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).