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width="1.25rem" xmlns="http://www.w3.org/2000/svg"><polyline points="6 9 6 2 18 2 18 9"></polyline><path d="M6 18H4a2 2 0 0 1-2-2v-5a2 2 0 0 1 2-2h16a2 2 0 0 1 2 2v5a2 2 0 0 1-2 2h-2"></path><rect x="6" y="14" width="12" height="8"></rect></svg></a></button></div></div><div><div class="flex flex-wrap"><p class=" text-primary font-semibold">Commentary</p><div class="h-[16px] border-l-2 border-gray-400 mt-1 mx-1"></div><p class=" text-primary font-semibold">Article</p><div class="h-[16px] border-l-2 border-gray-400 mt-1 mx-1 "></div><time class="text-gray-500 " dateTime="2024-08-23T12:00:00.000">August 23, 2024</time></div><h1 class="text-[26px] font-medium leading-8">Beyond Early Stage: Biomarker Testing's Role in Advanced Lung Cancer</h1><div class="py-3 text-gray-600 md:flex flex-col md:justify-between"><div class="flex flex-col xs:flex-row"><p class="mr-1 self-start">Author(s):</p><div class="flex flex-col xs:flex-row mb-3 md:mb-0"><div class="flex flex-wrap"><span class="text-md mr-2"><a class="text-author text-gray-500 hover:text-primary underline hover:no-underline decoration-gray-400" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></span></div></div></div><div class="max-w-full"><div class="flex flex-wrap sm:flex-nowrap items-center w-fit my-2"></div><div class="w-full flex flex-col sm:flex-row justify-between mt-2"><div class="block md:hidden "><div class="mt-2 flex items-center max-w-fit"><button title="Beyond Early Stage: Biomarker Testing's Role in Advanced Lung Cancer" aria-label="facebook" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#3b5998"></circle><path d="M34.1,47V33.3h4.6l0.7-5.3h-5.3v-3.4c0-1.5,0.4-2.6,2.6-2.6l2.8,0v-4.8c-0.5-0.1-2.2-0.2-4.1-0.2 c-4.1,0-6.9,2.5-6.9,7V28H24v5.3h4.6V47H34.1z" fill="white"></path></svg></button><button aria-label="twitter" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg fill="#DC7633" xmlns="http://www.w3.org/2000/svg" width="32" zoomAndPan="magnify" viewBox="0 0 375 374.9999" height="32" preserveAspectRatio="xMidYMid meet" version="1.0"><defs><path d="M 7.09375 7.09375 L 367.84375 7.09375 L 367.84375 367.84375 L 7.09375 367.84375 Z M 7.09375 7.09375 " fill="#000000"></path></defs><g><path d="M 187.46875 7.09375 C 87.851562 7.09375 7.09375 87.851562 7.09375 187.46875 C 7.09375 287.085938 87.851562 367.84375 187.46875 367.84375 C 287.085938 367.84375 367.84375 287.085938 367.84375 187.46875 C 367.84375 87.851562 287.085938 7.09375 187.46875 7.09375 " fill-opacity="1" fill-rule="nonzero" fill="#000000"></path></g><g transform="translate(85, 75)"> <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24" version="1.1" height="215" width="215"><path d="M18.244 2.25h3.308l-7.227 8.26 8.502 11.24H16.17l-5.214-6.817L4.99 21.75H1.68l7.73-8.835L1.254 2.25H8.08l4.713 6.231zm-1.161 17.52h1.833L7.084 4.126H5.117z" fill="#ffffff"></path></svg> </g></svg></button><button aria-label="linkedin" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#007fb1"></circle><path d="M20.4,44h5.4V26.6h-5.4V44z M23.1,18c-1.7,0-3.1,1.4-3.1,3.1c0,1.7,1.4,3.1,3.1,3.1 c1.7,0,3.1-1.4,3.1-3.1C26.2,19.4,24.8,18,23.1,18z M39.5,26.2c-2.6,0-4.4,1.4-5.1,2.8h-0.1v-2.4h-5.2V44h5.4v-8.6 c0-2.3,0.4-4.5,3.2-4.5c2.8,0,2.8,2.6,2.8,4.6V44H46v-9.5C46,29.8,45,26.2,39.5,26.2z" fill="white"></path></svg></button><button title="Beyond Early Stage: Biomarker Testing's Role in Advanced Lung Cancer" aria-label="pinterest" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#cb2128"></circle><path d="M32,16c-8.8,0-16,7.2-16,16c0,6.6,3.9,12.2,9.6,14.7c0-1.1,0-2.5,0.3-3.7 c0.3-1.3,2.1-8.7,2.1-8.7s-0.5-1-0.5-2.5c0-2.4,1.4-4.1,3.1-4.1c1.5,0,2.2,1.1,2.2,2.4c0,1.5-0.9,3.7-1.4,5.7 c-0.4,1.7,0.9,3.1,2.5,3.1c3,0,5.1-3.9,5.1-8.5c0-3.5-2.4-6.1-6.7-6.1c-4.9,0-7.9,3.6-7.9,7.7c0,1.4,0.4,2.4,1.1,3.1 c0.3,0.3,0.3,0.5,0.2,0.9c-0.1,0.3-0.3,1-0.3,1.3c-0.1,0.4-0.4,0.6-0.8,0.4c-2.2-0.9-3.3-3.4-3.3-6.1c0-4.5,3.8-10,11.4-10 c6.1,0,10.1,4.4,10.1,9.2c0,6.3-3.5,11-8.6,11c-1.7,0-3.4-0.9-3.9-2c0,0-0.9,3.7-1.1,4.4c-0.3,1.2-1,2.5-1.6,3.4 c1.4,0.4,3,0.7,4.5,0.7c8.8,0,16-7.2,16-16C48,23.2,40.8,16,32,16z" fill="white"></path></svg></button><button aria-label="email" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#7f7f7f"></circle><path d="M17,22v20h30V22H17z M41.1,25L32,32.1L22.9,25H41.1z M20,39V26.6l12,9.3l12-9.3V39H20z" fill="white"></path></svg></button><a class="print-wrap flex justify-center items-center cursor-pointer"><svg id="print" xmlns="http://www.w3.org/2000/svg" width="24" height="24" fill="currentColor" class="print bi bi-printer" viewBox="0 0 16 16"> <path d="M2.5 8a.5.5 0 1 0 0-1 .5.5 0 0 0 0 1z"></path> <path d="M5 1a2 2 0 0 0-2 2v2H2a2 2 0 0 0-2 2v3a2 2 0 0 0 2 2h1v1a2 2 0 0 0 2 2h6a2 2 0 0 0 2-2v-1h1a2 2 0 0 0 2-2V7a2 2 0 0 0-2-2h-1V3a2 2 0 0 0-2-2H5zM4 3a1 1 0 0 1 1-1h6a1 1 0 0 1 1 1v2H4V3zm1 5a2 2 0 0 0-2 2v1H2a1 1 0 0 1-1-1V7a1 1 0 0 1 1-1h12a1 1 0 0 1 1 1v3a1 1 0 0 1-1 1h-1v-1a2 2 0 0 0-2-2H5zm7 2v3a1 1 0 0 1-1 1H5a1 1 0 0 1-1-1v-3a1 1 0 0 1 1-1h6a1 1 0 0 1 1 1z"></path></svg></a></div><style> .print-wrap { width: 32px; height: 32px; background: #7F7F7F; border-radius: 100%; } .print { background: #7F7F7F; color: white; padding: 2px; border-radius: 100%; } </style></div></div></div></div><div class=" lg:w-full flex flex-col lg:flex-row lg:items-center lg:justify-end"></div><p class="py-2 mb-2 text-sm italic text-gray-600">In part 1 of our interview with David P. Carbone, MD, PhD, The Ohio State University, he addressed why it is important to conduct biomarker testing in both lung cancer overall and non–small cell lung cancer more specifically. </p><div class="py-2"><div class="blockText_blockContent__TbCXh"><div class="relative"><div class="brightcove-fluid" autoplay=""></div></div><p class="pb-2">In <a target="_blank" href="https://www.ajmc.com/view/biomarker-testing-key-to-personalized-lung-cancer-care">part 1</a> of our interview with David P. Carbone, MD, PhD, director, Thoracic Oncology Center, The Ohio State University (OSU) in Columbus, he addressed why it is important to conduct biomarker testing in both lung cancer overall and <a target="_blank" href="https://www.ajmc.com/compendium/nsclc">non–small cell lung cancer</a> more specifically. Here he continues the discussion on biomarker testing by explaining the cost breakdown and how even in late-stage disease, biomarker testing serves its purpose.</p><p class="pb-2"></p><p class="pb-2">Carbone is also a professor of internal medicine and coleader of the Translational Therapeutics Program at OSU, and president of the International Association for the Study of Lung Cancer.</p><p class="pb-2"></p><p class="pb-2"><strong><span style="text-decoration:underline">Transcript</span></strong></p><p class="pb-2"><strong>What is the cost impact of biomarker testing in lung cancer on value-based care?</strong></p><p class="pb-2"></p><p class="pb-2">Health care is expensive, and these tests are not cheap. Usually they run a few thousand dollars. Some of the simpler tests can be less expensive, but the fact is, a single dose of some of these drugs is way more than that cost. A dose of [pembrolizumab] can be over $10,000. The fact is, these biomarker tests are so important in selecting therapy—and you only need to do this once at the time of diagnosis, in general. I mean, we do repeat testing in resistant disease, but this is not a test that you need to do every 3 weeks. This is a test you do at the beginning of therapy, and it makes such a huge difference in the way a patient is treated, in the selection of which treatment is appropriate, that it's incredibly cost-effective in my mind. It costs less than a PET scan or other things that we don't think about charging for. So this is, to me, an absolutely essential expense in appropriate management of lung cancer.</p><p class="pb-2"></p><p class="pb-2"><strong>What purpose does biomarker testing serve in late-stage disease?</strong></p><p class="pb-2"></p><p class="pb-2">It’s very similar in early- and late-stage disease, in theory. If you have a patient with an <em>ALK</em> fusion abnormality in their tumor, that patient should be started on first-line alectinib or other drugs targeting <em>ALK</em>. And the same thing if you have an early-stage patient who gets a surgical resection and it's found to be <em>ALK</em>-fusion positive; that patient should receive alectinib as an adjuvant therapy. It's used to select therapies in exactly the same way, but in an advanced-stage patient, they usually start those therapies right away and in an early-stage patient, often surgery is followed by the targeted therapy.