New Prostate Cancer Therapies Raise New Issues

Lee Newcomer, MD

September 2010, Vol 1, No 4 - VBCC Perspectives


Prostate cancer patients have 2 new therapeutic options this summer with the approvals of sipuleucel-T and cabazitaxel. The former drug is an important scientific advance as one of the pioneering cancer vaccines to show a prolongation of survival. The latter is not a new scientific breakthrough, but it does offer another option for patients who have failed docetaxel.

Both drugs, however, spotlight the unsolved flaw in our national healthcare policy. The nation has not decided how much it is willing to pay for an additional year of life. Sipuleucel-T will cost $93,000 for the 3 required infusions and cabazitaxel is priced at $8000 per infusion. To put this in perspective, the average total cost of care for a prostate cancer patient at United Healthcare from diagnosis to death is $67,254. Treatment with just these 2 new drugs will increase the total cost of care by 210%. For that increased expenditure, those few patients fortunate enough to get a response would gain an additional 6.5 months of life.

Is that fair value? That decision is one for society to debate and decide. In the interim everyone will pay for the indecision with higher taxes and a higher premium for privately insured patients. Failing to address the issue is simply not sustainable.

In the interim, clinicians can help by being responsible stewards as they consider these therapies for patients. Sipuleucel-T was tested on a highly selected group of patients with a hormonally resistant disease, no visceral involvement, no opioid usage for 6 months, no chemotherapy for 3 months, opioid and an ECOG performance status of 0 or 1. The current manufacturing shortage will restrain off-label usage this year. Next year will be more challenging as the therapy becomes widely available. Using the therapy for patients who do not meet the precise indications is simply conducting a $93,000 clinical trial with 1 subject. It would be a waste of precious resources.

Second, patients should be monitored closely for progression with cabazitaxel therapy. It’s not often that insurers call for more testing, but at $8000 per treatment, a radiologic examination is an inexpensive way to ensure that the next treatment course is indicated.

Finally, these 2 drugs raise the question of regulation for pharmaceutical pricing. There is no competition for these products and the manufacturers are free to set any price they desire. In a free market where the patient was deciding how to spend his own money, this would be a fair practice. In today’s system, however, patients make the decision with the public’s money. Perhaps the public should decide what constitutes a fair price.