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Cancer Medications With Questionable Effectiveness Scrutinized

Oncologists are increasingly refusing to prescribe certain expensive medications

U.S. oncologists are increasingly considering patient cost burden and declining to prescribe medications with undifferentiated or no effect. Although medical groups such as the National Comprehensive Cancer Network and the American Society of Clinical Oncology are still working on ways to incorporate affordability in treatment decisions, physicians are starting to make what they feel are obvious changes.

In interviews with Reuters, top cancer specialists said that at least half a dozen drugs, including colon cancer treatments Cyramza, from Eli Lilly & Company, and Stivarga, sold by Bayer AG, aren't worth prices that can exceed $100,000 a year.

Doctors are unimpressed with so-called "me too" drugs developed by companies looking to grab market share from a more established product. They are also less likely to use a drug outside of its approved indication for patients who have exhausted other types of treatment.

"There are drugs that don't make much sense given how much they cost, given their small benefits," said Dr. Peter Bach, director of Memorial Sloan Kettering's Center for Health Policy and Outcomes in New York. "There are drugs that can cost up to $10,000 a month that provide, at the median, a few weeks or less than a month of additional life, but with substantial toxicity."

Of 51 cancer drugs approved between 2009 and 2013, 21 treatments classified as "novel" had a median annual price of $116,100, while the 30 deemed "next-in-class" had a median price of $119,765, according to a recent study in JAMA Oncology. At the same time, the cost of treatment is rising steadily. In 1995 oncology patients and their insurers paid $54,100 for an additional year of life, but by 2013 the price had jumped to $207,000, according to a study sponsored by the National Bureau of Economic Research.

Dr. Leonard Saltz, chief of gastrointestinal oncology at Memorial Sloan Kettering, cited Cyramza for colon cancer as an example of "a drug that costs much more and does absolutely nothing," but said doctors may find it harder to decide on a drug that "costs a lot and does very, very little."

Anthem Inc., the second-largest U.S. health insurer, has a program to steer oncologists toward effective treatments deemed to offer the best value, paying them a monthly fee for adhering to a recommended treatment regimen. Anthem cited drugs like Avastin and Celgene's Abraxane as overused relative to their value.

"Abraxane is a newer version of an older [generic] drug called paclitaxel — they basically do the same thing," said Dr. Jennifer Malin, medical director for oncology at Anthem and an attending physician at the Veterans Affairs Greater Los Angeles Health Care System.

Source: Reuters, October 8, 2015.

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