News of a new weapon in the "War of Cancer" raged across the internet last week with the publication of a paper in the New England Journal on vemurafenib, an immune system-targeting drug used in cases of advanced melanoma. Heretofore, prognosis of patients with stage IV melanoma has been dismal, at best. Most die within 6-10 months. Various attempts over the past 15 years to improve survival with the likes of chemotherapy or immune-modulating drugs such as interferon have miserably failed to meet expectations. Paul Chapman's group at Sloan Kettering trumpets the fact that, at 6 months, 84% of participants using vemurafenib were alive compared to 64% who took the chemo agent dacarbazine.
This paper was presented at the American Society of Clinical Oncology and the resultant fanfare would have you believe Jonas Salk himself had announced a cure for the common cold. Here's a sampling of headlines from major media outlets covering the presentation:
'Time to Celebrate'; New Metastatic Melanoma Agent Wows ASCO
Drugs hailed as a 'major breakthrough' in treating deadly skin cancer
The Biggest Skin Cancer Breakthrough In 30 Years
Skin cancer 'wonder' drugs that could offer years more life in biggest breakthrough for 30 years
---Daily Mail (UK)
Pretty exhilarating, no? But let's take a look at the actual data. At six months, 84% of patients on vemurafenib were alive compared to 64% on the other standard chemo agent, dacarbazine. Based on this modest 6 month improval, the patients in the dacarbazine group were then switched over to vemurafenib for "ethical" reasons. So there is no data on longer term efficacy or median survival. Since the patients were switched, we'll never know if survival at 12 months, 18 months, or even two years is any different between the two drugs. Isn't that something that would be interesting to know? Furthermore, the results show that less than 50% of patients even responded to vemurafenib. And close to 40% of patients experienced toxic side effects incapacitiating enough to mandate dose modification or even outright temporary cessation of the vemurafenib.
The cost of the drug has not been released but a similar medication, Yervoy, retails for close to $120,000 for a one year course of treatment. Presumably, verumafenib will cost somewhere in this neighborhood.
Now I don't want to belittle the scientific achievement that vemurafenib represents. Being able to manipulate the expression of certain viral and neoplastic proteins at the genetic level is an exciting new frontier. But let's not confuse modest, incremental scientific advancement with real life efficacy. The headlines suggest a quantum leap in medical insight and intervention; which is misleading at best and perilously close to fraudulent misrepresentation at worst.
When it comes to late stage cancer, these pharmaceutical firms and the doctors doing the research have a major financial stake in promoting these newer drugs. Billions of dollars are in play. But this misleading propaganda campaign shamefully exploits a very vulnerable, desparate patient population....