The decision to use expensive cancer therapies that typically produce only a relatively short extension of survival is a serious ethical dilemma in the U.S. that needs to be addressed by the oncology community, according to a commentary published online June 29 in the Journal of the National Cancer Institute.

Tito Fojo, M.D., Ph.D., of the Medical Oncology Branch, Center of Cancer Research at the National Cancer Institute, in Bethesda, Md., and Christine Grady, Ph.D., of the Department of Bioethics, the Clinical Center at the National Institutes of Health, tackle the controversy concerning the life-extending benefits of certain cancer drugs and the extent to which their cost should factor in deliberations.

The authors illustrate cost-benefit relationships for several cancer drugs, including cetuximab for treatment of non-small cell lung cancer, touted as “practice changing” and new standards of care by professional societies, including the American Society of Clinical Oncology.

They ask, “Is an additional 1.7 months [the additional overall survival for colorectal cancer patients treated with cetuximab] a benefit regardless of costs and side effects?”

According to Fojo and Grady, in the U.S., 18 weeks of cetuximab treatment for non-small cell lung cancer, which was found to extend life by 1.2 months, costs an average of $80,000, which translates into an expenditure of $800,000 to prolong the life of one patient by 1 year. At this rate, it would cost $440 billion annually, an amount 100 times NCI’s budget, to extend the lives of 550,000 Americans who die of cancer annually by 1 year.

To address the issue, the commentators recommend that studies powered to detect a survival advantage of two months or less should test only interventions that can be marketed at a cost of less than $20,000 for a course of treatment.

Every life is of infinite value, the authors say, but spiraling costs of cancer care makes this dilemma inescapable.

“The current situation cannot continue. We cannot ignore the cumulative costs of the tests and treatments we recommend and prescribe. As the agents of change, professional societies, including their academic and practicing oncologist members, must lead the way,” the authors write. “The time to start is now.”

Citation: Fojo T. and Grady C. How Much Is Life Worth: Cetuximab, Non - Small Cell Lung Cancer, and the $440 Billion Question J Natl Cancer Inst 2009, 101: 1-5.

Source:
Steve Graff

Journal of the National Cancer Institute

Lorus Therapeutics Inc. (TSX:LOR)(”Lorus”), a biopharmaceutical company specializing in the research and development of pharmaceutical products and technologies for the management of cancer, today announced a publication from investigators at the Ohio State University (OSU). The article entitled “A LC-MS/MS Method for the Analysis of Intracellular Nucleoside Triphosphate Levels” was published in the peer-reviewed journal, Pharmaceutical Research in the June issue (Vol. 26(6):1504-15).

In the article data was presented from studies using a novel analytical method. The results confirm pharmacological activity of LOR-2040, in five leukemia cell lines and in bone marrow samples of a patient with acute myeloid leukemia (AML) treated with LOR-2040 in a Phase II clinical trial. A significant decrease in intracellular deoxynucleoside triphosphate levels required for DNA synthesis in tumor cells treated with LOR-2040 confirmed the target inhibition effect of LOR-2040.

These studies were conducted by a clinical research team involved in the clinical trial of LOR-2040 and high dose cytarabine for treatment of refractory and relapsed AML, under the overall direction of Dr. Guido Marcucci and Dr. Kenneth Chan at the OSU Comprehensive Cancer Center.

“This method developed and validated by the OSU investigators has paved a novel way to monitor activity of LOR-2040 and could serve as a valuable tool to allow us to design improved treatment strategies,” said Dr. Aiping Young, Lorus’ President and CEO. “Continued collaboration with the OSU investigators is fostering unprecedented levels of understanding as to how LOR-2040 works and how this drug should be most effectively targeted to benefit cancer patients.”

About LOR-2040

LOR-2040 is an RNA-targeted drug that specifically targets the R2 component of ribonucleotide reductase, which is required for DNA synthesis and cell proliferation. Through downregulation of R2, LOR-2040 has demonstrated strong antitumor and antimetastatic activity in a variety of tumor types in both in vitro and in vivo models and is under study in a multiple Phase I/II clinical program, including an advanced Phase II clinical trial with LOR-2040 and high dose Ara-C (HiDAC) in refractory and relapsed Acute Myeloid Leukemia (AML). The R2 target has been described as a malignant determinant that is elevated in a wide range of tumor types, which can cooperate with a variety of cellular cancer causing genes known as oncogenes to enhance tumor growth and metastatic potential.

Source
Lorus Therapeutics Inc.

The International Diabetes Federation (IDF) called for urgent assessment and responses from regulatory authorities into a possible link between the use of insulin glargine (an insulin analogue) and increased risk of cancer based on findings published on 26 June, 2009 in Diabetelogia, the journal of the European Association for the Study of Diabetes (EASD).

The online data published in Diabetelogia is based on four studies relating to a possible link between a long-acting insulin analogue, insulin glargine and cancer. According to EASD, the findings are based on evidence from studies in Germany, Sweden, Scotland and the United Kingdom. The studies however, are not conclusive.

The International Diabetes Federation understands the concern about the Diabetelogia study findings but urges the diabetes community to wait for the current scientific information to be released and calls for urgent further scientific studies to be undertaken in other countries.

The International Diabetes Federation stresses that it is important that people needing insulin do not stop taking the drug. IDF cautioned that people with diabetes should see their doctor for advice before considering any change to their treatment.

Source
International Diabetes Federation