Monday, December 11, 2017

OCMA Blog

ASCO 2015 Update: Releasing the Potential of the Immune System

This article is brought to you by: John Link, MD of Breastlink

visit www.breastlink.com for more information

- The Annual Meeting of the American Society of Clinical Oncology (ASCO) provides an opportunity for thousands of oncologists and health care professionals to receive research updates and exchange ideas surrounding trends in cancer treatments.

More than 30,000 attend each year, making it one of the largest educational and scientific conferences dedicated to advancing cancer care. I recently joined my colleagues for the ASCO 2015 Annual Meeting, where a focus was on breakthroughs in immunotherapy.

What is Immunotherapy?

Immunotherapy refers to treatments that prompt the human body’s immune system to attack cancer cells. Cancer occurs when a genetic mutations occurs that causes a healthy cell to become cancerous. Can the immune system recognize these cancerous cells as harmful or are they too at home within the body?

Recently, we have determined that the immune system often does recognize cancerous cells. The immune system produces white blood cells called lymphocytes that target harmful substances, called antigens, within the body. In response to the development of some cancers, lymphocytes will gather around cancerous cells. However, they do not always infiltrate cancerous cells and cause them to die.

Some cancers produce certain proteins, such as programmed cell death 1 (PD1). These are similar to other naturally-occurring proteins that prevent the immune system from interrupting certain normal biological functions. For instance, these proteins prevent the body from rejecting a fetus during pregnancy. When a cancer cell produces PD1, it sends a message to lymphocytes to back off.

A relatively new class of drugs called PD1-inhibitors prevents cancer cells from disguising themselves as healthy cells. Several ASCO 2015 Annual Meeting presentations on PD1-inhibitors revealed that they were an effective treatment for several cancers.

  • Pembrolizumab – More than one-half of patients with advanced head and neck cancer experienced noticeable decrease in size of tumors following treatment with pembrolizumab.
  • Nivolumab – Tumors ceased growing in approximately one-half of patients with advanced liver cancer treated with nivolumab. Advanced lung cancer patients treated with nivolumab lived an average of three months longer than patients treated with docetaxel, a chemotherapy.

Immunotherapy in Breast Cancer Patients

Ongoing research is also investigating the use of PD1-inhibitors in breast cancer patients. In an early stage trial, 4 of 21 triple-negative breast cancer patients with the PD1 protein responded to a PD1-inhibitor currently under investigation. These results prompted the FDA to assign the drug, MPDL3280A, Breakthrough Therapy Designation, which is reserved for treatments that appear significantly more effective in clinical trials than existing treatments.

In an upcoming phase III trial sponsored by drug maker Hoffman-La Roche, researchers will investigate the use of MPDL3280A in combination with nab-paclitaxel, a type of chemotherapy, in patients with metastatic breast cancer. The phase III trial is currently recruiting patients. Eligible candidates include women with advanced triple-negative breast cancer with no prior chemotherapy or targeted systemic therapy for inoperable disease.

Breastlink will work with researchers as a clinical partner in ongoing MPDL3280A research. This means patients eligible to participate in the study can receive MPDL3280A at Breastlink locations in Orange County. At this time, Breastlink locations are the only sites in Orange County and Los Angeles County where patients can participate in this study. As part of our commitment to advancing innovative breast cancer therapies, Breastlink is excited to play a role in ongoing research and to offer patients an opportunity to participate.

One drug already approved by the FDA for breast cancer patients combines immunotherapy with conventional chemotherapy. Ado-trastuzumab emtansine ( T-DM1) uses an antibody called trastuzumab to target receptors present on cancerous cells in women with HER2-positive breast cancer. Once T-DM1 has bound to HER2 receptors, a chemotherapy agent called DM1 is delivered to the interior of cancerous cells, destroying them from the inside.

There are several benefits to immunotherapy over conventional chemotherapy and other targeted treatments. Researchers are continuing to produce evidence that immunotherapy improves clinical outcomes compared with conventional chemotherapy. Additionally, patients generally experience fewer side effects when treated. Immunotherapy also allows the immune system to develop a lasting memory of the antigen – in this instance, a type of cancer cell. If this specific type of cancer recurs, the immune system will continue to respond.

Developments such as those presented provide hope for a cure. The scientific and medical communities recognize new immunotherapy agents as huge breakthroughs. With these drugs, we can avoid treating more women with chemotherapy while improving their outcomes. At Breastlink, we are excited by these advancements and will eagerly track updates as they occur.


OC In+Care Newsletter - Issue 6


In this issue of the In+Care newsletter, we are going to discuss the Medi-Cal renewal process and some key things that may help your client(s) with their Medi-Cal redetermination packet. In Orange County, Medi-Cal is also called CalOptima.

