The past decade saw the development of several new therapies for non-small cell lung cancer (NSCLC), but little survival benefit for patients with advanced-stage disease, according to a new study led by researchers at the University of Colorado Cancer Center.
The study, published in the Journal of Clinical Oncology, is titled “Antineoplastic Treatment of Advanced-Stage Non–Small-Cell Lung Cancer: Treatment, Survival, and Spending (2000 to 2011).”
The authors of the study analyzed 22,163 people who were treated for NSCLC between 2000 and 2011 with novel approved therapies, including pemetrexed, erlotinib or bevacizumab, and found that patient survival increased an average of only 1.5 months.
Since these therapies replaced older methods, like chemotherapy, and there was a declining trend in performing surgeries at the time, spending fell about $5,600 per inpatient, but this was more than offset by the cost of these new therapies, which increased outpatient costs by an average of $8,800 per person.
“As new therapies were introduced, they were rapidly adopted and the old therapies were abandoned. Across the population in the past 12 years, these newly approved therapies have made little difference in overall survival,” Cathy Bradley, PhD, associate director for population sciences research at the Cancer Center and lead author of the study, said in a press release.
The team did not look only at the optimal application of these new therapies, as would happen in clinical trials; instead, they analyzed their use in the real world. For instance, some of these targeted therapies are only useful when targeting a certain cancer with a specific biomarker, but doctors prescribe them regardless of a patient’s biomarkers.
“Take erlotinib,” for instance, Bradley said. “A patient’s tumor must by marked by EGFR for it to be beneficial. But when some patients reach the end of their established options, some oncologists may prescribe erlotinib without the EGFR biomarker in hopes that the patient will benefit,” she said.
That type of decision might turn out costly as patients with cancer are 2.5 times more likely to report going bankrupt than cancer-free patients, according to the study. In an era when drug prices are rising continuously and patients are faced with increased financial burdens, treatment might easily reach $30,000 to $40,000 in out-of-pocket expenses per person.
“When you talk with patients, leaving their family in financial distress is an important concern,” Bradley said.
For the new therapies and the companies selling them, Bradley identifies the main challenge, which is to optimize the therapies’ value by using them only in the patient population that is most likely to benefit from them. This would also help patients to be better informed about treatment-associated costs that may have little to no impact on their survival.
“What we see here doesn’t definitively mean these drugs are unsuccessful. It means that despite their promise in clinical trials, they haven’t made a survival difference in the population. That may be because oncologists are giving them to people who will not benefit. Better predicting who will benefit from newer more expensive therapies is essential to making value-based decisions in the context of very high costs and new medicines,” Bradley concluded.