Something has to change. We cannot continue tolarate the high cost of new cancer drugs up to, and in excess of, $100,000 (£80,000). This is unsustainable and we need to be thinking seriously about how we can lower the prices.
What can be done to lower the cost while enabling patients receive the best treatment?
One in two people in the UK are expected to get cancer in their lives and the statistics are similarly shocking in many other Western nations – better treatments are clearly urgently needed. And better treatments are coming. For example, the innovative new targeted drugs and immunotherapies deliver significant benefit to cancer patients.
But we need to be able to afford them and the spiralling costs of these new drugs are threatening to make cancer treatment unsustainable. As one patient advocate recently put it, innovation is meaningless if nobody can afford it.
Even in 2012, 12 of 13 newly-approved cancer drugs were marketed at over $100,000 a year. These high prices are particularly concerning when clinicians often have to combine several of these drugs for the best results. For example, the hugely promising combined immunotherapy treatment of nivolumab and ipilimumab is priced at around $250,000. This exceeds the median cost of a home in the US, which is $240,000. In the UK, this game-changing treatment has recently been rejected for use on the National Health Service (NHS) for people with advanced head and neck cancer because of cost. This cannot go on.
But, often perhaps with good reason, we have come to accept high prices for cancer drugs. Many drugs fail to make it through. Research and development costs are high. And large clinical trials are very expensive. These factors are commonly cited as major contributors to cost. However, as we move further into an era of personalised medicine, do the arguments behind such high prices still hold up?
We can often select patients genetically when trialling targeted cancer drugs with great success, which means we can avoid the costly phase III trials with thousands of patients. In 2016 a study of only 50 patients was needed by the FDA to approve crizotinib for lung cancer patients with ROS1 mutations.
As we see FDA approvals expand the patient population across multiple cancer types, we would expect the price of the treatment to decrease but this rarely happens.
Recently, with colleagues from the MD Anderson Cancer Center and the Netherlands Cancer Institute, we considered the problem of unsustainable cancer drug prices in the journal Cell (http://www.cell.com/cell/abstract/S0092-8674(17)30124-1) and suggested a fundamentally different approach to drug discovery and development, which would keep lifesaving cancer treatments affordable.
We considered new models of discovery drug development, some low-hanging fruit to harvest as soon as possible, and ways in which the pharmaceutical industry could help itself to bring prices down.
Pharma companies, as commercial enterprises, could be more efficient – this is one element that contributes significantly to the high cost of cancer drugs. For example, there is massive unnecessary duplication with multiple companies working on the same small group of molecular targets. Many pharma companies perform very similar trials with comparable drugs but do not share their data. There are over 800 clinical trials testing T cell checkpoint immunotherapies, which together aim to enrol over 166,000 patients.
Imagine if the companies behind these studies collaborated more – far fewer studies would be needed. Key results would be generated quicker. Unfortunately it is people with cancer who will pay the price for this sort of inefficiency.
Another area for further improvement is the use of biomarkers for patient selection. Although there has been a welcome increase in the use of tests to dictate which patients should be included in a clinical trial – leading to stratified or personalised medicine – there is sti...
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