</p><p class="pb-2"></p><p class="pb-2">We always try to have curative intent. But for immunotherapies, PD-L1–positive patients, especially have a chance of being effectively cured of their lung cancers, even in advanced stage, stage IV. There are many patients who are alive 5, 6, 7, 8 years later with no evidence of disease off therapy. So I do say that there is some chance of cure with immunotherapy. Overall, it's about 20% of people who are alive at 5 years—which doesn't sound great, but it's a whole lot better than decades ago, when almost no one survived even 2 or 3 years with advanced lung cancer.</p><p class="pb-2"></p><p class="pb-2">With the targeted therapies, though, these right now are not thought to be curative, and eventually the cancer will become resistant and come back. But recent data, especially with <em>ALK</em>-fusion positive tumors, there are patients that are on therapy without recurrence for a decade, and that's that's very exciting. When you think about the average survival for metastatic lung cancer, it historically was 4 to 6 months from diagnosis to death. Now we're talking about 5 to 10 years. It's a huge improvement.</p><p class="pb-2"></p><p class="pb-2">Not everybody benefits from these and not everybody has a biomarker match, but it's important to look. And if you miss a biomarker match that's there because you didn't test or you didn't interpret the test properly, that's a real tragedy for that patient where they could have been helped more effectively. But it is true that some patients have no targetable biomarkers and a PD-L1 of 0 and don't respond to anything. 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/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1a4360029594090b3778ebf3cb4b361bbd0dc564-2859x1605.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=30 3840w" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F1a4360029594090b3778ebf3cb4b361bbd0dc564-2859x1605.png%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=30" decoding="async" data-nimg="fill" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%;object-fit:contain" loading="lazy"/></noscript></span></div><div class="w-full flex-wrap text-center text-sm mt-4 font-light no-underline text-white"></div></a></div></div><div class="relative block sm:hidden"><div class="mt-4 overflow-hidden"><div class="flex justify-between"><div class="flex items-center clear-both pt-4 pb-2 text-3xl lg:text-2xl xl:text-3xl min-w-fit ">Related Content </div><div class="hidden lg:flex w-full flex-col justify-end items-end"><div class="hidden w-full lg:flex flex-wrap pb-2 gap-x-2 gap-y-1 justify-end items-end"></div></div></div><div class="w-full mb-2 border border-secondary"></div><div class="lg:hidden flex flex-wrap items-center"></div><div class="flex flex-wrap w-full"><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-1"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/decoding-sma-progression-hfmse-analysis-spotlights-variability?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/16ff03fc3732bb1b18d238c8f8af52fac1f6476e-5696x3392.jpg?fit=crop&auto=format" alt="Keeping track of subgroup variability in SMA will provide more robust, comparable data in the long term | image credit: Bartek - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 27th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/decoding-sma-progression-hfmse-analysis-spotlights-variability?utm_source=www.ajmc.com&utm_medium=relatedContent">Decoding SMA Progression: HFMSE Analysis Spotlights Variability</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/kyle-munz">Kyle Munz</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/decoding-sma-progression-hfmse-analysis-spotlights-variability?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The authors emphasize the value of subgroup analyses for tracking patterns in spinal muscular atrophy (SMA), as opposed to drawing mean conclusions across entire cohorts. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/operationalizing-bispecifics-in-multiple-myeloma?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/9de113904a026205cbaf84d08420c4065d52fd67-1000x563.jpg?fit=crop&auto=format" alt="managed care cast logo" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 27th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/operationalizing-bispecifics-in-multiple-myeloma?utm_source=www.ajmc.com&utm_medium=relatedContent">Operationalizing Bispecifics in Multiple Myeloma</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/mary-caffrey">Mary Caffrey</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/laura-joszt">Laura Joszt, MA</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/operationalizing-bispecifics-in-multiple-myeloma?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Tyler Sandahl, PharmD, of Mayo Clinic, and Michael Byrne, DO, of Tennessee Oncology, discuss practical advice for bringing bispecifics to the community.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/how-did-vermont-get-the-best-maternal-health-score-in-the-us-?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/7928afa87272891a1211f02ab685217dc119fc12-5694x3800.jpg?fit=crop&auto=format" alt="Welcome to Vermont road sign | Image credit: rabbit75_fot – stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 26th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/how-did-vermont-get-the-best-maternal-health-score-in-the-us-?utm_source=www.ajmc.com&utm_medium=relatedContent">How Did Vermont Get the Best Maternal Health Score in the US?</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/hayden-e-klein">Hayden E. Klein</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/how-did-vermont-get-the-best-maternal-health-score-in-the-us-?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">State-level maternal health scores varied greatly in the 2024 March of Dimes report card, with Vermont getting the only A grade on preterm birth rates.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/expert-insights-on-how-utilization-management-drives-physician-burnout?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/9de113904a026205cbaf84d08420c4065d52fd67-1000x563.jpg?fit=crop&auto=format" alt="managed care cast logo" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 26th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/expert-insights-on-how-utilization-management-drives-physician-burnout?utm_source=www.ajmc.com&utm_medium=relatedContent">Expert Insights on How Utilization Management Drives Physician Burnout</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/brooke-mccormick">Brooke McCormick</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/expert-insights-on-how-utilization-management-drives-physician-burnout?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">On this episode of Managed Care Cast, we speak with the author of a study published in the November 2024 issue of The American Journal of Managed Care® to explore the link between utilization management and physician burnout. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/fda-approves-imatinib-oral-solution-for-treatment-of-various-cancers?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/f1f12e9d502c73f75e8062c6dd726c422c8aff78-4320x3473.jpg?fit=crop&auto=format" alt="FDA Approval | image credit: gomixer - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 26th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/fda-approves-imatinib-oral-solution-for-treatment-of-various-cancers?utm_source=www.ajmc.com&utm_medium=relatedContent">FDA Approves Imatinib Oral Solution for Treatment of Various Cancers</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/kyle-munz">Kyle Munz</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/fda-approves-imatinib-oral-solution-for-treatment-of-various-cancers?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The FDA approval marks the first oral solution indicated for patients with different forms of leukemia. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/nccn-guidelines-prioritize-quad-therapy-in-multiple-myeloma?