The story reports on new findings from a clinical trial of the drug Keytruda. Specifically, the story says that patients with late-stage lung cancer whose tumors produce a protein called PD-L1 had increased overall survival when taking Keytruda rather than docetaxel, which is is a widely-used drug for treating lung cancer. The story offers little information on how significant the health benefits associated with Keytruda are, what it costs or what its potential harms are. The story claims that more data on the trial findings will be available soon — and, given the paucity of information here, one wonders at the decision not to wait for that additional data.
Lung cancer is the leading cause of cancer deaths for both men and women in the United States, claiming more than 157,000 lives in 2012 alone. Similarly, cancer treatment is big business. The story notes that cancer immunotherapies, such as Keytruda, are expected to bring in annual sales of $20 billion by 2020. But that may be a conservative estimate. One recent estimate from a market research firm set the annual revenue from cancer immunotherapies at more than $80 billion by 2020. Between the health impact and the economic impact, any advances in treatment that can improve health outcomes for patients battling lung cancer is clearly a big story. But rushing to tell the story before all — or even most — of the facts are in can be a dicey business. Doctors and patients are eagerly awaiting news on new therapies. It’s important to give all parties concerned a clear picture, rather than a rushed one.
The story does not mention cost at all. Given that this is as much a business story as a health story, and that Keytruda has already been approved for use by regulators, this is a significant oversight. Previous news coverage of Keytruda in other news outlets says that Keytruda will cost $12,500 per month, and that median use of the drug is 6.2 months — or $77,500. If a patient takes it for a year, that comes to $150,000. That’s worth noting.
It would also have been worth noting what the estimated costs of docetaxel are, for comparison purposes.
The story notes that patients taking Keytruda had “longer overall survival compared with those taking docetaxel.” The story also notes that “Patients whose tumors had especially high levels of PD-L1 also went longer without a progression of disease than those taking docetaxel.” But the story doesn’t tell readers whether these measures improved by a day, a week, a month, or a year. This is likely because the source of the information — a news release from Merck, which produces Keytruda — doesn’t provide the information either. As the story notes, “More detailed data from the study will be provided soon, Merck said.” That forthcoming information is essential to understanding just how meaningful the Keytruda study’s findings are. Even if the story couldn’t wait for the forthcoming information, the story should have made clear that Merck is simply not telling anyone how much extra time Keytruda is buying people.
When making decisions about health care treatment options, patients often consider three factors: cost, benefit, and quality of life (i.e., potential harms/side effects). Some patients may decide not to pursue treatment that may extend life for a short period of time if that treatment will also have a significant adverse effect on their quality of life. In short, discussion of potential harms is extremely important. The story notes only that “[s]afety of Keytruda was consistent with what had been seen in previous trials among lung cancer patients.” Given that potential side effects include hepatitis, hypothyroidism, and Type 1 diabetes mellitus, it would have been worth devoting an additional sentence or two to possible harms.
The story describes the findings as coming from a “late-stage study” and describes the dosage that patients received. The Merck news release offers significantly more information. It was a randomized, phase 2/3 trial involving 1,034 patients. 550 of those patients received Keytruda (at either of two doses). But neither the story nor the release tells readers how long the trial lasted, whether there was any difference between the effects of the two doses of Keytruda, or how significant the difference was between Keytruda and docetaxel.
No disease mongering here.
The story does note that the Keytruda trial information came from Merck, which produces Keytruda. However, the story does not appear to include any input from independent sources.
The story does make clear that Keytruda was being compared to docetaxel, so we’ll award a Satisfactory here. Again, however, it would have been very good to know how well Keytruda compared to docetaxel. Was the improvement in overall survival time, and in postponing progression for patients with high-expressing PD-L1 cancers, a meaningful one? Even if Merck declined to provide that information, the story could say that. Are they still crunching the numbers? Or the story could have included input from independent experts on what a “meaningful” improvement might look like; reasons to be optimistic; reasons to be cautious.
The story notes that Keytruda has been approved for use in treating lung cancer.
The story does explain, in broad terms, the novel way in which Keytruda and a competing cancer immunotherapy drug, work. The story also talks about the expected economic impact of cancer immunotherapies broadly. So we’ll give the benefit of the doubt on the rating. However, it’s not clear how many cancer immunotherapy drugs are on the market — just these two? A dozen? More? The story also doesn’t tell readers how many of these drugs are approved for use against lung cancer. Is it just Keytruda?
While the story does offer some additional background information, it appears to draw almost exclusively from Merck’s news release.