Monday, June 6, 2016

To My Eye (Based On ASCO 2016 Data), Opdivo® + Yervoy® Will Still Be Prescribed Ahead Of Tecentriq® -- In Bladder Cancers

Of course, since there have been no head to head trials of the two therapies, in any cancer -- let alone bladder cancer -- I am wandering out on a decidedly-thin limb, here -- in making this rather-brash (and technically off-label) prediction. I freely admit it. [A fair bit of this assessment on my part has to do with the rather high discontinuation rates, due to side effects, seen with Roche/Genentech's atezolizumab. But that is just my opinion.]

Even so, I do see Roche/Genentech's atezolizumab as very promising -- it worked (showed a sustained response) on only 24 per cent of first line bladder cancer patients. I say "only" -- while even just a few years ago, we would have been shouting from the rooftops, over such a response rate. The checkpoint inhibitors, especially when delivered in combinations with older drugs (like Yervoy®) -- are clearly raising the bar. And that is good news for cancer patients everywhere.

So -- welcome to the races, Tecentriq®. But as The Wall Street Journal reporting quite rightly points out, overnight -- the other meta-narrative unfolding here, as to these excitingly life-prolonging new cancer therapies is. . . a dauntingly-high cost to the US health care delivery system (at over $12,500 per month -- and significantly more, when prescribed in combinations with other drugs -- do go read it all):

. . . .Keytruda is being tested in various combinations with more than 50 other drugs, while Opdivo is being tested with about 40 other drugs, according to Evaluate Ltd., a drug-industry research firm. Roche Holding’s Genentech unit, which recently began selling the immunotherapy Tecentriq, is running about 50 clinical trials of combinations of two or more cancer drugs, Chief Medical Officer Sandra Horning said in an interview.

Daniel O’Day, CEO of Roche’s pharmaceuticals unit, said the company has had discussions with health insurers “to move to a system where we can get combination-based pricing in the U.S.” A Roche spokeswoman said the company priced its breast-cancer drug Perjeta lower than many other new cancer drugs because the company knew it would be used in combination with its older breast-cancer drug Herceptin. Perjeta costs $6,300 a month and Herceptin costs $5,500 a month.

Robert Vonderheide, a cancer researcher at the University of Pennsylvania, said in an ASCO presentation that the choices of drugs to test in combination were "dizzying." But he added, "Can we afford it, given the cost of these drugs?. . . ."

I do expect this debate will make its way into the post-convention presidential electoral cycles, in 2016. Onward, on a short work-week Monday -- with a softly breezy, sunshine splattered walk in, ahead. Be excellent to one another. Smile.

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