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/124e5227038c54b0c2ef35d60292e6f37e89161a-1200x738.jpg?fit=crop&auto=format" alt="Guidelines | Image Credit: © momius-stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 26th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/nccn-guidelines-prioritize-quad-therapy-in-multiple-myeloma?utm_source=www.ajmc.com&utm_medium=relatedContent">NCCN Guidelines Prioritize Quad Therapy in Multiple Myeloma</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/nccn-guidelines-prioritize-quad-therapy-in-multiple-myeloma?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">In the most recent update to the National Comprehensive Cancer Network (NCCN) guidelines for treating patients who have multiple myeloma, a quadruplet regimen became the preferred first-line treatment option for transplant-eligible and -ineligible patients.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div></div></div><div class="relative hidden sm:block"><div class="mt-4 overflow-hidden"><div class="flex justify-between"><div class="flex items-center clear-both pt-4 pb-2 text-3xl lg:text-2xl xl:text-3xl min-w-fit ">Related Content </div><div class="hidden lg:flex w-full flex-col justify-end items-end"><div class="hidden w-full lg:flex flex-wrap pb-2 gap-x-2 gap-y-1 justify-end items-end"></div></div></div><div class="w-full mb-2 border border-secondary"></div><div class="lg:hidden flex flex-wrap items-center"></div><div class="flex flex-wrap w-full"><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-1"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/decoding-sma-progression-hfmse-analysis-spotlights-variability?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/16ff03fc3732bb1b18d238c8f8af52fac1f6476e-5696x3392.jpg?fit=crop&auto=format" alt="Keeping track of subgroup variability in SMA will provide more robust, comparable data in the long term | image credit: Bartek - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 27th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/decoding-sma-progression-hfmse-analysis-spotlights-variability?utm_source=www.ajmc.com&utm_medium=relatedContent">Decoding SMA Progression: HFMSE Analysis Spotlights Variability</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/kyle-munz">Kyle Munz</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/decoding-sma-progression-hfmse-analysis-spotlights-variability?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The authors emphasize the value of subgroup analyses for tracking patterns in spinal muscular atrophy (SMA), as opposed to drawing mean conclusions across entire cohorts. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/operationalizing-bispecifics-in-multiple-myeloma?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/9de113904a026205cbaf84d08420c4065d52fd67-1000x563.jpg?fit=crop&auto=format" alt="managed care cast logo" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 27th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/operationalizing-bispecifics-in-multiple-myeloma?utm_source=www.ajmc.com&utm_medium=relatedContent">Operationalizing Bispecifics in Multiple Myeloma</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/mary-caffrey">Mary Caffrey</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/laura-joszt">Laura Joszt, MA</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/operationalizing-bispecifics-in-multiple-myeloma?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Tyler Sandahl, PharmD, of Mayo Clinic, and Michael Byrne, DO, of Tennessee Oncology, discuss practical advice for bringing bispecifics to the community.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/how-did-vermont-get-the-best-maternal-health-score-in-the-us-?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/7928afa87272891a1211f02ab685217dc119fc12-5694x3800.jpg?fit=crop&auto=format" alt="Welcome to Vermont road sign | Image credit: rabbit75_fot – stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 26th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/how-did-vermont-get-the-best-maternal-health-score-in-the-us-?utm_source=www.ajmc.com&utm_medium=relatedContent">How Did Vermont Get the Best Maternal Health Score in the US?</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/hayden-e-klein">Hayden E. Klein</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/how-did-vermont-get-the-best-maternal-health-score-in-the-us-?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">State-level maternal health scores varied greatly in the 2024 March of Dimes report card, with Vermont getting the only A grade on preterm birth rates.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/expert-insights-on-how-utilization-management-drives-physician-burnout?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/9de113904a026205cbaf84d08420c4065d52fd67-1000x563.jpg?fit=crop&auto=format" alt="managed care cast logo" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 26th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/expert-insights-on-how-utilization-management-drives-physician-burnout?utm_source=www.ajmc.com&utm_medium=relatedContent">Expert Insights on How Utilization Management Drives Physician Burnout</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/brooke-mccormick">Brooke McCormick</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/expert-insights-on-how-utilization-management-drives-physician-burnout?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">On this episode of Managed Care Cast, we speak with the author of a study published in the November 2024 issue of The American Journal of Managed Care® to explore the link between utilization management and physician burnout. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/fda-approves-imatinib-oral-solution-for-treatment-of-various-cancers?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/f1f12e9d502c73f75e8062c6dd726c422c8aff78-4320x3473.jpg?fit=crop&auto=format" alt="FDA Approval | image credit: gomixer - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 26th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/fda-approves-imatinib-oral-solution-for-treatment-of-various-cancers?utm_source=www.ajmc.com&utm_medium=relatedContent">FDA Approves Imatinib Oral Solution for Treatment of Various Cancers</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/kyle-munz">Kyle Munz</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/fda-approves-imatinib-oral-solution-for-treatment-of-various-cancers?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The FDA approval marks the first oral solution indicated for patients with different forms of leukemia. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/nccn-guidelines-prioritize-quad-therapy-in-multiple-myeloma?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/124e5227038c54b0c2ef35d60292e6f37e89161a-1200x738.jpg?fit=crop&auto=format" alt="Guidelines | Image Credit: © momius-stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 26th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/nccn-guidelines-prioritize-quad-therapy-in-multiple-myeloma?utm_source=www.ajmc.com&utm_medium=relatedContent">NCCN Guidelines Prioritize Quad Therapy in Multiple Myeloma</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/nccn-guidelines-prioritize-quad-therapy-in-multiple-myeloma?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">In the most recent update to the National Comprehensive Cancer Network (NCCN) guidelines for treating patients who have multiple myeloma, a quadruplet regimen became the preferred first-line treatment option for transplant-eligible and -ineligible patients.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div></div></div><div class="pb-24"></div></div><script type="application/ld+json">{"@context":"https://schema.org","@type":"NewsArticle","headline":"Beyond Early Stage: Biomarker Testing's Role in Advanced Lung Cancer","datePublished":"2024-08-23T12:00:00.000Z","dateModified":"2024-08-23T12:00:15Z","inLanguage":"en-US","image":"https://cdn.sanity.io/images/0vv8moc6/ajmc/f41f4f274375893c9675c5fd07a821aec240b442-1200x738.jpg?fit=crop&auto=format","mainEntityOfPage":{"@type":"WebPage","@id":"https://www.ajmc.com/view/beyond-early-stage-biomarker-testing-s-role-in-advanced-lung-cancer"},"publisher":{"@type":"Organization","name":"AJMC","logo":{"@type":"ImageObject","url":"https://www.ajmc.com/ajmc_logo_inverted.png"}},"keywords":"biomarker match,late-stage disease,biomarker testing,NSCLC","articleBody":"\n\nIn part 1 of our interview with David P. Carbone, MD, PhD, director, Thoracic Oncology Center, The Ohio State University (OSU) in Columbus, he addressed why it is important to conduct biomarker testing in both lung cancer overall and non–small cell lung cancer more specifically. Here he continues the discussion on biomarker testing by explaining the cost breakdown and how even in late-stage disease, biomarker testing serves its purpose.