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Highlights - Report Card 2006
Research Saves Lives
Challenges
- How can we more effectively select the patients most likely to benefit from costly new drugs?
- Who will pursue the "other" research that reflects societal priorities for efficient and cost-effective cancer care?
- The cancer care system frequently fails to take rapid advantage of research findings already generated, missing opportunities of potential importance to patients and payers. Consequently, potentially curative treatments are sometimes given late, or at times to patients who may not ultimately benefit.
Herceptin as a Test Case
Using Herceptin adjuvant therapy for breast cancer as the test case, CACC explored three tests to make better use of the drug. All of them could help oncologists and patients get on with the best possible treatment rather than hit-and-miss attempts, and could potentially save money. Unfortunately, all three tests await simple confirmatory studies that are not being prioritized by researchers.
- Herceptin is an innovation in breast cancer therapy, improving the duration of survival in advanced disease; cost is approximately $50,000 per case (plus $20-30,000 in hidden costs for pharmacists, nurses, infusion rooms, etc.)
- At present, HER2/Neu testing on patient tumour samples is used to determine eligibility for treatment with Herceptin; ordinarily, 40% of patients with advanced disease who test positive for HER2/Neu will respond to the drug and up to 50% of early recurrences are avoided as a result
- Evidence suggests that more precise information could be gleaned by testing tumours for secondary markers:
- PTEN molecule (patients may do better when PTEN has been preserved)
- cMyc, (patients whose tumours are positive for cMyc could benefit more than twice as often from Herceptin as patients whose tumours are cMyc negative)
- Efficiencies and cost savings could also be gained by using the newer and more efficient CISH test (chromogenic in situ hybridization) at diagnosis, rather than the currently used more complex FISH (fluorescence in situ hybridization).
- A mechanism needs to be introduced to ensure that a number of post-market studies confirming a) a proper selection of patients and b) maximum efficiency takes place
Recommendations
What has to be done to generate more of these Phase 4 (post-market) trials? Surely the payers and the doctors (provincial governments) have both a financial and ethical interest in maximally improving patient selection for new cancer treatments and thus reducing overall cost and toxicity.
- A mechanism should be introduced to ensure a large number of post-market studies
- Logistics: Canadian provincial governments faced with escalating drug costs might set aside two to four percent of their drug budgets to contribute towards research for testing of new biomarkers, in order to refine eligibility for costly new drugs more accurately
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