Evicore has not heard of PEACE-1!

[thesauce]

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I had an interesting peer to peer with Evicore earlier this week for a metastatic prostate patient. RT to the prostate was denied in a metastatic case so I spoke to one of their radoncs and explained I was offering it based on the PEACE-1 study and he said "I'm not aware of that trial" (those exact words) and denied it again.

I'm astounded that these are the people making medical decisions for patients.

 

[medgator]

I had an interesting peer to peer with Evicore earlier this week for a metastatic prostate patient. RT to the prostate was denied in a metastatic case so I spoke to one of their radoncs and explained I was offering it based on the PEACE-1 study and he said "I'm not aware of that trial" (those exact words) and denied it again.

I'm astounded that these are the people making medical decisions for patients.

Nccn has it in the guidelines for low volume M1

 

[thesauce]

Nccn has it in the guidelines for low volume M1

I doubt they know that either

 

[Ray D. Ayshun]

NCCN:

Evicore:

PEACE-1 shows no OS benefit unlike STAMPEDE right, thus perhaps justifying evicore's guidelines? It does seem like an easy argument to make in direct appeal to insurer given NCCN, which could perhaps force evicore to change their guidelines.

 

[A_DeMichele]

Perhaps your pt had high metastatic burden? (by STAMPEDE definition)?

 

[thesauce]

NCCN:

View attachment 405232

Evicore:
View attachment 405233
PEACE-1 shows no OS benefit unlike STAMPEDE right, thus perhaps justifying evicore's guidelines? It does seem like an easy argument to make in direct appeal to insurer given NCCN, which could perhaps force evicore to change their guidelines.

If OS is our metric for insurance approval, radonc is f***d

 

[thesauce]

Perhaps your pt had high metastatic burden? (by STAMPEDE definition)?

The issue is that THEY HAD NEVER HEARD OF PEACE-1. Their opinion or guidelines are a different matter.

 

[alwaysbeIMRTing]

If OS is our metric for insurance approval, radonc is f***d

Radonc has been f****d for a while.
I feel like I'm part of a cartel some days.

We have our preeminent professional organization lobbying congress for literal price fixing (because price fixing has definitely never failed to accomplish what it was meant to accomplish every single time in history) and trying to ensure that someone who comes up with a 5 fraction partial breast plan in 5 minutes and does a single 2 minute OTV gets paid the same as somebody who has to treat a complicated bilateral post-mastectomy reconstruction case with skin involvement and extensive nodal disease over a period of 6 weeks. It is a complete farce and I am completely baffled how anyone here is supporting ASTRO's efforts on this.

Does anyone want to open a cash-based arthritis clinic?

The issue is that THEY HAD NEVER HEARD OF PEACE-1. Their opinion or guidelines are a different matter.

Was the issue that they were trying to restrict you to the 55 Gy in 20 fraction regimen instead of 74 Gy in 37 fractions or they wouldn't allow it at all?

 

[thesauce]

Radonc has been f****d for a while.
I feel like I'm part of a cartel some days.

We have our preeminent professional organization lobbying congress for literal price fixing (because price fixing has definitely never failed to accomplish what it was meant to accomplish every single time in history) and trying to ensure that someone who comes up with a 5 fraction partial breast plan in 5 minutes and does a single 2 minute OTV gets paid the same as somebody who has to treat a complicated bilateral post-mastectomy reconstruction case with skin involvement and extensive nodal disease over a period of 6 weeks. It is a complete farce and I am completely baffled how anyone here is supporting ASTRO's efforts on this.

Does anyone want to open a cash-based arthritis clinic?


Was the issue that they were trying to restrict you to the 55 Gy in 20 fraction regimen instead of 74 Gy in 37 fractions or they wouldn't allow it at all?

They denied it completely

 

[Ray D. Ayshun]

They denied it completely

Are you appealing to insurance company/involving state insurance commission? I relish the opportunity for the latter, especially here where time isn't of the essence.

 

[thesauce]

Are you appealing to insurance company/involving state insurance commission? I relish the opportunity for the latter, especially here where time isn't of the essence.

Yes. I’m going to appeal it all the way to the top.

 

[A_DeMichele]

The issue is that THEY HAD NEVER HEARD OF PEACE-1. Their opinion or guidelines are a different matter.