\n\n\n\nCarbone is also a professor of internal medicine and coleader of the Translational Therapeutics Program at OSU, and president of the International Association for the Study of Lung Cancer.\n\n\n\nTranscript\n\nWhat is the cost impact of biomarker testing in lung cancer on value-based care?\n\n\n\nHealth care is expensive, and these tests are not cheap. Usually they run a few thousand dollars. Some of the simpler tests can be less expensive, but the fact is, a single dose of some of these drugs is way more than that cost. A dose of [pembrolizumab] can be over $10,000. The fact is, these biomarker tests are so important in selecting therapy—and you only need to do this once at the time of diagnosis, in general. I mean, we do repeat testing in resistant disease, but this is not a test that you need to do every 3 weeks. This is a test you do at the beginning of therapy, and it makes such a huge difference in the way a patient is treated, in the selection of which treatment is appropriate, that it's incredibly cost-effective in my mind. It costs less than a PET scan or other things that we don't think about charging for. So this is, to me, an absolutely essential expense in appropriate management of lung cancer.\n\n\n\nWhat purpose does biomarker testing serve in late-stage disease?\n\n\n\nIt’s very similar in early- and late-stage disease, in theory. If you have a patient with an ALK fusion abnormality in their tumor, that patient should be started on first-line alectinib or other drugs targeting ALK. And the same thing if you have an early-stage patient who gets a surgical resection and it's found to be ALK-fusion positive; that patient should receive alectinib as an adjuvant therapy. It's used to select therapies in exactly the same way, but in an advanced-stage patient, they usually start those therapies right away and in an early-stage patient, often surgery is followed by the targeted therapy.\n\n\n\nWe always try to have curative intent. But for immunotherapies, PD-L1–positive patients, especially have a chance of being effectively cured of their lung cancers, even in advanced stage, stage IV. There are many patients who are alive 5, 6, 7, 8 years later with no evidence of disease off therapy. So I do say that there is some chance of cure with immunotherapy. Overall, it's about 20% of people who are alive at 5 years—which doesn't sound great, but it's a whole lot better than decades ago, when almost no one survived even 2 or 3 years with advanced lung cancer.\n\n\n\nWith the targeted therapies, though, these right now are not thought to be curative, and eventually the cancer will become resistant and come back. But recent data, especially with ALK-fusion positive tumors, there are patients that are on therapy without recurrence for a decade, and that's that's very exciting. When you think about the average survival for metastatic lung cancer, it historically was 4 to 6 months from diagnosis to death. Now we're talking about 5 to 10 years. It's a huge improvement.\n\n\n\nNot everybody benefits from these and not everybody has a biomarker match, but it's important to look. And if you miss a biomarker match that's there because you didn't test or you didn't interpret the test properly, that's a real tragedy for that patient where they could have been helped more effectively. But it is true that some patients have no targetable biomarkers and a PD-L1 of 0 and don't respond to anything. We need to work harder to find therapies for those people.","description":"In part 1 of our interview with David P. Carbone, MD, PhD, The Ohio State University, he addressed why it is important to conduct biomarker testing in both lung cancer overall and non–small cell lung cancer more specifically. ","author":[{"@type":"Person","name":"Maggie L. Shaw"}]}</script></div></div><div class="flex-none w-[300px] z-[9999] relative hidden md:block"><div style="top:5rem" class="sticky custom-spacing"><div class="collapse-container " style="overflow:hidden;max-height:900px;transition:max-height .4s ease-in-out"></div></div></div></div><div id="div-gpt-ad-pixel" style="width:1px;height:1px" class=""></div><noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-NK5KQXS" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript><div id="footerOuterWrap" class=" mx-auto flex"><div class="bg-[#00598D] xl:w-[70%] w-[70%] py-12 pl-auto"><div class="xxl:w-[75%] w-[90%] ml-auto"><div><span style="box-sizing:border-box;display:inline-block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative;max-width:100%"><span 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Usually they run a few thousand dollars. Some of the simpler tests can be less expensive, but the fact is, a single dose of some of these drugs is way more than that cost. A dose of [pembrolizumab] can be over $10,000. The fact is, these biomarker tests are so important in selecting therapy—and you only need to do this once at the time of diagnosis, in general. I mean, we do repeat testing in resistant disease, but this is not a test that you need to do every 3 weeks. This is a test you do at the beginning of therapy, and it makes such a huge difference in the way a patient is treated, in the selection of which treatment is appropriate, that it's incredibly cost-effective in my mind. It costs less than a PET scan or other things that we don't think about charging for. So this is, to me, an absolutely essential expense in appropriate management of lung cancer.","_key":"27f74ecae94c0"}],"upload_doc":null,"uploadAudio":null,"medias":null,"_type":"block"},{"style":"normal","_key":"d5cba2d44282","markDefs":[],"children":[{"_key":"3d33392f7d640","_type":"span","marks":[],"text":""}],"_type":"block","upload_doc":null,"uploadAudio":null,"medias":null},{"style":"normal","upload_doc":null,"uploadAudio":null,"medias":null,"_key":"5a83347b5c1e","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"What purpose does biomarker testing serve in late-stage disease?","_key":"f6ffc23f90680"}],"_type":"block"},{"markDefs":[],"upload_doc":null,"uploadAudio":null,"medias":null,"children":[{"_type":"span","marks":[],"text":"","_key":"0f7c78fb29c70"}],"_type":"block","style":"normal","_key":"60b257567f17"},{"medias":null,"markDefs":[],"children":[{"_type":"span","marks":[],"text":"It’s very similar in early- and late-stage disease, in theory. If you have a patient with an ","_key":"6d61734a7c950"},{"text":"ALK","_key":"6d61734a7c951","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":" fusion abnormality in their tumor, that patient should be started on first-line alectinib or other drugs targeting ","_key":"6d61734a7c952"},{"_type":"span","marks":["em"],"text":"ALK","_key":"6d61734a7c953"},{"marks":[],"text":". And the same thing if you have an early-stage patient who gets a surgical resection and it's found to be ","_key":"6d61734a7c954","_type":"span"},{"_type":"span","marks":["em"],"text":"ALK","_key":"6d61734a7c955"},{"_type":"span","marks":[],"text":"-fusion positive; that patient should receive alectinib as an adjuvant therapy. It's used to select therapies in exactly the same way, but in an advanced-stage patient, they usually start those therapies right away and in an early-stage patient, often surgery is followed by the targeted therapy.","_key":"6d61734a7c956"}],"_type":"block","style":"normal","_key":"2071afdd8fe3","upload_doc":null,"uploadAudio":null},{"style":"normal","_key":"c9dc55baba2d","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"f7698b6fbbd50"}],"upload_doc":null,"uploadAudio":null,"medias":null,"_type":"block"},{"_key":"80ca53ca3297","markDefs":[],"upload_doc":null,"uploadAudio":null,"medias":null,"children":[{"_type":"span","marks":[],"text":"We always try to have curative intent. But for immunotherapies, PD-L1–positive patients, especially have a chance of being effectively cured of their lung cancers, even in