This is a story about a lung cancer clinical trial for a drug known as Keytruda. As the story explains, Keytruda “worked at least as well if not better than the chemo, so the researchers have stopped the study to give everyone a chance to take” it.
The thorny issue here is that the drug company involved, Merck, issued a a detail-free announcement about the results, putting reporters in a tough position because they had no details about the study, but were expected to explain the importance of the findings.
Given this shortcoming, this NBC News story did many things right and packed a lot of information in, just as it did with its previous report on the same drug and its effect on melanoma.
We would have liked to have seen at least one voice of caution in the piece, as so many of the quotes seemed a little over-the-top given what we know right now about the findings. And the story should have made clear that until we have information on actual patient response rates, we don’t really know how much this will change lung cancer treatment.
Overall, though, this shows how you can capture the excitement in the scientific community around a new treatment while still providing important context. (We do want to note that the original headline, shown above, has since been edited by NBC to “Keytruda, the drug that helped Jimmy Carter, also protects against lung cancer.” That’s misleading, since it suggests that the drug prevents cancer when it’s established use is cancer treatment.)
Lung cancer is a common malignancy and the number one cause of cancer deaths in the U.S. Traditionally treatment includes surgery, radiation, and standard chemotherapy, but most patients who have lung cancer that is not very early stage will die of their disease.
The story notes the costs and puts the costs in perspective, too. It says, “Keytruda, approved October last year for lung cancer and in 2014 for melanoma, is pricey – costing about $150,000 a year for a course of treatment. It’s approved for use with a specific test for PD-L1 activity.”
The story does not quantify the benefits. We recognize this would be difficult given that the details around the study have not been released, but we also think that, because the details have not been released, more caution should have been used. It’s unfortunate to see a statement like this, for example: “It helped patients live longer overall and helped them live longer without their tumors growing or spreading, Merck said.” This is an unchallenged statement with no numbers to back it up, and it’s not even attributed to a human. It’s attributed to a company.
The story says about the whole class of drugs to which Keytruda belongs, “The new drugs are less toxic and more precise than standard chemotherapy. But they are not free of side-effects. Some are severe and can damage the lung, colon, liver, kidneys, hormone-producing glands and the brain, the FDA says.”
The story says up high that, “Keytruda was being tested for the first time in 305 lung cancer patients who had not been treated at all yet.” It does not spell out that the study findings were not published in a peer-reviewed journal, but that is implicit in the fact that the findings were announced by the company as it was deciding to stop its clinical trial for the drug.
Later in the story there is an important qualifier that we hope won’t be missed by readers busy tweeting about the “Jimmy Carter drug.” The story says, “This trial only included patients whose tumors cells made a lot of PD-L1. That is only a portion of people with lung cancer– 25 percent in one recent trial.”
The story also could have added this important piece of context: When clinical trials are stopped early for benefit, the reported results tend to overestimate the positive effects of the intervention.
There is no disease mongering in this story. Instead it says accurately that “Lung cancer is the top cancer killer in the U.S. It’s diagnosed in more than 220,000 people a year and it killed nearly 160,000 people last year, according to the National Cancer Institute.”
There are multiple independent sources quoted in the story.
However, all of the quotes in this story sound like this: “I suspect the findings were significant enough that this will be a practice-changing finding.” If there were numbers being released to back up a claim like that, we would be more comfortable with these kinds of quotes. Without more evidence, though, it gives readers the impression that the drug will have a massive impact.
The story does talk about the alternatives to this drug, and the “so-called standard of care.” But it does not provide any numbers to back these comparisons up. There’s a dilemma here because Merck did not release the details of the study. We would have been happy, though, even if the story made mention of some of the comparison findings from other studies. The drug is approved for treatment in lung cancer, so there must have been previous trials that could be referenced.
The story does establish availability, though it is confusing.
It calls the drug “the Jimmy Carter drug” in the headline, leading readers right away to believe this is an available drug that the former president took. But then it provides a tidy summary of drug trials and why the halting of this particular trial matters, saying:
“Cancer research goes forward in slow steps. In tests of new drugs, patients always get either the very best therapy already available, or the new drug. Often they get both. Usually, cancer drugs are only tested at first in patients who have tried everything else available and their cancer has come back, anyway. So it’s an important break for a company if its drug is the first one a patient gets and it works better than the so-called standard of care. The company now can ask the Food and Drug Administration if it will approve Keytruda to use as the first treatment a lung cancer patient tries.”
The nuance there might be missed by readers. But we are giving the story a pass here because later, the story says more clearly that Keytruda was “approved October last year for lung cancer and in 2014 for melanoma.”
The story establishes that this is the first trial in patients who have not been treated any other way for lung cancer, hence the excitement around these findings.
The story is not not overly reliant on a news release.