[Ip-health] Andrew Pollack in NYT: New Drugs Fight Prostate Cancer, but at High Cost

Jamie Love james.love at keionline.org
Tue Jun 28 04:42:59 PDT 2011


Andrew Pollack has an article in the New York Times today about new
drugs for prostate cancer.

*  ... prolong the lives and relieve the symptoms of men with advanced
prostate cancer, but could also add billions of dollars to the
nation’s medical bills.


*  Men with that late-stage cancer had a median survival of about a
year and a half using docetaxel. The new drugs each added two to five
months to median survival when tested in clinical trials. Doctors say
that men taking more than one of the drugs in succession would be
expected to live more than two years.

*  Provenge costs $93,000 for a course of treatment, while Zytiga
costs about $5,000 a month. Another of the new drugs, Sanofi’s
Jevtana, costs about $8,000 every three weeks.

*  With other pricey drugs on the way, said Joel Sendek, an analyst at
Lazard, “We could be talking easily $500,000 per patient or more over
the course of therapy, which I don’t think the system can afford,
especially since 80 percent of the patients are on Medicare.”


The version on the web includes graphics and additional data

http://www.nytimes.com/2011/06/28/health/28prostate.html

New Drugs Fight Prostate Cancer, but at High Cost
By ANDREW POLLACK
Published: June 27, 2011

A group of new drugs is promising to prolong the lives and relieve the
symptoms of men with advanced prostate cancer, but could also add
billions of dollars to the nation’s medical bills.

In the last 15 months, three new drugs that extended the lives of
prostate cancer patients in clinical trials have been approved by the
Food and Drug Administration and several other promising medicines are
in clinical trials. Before last year, only one drug had been shown to
improve survival — docetaxel, which was approved in 2004.

“What a great time it is in prostate cancer,” Dr. Daniel J. George of
the Duke Cancer Institute proclaimed earlier this month at the annual
meeting of the American Society of Clinical Oncology.

And it’s a great time for the drug makers, with several drugs
competing to fill a niche for longer-term survival. Analysts estimate
that some of the new drugs, particularly Dendreon’s Provenge and
Johnson & Johnson’s Zytiga, could reach annual sales of $1 billion or
even much more.

The recently approved drugs and most of those in development are for
cases in which the disease has spread beyond the prostate gland and is
no longer held in check by hormone therapy.

Men with that late-stage cancer had a median survival of about a year
and a half using docetaxel. The new drugs each added two to five
months to median survival when tested in clinical trials. Doctors say
that men taking more than one of the drugs in succession would be
expected to live more than two years.

But the price of these drugs has already stirred concerns about the
costs of care among patients, providers and insurers. For example,
Provenge costs $93,000 for a course of treatment, while Zytiga costs
about $5,000 a month. Another of the new drugs, Sanofi’s Jevtana,
costs about $8,000 every three weeks.

With other pricey drugs on the way, said Joel Sendek, an analyst at
Lazard, “We could be talking easily $500,000 per patient or more over
the course of therapy, which I don’t think the system can afford,
especially since 80 percent of the patients are on Medicare.”

Medicare has already fired what some analysts interpret as a warning
shot over prices, conducting a yearlong inquiry into whether to pay
for Provenge. In its final decision, due Thursday, Medicare is
expected to pay for the drug when used according to the label.

Medicare officials denied that price was the reason for the review.
But some patient advocates and politicians portrayed the review as a
step toward rationing.

Private insurers are also paying only if drugs are used according to
the label, according to doctors and patient advocates.

“The reality is, there’s pushback,” said Dr. Oliver Sartor of Tulane University.

Still, for now, one company’s price is prompting the next one to follow suit.

“The pricing environment is encouraging and getting better for us,”
Andrew Kay, the chief executive of Algeta, told securities analysts
earlier this month, after announcing that his company’s experimental
drug had extended median survival nearly three months in a clinical
trial.

Mr. Kay said he had initially thought that his company, which is based
in Norway, would charge about $25,000 for a typical course of
treatment with the drug, Alpharadin. But with the rival drug Jevtana
costing about $50,000, Algeta and its partner, Bayer, are considering
a higher price.

About 218,000 men in the United States get prostate cancer each year
and about 32,000 die, according to the American Cancer Society.

In many cases, the cancer is caught before it has spread beyond the
prostate gland and can be cured with surgery or radiation therapy.

If the cancer has spread, men usually are given drugs, particularly
Abbott Laboratories’ Lupron, that suppress the body’s production of
the hormone testosterone, which can fuel tumor growth.

The new drugs, for now at least, are for use when this
hormone-deprivation therapy has stopped working.

“This is a small subset of people with prostate cancer,” said Dr.
Charles Myers, a prostate cancer specialist in private practice in
Charlottesville, Va., who is a survivor of the disease himself.
However, he noted, “It’s the group of people who are dying.”

Provenge was approved in April 2010 for patients whose cancer was
late-stage but not yet causing many symptoms.

Once symptoms, mainly bone pain, have appeared, men are likely to
receive docetaxel, a generic drug also sold by Sanofi as Taxotere .

Two other new drugs are approved for use only after docetaxel has been
tried. One, Sanofi’s Jevtana, is a chemotherapy drug in the same class
as docetaxel; it was approved in June 2010. The other is Johnson &
Johnson’s Zytiga, approved this April.

Many patients and doctors are most enthusiastic about Zytiga and
Provenge because they are alternatives to chemotherapy, which many men
want to avoid because of side effects. Provenge works by training the
body’s immune system to fight the tumor.

Zytiga is a new form of hormone therapy. While Lupron mainly blocks
production of testosterone by the testes, there is still some hormone
produced by the adrenal gland or even by the tumor itself. Zytiga, by
inhibiting an enzyme called CYP17, clamps down on testosterone
production.

Doctors and patients say the new drugs can offer some men a decent
quality of life, although they are not free of side effects. For
instance, Zytiga, also known as abiraterone, can cause hypertension
and liver damage and must be taken with the steroid prednisone.

Many men are likely to try several of the drugs. Mark Maldonado, a
retired postal worker in Omaha, said that Jevtana had helped keep his
cancer in check without debilitating side effects. But knowing that
the drug would eventually stop working, he and his doctor “talked
about abiraterone being the next step in our progress through the
drugs.”

More competition is coming. Takeda Pharmaceutical and Medivation, a
San Francisco company, are separately developing other drugs that
block testosterone’s production or its effects.

Some of the most exciting advances, doctors say, are in the area of
fighting the spread of prostate cancer to the bone. Such bone
metastases are very common in men with advanced prostate cancer and
account for most of the death and disability from the disease.

Cabozantinib, an experimental drug being developed by Exelixis, seems
to be able to virtually eradicate bone metastases in some patients, at
least as measured by bone scans, something no other drug has done.

Amgen won F.D.A. approval in November for Xgeva, a drug that reduces
the risk of fractures and other problems caused by cancer in the
bones. The drug can also delay the spread of cancer to the bones,
according to the results of a more recent trial.

Dr. Christopher J. Logothetis, of the M. D. Anderson Cancer Center,
predicted further progress.

“It’s beyond the individual drugs,” he said. “One sees a manual now on
how to go forward.”

-- 
James Love.  Knowledge Ecology International
http://www.keionline.org, +1.202.332.2670, US Mobile: +1.202.361.3040,
Geneva Mobile: +41.76.413.6584, efax: +1.888.245.3140.
twitter.com/jamie_love




More information about the Ip-health mailing list