advanced stage, stage IV. There are many patients who are alive 5, 6, 7, 8 years later with no evidence of disease off therapy. So I do say that there is some chance of cure with immunotherapy. Overall, it's about 20% of people who are alive at 5 years—which doesn't sound great, but it's a whole lot better than decades ago, when almost no one survived even 2 or 3 years with advanced lung cancer.","_key":"26a51de8ace30"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"","_key":"d25de008986d0"}],"_type":"block","style":"normal","_key":"eeb22387e3fb","upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[]},{"uploadAudio":null,"medias":null,"_key":"43ae278ad59b","markDefs":[],"children":[{"_key":"37dbe41e065c0","_type":"span","marks":[],"text":"With the targeted therapies, though, these right now are not thought to be curative, and eventually the cancer will become resistant and come back. But recent data, especially with "},{"_type":"span","marks":["em"],"text":"ALK","_key":"37dbe41e065c1"},{"_type":"span","marks":[],"text":"-fusion positive tumors, there are patients that are on therapy without recurrence for a decade, and that's that's very exciting. When you think about the average survival for metastatic lung cancer, it historically was 4 to 6 months from diagnosis to death. Now we're talking about 5 to 10 years. It's a huge improvement.","_key":"37dbe41e065c2"}],"_type":"block","style":"normal","upload_doc":null},{"uploadAudio":null,"medias":null,"style":"normal","_key":"3b771b7b5803","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"3a87c43653270"}],"_type":"block","upload_doc":null},{"markDefs":[],"upload_doc":null,"uploadAudio":null,"medias":null,"children":[{"marks":[],"text":"Not everybody benefits from these and not everybody has a biomarker match, but it's important to look. And if you miss a biomarker match that's there because you didn't test or you didn't interpret the test properly, that's a real tragedy for that patient where they could have been helped more effectively. But it is true that some patients have no targetable biomarkers and a PD-L1 of 0 and don't respond to anything. 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A recent study examined 4-year outcomes using the Hammersmith Functional Motor Scale Expanded (HFMSE), considering factors like functional status, age, and SMN2 copies. The study included 388 patients, revealing significant motor changes, particularly in younger age groups. Baseline scores and age were key predictors of change. The findings highlight the variability in disease progression and treatment response, questioning the reliability of mean changes across SMA cohorts.","summary":"The authors emphasize the value of subgroup analyses for tracking patterns in spinal muscular atrophy (SMA), as opposed to drawing mean conclusions across entire cohorts. ","thumbnail":{"_type":"mainImage","alt":"Keeping track of subgroup variability in SMA will provide more robust, comparable data in the long term | image credit: Bartek - stock.adobe.com","caption":"Keeping track of subgroup variability in SMA will provide more robust, comparable data in the long term | image credit: Bartek - stock.adobe.com","asset":{"_ref":"image-16ff03fc3732bb1b18d238c8f8af52fac1f6476e-5696x3392-jpg","_type":"reference"}},"gptTakeaways":"• Real-world analyses in SMA provide crucial data for long-term comparisons, focusing on SMA types 2 and 3.\n• The HFMSE is a reliable tool for assessing motor abilities and disease progression in SMA2 and SMA3 patients.\n• The study included 388 patients, revealing significant motor changes, especially in younger age groups.\n• Baseline scores and patient age were the most predictive factors for changes over the 4-year period.\n• Variability in disease progression and treatment response challenges the reliability of mean changes across SMA cohorts.","contentCategory":{"_updatedAt":"2023-09-29T14:32:27Z","_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh","_type":"contentCategory","name":"Articles","_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2"},"seoTag":["spinal muscular atrophy","SMA","HFMSE","Hammersmith Functional Motor Scale Expanded","subgroup analysis"],"_id":"c912acfb-e0e8-4e31-9ade-a3c12a94ad04","drugMentions":"{\"drug_mentions\": []}","url":"decoding-sma-progression-hfmse-analysis-spotlights-variability","taxonomyMapping":[{"_id":"0f2e14f2-56c2-4fac-9660-fb8d20edc66f","pixelTrackingCode":null,"_createdAt":"2020-08-11T16:28:23Z","_type":"taxonomy","name":"Spinal Muscular Atrophy","_updatedAt":"2020-08-20T15:30:27Z","identifier":"sma","parent":{"_rev":"oruil6rlosjyltJbhrNMGF","_type":"taxonomy","_updatedAt":"2024-04-09T09:14:18Z","identifier":"compendium","isMainTopic":true,"_createdAt":"2020-03-30T18:16:46Z","name":"Compendium","_id":"297fa3d1-5216-46eb-bf51-66c5f77c3c8a","parent":null},"_rev":"pI9SawGKsTP14Lioy4tDhp"},{"_createdAt":"2020-05-04T23:46:13Z","_rev":"52vAUxG62nnEnK65ZDo5dG","_type":"taxonomy","pixelTrackingCode":null,"_updatedAt":"2022-11-29T18:34:57Z","identifier":"healthcare-delivery","parent":{"_type":"taxonomy","isMainTopic":true,"_rev":"SpZIJtjiAn4ebHE4u6sWYc","name":"Topic","_id":"15012229-f713-4f0a-8f82-7667530bb382","_updatedAt":"2021-10-21T10:15:35Z","identifier":"topic","_createdAt":"2020-03-31T14:24:50Z","parent":null},"name":"Health Care Delivery","_id":"topic_healthcare-delivery"},{"identifier":"news","_rev":"OU32WOWh4YetHW0RkWbkso","_type":"taxonomy","parent":null,"pixelTrackingCode":null,"name":"News","_id":"39be7351-bd4c-4e98-82b3-0d675ae4671b","_updatedAt":"2022-01-19T10:20:16Z","_createdAt":"2020-03-30T18:05:45Z"}],"factCheckAuthors":null,"audioUrl":"https://s3.us-east-1.amazonaws.com/ai-generated-audios/www.ajmc.com/c912acfb-e0e8-4e31-9ade-a3c12a94ad04_1732727480063.2102bc8e-d3b5-4c8b-b1cc-45fca8f7d247.mp3","title":"Decoding SMA Progression: HFMSE Analysis Spotlights Variability","_updatedAt":"2024-11-27T17:11:26Z","documentGroupMapping":null,"is_visible":true,"body":[{"children":[{"_type":"span","marks":[],"text":"Real-word and subgroup analyses in ","_key":"51331d23396e0"},{"_type":"span","marks":["ed647c22c2bc"],"text":"spinal muscular atrophy","_key":"51331d23396e1"},{"marks":[],"text":" (SMA) provide great reference data for long-term comparison. This approach can lead to valuable findings that better assess patterns throughout the various SMA types, rather than tracking average changes throughout entire cohorts.","_key":"51331d23396e2","_type":"span"}],"_type":"block","style":"normal","_key":"444fd918a0e2","markDefs":[{"blank":true,"_type":"link","href":"https://www.ajmc.com/compendium/sma","_key":"ed647c22c2bc"}]},{"_key":"587a0e3245e3","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"8951b269cfec0"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"A recent analysis published in ","_key":"5174fd15dde50"},{"text":"European Journal of Neurology","_key":"5174fd15dde51","_type":"span","marks":["em","dc38c9cdb621"]},{"_type":"span","marks":[],"text":" took a closer look at 4-year outcomes in patients with SMA type 2 (SMA2) and type 3 (SMA3); however, rather than adding to the body of literature that reports on disease-modifying treatments, the researchers sought to study changes in patients’ Hammersmith Functional Motor Scale Expanded (HFMSE) and with additional factors in mind such as functional status, age, and number of spinal motor neuron 2 (","_key":"5174fd15dde52"},{"_type":"span","marks":["em"],"text":"SMN2","_key":"3d01d659d0ae"},{"_type":"span","marks":[],"text":") copies.","_key":"31a959fb3c8c"},{"_key":"b68bfa9beaf3","_type":"span","marks":["superscript"],"text":"1"}],"_type":"block","style":"normal","_key":"3883a5c14424","markDefs":[{"_type":"link","href":"https://onlinelibrary.wiley.com/doi/10.1111/ene.16517","_key":"dc38c9cdb621","nofollow":true,"blank":true}]},{"_type":"block","style":"normal","_key":"a8bd61b8b1b3","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"6a1e50adfe510"}]},{"alt":"The HFMSE was originally created to assess nonambulatory children with SMA types 2 or 3 | image credit: iri.madrid.art - stock.adobe.com","_key":"daf84e415f82","widthP":30,"_type":"figure","imgcaption":[{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The HFMSE was originally created to assess nonambulatory children with SMA types 2 or 3 | image credit: iri.madrid.art - stock.adobe.com","_key":"75a9511492240"}],"_type":"block","style":"normal","_key":"60fb20eaf51f"}],"alignment":"left","asset":{"_ref":"image-470179e0fe6e475a20f68e6a5c78af502653afb1-3584x5376-jpg","_type":"reference"},"disableTextWrap":false,"disableLightBox":true},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Pediatric SMA professionals designed the HFMSE in 2003, primarily to evaluate the motor abilities and disease progression of children with SMA2 and SMA3. The scale is a viable measure for both children and adults. A composite score, accounting for 20 physical activities, helps clinicians and health care providers create a personal history for patients’ physical abilities. Over time, changes in patients’ ability to stand, crawl, roll, sit, and more allow them to reliably interpret improvements and decline in motor functioning. These records are invaluable for informing treatment approaches, confirming the efficacy of current therapeutics, and the makeup of the HFMSE ensures that it is replicable, reliable, and easy to use.","_key":"38881c82301d0"},{"_type":"span","marks":["superscript"],"text":"2","_key":"ff32a5fa8619"}],"_type":"block","style":"normal","_key":"086e113b830f"},{"_key":"6f558599d687","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"a53988e5a9ff0"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"ceab59840708","markDefs":[],"children":[{"text":"In the present study, the HFMSE evaluated 33 items with scores ranging from 0-2 (0 = unable to do a given physical activity; 1 = physical activity achievable with certain modifications; 2 = can perform activity without modification).","_key":"54dfaf69c1770","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"1","_key":"9cfa2493731a"}]},{"style":"normal","_key":"d0cfeb0ad92e","markDefs":[],"children":[{"_key":"b82b86a178350","_type":"span","marks":[],"text":""}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"Researchers utilized a combination of retrospective analysis and prospective data collection, drawing from multiple international data sets such as the Pediatric Neuromuscular Clinical Research Network for SMA in the US, Italy, and UK-SMA REACH. Additionally, data were collected from a Spain-based and Belgium-based prospective network. Overall, gathered data spanned between 2003 and 2022.","_key":"ac6078e856ac0"}],"_type":"block","style":"normal","_key":"b08efa923029","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"53849f5aba210"}],"_type":"block","style":"normal","_key":"9dab3f4035b7"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"In total, 388 patients with SMA were included in the final data set (SMA2 = 226; SMA3 = 162). The authors noted that nearly 60% of individuals with SMA3 experienced clinical onset before the age of 3 (SMA3a) and just under 25% experienced clinical onset after 3 years of age (SMA3b).","_key":"a91d0e5d9ec00"}],"_type":"block","style":"normal","_key":"a4daa56e6e51"},{"markDefs":[],"children":[{"_key":"da933a59a4920","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"80560c0e62b7"},{"children":[{"_type":"span","marks":[],"text":"Four years following their first clinical visit, patients with SMA2 exhibited a –2.2 change in HFMSE, with approximately a –0.58 change occurring each year. A sensitivity analysis for the SMA2 cohort revealed a 4-year change of –3.94 (95% CI, –4.29 to –2.39), estimating a –0.69 change annually (95% CI, –0.87 to –0.50). The researchers witnessed the largest average change for sitters between the ages of 5 and 14 years, and the most minimal change in individuals who lost the ability to sit without support.","_key":"920231f8afea0"}],"_type":"block","style":"normal","_key":"09459b963c1e","markDefs":[]},{"style":"normal","_key":"a6462990fd67","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"0803b16f41ec0"}],"_type":"block"},{"markDefs":[],"children":[{"marks":[],"text":"The SMA3 cohort experienced a 4-year change of –2.75, or, after the sensitivity analysis, –2.82 (95% CI, –4.29 to –1.34). Annual changes were approximately –0.82, or –0.81 (95% CI, –1.11 to –0.52) after the sensitivity analysis. In this group, the biggest mean motor changes occurred for individuals aged 7 to 15 years—and in those over 15 years in the SMA3a subgroup.","_key":"3e5774b322580","_type":"span"}],"_type":"block","style":"normal","_key":"2f245e0685a2"},{"_type":"block","style":"normal","_key":"a2001c24238a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c85d32d3e1060"}]},{"children":[{"_type":"span","marks":[],"text":"Notably, baseline scores and patient age were the most predictive of change over the 4-year period.","_key":"8b3beb89d41d0"}],"_type":"block","style":"normal","_key":"9b29305ce08f","markDefs":[]},{"_type":"block","style":"normal","_key":"393e4b7280e8","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"839510fac7940"}]},{"style":"normal","_key":"0b1d5ab2409f","markDefs":[],"children":[{"_key":"1ef1fdf6b5f90","_type":"span","marks":[],"text":"“Whilst this information helps understand when deterioration is perceived as clinically meaningful by individuals or caregivers, the observed variability also reinforces the idea that mean changes across different SMA cohorts are not reliable bench-marks, as they encompass a wide spectrum of individual variations in disease progression and treatment response,” the authors concluded."}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"6134ae59c6a90"}],"_type":"block","style":"normal","_key":"c8d175f7e194"},{"_key":"55f2e270b3db","markDefs":[],"children":[{"text":"References","_key":"4c369ac46ebf0","_type":"span","marks":["strong"]}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"ac0cebcd7994","markDefs":[],"children":[{"text":"","_key":"76f4d92fdb2d0","_type":"span","marks":[]}]},{"_key":"aa9a621c9c07","markDefs":[],"children":[{"_type":"span","marks":[],"text":"1. Coratti G, Bovis F, Pera MC, et al. Long-term natural history in type II and III spinal muscular atrophy: a 4-year international study on the Hammersmith Functional Motor Scale Expanded. ","_key":"8da81576c1170"},{"_type":"span","marks":["em"],"text":"Eur J Neurol","_key":"8da81576c1171"},{"_type":"span","marks":[],"text":". 2024;31(12):e16517. doi:10.1111/ene.16517","_key":"8da81576c1172"}],"_type":"block","style":"normal"},{"children":[{"text":"","_key":"16ffa3077e830","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"7675d2d21d13","markDefs":[]},{"markDefs":[{"href":"https://www.mysmateam.com/resources/what-is-the-hammersmith-functional-motor-scale","_key":"2580109efd72","nofollow":true,"blank":true,"_type":"link"}],"children":[{"text":"2. McKibben JC. What Is the Hammersmith Functional Motor Scale for SMA? mySMAteam. October 25, 2021. Accessed November 27, 2024. 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Breaking it down by county, Chittenden, Franklin, Rutland, Windham, and Windsor all saw improvements, while the rate in Washington county worsened compared with last year’s report. Additionally, half these counties got Bs, with Rutland county having the highest rate of 9.1%.","_key":"d4ec70c7c6660","_type":"span"}],"_type":"block","style":"normal","_key":"e17a41c4cf1e"},{"children":[{"text":"","_key":"f1afdc82fb560","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"103822ab6bec","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"There are a few factors that play into Vermont’s low preterm birth rate. First, the percentage of women having low-risk cesarean births in Vermont was 23.7%, comparable to the country-wide rate of 26.6%. Additionally, only 6.2% of birthing people were receiving inadequate prenatal care, much lower than the 15.7% rate across the US. These factors underline the importance of improving nationwide access to comprehensive maternal care.","_key":"11b31e281e870"}],"_type":"block","style":"normal","_key":"2a98f2795d63"},{"_key":"ee6246de4339","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"a077f75e18d20"}],"_type":"block","style":"normal"},{"_type":"figure","_key":"fa9dab67f41c","asset":{"_ref":"image-7928afa87272891a1211f02ab685217dc119fc12-5694x3800-jpg","_type":"reference"},"widthP":35,"imgcaption":[{"_key":"f7c6dd52bee1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Vermont had the lowest preterm birth rate in the US in 2023 | Image credit: rabbit75_fot – stock.adobe.com","_key":"852f8e890861"}],"_type":"block","style":"normal"}],"disableTextWrap":false,"disableLightBox":true,"alignment":"right","alt":"Welcome