9 ms·

Lung cancer pill cuts risk of death by half

284 points by bichonnages 3y ago

ulfw 3y ago
Can someone explain the numbers to me? "After five years, 88% of patients who took the daily pill after the removal of their tumour were still alive, compared with 78% of patients treated with a placebo. Overall, there was a 51% lower risk of death for those who received osimertinib compared with those who received placebo." So 88% instead of 78% without the pill were still alive five years on. I assume that is the maximum range they could test. How was the 51% then calculated? Edit: thank you all for the explanation. That makes a lot of sense!
- fithisux 3y ago
  The article makes the assumption that those that took the placebo represent the typical post removal patient (an assumption). So, for 100 untreeated patients 22 would die. Now for these 100 placebo patients, if they took the pill, they would die 12 (another assumption that the two populations are the same). The reduction is (22-12) / 22 = 10/22 is the risk of death if untreated. The complementary percentage is 12/22 approx 51%. However this does not come with confidence intervals.
- teraflop 3y ago
  If 22% of patients in the placebo group died, and 12% in the test group, then that's a reduction of 1 - (12/22) = 45% in the risk of death over that time interval. The true value could easily be 51% if the percentages reported in the Guardian were rounded.
  - cjbgkagh 3y ago
    You could subtract both percentages by the baseline average risk of death for 5 years at the age group that people are most likely to get this type of cancer.
- deleted 3y ago
  [deleted]
- deleted 3y ago
  [deleted]
- dullcrisp 3y ago
  22% of those who took the placebo died versus 12% with the medication. Seems it’d be a 45% improvement with those numbers.
- adriand 3y ago
  If you think about the numbers as 12% died vs 22% died, then the 51% intuitively makes more sense, although I don’t know if this is the correct explanation. My guess is that 12 and 22 are rounded numbers.
- evandijk70 3y ago
  Based on the abstract of the article https://www.nejm.org/doi/full/10.1056/NEJMoa2304594?query=featured_home https://www.nejm.org/doi/full/10.1056/NEJMoa2304594?query=fe..., I actually think the other explanations are wrong. They are probably reporting the Hazard Ratio, which is more often used as primary outcome for efficacy of drug than 5 year survival. (See for example: https://en.wikipedia.org/wiki/Hazard_ratio https://en.wikipedia.org/wiki/Hazard_ratio) The hazard ratio, under some assumptions, tries to estimate the relative risk of dying per unit of time. The benefit of this measure is that there is not some artificial cutoff (the difference between a death at 4 years and 364 days and 5 years and 1 day is neglible).
pfdietz 3y ago
In lung cancer with a particular mutation.
- znpy 3y ago
  Still a good news
chrisamiller 3y ago
This is a great example of where cancer treatment is headed and why it's so hard - namely that cancer isn't one disease, it's many thousands of diseases. This is a drug that targets lung cancer (~12% of cancers) and only one type of lung cancer (non-small cell lung cancer, ~80% of cases). It targets a particular mutated gene that occurs in about 30% of that subtype. And then, about 50% of those patients respond. So do that math, and you end up seeing that treating one of the most common mutations in one of the most common cancers with what is considered very high efficacy still only helps with about 1.4% of all cancers. This is actually an enormous number for this kind of treatment, and there is a long tail of rare cancers that are going to be much harder to find targeted therapies for. That all said, this currently appears to be an enormous success story, and the kind of treatment options that have been enabled by genomic sequencing of cancers, followed by many years of drug development and clinical trials. It's fantasically exciting to see us continue to chip away at the problem but by bit and grant people longer lives as a result!
- semenko 3y ago
  Agreed! This specifically is for adjuvant osimertinib for EGFR+ Stage IB–IIIA completely resected NSCLC. The headline here is really strong -- and the actual abstract is much more sober: "5-year OS rate was 88% with osimertinib vs 78% with placebo" [Full abstract is here: https://meetings.asco.org/abstracts-presentations/219805 https://meetings.asco.org/abstracts-presentations/219805 ] P.S. Hi Chris! (I think I picked up a summer student from you last week!)
  - haldujai 3y ago
    Very sober given the costs and %age of patients who didn’t receive adjuvant chemo in the initial trial. Interested to see their detailed results but I’m mildly suspicious this will be AstraZeneca PR buffing underwhelming results.
- earthbee 3y ago
  1.4% of all cancers is still a huge number of people helped in absolute numbers given around 40% of people will get cancer.
kman82 3y ago
[flagged]
MeteorMarc 3y ago
