the ASCO board of directors.
“It is likely that the upcoming years will see more stringent and uniform criteria for how these compendia review and select off-label oncology drug indications,” Dr Yu said. “At this time, the four chosen compendia provide oncologists with the necessary latitude when making treatment choices for their patients.
Obviously, meriting an indication does not mean that a drug is the best choice for every patient who fits that indication, but it does allow the physician and patient to select the best drug available for that particular patient.”
In an eff ort to continue to fill some of those holes in the decision-making process, the American Society of Health-System Pharmacists has recommended that CMS bolster the MedCAC list of “desirable characteristics” by adding requirements such as independence from manufacturing entities and evidence-based objectivity.
“If the compendia standards are not adequately maintained and the bar becomes set too low, then CMS will necessarily reconsider its position,” Dr. Saltz said.
“The compendia are a privilege. The cancer community must not abuse that privilege or we will lose it.”