The American Society of Clinical Oncology meeting finishes and I’m left with a continued disbelief in treatments with limited efficacy costing in the range of $60,000-120,000/year. Patients are not cured; many studies report no survival benefit found as of yet (reports of delays of progression abound); and yet there appears little or no concern whether the advances are affordable by the various insurance schemes or individuals.
Consider the improvement provided by sorafenib compared with sunitinib in Hepatoma ( abstract 4000 at the meeting).
Median OS (overall survival) was 8.1/10.0 mo (HR 1.31 [95% CI: 1.13–1.52], P=0.0019); PFS was 3.6/2.9 mo (HR 1.12 [95% CI: 0.98–1.29], P=0.1386) and TTP (Time to Progression) was 4.1/4.0 mo (HR 1.13 [95% CI: 0.97–1.31], P=0.1785). OS for pts with hepatitis B (Hep B; Su 290/So 288; post hoc analysis) was 7.8/7.9 mo (HR 1.09 [95%CI: 0.9–1.32], P=0.236). In 526/541 pts evaluable for safety, all-causality, grade 3/4 adverse events (AEs) occurred in 82/73% of pts; the most common were thrombocytopenia (19%) and neutropenia (16%) for Su, and skin disorders (21%) for So. Discontinuations due to AEs occurred in 26/23% of pts. Serious AEs were noted in 44/36% of pts, with grade 5 AEs in 18/16%.
Neither drug seems particularly effective but the fact that there was any effect in this difficult cancer is considered an event.
Medicynical Note: Sofafinib costs in the range of $6000/month. It has a benefit of a few months over no treatment and perhaps 2 months over sunitinib, apparently in patients with associated Hep C. Cases of cancer associated with Hep B cases were equally “improved” OS 7.8 and 7.9 months.
It should be noted that when compared with placebo in an earlier study the results were similar, a 2-3 month improvement of overall survival.
Median overall survival was 10.7 months in the sorafenib group and 7.9 months in the placebo group (hazard ratio in the sorafenib group, 0.69; 95% confidence interval, 0.55 to 0.87; P < 0.001).
Sorafenib has shown promising results in treating acute myeloid leukemia when there is an FLT3 gene mutation, per studies at the MD Anderson cancer center. The only hope for complete remission for AML with FLT3 is a bone marrow transplant.
I have had AML with FLT3 since Nov 2011. On diagnosis my blast count was 43%. The first 3 attempts at induction reduced the blasts to 8%, 13% and 9%. A fourth attempt, using sorafenib in conjunction with the chemo drugs, reduced the blasts to 2%. I am now on an outpatient regimen of sorafenib, and will return to hospital for one more chemo session to hopefully reduce the blasts to zero. Once that is done, I will qualify for transplant.
Were it not for sorafenib, there would be little hope at all. We’re not talking just a 2-month extension of life here, but possibly a complete remission. I’m fighting this AML like a badger, and I’ll use every advantage I can get.
Let me also add that the sorafenib usage has been approved by my Blue Cross health insurance.
Thanks for your comment. I’m sorry to hear of your AML and hope you attain the remission.
Regarding drugs, I certainly don’t oppose new drugs and their wide use. My concern is the overpricing of these agents by drug companies. In the 70’s and 80’s and early 90’s no single drug. not one, cost more than a fraction of a person’s yearly income (median income). Now, drug companies regularly market and push drugs costing one and half to two times the median income, and more, in the U.S. They take advantage of the illness, our dysfunctional health insurance system and charge usurious prices for drugs often with limited efficacy, particularly in life threatening situations. That doesn’t seem right.