These kind of medicines can easily cost 100k euro pp per year.
uxp100 3y ago
My mother is on what sounds like a similar pill (in result, if not mechanism of action) for a different cancer. Had a poor prognosis, genetically tested several times and after a few rounds of conventional chemo the test indicated she could take a daily pill. It’s wonderful, I’m so glad she is alive for her grandchild, for me, and for herself of course. I think she will probably still die “of” her cancer but at this point it has completely stopped the progression of it for several years. The side effects are a bit weird, and a bit bad, but not even THAT bad. Really came out of the blue for us, an unexpected outcome.
xivzgrev 3y ago
My mother in law has stage 4 lung cancer. Tagrisso is extending her life. The cancer has been shrinking since going on it with few side effects. Unfortunately stage 4 cannot be cured, and at some point tagrisso stops working. My understanding is the cancer mutates and eventually develops resistance. Then she will go on chemo and her quality of life will go down. I am thankful for modern medicine that we get some extra time with her.
- dangwhy 3y ago
  My father is in this situation with prostate cancer. First line therapies have stopped working and now its on to chemo. I am hoping chemo won't damage him too much. There are also radioligand therapies like lutetium 177 but they haven't been sequenced on chemo naive patients yet. So soc is chemo first.
  - haldujai 3y ago
    I wasn’t involved in this study but the cancer center I just left was one of the sites for the upfront Lu177 vs chemotherapy trial. Speaking casually with the physician involved recently he said the results weren’t promising thus far. I don’t think this is published yet and I’m not familiar with prostate ca treatment literature so take this with a grain of salt.
    - dangwhy 3y ago
      my father is in india where they've been giving lu177 ( and others) before chemo for quite a while ( other countries being germany and australia ) . Forums are awash with 'success stories' . There are many clinical trials currently in US and canada. Some have published results showing 'non inferiority' in small sample sizes but most are in progress https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627907/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627907/ https://clinicaltrials.gov/ct2/show/NCT04647526 https://clinicaltrials.gov/ct2/show/NCT04647526 this one was supposed to publish some preliminary results in q1 2023 but i don't see any updates :/
      - 3y ago
haldujai 3y ago
The data isn’t published yet (presumably this was shown during the ASCO conference this weekend) but this is a bit misleading and the results seem underwhelming. The DFS numbers are not new and known, the reason this is in the news as it’s the first report of OS numbers from the initial ADAURA trial. I can’t be definitive without seeing the data yet but: 1. Osimertinib is not that new, in the context of curative intent disease (i.e. resectable stage II-IIIA) it is currently (ideally) used post adjuvant chemotherapy (the only treatment to date with an overall survival benefit). We need clarification on what the placebo arm is and what the subgroup analysis showed. What it should be (and presumably) is an “active surveillance protocol” where patients underwent short course adjuvant platinum based therapy and then followed with imaging. Recurrences are then treated with systemic or locoregional therapy. As this is an update of the ADAURA trial we know that only 40% of patients received the standard of care platinum adjuvant therapy, this article claims an OS benefit was seen in all groups but we don’t have the numbers for the subset of patients who received appropriate adjuvant treatment. 2. Main criticism of the ADAURA trial thus far has been that the results only report “disease free survival”, while that intuitively makes sense as a metric what we really care about is “overall survival”. There are several reasons but to keep it simple this is now the third generation tyrosine kinase inhibitor, the first 2 also had DFS improvements (albeit not as dramatic) but failed to show OS benefits. 3. Osimertinib is expensive. Following the ADAURA protocol (3 years of adjuvant therapy) would have an incremental cost (ICER) somewhere around ~$3-450,000 per patient. “Willingness to pay” is variable, in most places it’s $50,000/quality adjusted life year. Some in the US are pushing for this to be ~$190,000/QALY (3x GDP). Based on extrapolated DFS and earlier OS data in the last year it was estimated that the OS would be around 5-6%, based on this threshold a system would need a willingness to pay of ~$320,000/QALY. Conversely, to meet the GDP threshold above OS would need to be ~20%. In a recent Canadian economic analysis they modelled 6% OS at 10 years and arrived at a ICER of ~$40,000 suggesting this protocol makes economic sense. To my knowledge this is the first report suggesting cost effectiveness and contradicted the Health Canada modelling. 