This article from Reuters is categorized under its “Health News” service, but in both content and reality is a “business and marketing” story about an incremental big pharma clinical trial of cancer immunotherapy drugs that closely follows the format, tone and conclusion of a Roche pharmaceutical news release.
The headline on the story, “Roche’s Tecentriq cocktail adds to lung cancer survival success,” asks readers to take Roche’s word for it, because neither it nor Roche offers any quantitative data to support the claim. Patients, physicians and the general public will have no idea from the story by how long, to what degree, and with what quality, the drug cocktail — as a first line treatment — extends survival for people with non-squamous non-small cell lung cancer; or for that matter anything about the the makeup of the trial in terms of numbers of patients, or their diagnostic and treatment histories.
The story makes clear that the results of this trial of the immunotherapy Tecentriq combined with two chemotherapies, is the latest in a series of studies designed as head-to-head tests of various combinations of cancer treatment cocktails. And to its substantial credit, the story also makes clear that Roche is going public with such incomplete and at best data-free pronouncements about incremental results in a “bid to catch up” to competitors’ better known immunotherapies and increase its market share of a drug already in use but facing stiff competition. It also reports that the ploy is working: Shares of Roche rose on the news about 1 percent the day the results were reported.
For the general public, as well as for cancer patients, the speed of “new news” about advances in immunotherapy drugs alone or in combination with other medicines is confusing if not head-spinning and overwhelming. And although such drugs — including Avastin, Keytruda and Opdivo — have indeed been shown to slow progression and/or extend survival in subsets of some cancer patients, drug makers, clinicians and researchers are far from having definitive understanding of when, how, in what combinations, and in what patients these extraordinarily expensive drugs work or don’t work.
In addition, patients also face confusion about the success of these drugs as first-line treatments, as compared to “last resort” therapies. Thus, establishing and increasing market share — as reflected in the drumbeat of TV and magazine ads for these new therapies — is a higher priority for drug makers than clarity and consensus, despite the modest clinical successes and unresolved treatment decisions. Stories that report claims of success should be carefully put in context and quantified — a difficult task at best to accomplish in a few hundred words. But without such care and caution, patients and those who care for them are often misled.
Not discussion of costs. Some estimates have put the monthly cost of Tecentriq alone at $12,500. Adding the three other drugs brings it to about
This is essentially a data-free story, as noted above. How long does this drug cocktail help patients live compared to the other treatment groups? This critical question goes unanswered.
Again, there is no information in the story about side effects, patient exclusions, or other potential harms of Tecentriq or the chemotherapies included in the cocktail.
Also, the common talking point around immunotherapy includes the claim that it is less toxic than traditional chemotherapy, so why would a person take both, instead of just one or the other? What does that do to the side effect profile?
Given that Roche gave very incomplete information about the trial’s protocol and outcomes, the Reuters article probably did the best it could in some respects to put the information in context and reveal the “marketing” strategy behind the company’s release.
However, we think it should have more emphatically stated that readers must be cautious about this evidence, since no one has actually seen the data. It has not been published nor peer-reviewed.
No mongering here, but no need. The mere mention of lung cancer will put many lung cancer patients, smokers, or worried well on high alert to this story. Some discussion of prevalence would have helped. What percentage of lung cancers fall into the category targeted by these treatments? How long do those people usually live?
The story includes an unattributed quote lifted from the Roche news release, and a quote from a financial analyst, who discusses the drug’s shifting market share–not the science. This was not sufficient sourcing.
The story contains some information about the nature of the new clinical trial and that it was designed to compare the “newer” cocktail to older ones, including one with a drug made by Roche. It’s also open that this is meant to boost sales of a drug to help offset the loss associated with other drugs going generic or facing biosimilar competition.
That wasn’t enough, though. Readers are not given enough information to know if this cocktail is better than cheaper and more tested alternatives. For example: What about the outcomes of lung cancer patients treated with the combination of drugs without immunotherapy?
For better or worse, the story makes clear that Roche intends to submit the new data to regulators right away.
This was a close call. The article does not address the ways in which Roche’s cocktail of drugs works better or differently than its own older therapies, or others on the market that are similar.
But it does reveal that it’s probably more of a financial move than a patient care concern:
The world’s biggest maker of cancer drugs is counting on growing sales of Tecentriq, which notched 487 million Swiss francs in 2017, to help offset falling revenue from its older cancer medicines Avastin, Rituxan and Herceptin whose patent expirations are exposing them to rivals’ cheaper copies.
This is useful and so we’ll lean toward satisfactory on this one.
The story used a quote from a Roche news release, but did not attribute it to the release:
We are pleased that the IMpower150 study demonstrated a clinically meaningful survival benefit for people receiving their initial treatment for this type of advanced lung cancer,” said Sandra Horning, MD, Roche’s Chief Medical Officer and Head of Global Product Development.”
But since it discussed the profit motives at play, which Roche didn’t disclose, it just barely offsets the reliance on the news release and earns a satisfactory score.
Systematic, Criteria-Driven
The inimitable @garyschwitzer has published an opinion piece on how health journalism contributes to public health outcomes - and why the industry works the way it does.
US-centric, but Australian journos will find this helpful.
#aushealth https://t.co/zBDaOOsMGx
In the latest installment of @JAMA_current's series on the public's eroding trust in health care, @garyschwitzer calls for improving the accuracy and quality of health journalism https://t.co/kgCNz0BTgq
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