Clinical Experiences for Biosimilars in Oncology

Bhavesh Shah, RPh, BCOP, shares his clinical experience with oncology biosimilars and thoughts on changing from 1 agent to another.

Anthony Mato, MD, MSCE: Let’s talk about our own experiences with biosimilars, because everybody here has had different exposure to different agents and within the health systems as well as in other professional responsibilities. I’m curious. We’ll start with Bhavesh. If you could talk about what your clinical experience with biosimilars has been, what feedback would you personally share with practitioners? Then we can take that to everybody here and try to answer that question.

Bhavesh Shah, RPh, BCOP: Sure, absolutely. Interestingly, as Tim had mentioned, tbo-filgrastim was our first agent, which was not approved as a biosimilar, but we were actually using it as a biosimilar based on it being approved as a biosimilar in Europe. There were tons of data that were already available in Europe. We were actually using tbo-filgrastim as a biosimilar for all the indications. One of the challenges we had was obviously, specifically in mobilization in transplant patients, so we decided to do our own experience.

Anthony Mato, MD, MSCE: When you say we, do you mean your institution?

Bhavesh Shah, RPh, BCOP: Yes, exactly. We basically used it for mobilization and also looked at engraftment, and we didn’t see any differences compared with our own experience with tbo-filgrastim. That was our first experience of a biosimilar but not approved as a biosimilar. But then that set the pathway for other biosimilars when they were approved that we had a much faster adoption rate, where providers were comfortable using the biosimilars and understood the approval process, the indications, and all the testing that was done. Right now we’re actually at 98% conversion rate for most of our biosimilars that we’re using in our practice.

Anthony Mato, MD, MSCE: I have a question, though. This is getting back to the earlier question about interchangeability. What’s the current practice at your institution if a patient is on 1 agent and needs to be switched to or is switched to a biosimilar? Does the order have to be rewritten? Is there anything unique that has to happen at the present time?

Bhavesh Shah, RPh, BCOP: Yes, absolutely. A lot of times what we find out is that payers actually dictate what agent the patient needs to be on. For billing purposes, you do need to actually have exactly what drug the patient is getting and also in regard to the order, it has to be signed off by a provider. The pharmacist is not doing that change. Maybe the pharmacist is, but the order is always signed off by the provider. This is because a lot of times a patient may actually have a change in their clinical response where a patient may not need to continue the same agent. It doesn’t make sense to change from 1 product to another with the same mechanism of action. So we always make changes in collaboration with the provider for anything from a reference to a biosimilar or a biosimilar to a biosimilar. We do actually have a plan to change from 1 biosimilar to another biosimilar because of significant cost savings. This is what we’ll talk about later probably.

Anthony Mato, MD, MSCE: It sounds like your general impression is favorable and guidance to clinicians who are very resistant would be what?

Bhavesh Shah, RPh, BCOP: It’s that they’re all essentially the same. If it’s a bevacizumab molecule, it’s a bevacizumab molecule, and you can basically use that at any time point. As long as the patient is supposed to continue that drug, you can basically substitute 1 bevacizumab for another bevacizumab.