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Study questions value of costly cancer-drug combinations

Monday, June 5, 2017

This is an excerpt of a story that appeared in the Wall Strett Journal. Read the full article here

Eleni Andreopoulou, M.DEleni Andreopoulou, M.D. A new study is stirring debate about whether the benefits of cancer drugs are worth their cost, particularly as drugmakers develop treatments that combine multiple pricey drugs.

The study of about 4,800 women with an aggressive type of breast cancer found that adding Roche’s drug Perjeta to the company’s older treatment Herceptin conferred a slight benefit versus Herceptin alone, after the women had undergone surgery to remove tumors. Some 94.1% of women receiving the combination in the study stayed free of invasive breast cancer three years after the start of treatment, versus 93.2% of those who received Herceptin alone—a difference of less than a percentage point.

That modest benefit comes at a high price: more than doubling the one-year treatment cost to $158,000 a patient from $74,500. The combination also had higher rates of certain side effects than Herceptin alone, including severe diarrhea.

“The marginal improvement of adding Perjeta is tiny for the average person, but the incremental cost is going to be substantial,” said Richard Schilsky, chief medical officer of the American Society of Clinical Oncology, which is hosting a conference where the study results were released Monday. He wasn’t involved in the study.

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Roche said the benefit of Perjeta and Herceptin in the new study could mean the difference between relapse and staying disease-free for many women. “We see this as a very meaningful benefit,” Daniel O’Day, CEO of Roche’s pharmaceutical unit, said in an interview. The company plans to file for regulatory approval to market the combination for patients after breast-cancer surgery, also known as adjuvant treatment.

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Some doctors said they would probably avoid using the Perjeta-Herceptin combination in patients at lower risk of relapse.

“Would I have preferred to see a higher benefit? Certainly yes,” Eleni Andreopoulou, a breast-cancer specialist at Weill Cornell Medicine and NewYork-Presbyterian hospital, said in an interview. Dr. Andreopoulou, who enrolled patients in the study but wasn’t a lead researcher, called it a positive result but said she would like to see more tests developed to predict which patients are more likely to benefit from the combination based on biological traits of tumors, and which aren’t.

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