Less Can Be More In Cancer Treatment

 

In the world of cancer treatment, more is not always better. That’s the lesson being learned by cancer treatment specialists through a series of recent studies.

For years oncologists have generally approached the challenge of cancer treatment with the attitude that more treatment is better – unless it kills you! They pushed the envelope of cancer drugs as far as the body would allow in a desperate attempt to stave off the onslaught of cancer cells. In general, this approach has produced improved cancer survival rates.

But now that cancer survival rates have improved, many are questioning the use of expensive cancer drugs when conditions don’t seem to warrant their use.

Peter Loftus, writing in The Wall Street Journal, reports a federal study, presented at the recent annual meeting of the American Society of Clinical Oncology, showed that many women with early-stage breast cancer could safely skip commonly used chemotherapy after surgery. This finding could potentially spare tens of thousands of women a year from chemotherapy side effects such as nausea and early menopause.

Another study presented at the meeting concluded that many patients with advanced kidney cancer could forgo kidney –removal surgery and instead take a drug called Sutent, manufactured by Pfizer, Inc. The study was funded by Pfizer.

A study by a U.K. health institute found that reducing treatment with Roche Holding AG’s breast cancer drug Herceptin to six months instead of twelve months reduced potential heart-related side effects and its cost without sacrificing effectiveness.

Rising Cost of Cancer Drugs

Part of the impetus for these studies, usually funded by government, is to lower the cost of cancer treatment by reducing the use of expensive cancer treatment drugs. The average U.S. monthly price of oncology drugs more than doubled to $15,535 per patient in 2015 from $7,103 in 2006, according to a May report in the Journal of Oncology Practice. Overall U.S. spending on cancer drugs doubled from 2012 to 2017, to nearly $50 billion, according to IQVIA Institute for Human Data Science.

The rising cost of cancer drugs has led patients and health insurers to question the assumption that “the maximum dose that they can physically cope with is the right dose,” said Christopher McCabe, executive director of the Institute of health economics, a health-policy non-profit in Edmonton, Alberta.

Unfortunately, the economics of such treatment decisions is highly influenced by the motives of those doing the studies. Pharmaceutical companies do studies that tend to encourage the use of their drugs. Governments that pay for the drugs do studies that tend to discourage the use of the drugs.

But at least one drug company executive thinks it is a good thing to analyze the effectiveness of current drug regimes. Pascal Soriot, CEO of Astra-Zeneca, said in a recent interview, “It is of course a threat, but I think it’s the right thing to do. The debate should happen.”

In 2006, the National Cancer Institute started a large clinical trial to test whether women at intermediate risk of recurrence could safely skip chemotherapy. Over 10,000 women were enrolled in the study. Women in the low risk group were assigned to receive hormone therapy alone, while those in the high-risk group received both hormone therapy and chemotherapy. In the intermediate-risk group, the most challenging for treatment decision-making, more than 6,700 were assigned either the combination treatment or hormone therapy alone.

Nine years later the results showed 83.3% of those who received hormone therapy alone were free of disease while 84.3% of those who received both hormones and chemotherapy were disease free. Obviously, the chemotherapy in these patients was unnecessary.

Studies like this can spare thousands of women the side effects and potential permanent harm from toxic chemotherapy agents. They can also substantially lower healthcare treatment costs. Sometimes less is more.

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