Cost of cancer drugs crushes all but hope

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

Cost of cancer drugs crushes all but hope

Updated 7/11/2006 10:50 AM ET

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 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.

PRESCRIPTION COSTS: Prices soar for cancer drugs

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.

, former president of the American Society of Clinical

Oncology, says a few of his patients are turning down care because of

the cost. , who has treated cancer for 25 years, notes, " That

never used to happen. "

All those years in medicine, though, also have made 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, " 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? "