to Vermont road sign | Image credit: rabbit75_fot – stock.adobe.com"},{"style":"normal","_key":"e13c0a625fda","markDefs":[{"_key":"703201b25ce8","nofollow":true,"blank":true,"_type":"link","href":"https://www.commonwealthfund.org/publications/scorecard/2024/jul/2024-state-scorecard-womens-health-and-reproductive-care"}],"children":[{"_type":"span","marks":[],"text":"Vermont is also one of the few ","_key":"0bb616cd5f0b0"},{"_type":"span","marks":["703201b25ce8"],"text":"top-performing states","_key":"0bb616cd5f0b1"},{"_type":"span","marks":[],"text":" in terms of women’s overall health.","_key":"0bb616cd5f0b2"},{"text":"3","_key":"d4f54cd29a81","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" According to the 2024 State Scorecard on Women’s Health and Reproductive Care, Vermont has the lowest all-cause mortality rate among women of reproductive age (15 to 44 years) and the lowest maternal mortality.","_key":"3ebeea4f932d"}],"_type":"block"},{"children":[{"text":"","_key":"7e1ac9d7e2a20","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"d9f35a7e1917","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"According to The Commonwealth Fund, this is largely due to the state increasing its number of maternity care providers and reducing the number of women lacking prenatal care, postpartum checkups, and insurance.","_key":"f82eda337ed50"},{"marks":["superscript"],"text":"3","_key":"1f9e57b99691","_type":"span"},{"_type":"span","marks":[],"text":" Expanding Medicaid to include more individuals with lower household incomes is linked to reduced maternal mortality rates, improved infant health outcomes, and increased access to reproductive health services, and Vermont is among the states that have adopted Medicaid expansion.","_key":"7cb096efbccf"}],"_type":"block","style":"normal","_key":"80bb43a5ed71","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"5e3e9cafea590"}],"_type":"block","style":"normal","_key":"c15f10d41d26"},{"_type":"block","style":"normal","_key":"56fff3fd9bf3","markDefs":[],"children":[{"_key":"c975f938521e0","_type":"span","marks":[],"text":"However, the maternal mortality rate nearly doubled between 2018 and 2022, increasing the most for Black and American Indian and Alaska Native women, though the role of the COVID-19 pandemic during this timeframe should be examined closer as there was a clear spike in 2021 that has since dropped."},{"_type":"span","marks":["superscript"],"text":"1","_key":"b32e7c9f6244"}]},{"_type":"block","style":"normal","_key":"0e7f43dce952","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"724da5094ffe0"}]},{"children":[{"_type":"span","marks":[],"text":"Despite progress in reducing preterm births, Vermont has also seen a slight increase in infant mortality over the past decade, with 26 babies dying before their first birthday in 2022. Interestingly, the infant mortality rate among Black babies was 20% lower than the state average, highlighting nuanced trends in outcomes.","_key":"d1217dce06ee0"}],"_type":"block","style":"normal","_key":"2350a02d254c","markDefs":[]},{"markDefs":[],"children":[{"_key":"ae230c62c1560","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"6ed4d8ddd5ca"},{"style":"h3","_key":"c8f8728286ed","markDefs":[],"children":[{"_key":"6cbaffb21d9a0","_type":"span","marks":["strong"],"text":"Racial Gaps in Preterm Birth Rates"}],"_type":"block"},{"markDefs":[],"children":[{"text":"Disparities remain as the preterm birth rate varied by race and ethnicity. The preterm birth rate among babies born to Hispanic birthing people was 1.3 times higher than among all other groups in 2023, similar to the gap between Black birthing people and other groups across the country as a whole.","_key":"03649279c02b0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"edbb0509f210"},{"markDefs":[],"children":[{"text":"","_key":"c118090966590","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"6430815c38ed"},{"children":[{"_key":"105e9dedc2e60","_type":"span","marks":[],"text":"According to the report, Hispanic people in Vermont have a 52% higher preterm birth rate relative to Asian people, with rates of 10% and 6.6%, respectively. Meanwhile, Black and White parents have rates of 8% and 8.1%, respectively. Hispanic and Latino individuals make up "},{"_type":"span","marks":["17676e233da0"],"text":"less than 3%","_key":"105e9dedc2e61"},{"_type":"span","marks":[],"text":" of Vermont’s predominantly non-Hispanic White population.","_key":"105e9dedc2e62"},{"_type":"span","marks":["superscript"],"text":"4","_key":"841aaf07e2fa"},{"_type":"span","marks":[],"text":" However, the Hispanic population has ","_key":"bce3c00f0f44"},{"text":"grown the most","_key":"105e9dedc2e63","_type":"span","marks":["31abd550b23f"]},{"marks":[],"text":" of any racial group in Vermont over the past decade, growing from 9291 in 2010, to 14,857 in 2022.","_key":"105e9dedc2e64","_type":"span"},{"_type":"span","marks":["superscript"],"text":"5","_key":"8eb8cc942a9c"},{"_type":"span","marks":[],"text":" As the state’s population slowly grows more diverse, it’s important that health care policies in the state focus on protecting those at higher risk of having a preterm birth.","_key":"441e881f62a9"}],"_type":"block","style":"normal","_key":"02f513621a0c","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.census.gov/quickfacts/VT#qf-headnote-b","_key":"17676e233da0"},{"nofollow":true,"blank":true,"_type":"link","href":"https://usafacts.org/data/topics/people-society/population-and-demographics/our-changing-population/state/vermont/","_key":"31abd550b23f"}]},{"_type":"block","style":"normal","_key":"8400a03a6ae5","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"fa766386ce4a0"}]},{"markDefs":[],"children":[{"text":"Chronic Health Conditions Increase Risk","_key":"1060d17085280","_type":"span","marks":["strong"]}],"_type":"block","style":"h3","_key":"cd1eed918ae3"},{"markDefs":[],"children":[{"marks":[],"text":"The report card also highlights the compounding risks faced by certain demographic groups when preexisting chronic health conditions intersect with systemic inequities. In Vermont, the influence of chronic conditions such as smoking, hypertension, unhealthy weight, and diabetes becomes more concerning.","_key":"9fa47c5da1a50","_type":"span"},{"_type":"span","marks":["superscript"],"text":"1","_key":"7f44ee413088"}],"_type":"block","style":"normal","_key":"a31a5facd4e5"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"e920808e9dcd0"}],"_type":"block","style":"normal","_key":"3a72bbd320ee"},{"markDefs":[{"href":"https://www.healthvermont.gov/stats/population-health-surveys-data/behavioral-risk-factor-surveillance-system-brfss","_key":"4e7a0751c1d2","nofollow":true,"blank":true,"_type":"link"}],"children":[{"_type":"span","marks":[],"text":"State-level data showed that preterm birth rates rise to 13.8% for those with smoking-related conditions, 17.3% with hypertension, 8.3% with unhealthy weight, and 22.6% with diabetes. With 13% of the state’s population smoking, 32% having hypertension, 35% having overweight, 27% having obesity, and 8% having diabetes ","_key":"079eaca848dd0"},{"_type":"span","marks":["4e7a0751c1d2"],"text":"in 2022","_key":"079eaca848dd1"},{"_key":"079eaca848dd2","_type":"span","marks":[],"text":", it’s important to focus on preventive strategies to mitigate the risk of these conditions and, in turn, preterm birth."},{"_type":"span","marks":["superscript"],"text":"6","_key":"fbd0e1d65118"}],"_type":"block","style":"normal","_key":"2f9d37f5ac43"},{"style":"normal","_key":"afce8f9c9c0b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"929cefb3d4760"}],"_type":"block"},{"markDefs":[{"href":"https://jamanetwork.com/journals/jama/fullarticle/2806661","_key":"d6631574d717","nofollow":true,"blank":true,"_type":"link"}],"children":[{"_key":"aa6185fe47990","_type":"span","marks":[],"text":"The report card credited mental health, substance use, and general health care as the primary factors that make Vermont patients more vulnerable to poor maternal outcomes."},{"_key":"fdc68357e932","_type":"span","marks":["superscript"],"text":"1"},{"_type":"span","marks":[],"text":" In 2019, Vermont was ","_key":"5b6a3291780f"},{"_type":"span","marks":["d6631574d717"],"text":"one of few states","_key":"aa6185fe47991"},{"_key":"aa6185fe47992","_type":"span","marks":[],"text":" to have a lower maternal mortality ratio for all racial and ethnic groups, “suggesting that either underlying risk factors that drive maternal deaths are lower in these states or that prevention efforts have had some success in these locations,” according to researchers."