A cancer doctor speaks out: How premature hype about experimental drugs fails patients

Last Friday, several news outlets reported that a study of a cancer drug combination cocktail showed it didn’t help melanoma patients live any longer, when compared to using one of the drugs alone.

Specifically, the study was examining if adding an experimental drug known as epacadostat would boost the effectiveness of the checkpoint inhibitor drug Keytruda (pembrolizumab), which is already approved and in use for some advanced melanoma patients.

In STAT, the disappointing news was framed as a “big setback” for Incyte, epacadostat’s drugmaker, noting that “the trial results could also ripple across the fledgling cancer immunotherapy field and the biotech stock sector.”

But in August of last year, STAT was singing a different tune about epacadostat. Although the older story is behind a pay wall, we are told in one headline and two paragraphs that the latest round of data “looks promising” and “match or exceed investor expectations.”

STAT was not alone in promoting this framing — the Philadelphia Inquirer headline had a similar angle on the study’s “promising” results. The website CureToday described the findings as a possible “paradigm shifting change” in melanoma treatment.

Occasionally news outlets follow up the breaking news with more thoughtful reporting. For example, after its August story, a few days later STAT published a more critical look at the lack of data.

Yet that deep dive doesn’t happen enough. Instead we get mostly whiplash reporting that lacks the context needed to help patients make sense of their health care options.

Analyzing the hype: How it happens

Vinay Prasad, MD

Oncologist Vinay Prasad, MD tweeted a series of points about why this latest trial exemplifies how early hype fails not just investors, but patients, too.

For our readers not well-versed in clinical trial jargon, here’s a basic translation of what he conveys in his tweets:

First, the drug company releases incomplete information about an early-stage trial. News outlets (of all kinds) mostly regurgitate the company’s talking points, and often end up overstating the evidence; for example, making the experimental drug sound effective, when the study was only designed to test for safety.

First, look at how we publicize early reports that are unsuited for drawing claims of efficacy pic.twitter.com/Bg7Wcnq0FP

— Vinay Prasad (@VinayPrasadMD) April 6, 2018

Second, prominent thought leaders–in this case, cancer doctors–read these early reports and offer up opinions that only add to the hype, overlooking the fact that the drug has never been proven to help when used by itself (known as “single-agent activity).

Third, the drug manufacturer, Incyte, pushes out a fancy video that Prasad says is “totally misleading:”

“These videos are highly misleading to patients, as they make it seem we have fully understood pathophysiology, when we have not,” he said in a tweet.

Patient engagement advocate and cancer survivor Dave deBronkart felt similarly.

“How is this not fraud?” he said of the videos. “How is it not equivalent to a real estate developer  claiming a development exists, using a fake video?

The next step is when biologists and biotech stock market analysts start weighing in, predicting the usefulness (and investor appeal) of the drug combination, even when there are plenty of warning signs that it won’t work.

Cancer drugs can easily cost $150,000 a year, so, in spite of these warnings, the drug company finally moves forward with a big trial of patients. The study is randomized and controlled for all the variables that haven’t been well-tested so far–like effectiveness.

And boom–we get news just like Friday’s news: The much-hyped drug combo doesn’t work.

“It is always sad for patients to have drug failures, and I hoped this succeeded for my patients’ sake; but we must remember never to let hype get in the way of evidence,” Prasad said.

We couldn’t agree more. For help on sorting through the hype, see our 10 review criteria.