Pharmaguy's Insights Into Drug Industry News
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Pharmaguy's Insights Into Drug Industry News
Pharmaguy curates and provides insights into selected drug industry news and issues.
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Will ASCO's Proposed Cancer Drug Scorecard Reap Big Pharma's Wrath?

Will ASCO's Proposed Cancer Drug Scorecard Reap Big Pharma's Wrath? | Pharmaguy's Insights Into Drug Industry News |

The American Society of Clinical Oncology promised a rating scale for cancer drugs--and now, it has delivered. Let the blowback begin.

The drug scorecard, published in the Journal of Clinical Oncology, is designed to simplify decision-making by boiling down available data--on survival benefits in specific types of cancer, as well as side effects--into one number. It rates treatment regimens on a 0-to-100 scale--0-to-130 in some cases, with bonus points--and the physicians' group hasn't been shy about awarding low scores.

A lung cancer cocktail that includes Eli Lilly & Co.'s ($LLYAlimta, for instance, got a big fat goose egg. A treatment combo with Roche's ($RHHBYAvastin won just 16 points in the same disease. A prostate cancer combo that incorporates Sanofi's ($SNYJevtana also racked up just 16 points.

The scorecard also tots up the cost of treatment, with the Alimta cocktail at $9,200 and the Avastin combo at $11,900. The Jevtana prostate cancer combo costs $10,700, the report says.

Of course, scores vary by type of cancer, and a low number in one indication doesn't mean similar ratings in other cancers. Avastin was first approved for colorectal cancer, and has better overall survival data in that disease; the scorecard examples the journal article presented didn't go into that field.

ASCO is asking for feedback on the drug-assessment framework, and there's likely to be plenty.

Pharma Guy's insight:

So far PhRMA -- the US drug industry trade association --  has been circumspect in its response (dated 22 June):

Pharmaceutical Research and Manufacturers of America (PhRMA) executive vice president, policy and research, Lori Reilly provided the following statement on the American Society of Clinical Oncology's (ASCO) conceptual framework for assessing the value of new cancer treatment options based on clinical benefit, side effects, and cost:

“We appreciate ASCO’s efforts to develop a new tool to support informed decision-making by physicians and cancer patients, with the goal of ensuring that each patient receives the treatments that are most valuable to them. Judgments about treatment value are highly individualized and vary over time as new research and new treatment options emerge. As the framework is finalized, it will be essential to ensure that it reflects the needs and preferences of individual patients, medical advances and increasing personalization in medicine, as well as the evolution of clinical value and cost over time. PhRMA looks forward to working with ASCO to develop sound decision support tools that support evidence-based decision-making by patients and physicians.”

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Hype Over "Miracle" Cancer Drugs Overshadowed by Cost Criticism at ASCO

Hype Over "Miracle" Cancer Drugs Overshadowed by Cost Criticism at ASCO | Pharmaguy's Insights Into Drug Industry News |

Every year in late May, nearly forty thousand oncologists flock to Chicago for the world's biggest cancer jamboree - ASCO, the American Society of Clinical Oncology. I've been going intermittently for as long as I've been an NHS consultant, over 35 years.

For the next few days the global media will be awash with miracle cancer drugs. Positive stories are carefully placed by smart marketing and PR people in Armani suits and dazzling power dresses on behalf of the pharmaceutical industry. It all sounds so convincing. But the reality is a sophisticated conspiracy to hype up products being sold to bigger companies by small start-ups, to get more investment for the industry from the City or Wall Street, or simply to ramp up share prices and make short-term gains.

Just look at one press release put out yesterday for a new immunotherapy product. It claimed: "Terminally-ill cancer patients have been “effectively cured” by a game-changing new class of drugs". This was for a new type of immune stimulation therapy studied in a variety of cancers. Called a checkpoint inhibitor, this drug removes the brakes from the immune system, allowing it to recognise and destroy cancer cells. But the key study only shows a 3 month prolongation of survival compared to chemotherapy alone. And the cost is over £100,000 a patient. Imagine all cancer patients were given it - that would consume more than the entire current NHS budget.

Pharma Guy's insight:

Read what a keynote speaker at ASCO had to say about prices of cancer drugs: Keynote Speaker at ASCO Says Value of Cancer Drugs Don't Justify the Cost - 

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#Pharma Trash Talk Bites Hand That Feeds ASCO

#Pharma Trash Talk Bites Hand That Feeds ASCO | Pharmaguy's Insights Into Drug Industry News |

In a sign of growing frustration with rising drug prices, a prominent cancer specialist on Sunday sharply criticized the costs of new cancer treatments in a high-profile speech at one of the largest annual medical meetings in the U.S.

