How much is a month of life worth?
It's the kind of question that was troubling doctors who treat cancer as the American Society of Clinical Oncology (ASCO) opened its annual meeting today.
The organization has "been very concerned about the rising cost of cancer care," ASCO's president, Dr. Richard Schilsky, told reporters.
Concern is so high that ASCO is now pressing members "to address this issue with patients," he added.
Consider one of the meeting's first presentations, involving the chemotherapy agent pemetrexed (brand name Alimta).
Researchers reported that maintenance treatment with pemetrexed (Alimta) added about three months to overall survival in patients with advanced, non-small cell lung cancer (NSCLC) whose disease had not progressed on platinum-based therapy.
Patients who received pemetrexed, plus intense supportive care, survived just over 13 months compared with 10.6 months for controls, said Dr. Chandra P. Belani, deputy director of the Penn State Cancer Center.
Belani said this is the type of finding that would change clinical practice. But such a change would be expensive.
The estimated cost per treatment cycle of pemetrexed is $3,900, compared to $1,664 for docetaxel (Taxotere), according to a 2004 comparison published in Nature Reviews Drug Discovery .
Before FDA approval of pemetrexed, docetaxel was considered the standard for recurrent NSCLC.
A year ago initial reports from the pemetrexed study -- which randomly assigned 441 patients to pemetrexed and 222 to placebo -- found that pemetrexed increased progression-free survival. But those early data did not demonstrate a significant increase in overall survival.
With a longer follow-up, the survival benefit has emerged but it's still measured in months, not years.
Pemetrexed-treated patients also experienced significantly more treatment-related toxicities -- 16 percent versus 4 percent among controls. The most common side effects were fatigue (5 percent) and a low white blood cell count (2.9 percent). But toxicities did not increase or worsen with duration of therapy. There were no pemetrexed-related deaths.
The study was funded by Lilly, which developed and markets pemetrexed. Belani said disclosed that she worked as a consultant or advisor to Eli Lilly and has also received honoraria from Eli Lilly.