How much cancer treatment progress, and at what cost?

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On the NPR Health Blog, Scott Hensley reflects on news out of this week’s American Society of Clinical Oncology meeting. Excerpts:

“The American Society of Clinical Oncology confab is the place to present the latest research on cancer treatments. But if you’re hoping for breakthroughs, this doesn’t look like the best year to attend.

But cancer keeps turning out to be more complex, as researchers tease apart the genetic characteristics that distinguish one variety from another. The differences make it hard to come with drugs that will help lots of people.

“Cancer is like cable television,” Dr. George Sledge, a breast cancer specialist and ASCO president, told the Wall Street Journal. “Thirty years ago you had three channels. Now you have 500.” “

He links to another good piece by Forbes’ Robert Langreth on disappointments outweighing victories. Excerpts:

“The paucity of successful trials raises serious questions about whether big drug companies, in their efforts to replenish their empty pipelines, may be rushing too fast to push their targeted cancer drugs into large-scale trials before they understand the biology enough. It suggests that the success rate for novel cancer drugs remains dismal despite the big advances in basic science.

Memorial Sloan-Kettering colon cancer specialist Leonard Saltz says that despite all the hype and excitement about pricey new cancer drugs, in fact, by far the most important colon cancer drug remains a 50-year-old chemotherapy drug called 5-FU. No one has been able to find a better drug to replace it. “It is humbling and embarrassing,” he admits. New drugs like Avastin and Erbitux “have added very modest benefits. They increase survival a few months, but they increase the cost of care tremendously.”

In some cases, researchers don’t know whether tremendously expensive new drugs keep people alive longer. In one of the big studies presented Sunday at the meeting, researchers revealed that ovarian cancer patients who got Roche’s Avastin in addition to standard chemo lived 14 months before their tumors progressed, vs. 10 months for those who got standard therapy.

But to get this modest improvement, patients had to remain on the Avastin drug for 15 months, adding to the potential expense, hassle and side effects. So far, there is no statistically significant survival difference between the two groups; because most patients are alive it may be too early to measure this. “We may never know” whether it extends survival, admits lead researcher Robert Burger of the Fox Chase Cancer Center.”

And, according to the New York Times, Avastin’s cost – around $72,000 to slow the growth of ovarian tumors by about four months – raises questions:

“Many would not consider this cost effective for the gain seen,” said Dr Elizabeth A. Eisenhauer of Canada’s National Cancer Institute, in the Times.

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Gregory D. Pawelski

June 7, 2010 at 5:50 pm

When the front-line treatment for solid tumors is still chemotherapy (cytotoxic or targeted) and the best that blockbuster drugs can achieve is to prolong the inevitable by either a few months or not at all, then it’s surely time to look outside the box.
Today, we have the ability to take a cancer specimen, analyze it, and follow those genetic changes that influence particular pathways, then use two, three, four or more targeted therapies, perhaps simultaneously, and be able to completely interrupt the flow of the cancer process.
A number of cell-based assay labs across the country have data from tens of thousands of fresh human tumor specimens, representing virtually all types of human solid and hematologic neoplasms. They have the database necessary to define sensitivity and resistance for virtually all of the currently available drugs in virtually all types of human solid and hematologic neoplasms.
Genomics is far too limited in scope to encompass the vagaries and complexities of human cancer biology when it comes to drug selection. Efforts to administer targeted therapies in randomly selected patients often result in low response rates at significant toxicity and cost.
Cell-based functional profiling is able to accurately predict how an individual patient’s cancer cells will repond to an array of drug combinations. It is able to quantify synergistic drug combinations and individually tailor treatment.