The annual oncology meetings (American Society of Clinical Oncology–ASCO) are on and we are destined, the next few days, to be bombarded with reports extolling the virtue of various interventions. There is real progress being made, new approaches based on blocking cell receptors, anti-angiogenic strategies and new combinations of various cyto-toxic agents.
The issue in not whether there is progress but how much progress and at what financial cost. The pharmaceutical patent monopoly allows companies to charge whatever they wish for new agents, no matter how marginal the results. The cost is based not on the cost of research or production or even the amount spent on promotion (which exceeds the costs of research by a wide margin).
Rather the pharmaceutical companies realize patients with cancer are not rational consumers who have the luxury of comparing products (approaches) and choosing the best value. Rather they are desperate for anything that might help their situation. I’ve been in the position of informing patients they have incurable disease and that the best we can do is offer medications that offer a chance of amelioration for a time–often as little as 10% response rate and as little as a month or two median improvement in survival. Patients more often than not choose to be treated, even though the costs are extreme.
There are numerous examples but take today’s news about a survival benefit in liver cancer with the use of a drug Nexavar . Nexavar is a multi-kinase inhibitor that targets serine/threonine and receptor tyrosine kinases. These are found in both the tumor cells and blood vessels so the action sites are multiple.
Reuters reported from the ASCO meeting:
An experimental pill for advanced liver cancer helped patients live about three months, or 44 percent, longer than those on a placebo, according to a study released on Monday.
The trial found the drug Nexavar, by German drug maker Bayer AG (BAYG.DE: Quote, Profile, Research and its U.S. partner Onyx Pharmaceuticals (ONXX.O: Quote, Profile, Research, extended survival to 10.7 months, compared with 7.9 months for those on a placebo.
The drug was previously reported to be active against kidney cancer. In that tumor progress was delayed (“growth slowed”) for 4 months.
Last year Forbes noted:
“Onyx’s announcement that Nexavar will be priced at $4,333 a month, above the firm’s estimate of $3,200 and a Street consensus of $3,000, the financial analyst said in a report issued Wednesday.”
Also from the Forbes article this analysis: “We believe the drug should have limited exposure to price sensitivity, since Medicare Part D insulates Medicare patients from the cost of highly expensive drugs,” said the research analyst. “Private insurers are likely to look favorably on this drug as well, especially when compared to potentially toxic competitors with high treatment-associated costs,”
It’s wonderful that there is progress, but can we as a society afford the price? We need to revisit patents, the issue of responsible pricing and the non-negotiation policy of Medicare Part D–most of these patients are over 65 years of age.