The Daily Rise: Tuesday, April 19

Immunotherapy Survival Rates

Good news for patients with melanoma. The Washington Post’s Laurie McGinley reports that immunotherapy has helped double the long-term survival rates for melanoma patients.

According to new research released at the American Association for Cancer Research annual meeting, 34 percent of patients with metastatic melanoma who received the immunotherapy treatment have survived. That’s double the five year survival rate for patients with advanced melanoma who received other treatments.

“It is very encouraging that a subset of melanoma patients is experiencing a long-term survival benefit,” Stephen Hodi, the director of the Melanoma Center at Dana-Farber Cancer Institute and lead author of the study, told the Washington Post. “Hopefully this would translate to other cancers as well.”

The immunotherapy treatment “targets the PD-1 protein, which is involved in a complex process that prevents the immune system’s T-cells from attacking cancer.” Many researchers are optimistic that the strategy could yield promising results for other types of cancer.

“A lot more people are living longer and hitting major milestones with their loved ones because of this,” said Louis Weiner, director of the Georgetown Lombardi Cancer Center.

Not Your Average Article on Drug Prices

Everyone has an opinion about drug prices. Most repeat the same tired sound-bytes. Today, we’re sharing a thoughtful piece by Jeffrey S. Flier, the dean of Harvard Medical School. He shares his views on drug prices, raising a great point: the media narrative has unwisely conflated all drug price stories under the same headline – when more nuance is needed.

He points out that different treatments have “high prices” for different reasons. While one drug may exploit a quirk or loophole, another treatment in the same price range may be the result of billions of dollars of research.

“The overall costs and reduced coverage for prescription drugs largely reflects imperfections in the way we approve and pay for drugs,” Flier writes in an opinion piece published at the Boston Globe. “New drugs require expensive research and development under tight regulatory oversight. The cost of developing a single new drug may exceed $2 billion when including the cost of failures.”

His suggestions for reducing price include:

1. Streamlining FDA Approval 

“Procedures required by the FDA for development and approval of new products need to be thoroughly redesigned, including new approaches to adaptive design of clinical trials and use of biomarkers to provide earlier evidence of efficacy than available through mortality-based metrics. Thresholds to clear a drug through the FDA process should more readily consider both medical need and the severity of the disease being treated. Though many regulatory hurdles were established to guarantee safety, patients with otherwise untreatable diseases may be willing to accept an uncertain risk for the chance of benefit, and should be permitted to do so.”

2. Ensuring Proper — Not Excessive — Testing  

“More important, many steps in the highly regulated development process, however originally justified, lack scientific rationale, drive up costs, and could be safely eliminated. One example: human small-scale tests of a new molecule must have the drug prepared by elaborate manufacturing procedures required for a commercial drug in full distribution, well beyond the scientific standards necessary to insure that a particular research batch of a drug is pure. This difference can literally cost millions of dollars for even the first testing, providing no significant benefit in safety. However straightforward, this reform has been difficult to achieve.”

Stigma Blocks Access to Palliative Care

More work can be done to eliminate the stigma of receiving palliative care. According to a new study from Canada, cancer patients “may turn down care that could ease their pain and improve their quality of life because they think this type of ‘palliative’ treatment amounts to giving up and simply waiting to die.”

“Patients and caregivers in our study saw palliative care as being equated with death, loss of hope, dependency, and going into places you never get out of again,” Dr. Camilla Zimmermann, head of the division of palliative care at the University Health Network in Toronto, told Reuters about the findings. “This is in stark contrast with the actual definition of palliative care, which is interdisciplinary care that provides quality of life for patients with any serious illness and their families, and that is provided throughout the course of the illness rather than only at the end of life.”

Admittedly, this was a very small study — of just 48 cancer patients. Nevertheless, it serves as a valuable reminder that patients should be aware of all of their treatment options. Every patient should have access to the right treatment and make a decision based on proper research into what’s right for them. No medical decision should be the result of pressure or stigma against a course of treatment.

What the Media Missed

Dr. Robert Goldberg, PhD points out what the media missed in covering one recent drug cost study. Goldberg contends that most of the increase in drug spending has been pocketed by pharmacy benefit managers and insurers.

“Spending on drugs in the outpatient, hospital and nursing homes was $425 billion. However, the drug and biotech companies made $310 billion of that total. Where did the other $125 billion go? The vast majority of articles don’t tell.” Goldberg writes at DrugWonks.com.

Goldberg points to data that shows pharmacy benefit managers and insurers have increased cost sharing by more than 25% since 2010.

“The real story about drug pricing is how PBMs like Express Scripts and health plans are pocketing about a bigger and bigger share of drug revenues while increasing what patients – especially those with the greatest need for the newest drugs generating the biggest rebates – are seeing their share of the invoice price of a medicine surge,” he concludes.

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