There are currently no TKI's approved to treat differentiated thyroid cancer, yet TKI efficacy has been demonstrated in various phase 2 trials. To cover this gap in the approval process, the NCCN thyroid committee recommends the off label use of 3 TKI's already approved for other indications, namely Nexavar, Sutent and Votrient. By virtue of having done so, DTC patients can get reimbursement for those drugs prescribed off label.
Nexavar is the first TKI to complete a phase 3 trial in this indication, as such, its evidence of efficacy essentially trumps the various phase 2 trials that formed the basis for the NCCN compendia listing. EXEL will likely submit Comet for consideration for DTC compendia listing at the next NCCN thyroid committee meeting. Prior to the Nexavar phase 3 result, I would have bet on Comet being added to the compendia for DTC treatment, now I would say its more complicated. The Nexavar data has not been released so the committee is left a bit in the dark. They can add Comet to the list, they can leave the list unchanged, or thay can remove all the TKI's except Nexavar. Even if Comet is added to the compendia, oncologists will likely prescribe the Nexavar far more often than the competing off label TKI's, including Comet.
All correct but I did not know that there were any efforts to get Cabo into other types of thyroid cancer. Without data and as far as I know there are no data in papillary or other types of thyroid cancer there can be no successful effort to get Cabo on the compendium for other than medullary ca of the thyroid nor any possibility of having any of the other TKIs approved for medullary. Let us not mix apples and oranges
sorry. I do this for a living. Cabo will be added to the compendium for medullary ca. There are no data that I know of supporting nexavar for this indication and the fact that nexavar works in a completely different disease will have no impact on compendium listing nor insurance payments for Cabo. Off label use does not exist anymore because the insurance co., medicare and medicaid won't pay for these very expensive drugs unless they are approved for a very specific indication. You have no idea what I go thru every day to get meds for my patients.