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High drug costs (and stock values) take center stage at final day of ASCO

High drug costs (and stock values) take center stage at final day of ASCO

costs of healthcare

For the past few days we’ve been keeping a close eye on the news coverage coming out of the annual meeting of the American Society of Clinical Oncology (ASCO), the world’s largest cancer research conference:

Small studies get big headlines at ASCO 2017
6 things to keep in mind if you read cancer-related news in the next few days

The theme of this year’s conference was “making a difference in cancer care with you.” Yesterday the embargo lifted on a few more studies that ASCO had highlighted for newsworthiness, and right away we noticed an interesting and encouraging pattern emerge, particularly from attendees at the conference, and the financial news media: Diverging from the hopeful tone of the PR materials, both groups often zeroed in on the extravagant costs and the often marginal benefits of new treatments.

Dr. S. Vincent Rajkumar, a Mayo Clinic internist specializing in hematology and oncology, commented on all the cost chatter at the meeting. His viewpoint was echoed by Greg Matthews, managing director of MdigitalLife, which tracks digital healthcare trends.


Breast cancer drug study showcased by ASCO PR team

costs of healthcareThis trend was also apparent with the news coverage for a breast cancer study showcased at the meeting (via a news release, embargoed abstract and a media briefing). The study focused on a combination treatment for women with HER2-positive early-stage breast cancer. The treatment combined a newer drug pertuzumab (marketed as Perjeta and approved in 2012) with an old drug, trastuzumab (Herceptin), which received FDA approval in 1998.

This combo of Perjeta-Herceptin was given to one group of women, while a second group–the control group–received only Herceptin.

To its credit, the ASCO release, “Adding a second HER2 blocker may lower chance of invasive breast cancer for some women,” had some cautious notes, and was upfront that there wasn’t a big absolute difference between the two groups. Specifically, after three years “an estimated 94.1% of patients in the combo group were free of invasive breast cancer, compared to 93.2% of patients” in the control group, according to the release.

That’s a difference of less than 1%.

But it goes on to claim that the combined Perjeta-Herceptin treatment provided “a 19% lower chance of developing invasive breast cancer” than the old drug Herceptin alone. That’s just a different and potentially misleading way of framing the 1% difference that was already thoroughly described using absolute numbers. Why include the 19% figure at all when it may only serve to exaggerate the drug’s very modest benefits?

Early on it also downplays the side effects of the combo treatment, making it sound like the combo group didn’t have an increased risk of serious side effects than the control group. Later on, at the end of the release, though, we learn that isn’t quite accurate when it came to heart failure or heart-related death (occurred in .7% of patient in the combo group vs .3% in the control group) and severe diarrhea (9.8% of the combo group, compared to 3.7% of the control group).

Financial media push back

Fortunately, the financial and business news media pushed back, leading to some excellent coverage that will benefit patients, even if they aren’t the targeted audience.

In particular, Bloomberg News’s story was excellent. “Roche’s Pricey New Breast-Cancer Combo Barely Beats Old Drug” focused on the questionable benefits in its headline, and in the article itself.

“Adding Roche’s new medicine Perjeta to Herceptin — which could double the current monthly cost of $6,100 — resulted in about 1 percentage point of improvement in the proportion of women who lived at least three years without tumors returning. For patients with less severe cancer, where tumors hadn’t spread to the lymph nodes, Perjeta didn’t help at all.”

As well, the Wall Street Journal took a close look at the cost of the drug combination and questioned its value versus the marginal benefit in its article, “Study Questions Value of Costly Cancer-Drug Combinations.

Many other outlets wrote about the study, as well:

Fortune: Roche Loses Billions in Value After Pricey Breast Cancer Drug Combo Disappoints
Financial Times: Roche suffers blow over breast cancer combination therapy
Forbes: Roche Drug Helps Keep Breast Cancer In Remission, But Tiny Benefit Stokes Hopes For Rival, Puma

All of the stories are geared at investors. And the focus on investor benefit–and not patient benefit–can be unsettling for some.

“It’s been interesting to see how various media outlets and other organizations have covered this study,” said Deanna Attai, MD, a breast cancer surgeon and frequent HealthNewsReview.org contributor who attended ASCO. “The Bloomberg story was certainly comprehensive, interviewed multiple sources, and teased out subgroup responses.”

But, she added, “I’m not really a fan of commenting on the stories that approach things from the financial aspect.”

She’s not alone. Ricardo Carvalho, medical oncologist of BP Mirante Hospital in São Paulo, Brazil, tweeted:

We can certainly empathize, but regardless, at least the coverage was critical and scrutinized the findings. Too often journalists don’t dig deep enough, and instead just repeat the talking points of news releases.

That didn’t happen here. It may be a small victory, but we’ll take it.

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Updated: June 6, 2017 — 9:00 pm

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