“These drugs cost too much,” Leonard Saltz, chief of gastrointestinal oncology at Memorial Sloan Kettering Cancer Center, said in a speech heard by thousands of doctors here for the annual meeting of the American Society of Clinical Oncology.

Dr. Saltz’s remarks focused mainly on an experimental melanoma treatment made byBristol-Myers Squibb Co., but he also criticized pricing more widely.

(Read the statistics he cited here: 

Dr. Saltz’s speech was unusual because it was made at the meeting’s plenary session, where the field’s most significant scientific research is presented and which all meeting participants are expected to attend. An estimated 25,000 doctors and scientists attended this year’s meeting.

It is unprecedented for plenary speeches, which typically address scientific and medical issues, to substantially take on the topic of drug costs, said Alan Venook, a professor of medicine at the University of California San Francisco who planned the meeting’s scientific session and invited Dr. Saltz to speak.

The prominent venue for the speech was also unusual because, like many medical meetings, ASCO is sponsored by pharmaceutical companies and often focuses on highlighting advancements in drug development, said Dr. Venook. He said discussing drug prices there is “uncomfortable” because it could be seen as “biting the hand that feeds you.”

Doctors are also reluctant to antagonize the drug industry because they need pharmaceutical firms to invest in developing new medicines for patients, he said.

“It’s a tough balancing act for ASCO where the meeting is largely funded by pharma,” Dr. Venook said in an interview. “You can’t have a [plenary] talk trashing pharma, but you can have a talk by a respected person questioning it.”

“All of the stakeholders involved need to stop pretending that price is something we don’t need to discuss, because it affects all of us, and it’s affecting our ability to deliver quality care to everyone,” Dr. Saltz said in the interview. He said that one step toward controlling prices would be allowing Medicare to negotiate prices directly with pharmaceutical companies, which it is currently barred by law from doing. He also called for changing the way Medicare pays for infused drugs. Doctors currently receive a percentage of the drug’s total sales price. The payment method has created a conflict of interest because cancer doctors can make more money by using the most expensive drugs, he said.

Pharma Guy's insight:

Meanwhile, Robert Goldberg over at Drug Wonks blog said: "Dr. Saltz said cancer drug prices are insane and immoral.  I’d say the same about someone who said ... we shouldn’t perhaps pay even a little more."

Leonard Saltz, MD, is the C.K. Lewis of ASCO!

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Keynote Speaker at ASCO Says Value of Cancer Drugs Dosen't Justify the Cost

Keynote Speaker at ASCO Says Value of Cancer Drugs Dosen't Justify the Cost | Pharmaguy's Insights Into Drug Industry News |

Leonard Saltz of Memorial Sloan Kettering Cancer Centre (MSKCC) told delegates in a keynote presentation that cancer drug prices are not related to the value of the drug but are "based on what has come before and what the seller believes the market will bear."

In a presentation focusing mainly on immuno-oncology drugs, he pointed out that the much-lauded combination of Bristol-Myers Squibb's PD-1 inhibitor Opdivo (nivolumab) and anti–CTLA-4 antibody Yervoy (ipilimumab) in melanoma carries a regimen cost for a typical 80kg patient of nearly $300,000.

If all the US patients with metastatic cancer took a regimen set at that price, the total cost to the healthcare system would be an eye-watering $174bn, he pointed out.

"The price of ipilimumab is "approximately 4,000 times the cost of gold," said Saltz who indicated that while the efficacy of Opdivo/Yervoy was clear from the study, their value in terms of cost and associated benefits is still in question.

The rising costs of these drugs do not reflect development costs, nor do they help drive innovation, said Saltz, who noted that the median price of new cancer therapies in the US had doubled from $4,716 in 2000-2004 to $9,900 in 2010-2014.

He also outlined a hypothetical case in which Merck & Co's Keytruda (pembrolizumab) - given at a dose of 10mg/kg every two weeks to a 75kg patient - could cost $83,500 per month or more than $1m a year. Even at the lower dose of 2mg/kg the price would still be $16,700 per month using the model.

"The unsustainably high prices of cancer drugs is a big problem, and it's our problem," he told delegates at ASCO, suggesting there has to be some upper limit that society is prepared to pay to treat a cancer patient.

"It's a very unpleasant discussion. It's very uncomfortable," but it is a necessary one to have, he said.  

Pharma Guy's insight:

I wonder if he was booed off the stage?

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