4. Based on this news article, there was an absolute reduction in OS of 10% at 5 years which seems underwhelming given that we know most of the patients did not receive adjuvant platinum based chemotherapy, the OS in the subgroup that received both treatments is what matters here. From the US analysis, this would still not meet the willingness to pay threshold. The Canadian one would need to be re-run with 5 year numbers to see what the ICER is. Overall, it’s potentially a very positive result but at face value the OS numbers seem less impressive than anticipated. If someone has the $ and an EGFR ex19 mutation there is definitely benefit but it remains unclear whether this is cost-effective for a system vs other treatment options we have. (N.B. These numbers are approximate from my recollection of the literature but I can dig up references if something seems off. For background I’m a radiologist focused on oncologic imaging, this has been a hot topic in rounds/case conferences for a few years now hence my familiarity.)
phneutral26 3y ago
To late for Whalter White, sorry, I mean Heisenberg. :(
faangguyindia 3y ago
I just wonder how we've not been able to make a drug to increase lean mass without negative effect on cardiovascular system
- smileysteve 3y ago
  Aspirin, Creatine, l arginine, coq 10, ozempic
  - GenerWork 3y ago
    Out of all of these, creatine is the closest thing to what OP was describing, but even then it doesn't affect lean mass, it just draws water into muscles and increased endurance.
  - lagniappe 3y ago
    L-Argenine is huge for me in competitive cycling. Among many effects, it allows more oxygen to get to my muscles, which can double my range and substantially increase my speed.
- thebigjewbowski 3y ago
  https://en.wikipedia.org/wiki/Enobosarm https://en.wikipedia.org/wiki/Enobosarm I’d read some research about this a couple years ago and didn’t remember seeing anything about effects on the cardiovascular system but that does seem like a possibility
- SnowHill9902 3y ago
  Increase your natural T. Doubt you maxed it.
phtrivier 3y ago
The pricing of drugs is always weird to me. Is there a good book / article / primer on why a drug can cost the price of a good house per person ? Is it just about recouping R&D, does manufacturing requires very rare raw materials, is the bill going up because of regulation, etc... ? How big a check would a government have to do to just "buy" the rights to a drug ? (Both in the "legal" and in the "an offer the CEO can't refuse" version ?)
- evandijk70 3y ago
  All of the above, but my guess would be that the most expensive part is usually running the phase III clinical trial. You have to pay data managers to perform the randomization, train doctors and nurses to administer it, and the hospital for the added time it takes them to run the trial, pay the statisticians that perform the analysis, an agency that helps prepare the application, etcetera. You have to recruit patients, gather informed consent (though that is sometimes done by doctors and nurses). Also, you have to give the drug for free, since insurance companies do not cover experimental drugs. Sometimes patients also receive a fee for participating in the trial. All in all, the median cost of pivotal trials is 50 million dollars. This is the cost after you already did studies to discover the drug, and determine the dosage. Half of these trials fail, and all the previous investments are lost in that case. [1] https://bmjopen.bmj.com/content/10/6/e038863 https://bmjopen.bmj.com/content/10/6/e038863
- yieldcrv 3y ago
  the pricing is partially due to a lack of collective negotiation the government programs carry a lot of weight as a large client but are currently barred from negotiating on prices part of some US universal healthcare proposals are to just allow existing government programs to negotiate on prices, while simultaneously extending coverage to more people
  - qwytw 3y ago
    It costs about $7000 in Europe (the price seems to be similar in different country even though there is no EU wide collective negotiation). The price in the US seems to be around double in the US. But maybe that just pharma companies do PPP adjusted pricing? e.g. it seems to cost ~1500 in India for instance. Americans are simply much richer and also significantly more on healthcare than people in other countries.
breck 3y ago
