Progress against cancer–Very Limited and Very Expensive

Gina Kolata’s article in the NY Times (4/24/2009) omits noting the high cost of new approaches to cancer treatment but does highlight the limited progress that has been made.

Over the past 50 years she notes the death rate from cancer has declined only 5% and success in treatment of advanced diseases has been limited.

“With breast cancer, for example, only 20 percent with metastatic disease – cancer that has spread outside the breast, like to bones, brain, lungs or liver – live five years or more, barely changed since the war on cancer began.”

“colorectal cancer , only 10 percent with metastatic disease survive five years. That number, too, has hardly changed over the past four decades. The number has long been about 30 percent for metastatic prostate cancer , and in the single digits for lung cancer.”

But the for drug companies financial results have been spectacular. Drugs, even relatively ineffective ones, may be priced at $100,000/year for the drug alone as noted here.

In the rare instance when a drug is effective the cost is even higher. Gleevec (imitinib), developed largely with tax funds for treatment of chronic myelogenous leukemia, is priced by Novartis in the range of $50,000-$100,000/year (depending on stage of disease and indication). These patients may live 10 years or more at a cost of $500,000 to a million dollars for the drug alone. Is this reasonable? It it the best we can do? Can we afford successful treatments?

The problem with cancer is that it is a genetic disease. As one ages and cells divide mistakes in DNA replication occur. These are random, occurring simply because nature isn’t perfect or because of influence of carcinogens. We can try to control the latter but cancer prevention is not simply a matter of smoking cessation (thought that helps) or diet modification and vitamins (they don’t appear to work). We can try to treat but this ordinarily won’t eradicate the genetic cause.

Medicynical note: The letters to the editor in response to the Kolata article are remarkable. Some quite informed. Some with THE answer: a diet cure , pot, homeopathy, diet to lower the body’s pH, etc.

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