With the recent death of Judah Folkman there have been a number of articles touting the using of this drug in varied tumors. There is little doubt antiangiogenesis is an advance, but how much of an advance and can we afford it? Is two month’s survival benefit worth $50-$100,000 in expenditures for the drug alone?
Folkman’s research on anti-angiogenic agents was funded for many years (over 20 years) by you and me through NIH grants to the researcher. When agents were identified with activity they were taken private by pharmaceutical companies and developed for market.
Avastin, one of the agents related to his research, has been shown to have limited activity in an number of tumors when combined with traditional agents. In GI cancer it may extend life in advanced cases by about 2 months for about $4400/month. In advanced Lung cancer, there is a survival advantage of just two months at a cost of $7700/month’ Similarly in breast cancer, a disease for which no survival benefit from Avastin has been proven, the costs will be in this higher range. The FDA approval to use this very expensive agent in diseases with a limited or no no survival benefit is highly controversial.
Adding insult to injury the Times in a recent article reported on one single case of an ependymoma that may have responded to Avastin. It was suggested that this indicated amazing effectiveness, dispite the well known fact that ependymoma has a widely varied rate of progression and that one case does not prove efficacy.
Genentech the manufacturer has magnanimously created a program that limits charges to patients to $55,000/year if your income does not exceed $100,000/year.
The medication is not without side-effects they include: arterial thromboembolic events, congestive heart failure, GI perforation, hemorrhage, hypertensive crisis, nephrotic syndrome. neutropenia and infection, reversible posterior leukoencephalopathy syndrome, wound healing complications
Is it any wonder that our health care system spends 2 trillion dollars a year without improving outcomes?