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New York Times: Hopes and Dilemmas of Modern Medicine

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The New York Times on Sunday examined how the Genentech cancer drug Avastin "signifies both the hopes and dilemmas of modern medicine" because while it offers incremental benefits for cancer patients, the drug is costly and concerns have been raised about its safety and efficacy. The drug, which is seen as a "wonder drug" for its ability to cut off blood supply to tumors, costs as much as $100,000 annually and had sales of $3.5 billion last year. Research shows that the drug prolongs the lives of patients with colon, lung or breast cancer by "only a few months, if that," and some recent studies suggest that it could be less effective than FDA believed it to be when approving the drug, the Times reports. Some patients and physicians say Avastin improves the quality of life, allowing patients to perform daily functions without exhaustion, but such benefits are difficult to confirm, according to the Times.

Side effects for the drug are "serious, if infrequent," and can be lethal, according to the Times. Studies have shown that the drug is more effective when used with standard chemotherapy, so "patients on Avastin do not escape chemotherapy's side effects," according to the Times. In addition, patients with cancers other than colon, lung or breast are often given the drug, even in cases where there is not "compelling evidence that it can help," according to the Times. "I still use Avastin routinely, but it's sobering," Leonard Saltz, a colon cancer specialist at Memorial Sloan-Kettering Cancer Center, said. He added, "It's not a small dunk, and in fact, the incremental benefit may be more modest than we want to admit."

Some "in the pharmaceutical industry worry" that high prices "will raise concerns about whether the drug is worth it," potentially causing "backlash like price controls or restrictions on use," the Times reports. Roy Vagelos, a former CEO of Merck, said, "There is a shocking disparity between value and price, and it's not sustainable." Medicare reimburses physicians prescribing Avastin at an amount equal to Genentech's average selling price -- which is between $4,000 and $9,000 per month -- plus a markup of 5% to 6%. Medicare pays 80% of the cost of the drug and beneficiaries pay the remaining 20%. Private insurers "sometimes pay several times as much as Medicare" for the drug because physicians and hospitals at times have charged up to $35,000 per month for Avastin and insurers' contracts require them to cover a certain percentage of the cost.

Avastin is being formally tested in up to 450 clinical trials for about 30 types of cancer. Genentech and its partner Roche, as well as the National Cancer Institute are beginning studies involving more than 26,000 people with colon, lung and breast cancer at earlier stages of the disease than were previously studied. If the drug is found effective in delaying the return of cancer in these groups and it is approved by FDA, Avastin could be prescribed to hundreds or thousands of additional people, which experts say could "impose a considerable financial burden," the Times reports.

(Medical News Today, Cancer/Oncology, July 8, 2008[source])


The information contained in these articles may or may not be in agreement with my own opinions. They are not posted as medical advice of any kind.

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