Final Thoughts on Effective Therapy and Financial Toxicity

Mark Socinski, MD: We’re getting close to the end of our discussion. I want to thank all of you. This has been a great discussion and very informative. We’ve covered a lot of things, which we’ve expressed our opinions on. Before we close for the evening and conclude the discussion, I wanted to get some final thoughts from each of you in terms of the topics we’ve covered. I’ll start with Gilberto. Give us some of your final thoughts in closing the program.

Gilberto Lopes, MD: We still have a lot of work to do in lung cancer. We have certainly done a lot better in the past few years than we did in the couple of decades before, but of course, there’s a lot of work to do. If we look at targeted agents, most patients eventually will progress. If we look at immunotherapy, most patients don’t benefit from it. So of course, we have to continue bringing new drugs to the market, and we need to find out what this sweet spot, the perfect balance, is between bringing innovative drugs to the market and charging for them. And I don’t know that we have that answer today. We need to continue looking for that.

Mark Socinski, MD: Dr Barzi?

Afsaneh Barzi, MD, PhD:I think, as oncologists, we are all trained to take charge of helping our patients and protecting them as much as we can. I think the financial toxicity is real and is here. It isn’t going to go away unless we step in, and I don’t want to say solve the problem, but be part of the solution of this real problem for all of our patients, regardless of the disease and regardless of the treatment.

Mark Socinski, MD: Jack?

Jack West, MD: I think that we have some agency here. I used to do more GU [genitourinary] oncology, as well as thoracic, and we saw sipuleucel-T, or Provenge, basically die on the vine. I don’t think that was because the data were so poor, but because the world wasn’t ready for a drug that cost $93,000. Now, today that would be extremely restrained, but the world wasn’t ready for it at that time. Because of that, it just didn’t get uptake. We have more modern agents, like ramucirumab has a survival benefit, but people weren’t that impressed by it. It gets intermittent use as well. Necitumumab was FDA approved, but I don’t think anyone ever used it because it didn’t seem to provide meaningful benefit relative to the cost of the drug, and arguably, the toxicity. So we do have some control where FDA approval isn’t the same as a mandate to use something clinically. I think that’s especially true when you have fungible choices, like multiple ALK inhibitors or PD-L1 inhibitors, etc. We also see that when we have the enviable problem of effective treatments, we can start to pull back. Just like we had a debate about, “Well, how long is too long for immunotherapy, and can we do as well with less treatment?” I think we can start to ask that about the financial toxicity. We should ideally not have to choose between effective drugs and unfathomably ridiculous pricing. While I appreciate that we want to incentivize companies to innovate, we are too far on the end of unchecked price restraints, and have very little incentive to control costs. There’s plenty of room for companies to still make a healthy profit, for us to respect and protect that, while not giving away all controls to the point of bankruptcy and forcing us to make choices we shouldn’t have to make, considering how much money we dedicate to health care.

Mark Socinski, MD: Thank you all. One final thought that I would render, and we didn’t have a chance to talk about this, is that if we’ve learned anything over the past couple of decades, we’ve learned that in oncology, one size doesn’t fit all. All of us would be happily willing to use a drug—I’m not saying without cost concerns—if we knew the drug was going to be highly effective. And if we knew the drug was going to have no effect, we wouldn’t use it. That brings up the issue of biomarkers, and if we can truly personalize medicine and say, “This therapy is going to work, or this therapy is not going to work,” to a greater degree than we do today. We are certainly better than we were 20 years ago, but we’re not where we would like to be with regard to using ineffective therapy in patients, which isn’t attractive to any of us. If we would have a greater ability to identify the patients who are truly going to benefit, that would go a long way to helping us with the cost effectiveness of all these things. That’s my parting comment.

I want to thank all 3 of you. It’s been a great discussion. I also want to thank our viewing audience. We hope you found this OncLive® Peer Exchange discussion to be useful and informative. Thank you.

Transcript edited for clarity.