Expensive new cancer drugs

From Stuff:

Revolutionary new drugs that could cure terminal cancer should be on the market here within a few years but patients will have to be “super rich” to afford them.

One four-dose treatment of the drug now under clinical trials costs about $140,000 while other ongoing courses can cost hundreds of thousands of dollars

That’s one real possibility, but there are others.

Firstly, the new drugs might not be all that good. After all, we had some of the same enthusiasm about angiogenesis inhibitors in the late 1990s and about selective tyrosine kinase inhibitors a few years later. The new immunotherapies look wonderful, but so far only  for a minority of patients. And we’re seeing their best side now, from trials stopped early for efficacy.

Alternatively, they might be too effective.  The adaptive immune system is kept under the same sort of strict controls as nuclear weapons, and for much the same reason — its ability to turn the battlefield into a lifeless wasteland. The most successful new treatments remove one of the safety checkpoints, and it’s possible that researchers won’t be able to dramatically expand the range of patients treated without producing dangerous collateral damage.

Finally, there’s the happy possibility. If we get evidence that inhibiting PD-1 and other T-cell checkpoints is safe and broadly effective, everyone will want to make inhibitors, and we’ll get competition. Bristol-Myers-Squib has a monopoly on nivolumab, but it doesn’t have a monopoly on immune checkpoint inhibition. This is already happening, as Bruce Booth reports from the ASCO conference

Most major oncology players have abstracts involving PD-1, including Merck, BMS, AZ, Novartis, Roche, and pretty much everyone else.  Other T-cell related targets like CTLA-4, TIM-3, OX-40, and LAG-3 round out the list of frequent mentions

The drugs still won’t be cheap, because each company will need its own clinical trials, but the development risk will be much lower and the margin for rapacious price-gouging narrower, so they won’t be $140000 per patient for very long.