Oncotype DX AR-V7 Test Approved for Coverage by Medicare

[cesanon]

This is a sort of important test. Especially if you start becoming castration-resistant, which apparently eventually happens to most of us.

investor.genomichealth.com/...

[Tall_Allen]

I never understood - Why not try Zytiga anyway?

[cesanon in reply to Tall_Allen]

I don't know the answer to that question.

But I bet you do.

There are often good reasons not to take powerful drugs, beyond cost.

What are some of the side effects ect? There must be some.

[Tall_Allen in reply to cesanon]

Yes, there are certainly side effects to the second line hormonals. But that would be true of ANY therapy that follows up ADT. There is intriguing suggestions that docetaxel or megadose testosterone may reverse AR-V7 splice variant positivity, at least in some cases. I guess if the test is positive, the patient should be steered to docetaxel first; and if the test is negative, he can take docetaxel or Zytiga first.

I think Fairwind is right - it depends on whether it's cheaper to get the test or to try Zytiga.

[Hidden in reply to Tall_Allen]

I've read some opinions on this from oncologists specializing in prostate cancer. They say you should try Zytiga even if you have the mutation. That's what I would do.

[Fairwind]

I think this test needs to pass a cost / benefit analysis before it is put into regular use...

[cesanon in reply to Fairwind]

Fairwind

Are you saying that this is what Medicare will do? Or just speculating what they might do?

[Hidden]

Here's a good talk about AR-V7.

The doctor is saying that AR-V7 testing is more useful in the second-line setting after the failure of either Zytiga or Xtandi when considering whether to switch after the failure of the first. At the onset of CRPC, the percentage of AR-V7 is very low and both Zytiga and Enzalutamide are both around 90% effective. But after the failure of the second-line treatment, the percentage of AR-V7 more than doubles.

onclive.com/insights/prosta...

[Tall_Allen]

Granted that Xtandi usually doesn't work long after Zytiga fails, and vice versa. But why not TRY the other? if you only get a month or two out of the other, why not get it? And, based on the SWITCH trial, why not switch to dexamethasone instead of prednisone with Zytiga? And afterwards, why not try docetaxel to see if it restores sensitivity? How does knowing that you have the AR-V7 splice variant at some point in time help you make treatment decisions? Unless it's an economic decision.

[cesanon in reply to Tall_Allen]

Tall Allen

Why waste time on something that will predictably not work?

You always want an overwhelming attack on cancer to avoid giving it any breathing room to adapt.

That is the answer to your question. What am I missing?

[Tall_Allen]

Because it works until it doesn't. Even in men who were AR-V7 positive, Zytiga/prednisone gave them clinical progression-free survival of 2.3 months. So why not take the couple of months? In men who are AR-V7 positive, SOME of the cancer cells are AR-V7 negative - why not pick off those? I hope they will find something to reliably reverse it. But I can also see the argument for testing for it, and if positive, going straight to chemo, and later doing Zytiga. I just don't know which strategy buys one more time.

[Lakefisher]

I think the issue for some is financial. I'm on Medicare and the cost of Zytiga is $2000 the first month and $500 after that. So a three month trial is $3000, unless you can get on low income plan from the manufacturer. I'd rather not spend 3 grand on something that probably won't work.

[cesanon]

Isn't there a total cap on Medicare drug costs?

Though the copay on the test is probably covered under Medicare part B as opposed to part D (drugs).

[mcp1941 in reply to cesanon]

There is NO cap on cost with Part D. First script for Erleada the copay was about $2700 and that put me right away into catastrophic coverage. From then on my copay was $560 per month. This January I will be hit again with the $2700 copay.

[cesanon in reply to mcp1941]

Hmmm, is that with or without part D supplemental insurance?

What is all the talk about the so called donut holes?

You know I just discovered something else. While Obamacare removed preexisting conditions for most people. If you want to change Medicare supplemental plans, we are still subject to preexisting conditions.

And they are unlikely to change that in the near future. Not with the healthcare crap going on in Congress.

[mcp1941 in reply to cesanon]

That is with Part D insurance. I just skipped over the donut hole. Regarding pre-existing conditions, I also read somewhere (I can't remember anything anymore) about changing plans could be a disaster. I am staying put.

[cesanon]

"changing plans could be a disaster"

Yes. You have to apply and they get to turn you down.

What I don't know is if they accept you, can they find excuses to reject claims because of incomplete disclosure. They used to do that a lot before Obamacare.