> After five years, 88% of patients who took the daily pill after the removal of their tumour were still alive, compared with 78% of patients treated with a placebo. My chance of living 5 years goes from 78% to 88% by taking an expensive pill everyday with side effects? That's not an amazing thing. If it was 78% to 95% with one or two pills, or a positive healthy lifestyle change, then that's something. I'm going to push back and say this is garbage. The fact that this is being billed as "thrilling" and "incredibly positive" makes me want to puke. This is par for the course in the cancer industry. I'm going to call this what it is: an advertisement for two crappy new lines of business. First, we have a new genetic testing business: "Not everyone diagnosed with lung cancer is tested for the EGFR mutation, which needs to change, Herbst said, given the study’s findings." Cha-ching! Then, we have the actual new business of the pill. What are they going to charge, $50,000 a year? Imagine if you could choose 2 options: 1. Take a pill everyday. Have side effects. Pay $250,000 2. Don't take a pill. No side effects. Keep the $250,000 If that was the choice I'd bet people in group #2 live longer. This isn't science or medicine, this is advertising. Pardon my bluntness, but sometimes anger is necessary to get people to wake up.
- ProjectArcturis 3y ago
  Far too cynical. You are incredibly uninformed about the significance of this drug.
  - breck 3y ago
    I could be wrong. Absolutely. I am always open to more information. However, I'm usually not wrong about these things. This pattern is so common in big pharma it's an easy bet right now. Based upon the limited information released I would bet: 1) it has high odds of being very lucrative for a small number of people 2) it will be a net negative for patients^ ^ Patients would be better off with more money and using an alternative treatment strategy. This drug is priced at $12,750 per month, according to Wikipedia.
    - dennis_jeeves1 3y ago
      >I could be wrong. Absolutely. I am always open to more information. You really need not be apologetic, being too 'open' to repeated nonsense from the same entities (big pharma in this case) is not a good thing either.
activiation 3y ago
I thought that death risk was 100 percent, no matter what
- mhh__ 3y ago
  99% of all non-smokers die
  - activiation 3y ago
    You need to update those stats
Teslazar 3y ago
According to the CDC, 80-90% of lung cancer deaths are linked to cigarette smoking (1). It seems like a simple solution for people to just not smoke... (1) https://www.cdc.gov/cancer/lung/basic_info/risk_factors.htm#:~:text=This%20animated%20infographic%20shows%20the,90%25%20of%20lung%20cancer%20deaths https://www.cdc.gov/cancer/lung/basic_info/risk_factors.htm#....
- thangalin 3y ago
  'Nicotine releases a chemical called dopamine in the same regions of the brain as other addictive drugs. It causes mood-altering changes that make the person temporarily feel good. Inhaled smoke delivers nicotine to the brain within 20 seconds, which makes it very addictive—comparable to opioids, alcohol and cocaine. This "rush" is a major part of the addictive process. 'When the person stops using tobacco, nicotine levels in the brain drop. This change triggers processes that contribute to the cycle of cravings and urges that maintains addiction. Long-term changes in the brain caused by continued nicotine exposure result in nicotine dependence, and attempts to stop cause withdrawal symptoms that are relieved with renewed tobacco use.' https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/nicotine-dependence https://www.camh.ca/en/health-info/mental-illness-and-addict...
  - qwytw 3y ago
    There are other ways to consume nicotine which are much less harmful.
    - fulafel 3y ago
      Same for lots of dependence causing substances, effects are greatly varied by delivery mechanism. Eg heroin pills used to be quite common over the counter and weren't considered a hard drug.
      - qwytw 3y ago
        Vaping should be about as efficient if not more than smoking? Probably not something we should encourage but still way safer than inhaling smoke.
rob74 3y ago
Halfway through the article, they spell out what they mean by "cuts risk of death by half": > After five years, 88% of patients who took the daily pill after the removal of their tumour were still alive, compared with 78% of patients treated with a placebo. ...which is still remarkable, but doesn't sound quite as good as "cutting by half".
- ieeamo 3y ago
  After 5 years, (i) Placebo: 22% mortality, (ii) Daily Pill: 12% mortality. 45% reduction in 5-year mortality. Quite close to “cutting by half”
hentrep 3y ago
I’m writing this live from the ASCO meeting where this was just presented. Osimertinib (TAGRISSO) has truly transformed the way we treat EGFR-mutant NSCLC, having repeatedly redefined standards of care. I don’t have a source handy, but osi used to hold a record in oncology as being the fastest drug to go from IND (trial-enabling) to approval - less than 18 months. Osimertinib did $5.44B in global sales last year, leading AstraZeneca’s oncology portfolio [0] [0] https://www.astrazeneca.com/content/dam/az/PDF/2022/fy/Full-year-and-Q4-2022-results-announcement.pdf https://www.astrazeneca.com/content/dam/az/PDF/2022/fy/Full-...
cutler 3y ago
In other news shares in Marlborough saw hockey stick growth.

