Millionaires, Rest Easy: New Melanoma Treatments Fit Your Budget

An exciting phase 3 study shows a combination immunotherapy treatment for advanced melanoma is better than anything ever devised, but as one renowned researcher points out, for most patients this treatment and others like it are so far beyond being affordable for the average patient that they can hardly even be considered options.

The gold standard in the front-line treatment of non-BRAF-mutated melanoma is ipilimumab (Yervoy), although calling it the 'gold standard' is an insult to gold and to standards because of how unsuccessful this single-agent therapy really is, since it only slows progression of the disease (progression-free survival, PFS) a median of about 2.9 months.

This most recent study has demonstrated that front-line therapy in the form of nivolumab (Opdivo) leads to longer PFS times when used as a single agent, and significantly longer PFS times when used in combination with ipilimumab.

Specifically, PFS is twice as long with nivolumab alone compared to ipilimumab alone. Given together, their PFS is almost four times longer compared to ipilimumab alone.

This is great news, and these are considered to be very important findings. But like all good news associated with Pharma these days, there's a catch: almost nobody can possibly afford both of these drugs.

Real Gold Has Nothing on These Drugs

Speaking at the annual meeting of the American Society of Clinical Oncology, researcher Dr. Leonard Saltz of Memorial Sloan Kettering Cancer Center told his audience that this new and exciting combination is completely beyond the average person's ability to afford it.

Here's the essence of the math he did.

• - Nivolumab costs $28.78 per mg.
• - Ipilimumab costs $157.46 per mg.
• - The average adult American weighs, unfortunately, about 80 kg.

"To put that into perspective," Medscape quoted him as saying, "that's approximately 4000 times the price of gold."

In the trial mentioned above and using the average adult weight, the cost of ipilimumab alone reached $158,282 (that's $158,282 to slow the progression of disease about 2.9 months. Keep in mind that progression-free survival has NOTHING at all to do with how long a patient actually lives and PFS does not necessarily extend survival times).

The cost of nivolumab alone was $103,220.

The combined cost was $295,566 (with a PFS of 11.4 months).

Dr. Saltz notes that for Medicare patients who have a 20 percent copay, this treatment amounts to an out-of-pocket expense of around $60,000.

The Seven Figure Treatment

Dr. Saltz also offered up an example of a million dollar cancer treatment coming soon.

In his example he conservatively dropped the weight of the average adult American from 80 kg to 75 kg.

Pembrolizumab (Keytruda) is an immunotherapy drug very recently approved to treat melanoma. It was approved for use at a dose of 2 mg/kg, which costs a staggering $14,500 per month.

But researchers are now running trials in which patients are receiving five times that amount, or 10 mg/kg.

This new higher dosage costs $83,000 per month.

Thus the patient who weighs 75 kg and who receives the higher dose of pembrolizumab would be looking at an annual cost of no less than $1,009,944.

"This is unsustainable," he concluded.

Dr. Saltz is no stranger to attacking Pharma for their absurd pricing schemes, which have nothing to do with value and everything to do with charging what the market can bear. In 2012 he and two others from Memorial Sloan Kettering wrote an amazing op-ed in the New York Times explaining why they were refusing to prescribe a new drug, Zaltrap, for their patients because it was so expensive and no one had ever proven that it was any better than the existing options.

Source: Medscape

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