What is Medi-Cal redetermination?

Medi-Cal recipients must have their eligibility assessed and verified every 12 months1. This process is to make sure clients are still eligible to receive Medi-Cal benefits. This process is different from Ryan White eligibility screening. If someone is receiving Ryan White services, they must continue to be screened for Ryan White eligibility every 6 months.

What will happen and what must be done?

Beginning in 2015, Medi-Cal will do a prescreening of recipients’ files to see if they are still eligible to receive services under Medi-Cal1. Clients may have received a Request for Tax Household Information (RFTHI) that must be completed for Medi-Cal to gain access to income information. If the information show that the individual is still eligible to receive Medi-Cal, their eligibility will automatically renew. Clients will receive a letter that states they are renewed for another year1. This means that they will not need to submit any information to continue being eligible for Medi-Cal.

However, if current or updated information is needed, a redetermination packet will be sent to the client asking for specific documents. Information needed is on a case-by-case basis1.

My client does not have a stable address, how can they complete the redetermination process?

Clients can call (800) 281-9799 or visit any Social Services Agency office (listed at the end of the newsletter) to complete the process.

My client received a redetermination packet, what are they supposed to do with it?

If the client receives a redetermination packet, provide all the required information before the due date indicated in the packet.

My client does not have a stable address or the address on file is wrong; what should they do?

Individuals can call (800) 281-9799 to see if they need to complete the redetermination process. If so, they can go to a Medi-Cal office (locations listed at the end of the newsletter) and find out what you need to do to get or keep coverage. If they need to update their address, they can call (800) 281-9799.

If my client has questions about the requested information who should they contact?

If there are questions, clients can contact their Medi-Cal worker or the contact person indicated in the redetermination packet.

Clients can also contact (800) 281-9799 for general Medi-Cal coverage questions.

When do clients have to return the completed redetermination packet?

The redetermination packet should have the due date when and all of the requested information must be provided. Make sure you do this as soon as possible before the due date.

What if clients do not submit their documents on time?

Medi-Cal benefits will be stopped. Clients will receive a Notice of Action that explains why their benefits have been stopped1.

The Notice of Action will also state that they have 90 days from the date of the Notice of Action, also called a “cure period”, to provide requested information2.

If the client provides the requested information within the 90 days after the notice, their benefits may be reinstated and there should be no break in Medi-Cal coverage. However, there may be delays in benefit claims if they are reinstated during the 90 day period.

If clients do not provide the information or the information submitted is not acceptable, their benefits will be stopped and they will have to reapply for Medi-Cal.

Can my client get ADAP for their medications if they are in the 90-day “cure” period?

No. Currently, ADAP guidelines states that clients cannot receive ADAP during the 90-day period. If clients receive a denial letter from Medi-Cal, they can apply to receive ADAP services with a Ryan White eligibility worker.

Can my client get Ryan White medical care if they are in the 90-day “cure” period?

No. Ryan White services are provided as payer of last resort. In order to receive Ryan White medical care a denial letter from Medi-Cal would be needed.

Should my client apply for Ryan White if they have Medi-Cal?

Yes. Ryan White covers services that are not covered by Medi-Cal (for example, food pantry, housing services, or legal services). Ryan White covers services that are partially covered by Medi-Cal (for example dental care). It is important to be screened for Ryan White eligibility to ensure they can access all the services they need and are eligible to receive.

Reminders:

  • Call (800) 281-9799 for Medi-Cal questions.
  • Clients should check and open your mail!
  • If clients change their address, they should let their Medi-Cal worker know.
  • If clients received a redetermination packet, they should provide the requested information as soon as possible to prevent a loss in coverage.
  • Clients can use https://www.mybenefitscalwin.org/ to help manage their Medi-Cal account online!

1 Department of Health Care Services. (2014, September 19). Medi-Cal Annual Redetermination Process for MAGI Beneficiaries (Reference ACWDL 14-18) Letter No. 14-32.

2 Department of Health Care Services. (2014, December 10). Medi-Cal Eligibility Division Information Letter No.: I14-60. Medi-Cal Renewal Process-The 90-Day Cure Period Job Aid.

 

Medi-Cal Locations
Hours of Operation: 7am-5pm, Monday-Friday

(800) 281-9799

Anaheim Regional Center
3320 E. La Palma Ave.
Anaheim, CA 92806


Garden Grove RegionalCenter
12912 Brookhurst St.
Garden Grove, CA 92840

Aliso Viejo RegionalCenter
115 Columbia
Aliso Viejo, CA 92656

Santa Ana Regional Center
1928 S. Grand Ave., BLDG. B
Santa Ana, CA 92705

 


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