284 points by bichonnages 3y ago

ulfw 3y ago

Can someone explain the numbers to me? "After five years, 88% of patients who took the daily pill after the removal of their tumour were still alive, compared with 78% of patients treated with a placebo. Overall, there was a 51% lower risk of death for those who received osimertinib compared with those who received placebo." So 88% instead of 78% without the pill were still alive five years on. I assume that is the maximum range they could test. How was the 51% then calculated? Edit: thank you all for the explanation. That makes a lot of sense!

fithisux 3y ago
The article makes the assumption that those that took the placebo represent the typical post removal patient (an assumption). So, for 100 untreeated patients 22 would die. Now for these 100 placebo patients, if they took the pill, they would die 12 (another assumption that the two populations are the same). The reduction is (22-12) / 22 = 10/22 is the risk of death if untreated. The complementary percentage is 12/22 approx 51%. However this does not come with confidence intervals.
teraflop 3y ago
If 22% of patients in the placebo group died, and 12% in the test group, then that's a reduction of 1 - (12/22) = 45% in the risk of death over that time interval. The true value could easily be 51% if the percentages reported in the Guardian were rounded.
- cjbgkagh 3y ago
  You could subtract both percentages by the baseline average risk of death for 5 years at the age group that people are most likely to get this type of cancer.
deleted 3y ago
[deleted]
deleted 3y ago
[deleted]
dullcrisp 3y ago
22% of those who took the placebo died versus 12% with the medication. Seems it’d be a 45% improvement with those numbers.
adriand 3y ago
If you think about the numbers as 12% died vs 22% died, then the 51% intuitively makes more sense, although I don’t know if this is the correct explanation. My guess is that 12 and 22 are rounded numbers.
evandijk70 3y ago
Based on the abstract of the article https://www.nejm.org/doi/full/10.1056/NEJMoa2304594?query=featured_home https://www.nejm.org/doi/full/10.1056/NEJMoa2304594?query=fe..., I actually think the other explanations are wrong. They are probably reporting the Hazard Ratio, which is more often used as primary outcome for efficacy of drug than 5 year survival. (See for example: https://en.wikipedia.org/wiki/Hazard_ratio https://en.wikipedia.org/wiki/Hazard_ratio) The hazard ratio, under some assumptions, tries to estimate the relative risk of dying per unit of time. The benefit of this measure is that there is not some artificial cutoff (the difference between a death at 4 years and 364 days and 5 years and 1 day is neglible).

pfdietz 3y ago

In lung cancer with a particular mutation.

znpy 3y ago
Still a good news

chrisamiller 3y ago

This is a great example of where cancer treatment is headed and why it's so hard - namely that cancer isn't one disease, it's many thousands of diseases. This is a drug that targets lung cancer (~12% of cancers) and only one type of lung cancer (non-small cell lung cancer, ~80% of cases). It targets a particular mutated gene that occurs in about 30% of that subtype. And then, about 50% of those patients respond. So do that math, and you end up seeing that treating one of the most common mutations in one of the most common cancers with what is considered very high efficacy still only helps with about 1.4% of all cancers. This is actually an enormous number for this kind of treatment, and there is a long tail of rare cancers that are going to be much harder to find targeted therapies for. That all said, this currently appears to be an enormous success story, and the kind of treatment options that have been enabled by genomic sequencing of cancers, followed by many years of drug development and clinical trials. It's fantasically exciting to see us continue to chip away at the problem but by bit and grant people longer lives as a result!

semenko 3y ago
Agreed! This specifically is for adjuvant osimertinib for EGFR+ Stage IB–IIIA completely resected NSCLC. The headline here is really strong -- and the actual abstract is much more sober: "5-year OS rate was 88% with osimertinib vs 78% with placebo" [Full abstract is here: https://meetings.asco.org/abstracts-presentations/219805 https://meetings.asco.org/abstracts-presentations/219805 ] P.S. Hi Chris! (I think I picked up a summer student from you last week!)
- haldujai 3y ago
  Very sober given the costs and %age of patients who didn’t receive adjuvant chemo in the initial trial. Interested to see their detailed results but I’m mildly suspicious this will be AstraZeneca PR buffing underwhelming results.
earthbee 3y ago
1.4% of all cancers is still a huge number of people helped in absolute numbers given around 40% of people will get cancer.