A European systemic therapy study? don't be too harsh on your senior colleagues

 

[Haybrant]

could we stop with the innuendo and can you tell us why you are arguing your side. You are verifying that this is a low burden mets (less than 3) and they are denying you prostate directed RT? Am i right that in peace-1 low burden met patients there was a PFS benefit (which seemed substantial) but no OS benefit - this was with enhanced ADT. In high burden patients there was no PFS or OS benefit with enhanced ADT. So you're arguing that the substantial PFS benefit is the reason to offer prostate directed RT and evicore is saying just offer palliative prostate RT when they progress in the prostate 4 yrs down the line? But duidelines should already allow RT in low burden patients based on stampede. Should it really be so surprising that someone who doesn't specialize in GU RT doenst know peace-1?

 

[thesauce]

could we stop with the innuendo and can you tell us why you are arguing your side. You are verifying that this is a low burden mets (less than 3) and they are denying you prostate directed RT? Am i right that in peace-1 low burden met patients there was a PFS benefit (which seemed substantial) but no OS benefit - this was with enhanced ADT. In high burden patients there was no PFS or OS benefit with enhanced ADT. So you're arguing that the substantial PFS benefit is the reason to offer prostate directed RT and evicore is saying just offer palliative prostate RT when they progress in the prostate 4 yrs down the line? But duidelines should already allow RT in low burden patients based on stampede. Should it really be so surprising that someone who doesn't specialize in GU RT doenst know peace-1?

LOL are you with evicore? Sorry, but there is no excuse to not knowing major studies when your job is literally to tell people they can’t get treatment. You better know the studies f—- COLD.

 

[Haybrant]

LOL are you with evicore? Sorry, but there is no excuse to not knowing major studies when your job is literally to tell people they can’t get treatment. You better know the studies f—- COLD.

lol yep im evicore! i didnt even see who started this, you were op sauce, tell those of us that dont do as much GU as you clearly do what to take from the study. I laid out the whole situation above i really dont understand what you are arguing

 

[thesauce]

lol yep im evicore! i didnt even see who started this, you were op sauce, tell those of us that dont do as much GU as you clearly do what to take from the study. I laid out the whole situation above i really dont understand what you are arguing

I’m “arguing” that a reviewer had never heard of Peace-1. You think radonc is so big now that we can’t keep up with major randomized trials in all disease sites that directly relate to radiation? It’s been awhile but I seem to remember having to do this for my boards. I know some are grandfathered in and don’t have to do any MOC, but you should at least keep up a little if you’re going to be telling others what care they can’t get.

 

[grenz]

PEACE-1 showed that RT delayed castrate resistance and reduced the risk of high grade urinary complications of the cancer. I’ve always felt that is well worth the risk of tx, even if OS isn’t improved

 

[A_DeMichele]

PEACE-1 showed that RT delayed castrate resistance and reduced the risk of high grade urinary complications of the cancer. I’ve always felt that is well worth the risk of tx, even if OS isn’t improved

In which patients? low metastatic burden only?

 

[Doctorer]

In which patients? low metastatic burden only?

No, that was seen in the entire study population.

I'm pretty sure...GU isn't my treatment site. 😉

 

[A_DeMichele]

No, that was seen in the entire study population.

I'm pretty sure...GU isn't my treatment site. 😉

Looks like you're incorrect... High metastatic burden (per the original CHAARTED) patients did not show delayed castrate resistance with RT vs no RT

 

[Doctorer]

Looks like you're incorrect... High metastatic burden (per the original CHAARTED) patients did not show delayed castrate resistance with RT vs no RT

Should have specified: I was referring to the delay in adverse GU complications.

 

[Haybrant]

I’m “arguing” that a reviewer had never heard of Peace-1. You think radonc is so big now that we can’t keep up with major randomized trials in all disease sites that directly relate to radiation? It’s been awhile but I seem to remember having to do this for my boards. I know some are grandfathered in and don’t have to do any MOC, but you should at least keep up a little if you’re going to be telling others what care they can’t get.

i went back to the peace-1 thread from '24 and bro you cleaqrly said many times in that thread you didnt understand the study outcomes. i dont have to call evicore for anything so i dont know them and im sure theyre annoying af BUT it doesnt feel like you can use this study as the one to hate on them for lol

 

[thesauce]

i went back to the peace-1 thread from '24 and bro you cleaqrly said many times in that thread you didnt understand the study outcomes. i dont have to call evicore for anything so i dont know them and im sure theyre annoying af BUT it doesnt feel like you can use this study as the one to hate on them for lol

🤦‍♂️ I can’t keep up with your straw man. They had never heard of it. Whether we agree on the treatment approach is an entirely different issue.