Zevalin/Bexaar

[deleted4401]

There is a NYTimes article these weekend on the lack of use of Bexaar and Zevalin for lymphoma. The article makes it seem like there are indications for it that are being ignored by med-oncs or only used as a last resort after the disease is found to be refractory to chemo + Rituxan. It seems to indicate that a med-onc has to 'refer out' to a nuc med or rad onc, and that they are reluctant to do so, because they make money from chemo administration, but none from Zevalin/Bexaar.

In the context of what we've been discussing - e.g. being primary oncologists - I guess here is an example of where we are losing an opportunity to possibly treat patients more effectively and losing a potential source of income.

I'm still not sure I'm willing to deal with the headaches of an inpatient service, but as radioimmunotherapeutics increase in quantity and efficacy, we may have to go there

-S.

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[Brim]

I'm glad to see that article bring attention to radioimmunotherapy, as I'm sure the general public and most lymphoma patients aren't aware of RIT. That's about the only thing the article did right.

(Note: for those of you who haven't seen it, the article can be accessed online here.)

Unfortunately, the article is heavily skewed and ignores mentioning a major point -- that Bexxar and Zevalin are only approved for refractory lymphomas. They don't mention this until the 2nd page of the article, so they make it sound as if everyone should be getting Bexxar.

That they make it sound like the only reason oncologists are prescribing these drugs is for personal financial reasons really gets to me. It's so popular in the media recently to attack doctors -- oncologists in particular, for some reason -- and make them seem like "evil" beings who give patients ineffective treatments just to help their bottom line. This is a terrible perception to give to our patients and our nation. While doctors surely care about the finances of their practice, it is hardly what motivates most of them in taking care of patients. Oncologists are in it the same reason most of us are -- because they want to help patients. Unfortunately, they've been hit hard by decreasing reimbursements, and it's not their personal financial gain that's affected, but the medical practice altogether, and this affects the end-user, the patient. Sadly, the article does nothing to talk about this effect of these external pressures which the oncologist can do nothing to control. Instead, the only tone the article seems to have is that the oncologists are greedy bastards.

In the end, this hurts all of us.

And, as if this point wasn't enough to leave a bitter taste in my mouth, the article never mentions radiation oncologists! Apparently "academic hospitals" (also known as "competitors") are the ones who administer these radioactive sources. Perhaps at some institutions, it is only the med oncs and nuclear medicine who are involved in giving Bexxar and Zevalin, but it would have been nice to acknowledge radiation oncologists who are the specialists who advocate for these treatments, who have extensive experience in administering unsealed radioactive sources, and who understand its application. Not to mention nuclear medicine physicians who really should be acknowledged as much as radiation oncologists for this.