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A further strategy to combat the high price of anticancer drugs

Nature Reviews Clinical Oncology volume 14, page 629 (2017)Cite this article

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We thank Mr Gilbar for his interest in our Perspectives article (The high price of anticancer drugs: origin, implications, barriers, solutions. Nat. Rev. Clin. Oncol. 14, 381–390 (2017))1, and his expansion on the approaches to tackling the problem of the high prices of anticancer drugs (A further strategy to combat the high price of anticancer drugs. Nat. Rev. Clin. Oncol. http://dx.doi.org/10.1038.org/nrclinonc.2017.31-c1(2017))2. Mr Gilbar focuses on the issue of wastage that occurs when single-use vials of anticancer drugs are partially used, and the remaining drug discarded. As Mr Gilbar describes2, ways to minimize such waste include the availability of smaller vials or a greater range of vial sizes, the use of multi-use containers, and others. These solutions are reasonable and must be considered by physicians and policy makers.

We would like to highlight two additional strategies for reducing the unnecessary expenditure on anticancer drugs that have been proposed recently. Firstly, in June 2017, Goldstein and colleagues3 reported that personalized dosing of pembrolizumab at 2 mg/kg for patients with metastatic non-small-cell lung cancer would lead to annual savings of $825 million in the USA, compared with the use of this agent at a fixed dose of 200 mg. Secondly, interest in conducting clinical trials focused on lowering the dose of anticancer drugs without compromising efficacy is increasing. For example, the Value in Cancer Care consortium (http://www.vi3c.org/), a nonprofit organization inaugurated in May 2017, reported results of a pilot clinical trial demonstrating that lower doses of abiraterone (up to three-quarters lower than the standard dose) taken with a low-fat breakfast has similar efficacy in men with prostate cancer to the standard dose taken on an empty stomach4; the consortium are planning a larger follow-up study. Thus, we agree that improvements in the efficiency of anticancer drug dosing and administration can result in cost savings.

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References

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Authors and Affiliations

  1. Vinay Prasad is at the Division of Hematology and Medical Oncology, Department of Preventive Medicine and Public Health, Knight Cancer Institute, and Center for Health Care Ethics, Oregon Health and Science University, Portland, Oregon 97239, USA.,

    Vinay Prasad

  2. Kevin De Jesús is at Ponce Health Sciences University–School of Medicine, P.O. BOX 7004, Ponce, Puerto Rico 00716–2347, USA.,

    Kevin De Jesús

  3. Department of Medicine, Sham Mailankody is at the Myeloma Service, Memorial Sloan Kettering Cancer Center, SR-505N3, Scholars Building, 5th Floor, 1233 York Avenue, New York, New York 10065, USA.,

    Sham Mailankody

Authors
  1. Vinay Prasad
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  2. Kevin De Jesús
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  3. Sham Mailankody
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Corresponding author

Correspondence to Sham Mailankody.

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Competing interests

S.M. reports serving as a Principal Investigator of clinical trials with research funding from Juno Therapeutics and Takeda Oncology. V.P. and K.D.J. declare no competing interests.

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Prasad, V., De Jesús, K. & Mailankody, S. A further strategy to combat the high price of anticancer drugs. Nat Rev Clin Oncol 14, 629 (2017). https://doi.org/10.1038/nrclinonc.2017.137

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