While I’ve been focusing on pricking egos in the HBS common room, Greg Pawelski has been keeping vigil on our friends over in the wonderful world of chemo. The main recent development is the FDA issuing a warning about overuse of the anti-anemia drugs Eopgen, Arenesp and Procrit. Amgen (which makes the first two and JVs the latter) is running into problems because of this. Greg believes that things may be worse than that. He wrote to me saying:
Superficially, it sounds like a great expose—greedy clinics/doctors trying to make money by pushing drugs. The New York Times article states that the drugs, given by injection, have been heavily advertised, and there is evidence that they have been overused, in part because oncologists can make money by using more of the drug. That’s not really a new revelation. We’ve been down that road before without much done to change it. According to Dr. John Glaspy, director of UCLA’s Outpatient Oncology Clinic, one complicating factor, experts say, is that oncologists make significant revenue buying cancer drugs from manufacturers and charging patients a higher price for receiving the drugs in their offices. That profit motive could influence some doctors’ decisions. However, patients with anemia, which can cause sluggishness in its early stages and can be fatal in advanced phases, can get blood transfusions, typically every few weeks, instead of using EPO.
Could it be that increased numbers of red cells deliver more oxygen to the tumor cells and thereby increase their activity across the board, including with respect to invasion, proliferation, and metastasis? On one hand they’re developing drugs to halt and reverse angiogenesis while on the other hand they’re helping the tumor to obtain more oxygen with existing vasculature. And nobody in charge foresaw that? Amazing how they can apply differing standards for proof or benefit when profit is involved.
Whether or not there’s any truth in that it’s clear that bigger guns than Greg’s are being aimed at the issue. And one such gun belongs to United Healthcare which has found some pretty disquieting things about the use of some big time biotech drugs including Epogen and Herceptin among its cancer patients. Lee Newcomer, United’s ex-Senior Medical Director (but still an employee) told a meeting last week:
In reviewing records of patients who were prescribed the drug erythropoietin — an expensive agent that boosts blood supply in patients with anemia — <snip> 44 percent of those patients had blood work-ups that would indicate they were not anemic. Last year at the NCCN meeting, Newcomer also cited the use of the new breast cancer drug tratuzumab, sold as Herceptin, which has been found to be helpful in a group of women with breast cancer that overexpresses a certain gene known as HER2. The drug is ineffective in women with normal levels of HER2, yet Newcomer said about 12 percent of drug orders — which costs thousands of dollars per treatment — were for women who tested negative for HER2 overexpression.
So right there, real questions abut the inappropriate overuse of the two most popular biotech drugs. But that’s not all. What about overuse of other drugs that may also be innapropriate, but that we’re not so sure about?
Newcomer also said that, when he scrutinized prescribing habits for treatment of patients with pancreatic cancer, "we had doctors writing prescriptions for 188 different combinations of treatments, yet we know that there are only two drugs that have any activity against that disease."
Newcomer said that one of the newest biological targeted agents, bevacizumab, sold under the trade name Avastin, which is rapidly being included in numerous drug cocktails because it has been shown to extend survival in diseases such as colon cancer, can cost as much as $47,000 a year for one person. "But that doesn’t explain its true cost," Newcomer said. "We know that Avastin improves outcomes in about 20 percent of patients, but we have no idea which cancer patients will benefit from a course of treatment." According to his calculation, it costs $354,000 per year of life extended with Avastin.
And of course, there’s a message in all this for Pharma and the Oncology-Industrial Complex.
Newcomer and other panelists said that unless the prices of the drugs are controlled, a major backlash against the pharmaceutical industry is brewing.