Envisioning Cancer as a Chronic Disease
The American Society of Clinical Oncology (ASCO) meeting begins this weekend in Chicago. It promises to be an exciting meeting with 4,000 clinical studies being disclosed covering a wide variety of topics. All are critical to the future treatment of cancer including new drugs for melanoma, lung cancer, and kidney cancer, new biomarkers to identify the cause of one’s cancer and genetic markers to help design specific treatments for certain cancers. The scientific breakthroughs that will be discussed at this meeting dwarf what was known about this disease a decade ago.
In fact, many researchers now believe that, much like the case with AIDS, we are not far from the time when a cancer diagnosis will not be a death sentence but rather a diagnosis of a chronic disease, one that might not necessarily be cured but rather be treated with a variety of medications which will keep one’s cancer in check. As AIDS patients are treated with a combination of drugs, so too, will cancer patients be treated. Getting to this point will be the result of decades of research and billions of dollars in investment. But what a wonderful situation for patients.
The new cancer medications are expensive and annual costs can range anywhere from $10,000 to $100,000. Furthermore, multiple drugs will be needed to keep one’s cancer in check; perhaps a patient will be on a drug specifically designed to stop cancer cells from proliferating in her breast, another drug designed to prevent the breast tumor from growing new blood vessels thereby starving it and finally a third drug designed to help her own immune system to fight the disease. (This is not a fantasy – there are now drugs on the market that do all of this.) And there are not just 10 or 20 such drugs in clinical development – there are close to 1,000! Not all of these will make it through FDA approval and the market. But the odds are that 100 or more might. These drugs will be specific not for a broad disease such as breast cancer but for a specific subtype of breast cancer – great examples of designed drugs. But these drugs, too, will be expensive.
This welcome news for cancer patients, unfortunately, poses a potential problem for healthcare systems. Conversion of cancer from a fatal disease to a chronic one means that many people (millions?) will be living for 10, 20, 30 years on expensive medications. One can begin to do the math and show the tremendous burden that such costs will add to an already high health care bill for governments and other payers. One can argue that, as the cancer survivor population grows, paying for its medicines will become unsustainable. How does one get to a situation where all patients will be able to get life-saving medications?
The companies that will be successful in this field will be ones that can “bundle” the medications needed to treat certain cancers. Thus, it will behoove companies to develop, either internally or through alliances, the best drugs to treat certain cancers. By having these multiple agents in hand, one can envision a scenario where a company can work with healthcare providers to deliver triple therapies at a reasonable cost. There is evidence that such positioning is already happening. BMS and Roche recently have joined forces to combat melanoma. They have agreed to fund clinical studies that combine BMS’s recently approved melanoma drug, ipilimumab, with Roche’s late stage clinical compound, vemurafenib. Both of these attack melanoma in different but potentially complementary ways. Theoretically, the combined therapy should be far more effective than either is alone. Perhaps it is naïve to assume that, should this combined therapy be successful, the cost of this combination would not be additive but rather be lower than the cost of each individually. Nevertheless, one would expect more such joint ventures in the future and as multiple cancer treatments emerge perhaps competition will help drive down price.
The “War on Cancer” has been waged for decades. Now that it appears that the control of this disease is possible, it is imperative to find business models which allow for patients to be treated with medications and protocols that don’t bankrupt the healthcare system.