Herceptin, Tykurb in Breast Cancer : What wasn’t reported

Tis the season of the San Antonio Breast Conference and the season of overstatements–most often by people with drug company ties.

There was an interesting report on combining Herceptin (trastuzumab) and Tykurb (lapatinib) in Her2neu positive breast cancers.

The report studies neoadjuvant use of targeted treatment in breast cancer. That is, treatment prior to surgery with the goal of shrink tumors, making breast conservation more possible and hopefully improving patient survival.

What wasn’t noted in the report:

1. Neoadjuvant therapy with conventional drugs alone results in drug shrinkage and complete response in about 25% of patients,and improves breast conservation rates, but shows no survival advantage after several years study.
2. Neo adjuvant treatment including Tykurb and Herceptin (the current study) shows shrinkage of tumors and improved ability to do breast conservation surgery. BUT, despite the hooplah, no survival studies have been completed. It is not known whether the drugs actually improve survival.
3. The drugs are only effective when used on the small group, 15-20% of breast cancer patients, who have overexpression of Her 2 neu.
4. The cost of the two drugs in combination is at least $10,000/month, probably more. Added to the other drugs used, doctors fees the cost for this treatment is probably around $20,000/month.

Medicynical Note: I recall a patient of mine who informed me, when told he would have to pay $38/pill for a new anti-nausea drug, that he’d rather throw up than pay that. He seems somewhat prosaic given the current inflation of cancer drug costs.

You better believe that cost is a major issue, particularly in a non-system that is bankrupting us. In what other area of consumer commerce would $20,000/month be spent?

In this study half the patients apparently have little or no response. So let me rephrase the question. In what other area of consumer commerce would $20,000/month be spent on a product which only works half the time (if every one of the responding patients lived longer, which is extremely doubtful). Consider also the impact of 13 months treatment at $20,000/month (4 months pre-surgery and 9 months post), that is $260,000 for drugs alone–not counting the costs for the 50% of patients that don’t respond, a minimum it seems of 4 months of treatment, $80,000.

The issue now and in the future is likely cost. Who will pay? How? A further issue is how can an industry produce and market drugs so inefficiently that costs are so high?

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