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Immunotherapy prolongs survival, but at what cost? Washington Post needed more on treatment downsides


3 Star


For advanced lung cancer, immune therapy plus chemo prolongs survival

Our Review Summary

This story is one of two we reviewed about lung cancer immunotherapy studies presented at the American Association for Cancer Research meeting. Our other review is of TIME’s coverage.

The three drugs mentioned in the story — Keytruda, Yervoy and Opdivo — are known as checkpoint inhibitors, which remove the ability of some cancer cells to hide from the immune system. This story highlights a study that showed Keydruda specifically improved survival in people diagnosed with advanced nonsquamous non-small cell lung cancer. Results were discussed Monday at an American Association for Cancer Research conference in Chicago and published by the New England Journal of Medicine.

The story refrains from sensational wording, attempts to quantify benefits, and offers a comment from one independent expert. However, it doesn’t discuss side effects or conflicts of interest and — most significantly — doesn’t tell us about the $150,000 annual price tag for each patient.


Why This Matters

News coverage hailing new cancer therapies should always include details such as side effects and price — particularly when they will potentially add billions of dollars to annual U.S. healthcare spending.


Does the story adequately discuss the costs of the intervention?

Not Satisfactory

Costs of these drugs weren’t given. Checkpoint inhibitors run about $150,000 a year, according to some published news reports. With 140,000 people in the U.S. diagnosed annually with non-squamous non-small cell lung cancer — the type in the Keytruda trial — the cost of treating people with this drug could easily run into the billions.

It’s also worth noting it isn’t clear how long treatment with these drugs should continue, which significantly affects costs.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

When it comes to the overall survival benefit, the story reports that after a median follow-up time of 10.5 months patients who received both Keytruda and chemotherapy were 51 percent less likely to die, compared with patients who received only chemo.

But actual percentages aren’t given. According to the study, the estimated proportion of patients who were alive at 12 months was 69% in the combination group and 49% in the chemo-only group.

The story also describes — but doesn’t give numerical data — on a different Keytruda trial that it says “showed that the medication prolonged survival even when used alone, compared with chemo.”

The story mentions two other immunotherapy lung cancer studies, one using two medications called Opdivo and Yervoy to treat newly diagnosed patients with advanced non-small cell lung cancer with a high number of mutations in their tumors, and another treating patients with early-stage lung cancer with Opdivo before and after surgery. Only some data were reported for those studies.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

Side effects were not addressed. About 14% of the patients in the combination group dropped out of the trial due to adverse events, versus about 8% of those in the chemo-only group.

Acute kidney injury and fever relating to neutropenia, a low white blood cell count, occurred more frequently in patients who received Keytruda.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story tempers the positive news, stating: “Roy Herbst, an oncologist at Yale Cancer Center said that most lung cancer patients now will be offered immunotherapy in some form much earlier than before. Still, he said, the approach was not a cure and there is a lot of room for improvement.” That is information we wish the TIME story had included, too.

It also states that it’s unclear whether Keytruda will work alone, without chemo. And it notes that it’s too early to know whether two other treatments will translate to benefit that matter to patients.

However, the story lumps together survival and progression-free survival — or non-worsening of the cancer — into the same group without explaining that progression-free survival may not translate into overall survival.

Also, the story doesn’t go into the remaining unknowns about the studies and these treatments. How many years will these patients survive? And will they have to take these drugs indefinitely?

Does the story commit disease-mongering?


No disease-mongering here. The story states that lung cancer is the “second-most-common malignancy in the United States, after breast cancer. The American Cancer Society estimates that 234,000 people will be diagnosed with the disease this year, and 154,050 will die of it.”

However, the story could have explained that about 140,000 of these patients have nonsquamous non-small cell lung cancer, the condition that is treatable with Keytruda.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

The story has one independent source:

“Scientists who weren’t involved in the study agreed that it was highly significant. H. Jack West, an oncologist at Swedish Medical Center in Seattle, said, ‘It is literally practice-changing — immediately.’

However, it doesn’t say that the studies were sponsored by the drugmakers and many study leaders as well as another oncologist who’s quoted, Roy Herbst, MD, has received consulting fees for companies that make immunotherapy drugs.

Does the story compare the new approach with existing alternatives?


The story states that most patients diagnosed with advanced lung cancer “initially receive chemotherapy, which provides only marginal benefit” and “researchers are trying to develop and use more effective approaches earlier.”

Does the story establish the availability of the treatment/test/product/procedure?


The story states that the FDA approved the Keytruda-chemo combination last May based on an early-stage trial, but many doctors did not adopt it because the trial was small and didn’t initially show a survival benefit.

Does the story establish the true novelty of the approach?


The story describes this as “a new study that is expected to change the way such patients are treated.”

It also says several reports “underscore the increasingly important first-line role that immunotherapy, which unleashes the immune system to destroy cancer cells, is taking against the deadliest cancer.”

We think it’s interesting that one of the quotes is: “Instead of chemo being the backbone on which to improve, immunotherapy is now the backbone on which we build.” This may technically be true but the over-arching fact is that cancer treatment is a multi-pronged approach.

Does the story appear to rely solely or largely on a news release?


The story does not appear to rely on a new release.

Total Score: 5 of 10 Satisfactory


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