kman82 3y ago

[flagged]

MeteorMarc 3y ago

These kind of medicines can easily cost 100k euro pp per year.

uxp100 3y ago

My mother is on what sounds like a similar pill (in result, if not mechanism of action) for a different cancer. Had a poor prognosis, genetically tested several times and after a few rounds of conventional chemo the test indicated she could take a daily pill. It’s wonderful, I’m so glad she is alive for her grandchild, for me, and for herself of course. I think she will probably still die “of” her cancer but at this point it has completely stopped the progression of it for several years. The side effects are a bit weird, and a bit bad, but not even THAT bad. Really came out of the blue for us, an unexpected outcome.

xivzgrev 3y ago

My mother in law has stage 4 lung cancer. Tagrisso is extending her life. The cancer has been shrinking since going on it with few side effects. Unfortunately stage 4 cannot be cured, and at some point tagrisso stops working. My understanding is the cancer mutates and eventually develops resistance. Then she will go on chemo and her quality of life will go down. I am thankful for modern medicine that we get some extra time with her.

dangwhy 3y ago
My father is in this situation with prostate cancer. First line therapies have stopped working and now its on to chemo. I am hoping chemo won't damage him too much. There are also radioligand therapies like lutetium 177 but they haven't been sequenced on chemo naive patients yet. So soc is chemo first.
- haldujai 3y ago
  I wasn’t involved in this study but the cancer center I just left was one of the sites for the upfront Lu177 vs chemotherapy trial. Speaking casually with the physician involved recently he said the results weren’t promising thus far. I don’t think this is published yet and I’m not familiar with prostate ca treatment literature so take this with a grain of salt.
  - dangwhy 3y ago
    my father is in india where they've been giving lu177 ( and others) before chemo for quite a while ( other countries being germany and australia ) . Forums are awash with 'success stories' . There are many clinical trials currently in US and canada. Some have published results showing 'non inferiority' in small sample sizes but most are in progress https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627907/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627907/ https://clinicaltrials.gov/ct2/show/NCT04647526 https://clinicaltrials.gov/ct2/show/NCT04647526 this one was supposed to publish some preliminary results in q1 2023 but i don't see any updates :/
    - 3y ago

haldujai 3y ago

The data isn’t published yet (presumably this was shown during the ASCO conference this weekend) but this is a bit misleading and the results seem underwhelming. The DFS numbers are not new and known, the reason this is in the news as it’s the first report of OS numbers from the initial ADAURA trial. I can’t be definitive without seeing the data yet but: 1. Osimertinib is not that new, in the context of curative intent disease (i.e. resectable stage II-IIIA) it is currently (ideally) used post adjuvant chemotherapy (the only treatment to date with an overall survival benefit). We need clarification on what the placebo arm is and what the subgroup analysis showed. What it should be (and presumably) is an “active surveillance protocol” where patients underwent short course adjuvant platinum based therapy and then followed with imaging. Recurrences are then treated with systemic or locoregional therapy. As this is an update of the ADAURA trial we know that only 40% of patients received the standard of care platinum adjuvant therapy, this article claims an OS benefit was seen in all groups but we don’t have the numbers for the subset of patients who received appropriate adjuvant treatment. 2. Main criticism of the ADAURA trial thus far has been that the results only report “disease free survival”, while that intuitively makes sense as a metric what we really care about is “overall survival”. There are several reasons but to keep it simple this is now the third generation tyrosine kinase inhibitor, the first 2 also had DFS improvements (albeit not as dramatic) but failed to show OS benefits. 3. Osimertinib is expensive. Following the ADAURA protocol (3 years of adjuvant therapy) would have an incremental cost (ICER) somewhere around ~$3-450,000 per patient. “Willingness to pay” is variable, in most places it’s $50,000/quality adjusted life year. Some in the US are pushing for this to be ~$190,000/QALY (3x GDP). Based on extrapolated DFS and earlier OS data in the last year it was estimated that the OS would be around 5-6%, based on this threshold a system would need a willingness to pay of ~$320,000/QALY. Conversely, to meet the GDP threshold above OS would need to be ~20%. In a recent Canadian economic analysis they modelled 6% OS at 10 years and arrived at a ICER of ~$40,000 suggesting this protocol makes economic sense. To my knowledge this is the first report suggesting cost effectiveness and contradicted the Health Canada modelling. 4. Based on this news article, there was an absolute reduction in OS of 10% at 5 years which seems underwhelming given that we know most of the patients did not receive adjuvant platinum based chemotherapy, the OS in the subgroup that received both treatments is what matters here. From the US analysis, this would still not meet the willingness to pay threshold. The Canadian one would need to be re-run with 5 year numbers to see what the ICER is. Overall, it’s potentially a very positive result but at face value the OS numbers seem less impressive than anticipated. If someone has the $ and an EGFR ex19 mutation there is definitely benefit but it remains unclear whether this is cost-effective for a system vs other treatment options we have. (N.B. These numbers are approximate from my recollection of the literature but I can dig up references if something seems off. For background I’m a radiologist focused on oncologic imaging, this has been a hot topic in rounds/case conferences for a few years now hence my familiarity.)

