June 28, 2011

USA: New Drugs Fight Prostate Cancer, but at High Cost

NEW YORK, NY / The New York Times / Health /  June 28, 2011

By Andrew Pollack

A group of new drugs is promising to prolong the lives and relieve the symptoms of men with advanced prostate cancer, but could also add billions of dollars to the nation’s medical bills.

In the last 15 months, three new drugs that extended the lives of prostate cancer patients in clinical trials have been approved by the Food and Drug Administration and several other promising medicines are in clinical trials. Before last year, only one drug had been shown to improve survival — docetaxel, which was approved in 2004.

“What a great time it is in prostate cancer,” Dr. Daniel J. George of the Duke Cancer Institute proclaimed earlier this month at the annual meeting of the American Society of Clinical Oncology.

And it’s a great time for the drug makers, with several drugs competing to fill a niche for longer-term survival. Analysts estimate that some of the new drugs, particularly Dendreon’s Provenge and Johnson & Johnson’s

Bone-scan images before and after treatment with Cabozantinib. The dark spots are where cancer had spread to bones.
Zytiga, could reach annual sales of $1 billion or even much more.

The recently approved drugs and most of those in development are for cases in which the disease has spread beyond the prostate gland and is no longer held in check by hormone therapy.

Promising Treatments for Prostate Cancer Patients

Men with that late-stage cancer had a median survival of about a year and a half using docetaxel. The new drugs each added two to five months to median survival when tested in clinical trials. Doctors say that men taking more than one of the drugs in succession would be expected to live more than two years.

Mark Moldanado, a retired postal worker in Omaha, said that Jevtana had helped keep his cancer in check. Jenny Mass

But the price of these drugs has already stirred concerns about the costs of care among patients, providers and insurers. For example, Provenge costs $93,000 for a course of treatment, while Zytiga costs about $5,000 a month. Another of the new drugs, Sanofi’s Jevtana, costs about $8,000 every three weeks. 

With other pricey drugs on the way, said Joel Sendek, an analyst at Lazard, “We could be talking easily $500,000 per patient or more over the course of therapy, which I don’t think the system can afford, especially since 80 percent of the patients are on Medicare.”

Medicare has already fired what some analysts interpret as a warning shot over prices, conducting a yearlong inquiry into whether to pay for Provenge. In its final decision, due Thursday, Medicare is expected to pay for the drug when used according to the label.

Medicare officials denied that price was the reason for the review. But some patient advocates and politicians portrayed the review as a step toward rationing.

Private insurers are also paying only if drugs are used according to the label, according to doctors and patient advocates.

“The reality is, there’s pushback,” said Dr. Oliver Sartor of Tulane University.

Still, for now, one company’s price is prompting the next one to follow suit.

“The pricing environment is encouraging and getting better for us,” Andrew Kay, the chief executive of Algeta, told securities analysts earlier this month, after announcing that his company’s experimental drug had extended median survival nearly three months in a clinical trial.

Mr. Kay said he had initially thought that his company, which is based in Norway, would charge about $25,000 for a typical course of treatment with the drug, Alpharadin. But with the rival drug Jevtana costing about $50,000, Algeta and its partner, Bayer, are considering a higher price.

About 218,000 men in the United States get prostate cancer each year and about 32,000 die, according to the American Cancer Society.

In many cases, the cancer is caught before it has spread beyond the prostate gland and can be cured with surgery or radiation therapy.

If the cancer has spread, men usually are given drugs, particularly Abbott Laboratories’ Lupron, that suppress the body’s production of the hormone testosterone, which can fuel tumor growth.

The new drugs, for now at least, are for use when this hormone-deprivation therapy has stopped working.
“This is a small subset of people with prostate cancer,” said Dr. Charles Myers, a prostate cancer specialist in private practice in Charlottesville, Va., who is a survivor of the disease himself. However, he noted, “It’s the group of people who are dying.”

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