Tuesday, June 2, 2009

The Cocktail Hour

An admission that a single magic bullet won't work for cancer? A possible solution? Yep, you guessed it...

From the WSJ:

"As the era of targeted cancer drugs has matured, it’s become clear that any single drug stands little chance of keeping cancer in check for an extended period of time in large numbers of patients."

"So researchers have begun testing combinations of targeted drugs in hopes that a cocktail will prove more effective."

"Now Merck and AstraZeneca are pushing the idea further, by pairing two targeted cancer drugs early in development, before either has been clearly proven on its own."
[Yep, you heard that right..]
“The notion that a single agent is going to be dramatically active in a broad population is unrealistic,” AstraZeneca’s head of oncology told the WSJ.
[But, but... Isn't that the way these things have been, er, sold?]

"Meanwhile, researchers continue to look at combinations of approved targeted drugs. In a trial announced last week for patients with advanced liver cancer, Nexavar, co-marketed by Bayer and Onyx, will be combined with Tarceva, sold by OSI Pharmaceuticals and Roche."

[Ah, yes, two dead drugs can thus limp along a little longer.]

"Such combinations aren’t a sure thing — sometimes patients fare worse when doctors add more drugs. Another issue with combinations of targeted therapy is cost. Individual targeted cancer drugs can costs tens of thousands of dollars per patient. Add more drugs, and the cost will climb even higher."

[And that, of course, is the point of the exercise.]

As Dr. Atul Gawande wrote in an excellent recent article in the NewYorker:
When you look across the spectrum from Grand Junction to McAllen—and the almost threefold difference in the costs of care—you come to realize that we are witnessing a battle for the soul of American medicine. Somewhere in the United States at this moment, a patient with chest pain, or a tumor, or a cough is seeing a doctor. And the damning question we have to ask is whether the doctor is set up to meet the needs of the patient, first and foremost, or to maximize revenue.

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