phneutral26 3y ago

To late for Whalter White, sorry, I mean Heisenberg. :(

faangguyindia 3y ago

I just wonder how we've not been able to make a drug to increase lean mass without negative effect on cardiovascular system

smileysteve 3y ago
Aspirin, Creatine, l arginine, coq 10, ozempic
- GenerWork 3y ago
  Out of all of these, creatine is the closest thing to what OP was describing, but even then it doesn't affect lean mass, it just draws water into muscles and increased endurance.
- lagniappe 3y ago
  L-Argenine is huge for me in competitive cycling. Among many effects, it allows more oxygen to get to my muscles, which can double my range and substantially increase my speed.
thebigjewbowski 3y ago
https://en.wikipedia.org/wiki/Enobosarm https://en.wikipedia.org/wiki/Enobosarm I’d read some research about this a couple years ago and didn’t remember seeing anything about effects on the cardiovascular system but that does seem like a possibility
SnowHill9902 3y ago
Increase your natural T. Doubt you maxed it.

phtrivier 3y ago

The pricing of drugs is always weird to me. Is there a good book / article / primer on why a drug can cost the price of a good house per person ? Is it just about recouping R&D, does manufacturing requires very rare raw materials, is the bill going up because of regulation, etc... ? How big a check would a government have to do to just "buy" the rights to a drug ? (Both in the "legal" and in the "an offer the CEO can't refuse" version ?)

evandijk70 3y ago
All of the above, but my guess would be that the most expensive part is usually running the phase III clinical trial. You have to pay data managers to perform the randomization, train doctors and nurses to administer it, and the hospital for the added time it takes them to run the trial, pay the statisticians that perform the analysis, an agency that helps prepare the application, etcetera. You have to recruit patients, gather informed consent (though that is sometimes done by doctors and nurses). Also, you have to give the drug for free, since insurance companies do not cover experimental drugs. Sometimes patients also receive a fee for participating in the trial. All in all, the median cost of pivotal trials is 50 million dollars. This is the cost after you already did studies to discover the drug, and determine the dosage. Half of these trials fail, and all the previous investments are lost in that case. [1] https://bmjopen.bmj.com/content/10/6/e038863 https://bmjopen.bmj.com/content/10/6/e038863
yieldcrv 3y ago
the pricing is partially due to a lack of collective negotiation the government programs carry a lot of weight as a large client but are currently barred from negotiating on prices part of some US universal healthcare proposals are to just allow existing government programs to negotiate on prices, while simultaneously extending coverage to more people
- qwytw 3y ago
  It costs about $7000 in Europe (the price seems to be similar in different country even though there is no EU wide collective negotiation). The price in the US seems to be around double in the US. But maybe that just pharma companies do PPP adjusted pricing? e.g. it seems to cost ~1500 in India for instance. Americans are simply much richer and also significantly more on healthcare than people in other countries.

breck 3y ago

> After five years, 88% of patients who took the daily pill after the removal of their tumour were still alive, compared with 78% of patients treated with a placebo. My chance of living 5 years goes from 78% to 88% by taking an expensive pill everyday with side effects? That's not an amazing thing. If it was 78% to 95% with one or two pills, or a positive healthy lifestyle change, then that's something. I'm going to push back and say this is garbage. The fact that this is being billed as "thrilling" and "incredibly positive" makes me want to puke. This is par for the course in the cancer industry. I'm going to call this what it is: an advertisement for two crappy new lines of business. First, we have a new genetic testing business: "Not everyone diagnosed with lung cancer is tested for the EGFR mutation, which needs to change, Herbst said, given the study’s findings." Cha-ching! Then, we have the actual new business of the pill. What are they going to charge, $50,000 a year? Imagine if you could choose 2 options: 1. Take a pill everyday. Have side effects. Pay $250,000 2. Don't take a pill. No side effects. Keep the $250,000 If that was the choice I'd bet people in group #2 live longer. This isn't science or medicine, this is advertising. Pardon my bluntness, but sometimes anger is necessary to get people to wake up.