},{"_type":"span","marks":["superscript"],"text":"7","_key":"57c8fe932ec3"}],"_type":"block","style":"normal","_key":"e59cf739ff87"},{"children":[{"_type":"span","marks":[],"text":"","_key":"a6d82e54d8a40"}],"_type":"block","style":"normal","_key":"575a9e60d7e8","markDefs":[]},{"_type":"block","style":"h3","_key":"3a993c08aa7a","markDefs":[],"children":[{"_key":"37f7ff1ef9410","_type":"span","marks":["strong"],"text":"Ways Vermont Could Still Improve"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Despite having the lowest preterm birth rate in the country, there are a few policies Vermont does not have in place that could improve outcomes.","_key":"19df4bf4fba60"},{"_key":"308cad193046","_type":"span","marks":["superscript"],"text":"1"},{"_type":"span","marks":[],"text":" March of Dimes reported the state has only adopted 1 of 4 midwife policies that “support the growth and sustainability of the midwifery workforce.”","_key":"141026417d27"}],"_type":"block","style":"normal","_key":"34f1e32f5786"},{"style":"normal","_key":"dfab23b06adf","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"427d31c2bedc0"}],"_type":"block"},{"style":"normal","_key":"df26604d98fa","markDefs":[],"children":[{"text":"As previously mentioned, Vermont expanded Medicaid to allow birthing people more access to preventive care during pregnancy, in addition to extending coverage for women to 1 year postpartum. However, the state Medicaid program does not require nor reimburse for postpartum mental health screening, nor does it reimburse doula care. Vermont also does not require employers to provide a paid parental leave option according to the report card, and does not have a CDC-funded maternal mortality review committee that reviews fetal and infant deaths.","_key":"7379e24575340","_type":"span","marks":[]}],"_type":"block"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"388d4b7cd0760","_type":"span"}],"_type":"block","style":"normal","_key":"c117ae727528"},{"children":[{"_key":"b367e78aa2260","_type":"span","marks":[],"text":"These state-level findings show how effective policies and investments can improve outcomes for birthing people and their infants. While the state sets an example with its low preterm birth rate and strong overall health rankings, addressing gaps in midwifery support, postpartum mental health care, and parental leave could further enhance Vermont’s standing as a national leader in maternal health."}],"_type":"block","style":"normal","_key":"51502ff748a7","markDefs":[]},{"children":[{"marks":[],"text":"","_key":"ca0c704f886b0","_type":"span"}],"_type":"block","style":"normal","_key":"7907d2573b6f","markDefs":[]},{"_type":"block","style":"normal","_key":"d73f8a6152a0","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"References","_key":"f34640a4c12b0"}]},{"listItem":"number","markDefs":[],"children":[{"_type":"span","marks":[],"text":"2024 March of Dimes report card for United States. March of Dimes. November 2024. 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The Commonwealth Fund. July 18, 2024. Accessed November 25, 2024. https://www.commonwealthfund.org/publications/scorecard/2024/jul/2024-state-scorecard-womens-health-and-reproductive-care","_key":"70a6768e38d20"}],"level":1,"_type":"block"},{"_type":"block","style":"normal","_key":"0a22fb30a39e","listItem":"number","markDefs":[],"children":[{"text":"QuickFacts – Vermont. US Census Bureau. Updated July 1, 2023. Accessed November 25, 2024. https://www.census.gov/quickfacts/VT#qf-headnote-b","_key":"4a53cbcf28e70","_type":"span","marks":[]}],"level":1},{"children":[{"marks":[],"text":"Our changing population: Vermont.USA Facts. Updated July 2022. 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Shorla Oncology announces FDA approval of IMKELDI (imatinib) oral solution, an oral liquid for the treatment of certain forms of leukemia and other cancers. News release. Shorla Oncology. November 25, 2024. Accessed November 26, 2024. ","_key":"fcc66983d1cc0"},{"_type":"span","marks":["ae7780cb14be"],"text":"https://www.businesswire.com/news/home/20241125044117/en/Shorla-Oncology-Announces-FDA-Approval-of-IMKELDI-imatinib-Oral-Solution-an-Oral-Liquid-for-the-Treatment-of-Certain-Forms-of-Leukemia-and-Other-Cancers","_key":"fcc66983d1cc1"}],"_type":"block","style":"normal","_key":"2e3ed5d87cb6"},{"children":[{"_type":"span","marks":[],"text":"2. Key statistics for acute lymphoblastic leukemia (ALL). American Cancer Society. Updated January 17, 2024. Accessed November 26, 2024. ","_key":"7118d79650890"},{"_type":"span","marks":["1721013932bc"],"text":"https://www.cancer.org/cancer/types/acute-lymphocytic-leukemia/about/key-statistics.html","_key":"7118d79650891"}],"_type":"block","style":"normal","_key":"9fb30d9db5a8","markDefs":[{"href":"https://www.cancer.org/cancer/types/acute-lymphocytic-leukemia/about/key-statistics.html","_key":"1721013932bc","nofollow":true,"blank":true,"_type":"link"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"3. Ravandi F. Managing Philadelphia chromosome-positive acute lymphoblastic leukemia: role of tyrosine kinase inhibitors. ","_key":"7b8e2d60de4e0"},{"_type":"span","marks":["em"],"text":"Clin Lymphoma Myeloma Leuk","_key":"7b8e2d60de4e1"},{"_type":"span","marks":[],"text":". 2011;11(2):198-203. doi:10.1016/j.clml.2011.03.002","_key":"7b8e2d60de4e2"}],"_type":"block","style":"normal","_key":"26fb2630c5a9"},{"children":[{"_key":"16ab5d850477","_type":"span","marks":[],"text":"4. Imatinib (oral route). 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","_key":"b2d3deec344e0"},{"_type":"span","marks":["1589d1b4a80d"],"text":"multiple myeloma","_key":"7659b9ffcd1b"},{"_type":"span","marks":[],"text":" were updated on September 17, 2024—their most recent update, although additional updates are expected in 2025—for the first time, a quadruplet regimen became a category 1 recommendation and the preferred first-line treatment option for transplant-eligible patients and transplant-ineligible patients.","_key":"52fd991e9835"},{"_type":"span","marks":["superscript"],"text":"1","_key":"dc74456f2009"}],"_type":"block","style":"normal","_key":"bec520c3fd0e"},{"_type":"block","style":"normal","_key":"6481145e10e1","markDefs":[],"children":[{"_key":"2c6d0ce69b530","_type":"span","marks":[],"text":""}]},{"_type":"block","style":"normal","_key":"5226f35cc331","markDefs":[],"children":[{"marks":[],"text":"Daratumumab, lenalidomide, bortezomib, and dexamethasone comprise the new category 1 preferred regimen for patients eligible for transplant, 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Maintenance therapy recommendations now include carfilzomib/lenalidomide and daratumumab/lenalidomide, but the preferred maintenance regimen is lenalidomide (category 1). 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For patients who have lenalidomide-refractory disease, the triplet of selinexor/bortezomib/dexamethasone (category 1) was moved to “other recommended” and elotuzumab/pomalidomide/dexamethasone is now a recommendation for use after failure on 2 prior therapies, including lenalidomide and a PI.","_key":"f5c294e35cab0"}],"_type":"block"},{"_key":"185123abafea","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"0fb8278a803a0"}],"_type":"block","style":"normal"},{"style":"normal","_key":"36427e8a5fbf","markDefs":[],"children":[{"_type":"span","marks":[],"text":"For CAR T-cell therapies, there were notable additions for its use after 1 and 2 prior lines of therapy,","_key":"f1c4b51672aa0"},{"text":"1","_key":"f1c4b51672aa1","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" both category 1 recommendations and approved on April 5 by the FDA for earlier use in patients who have relapsed/refractory multiple myeloma","_key":"f1c4b51672aa2"},{"_type":"span","marks":["superscript"],"text":"2,3","_key":"29ef56da060c"},{"_type":"span","marks":[],"text":":","_key":"454c3a20d062"}],"_type":"block"},{"style":"normal","_key":"7a9bde4bcb52","listItem":"bullet","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Ciltacabtagene autoleucel (cilta-cel; 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