After reading some of the analyst reports, I can see that most of them are not oncologists or ever had the misfortune to be a cancer patient. Some of them actually think that ERBITUX's side effects are so mild that you can all but forget it in making treatment decisions. Everything is relative but half life of 4 days and 8% grade 3/4 rash, 10% grade 3/4 Malaise, 9% grade 3/4 abdominal pain, 5% grade 3/4 general pain, 7% grade 3/4 dyspnea, 3% grade 3/4 infusion reactions.
Not exactly something you would wish to do to yourself on a weekly basis unless you have no other choice. These patients are SICK and giving up is a real option and docs must to do what they can to counter.
Chemo FOLFOX and FOLFIRI are on a biweekly cycle. On this every other week cycle, patients have a chance to feel a little "normal" in between cycles. Feeling "a little normal" is good for the mind and elongation of treatment. Would you like a little weekly ERBITUX with that?
While we are arguing low +/- % points in PFS, we are not speaking of a cure for this disease. Most/all of these patient will die from the disease. Most patients at some point do figure out that this is all about quality of life and getting to the grandson's wedding or seeing a love one back from Iraq, etc.
No cure. Every useful drug has a trade off. Take a poison and it may prolong your life for a little bit but at what costs?
For the patient/oncologist, the decision points should be: efficacy, costs, and quality of life.
Efficacy: P is at least as good as E. Scientific differences likely to be small but real life differences possible with P. biweekly vs. E. weekly adminstration schedule resulting in more cycles.
Costs: P should be the cheaper drug because dosage is ~half of E every 2 weeks. Actual pricing is up to Amgen. Reimbursement will come in combo chemo with community support. Oncologists will use it and AHFSDI and/or USPDI will pick up the activities resulting in recommendation.
QoL: already covered.
And finally IMCL's combo chemo patent. Even if Amgen does not register P+chemo, would BMY sue docs for using off label? It would make wonderful headlines on CNN and CBS, etc. |
