Will Big Pharma Cancer Drug Collaborations Set The Stage For Lower Drug Costs?
The promise of cancer drug R&D has been on display these past few days at the American Society of Clinical Oncology (ASCO) meeting in Chicago. Breakthroughs abound with a good deal of attention being focused on immuno-oncology drugs that enhance the immune system to combat various forms of cancer. Of particular interest are the “checkpoint inhibitors” drugs like Yervoy from Bristol-Myers Squibb (BMS) and Merck’s Keytruda which, while acting by different mechanisms, facilitate the ability of one’s own T-cells to kill tumors. Progress also continues to be made with targeted therapies, drugs specifically designed to block the genetic aberrations that cause tumor cells to grow uncontrollably. These and other new drugs to treat cancer are raising hopes that, within a decade, various forms of cancer will be able to be controlled by these medicines.
Particularly intriguing is the potential to use these medicines in combinations to maximize their effectiveness. In fact, at ASCO BMS reported exciting results obtained in treating melanoma by combining Yervoy with another of its immune-oncology drugs, Opdivo, where 58% of patients on the combination saw their tumors shrink – better than either drug alone.
But combinations do worry many people, not because of efficacy, but for the looming costs of these drugs. Almost as big a part of the discussions around these breakthroughs has been the worries about the prices of these cancer drugs. Typical were the comments of Dr. Leonard Saltz, chief of gastrointestinal oncology at Memorial Sloan Kettering Cancer Center:
“These drugs cost too much. The unsustainably high prices of cancer drugs is a big problem, and it’s our problem.”
Dr. Saltz’s concerns become magnified when one considers the promise of these medicines. It is entirely possible that many forms of cancer will be controlled by various drug combinations, much like the current situation in treating AIDS. One can envision a “cocktail” of drugs consisting of an immune-oncology drug that upregulates one’s immune system to attack the tumor, a targeted drug that blocks a tumor’s uncontrolled growth, and a third agent that prevents a tumor from growing blood vessels needed for nourishment. We are on the threshold of this now. However, given the current pricing paradigm with each component of the cocktail costing $100,000/year or more, keeping every cancer patient alive at a cost of $300,000/year becomes unsustainable. Such healthcare costs could bankrupt the system. Ironically, while science has put us in the position of curing cancer, we run the risk of pricing society out of the benefit of these great medicines.
A number of companies are working together to do combination studies with their drugs. Merck has been a leader with multiple alliances studying Keytruda combined with targeted therapies. These include a deal with Pfizer looking at the combination of Keytruda with Xalkori to treat lung cancer, deals with Amgen looking at combinations of T-Vec in head and neck cancer as well as in melanoma, and a collaboration with Tesaro in breast cancer. Merck isn’t unique. AstraZeneca with its immuno-oncology agent, MEDI4736, has teamed up with Lilly to combine the latter’s anti-angiogenesis agent, Cyramaza, in treating solid tumors. BMS with Opdivo and Novartis with Zykadia are collaborating to study this combination in treating lung cancer. These and other such collaborations had been rare in the pharmaceutical industry, but they are occurring at an unprecedented rate in oncology R&D.
In many ways, these collaborations are terrific for cancer patients, physicians, and regulators. There are combinations being explored that previously would have only been done empirically by oncologists at the interface of research and medicine. With major companies now exploring these regimens prior to the drug approval process, all will understand the risk-benefit of the combinations before they are prescribed. More importantly, the value of these combinations versus current therapy will be better understood.
But, will payers also see a benefit? Perhaps this is a naïve view, but they might. Big Pharma already has a reputation issue. Pricing these combination at a range that makes access to them unaffordable will damage the industry’s image even more. Big Pharma understands this. One can, therefore, envision a scenario where an effective drug combination to treat lung cancer would not be priced at the cost of each component, but rather be set at a price LESS than either component alone. Why would this occur? Theoretically, the combination would be extending cancer patients’ lives for years not just months. Thus, companies would make up in volume what would be lost in price.
The spiraling costs of cancer drugs cannot continue. The creation of effective new combinations will greatly improve the treatment of cancer – and offer the potential of reduced costs as well.
Source: Forbes