ProjectArcturis 3y ago
Far too cynical. You are incredibly uninformed about the significance of this drug.
- breck 3y ago
  I could be wrong. Absolutely. I am always open to more information. However, I'm usually not wrong about these things. This pattern is so common in big pharma it's an easy bet right now. Based upon the limited information released I would bet: 1) it has high odds of being very lucrative for a small number of people 2) it will be a net negative for patients^ ^ Patients would be better off with more money and using an alternative treatment strategy. This drug is priced at $12,750 per month, according to Wikipedia.
  - dennis_jeeves1 3y ago
    >I could be wrong. Absolutely. I am always open to more information. You really need not be apologetic, being too 'open' to repeated nonsense from the same entities (big pharma in this case) is not a good thing either.

activiation 3y ago

I thought that death risk was 100 percent, no matter what

mhh__ 3y ago
99% of all non-smokers die
- activiation 3y ago
  You need to update those stats

Teslazar 3y ago

According to the CDC, 80-90% of lung cancer deaths are linked to cigarette smoking (1). It seems like a simple solution for people to just not smoke... (1) https://www.cdc.gov/cancer/lung/basic_info/risk_factors.htm#:~:text=This%20animated%20infographic%20shows%20the,90%25%20of%20lung%20cancer%20deaths https://www.cdc.gov/cancer/lung/basic_info/risk_factors.htm#....

thangalin 3y ago
'Nicotine releases a chemical called dopamine in the same regions of the brain as other addictive drugs. It causes mood-altering changes that make the person temporarily feel good. Inhaled smoke delivers nicotine to the brain within 20 seconds, which makes it very addictive—comparable to opioids, alcohol and cocaine. This "rush" is a major part of the addictive process. 'When the person stops using tobacco, nicotine levels in the brain drop. This change triggers processes that contribute to the cycle of cravings and urges that maintains addiction. Long-term changes in the brain caused by continued nicotine exposure result in nicotine dependence, and attempts to stop cause withdrawal symptoms that are relieved with renewed tobacco use.' https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/nicotine-dependence https://www.camh.ca/en/health-info/mental-illness-and-addict...
- qwytw 3y ago
  There are other ways to consume nicotine which are much less harmful.
  - fulafel 3y ago
    Same for lots of dependence causing substances, effects are greatly varied by delivery mechanism. Eg heroin pills used to be quite common over the counter and weren't considered a hard drug.
    - qwytw 3y ago
      Vaping should be about as efficient if not more than smoking? Probably not something we should encourage but still way safer than inhaling smoke.

rob74 3y ago

Halfway through the article, they spell out what they mean by "cuts risk of death by half": > After five years, 88% of patients who took the daily pill after the removal of their tumour were still alive, compared with 78% of patients treated with a placebo. ...which is still remarkable, but doesn't sound quite as good as "cutting by half".

ieeamo 3y ago
After 5 years, (i) Placebo: 22% mortality, (ii) Daily Pill: 12% mortality. 45% reduction in 5-year mortality. Quite close to “cutting by half”

hentrep 3y ago

I’m writing this live from the ASCO meeting where this was just presented. Osimertinib (TAGRISSO) has truly transformed the way we treat EGFR-mutant NSCLC, having repeatedly redefined standards of care. I don’t have a source handy, but osi used to hold a record in oncology as being the fastest drug to go from IND (trial-enabling) to approval - less than 18 months. Osimertinib did $5.44B in global sales last year, leading AstraZeneca’s oncology portfolio [0] [0] https://www.astrazeneca.com/content/dam/az/PDF/2022/fy/Full-year-and-Q4-2022-results-announcement.pdf https://www.astrazeneca.com/content/dam/az/PDF/2022/fy/Full-...

cutler 3y ago

In other news shares in Marlborough saw hockey stick growth.