Ralph Moss: Chemo for life?

[Guest guest]

BlankChemo for life?

Sunday, 30 May 2010

There is an emerging trend in oncology to keep patients on anticancer

drugs for longer period, even for years at a stretch. This concept was given

support from two studies to be presented at the 2010 annual meeting of the

American Society for Clinical Oncology (ASCO). Both studies show that patients

who received long-term treatment for multiple myeloma and follicular lymphoma

remained free of disease progression longer than patients who were taken off

their treatment once the disease was in remission.

The first study was of the drug lenalinomide (Revlemid) given after

stem-cell transplant. It cut the recurrence rate of a cancer of the bone marrow

known as multiple myeloma. After three years, the study showed that 68 percent

of patients who took lenalinomide were free of disease progression. This

compared to 35 percent of those who only received a placebo drug. " This is of

major clinical important for patients, " Attal of Purpan Hospital,

Toulouse, France told the New York Times (Pollack 2010).

In the second study, two years of maintenance with the drug rituximab

(Rituxan) similarly cut the risk of recurrence among patients with follicular

lymphoma (a type of non-Hodgkin's lymphoma) in half.

The New York Times raised three concerns about this type of maintenance

therapy. First, the data does not reveal whether such treatment improved the

rate of overall survival in such patients. This is key. Both multiple myeloma

and follicular lymphoma are diseases in which people often live a decade or more

post-diagnosis. So it is too early to say if longevity is truly being increased,

or if doctors are simply changing the shape of the curve leading to the

patient's demise.

Second, we do not know what the adverse effects would be of taking these

drugs for long periods of time. These drugs have many possible side effects, and

some of these might reveal themselves only after prolonged use.

Finally, the cost of maintenance therapy could be very high for the

individual and for society. Two years of maintenance with rituximab is $50,000.

Lenalidomide costs even more, about $6,000 per month (Pollack 2010). Think about

the implications of this. In 2009 there were 20,580 new US cases of multiple

myeloma (ACS 2009). If each of these patients received rituximab for a two

years, this would cost society about $1 billion. Follicular lymphoma is the most

common form of lymphoma About 30 percent of low-grade lymphomas are of this

type. If we estimate about 20,000 US cases of follicular cancers per year, then

that would also cost $1 billion per yearly cohort. But as each year's new cohort

of NHL patients would need to be similarly treated, it would add additional

billions in cost (and in chemotherapy sales). As the late Sen. Everett Dirksen

once said, in a different context: " A billion here, a billion there, pretty soon

it adds up to real money. "

--Ralph W. Moss, Ph.D.

References:

American Cancer Society (ACS), 2009 Cancer Facts and Figures. Available

at:

http://www.cancer.org

Pollack, . Study finds certain drugs can keep some forms of cancer

in remission longer. New York Times, May 20, 2010.

Follicular lymphoma occurrence:

http://tinyurl.com/338svyu