Interesting article about the cost of cancer treatment

http://www.usatoday.com/news/health/2006-07-10-cancer-drugs_x.htm



Cost of cancer drugs crushes all but hope

Genentech reported a 61% rise in quarterly profit on strong sales of its cancer drugs in April 2005. Genentech's Avastin, Herceptin, Rituxan from $3,000 to $13,000.

VARIOUS TREATMENTS, COSTS

Some doctors and patients are concerned about the price of new cancer therapies.

Drug Company Monthly cost

Avastin Genentech $4,400
Erbitux ImClone/Bristol-Myers $10,000
Gleevec Novartis $2,600
Herceptin Genentech $3,000
Nexavar Bayer Pharmaceuticals $4,300
Revlimid Celgene $4,500
Rituxan Genentech $4,200 to $13,000 1
Sutent Pfizer $4,000
Tarceva Genentech/OSI Pharmaceuticals $2,400 to $2,700

Sources: manufacturers





By Liz Szabo, USA TODAY

When Tom Reek was diagnosed with a rare leukemia at age 65, doctors said he might live only another three years. Today, Reek is thriving at age 72, thanks to a drug called Gleevec.
"I used to kid around and say that I feel like Clark Kent," says Reek, who lives on Long Island, N.Y., and volunteers as a peer counselor with other patients, including youngsters. "It's like a gift from God to be able to work with these children."

The only downside to Gleevec, Reek says, is the cost: $3,100 a month. Reek went back to work four years ago as a truck driver, delivering blood tests and lab results to medical offices. With insurance, his pills cost only about $50 a month.

Since Gleevec was approved in 2001, researchers have hoped that every new cancer therapy would copy its success: a convenient pill that lets patients live for years with relatively few serious side effects. Though experts say few of the new "targeted" therapies come close to that ideal, they do have one thing in common with Gleevec: They're all incredibly expensive.

Some doctors are questioning whether targeted therapies — designed to turn cancer into a chronic disease by silencing growth signals inside malignant cells — are worth the expense to individuals and taxpayers.

Most new cancer drugs improve survival by only a few weeks or months, says researcher Leonard Saltz of New York's Memorial Sloan-Kettering Cancer Center. Although Erbitux, for example, costs almost $10,000 a month, studies have not shown that it helps colorectal cancer patients live longer.

"There is a real question whether insurance ought to pay for a drug like that," says Ezekial Emanuel, chairman of clinical bioethics at the National Institutes of Health clinical center. "If you pay for something that doesn't have a big impact, you could lose out on treatments that really do work.

"We can cure testicular cancer. We can cure Hodgkin's disease. You don't want to skimp on that."

Canada has decided that Erbitux isn't worth the money. Last month, Bristol-Myers Squibb Canada announced that it won't sell Erbitux there because it couldn't get "an appropriate price for its product reflecting the value of the innovation it brings."

Today's prices seem especially high, given that the new targeted therapies don't actually cure cancer, says Jerome Kassirer, former editor of The New England Journal of Medicine and author of On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health

"Families could end up spending their fortunes for what turns out to be a minor benefit," Kassirer says.

As the number of targeted therapies increase, more patients are facing this decision. Almost 200,000 patients could soon be eligible for the drug Avastin if it's approved for lung and breast cancers, two of the most common malignancies, according to Genentech.

David Johnson, former president of the American Society of Clinical Oncology, says a few of his patients are turning down care because of the cost. Johnson, who has treated cancer for 25 years, notes, "That never used to happen."

All those years in medicine, though, also have made Johnson optimistic about targeted therapies, in spite of their high prices. A handful of his lung cancer patients have done remarkably well on Tarceva, he says, although patients overall live only two months longer than those on placebos.

"Some folks tend to hype any therapy that is new," Johnson says. "Reality always tends to center us."

Although he is glad new cancer drugs are available, Saltz says, doctors had hoped that targeted drugs would replace chemotherapy, making cancer treatment gentler.

But unlike Gleevec, many of the new drugs work only when combined with chemo, he says. Adding drugs such as Erbitux and Avastin to older therapies increases costs as well as side effects.

Patients today still don't live very long on most of the new medications. Survival for patients with advanced colon cancer has increased from one year to about two years over the past decade, Saltz says. Patients with only two years to live may see that as major progress, he says.

"The drug companies have been trying to put the word 'breakthrough' in my mouth since 1995," Saltz says. "But it's far too flattering to say we've made significant progress. ... The vast majority of targeted drugs are a long way from what we hoped they would be."

Industry leaders defend their prices. Officials from Bristol-Myers Squibb Co., which sells Erbitux, note that patents offer companies a limited amount of time to recoup their investments.

Tony Plohoros, a company spokesman, says the company respects the decisions of patients who opt not to use Erbitux. "That is a personal decision up to each individual patient and their loved ones," Plohoros says.

Administrators at public hospitals with limited budgets, such as Atlanta's Grady Hospital, have to make hard choices, says Otis Brawley, director of Grady Health System's Georgia Cancer Center for Excellence. Grady doctors also are considering limiting the use of Erbitux, Brawley says.

"We are constantly asking ourselves: Are we buying drugs that we really ought not to be buying?" says Brawley, a professor at Atlanta's Emory School of Medicine. "Are we going to bankrupt ourselves buying Avastin so we won't be around to treat other people?"