Cancer drug prices are so high that doctors will test cutting doses

By Laurie McGinley June 8 at 3:01 PM

A group of prominent cancer doctors is planning a novel assault on high drug costs, using clinical trials to show that many oncology medications could be taken at lower doses or for shorter periods without hurting their effectiveness. As Exhibit A, they point to their pilot study involving a widely prescribed drug for advanced prostate cancer. Cutting the standard dose of Zytiga by three-quarters was as effective as taking the full amount — as long as patients swallowed the medication with a low-fat breakfast rather than on an empty stomach, as directed by the label.

“It's inefficient, even wasteful, to take this medicine while fasting,” University of Chicago oncologist Russell Szmulewitz said in presenting the data at a conference earlier this year. Reducing the dosage of the $9,400-a-month medication as studied would sharply lower costs even for well-insured patients, he said. Another benefit would be fewer side effects; the patients who'd eaten breakfast with Zytiga, for example, had fewer stomach issues.

Szmulewitz and others now want to run full trials to see whether the doses of other oral oncology drugs can be ratcheted back because of the “food effect,” which can alter how a medication is absorbed. They also plan to explore whether the duration of some prescriptions can be shortened and whether some cheaper non-cancer drugs can be substituted for expensive cancer ones. They recently created a nonprofit organization, the Value in Cancer Care consortium, to organize their work.

The initiative is the latest response to rising concerns over “financial toxicity,” the economic devastation that can be wrought by the high cost of cancer care. With new oncology therapies routinely debuting at more than $100,000 a year, “lots of people are worried about developing drugs that people can't get,” said Leonard Saltz of Memorial Sloan Kettering Cancer Center in New York, who helped organize the new group. The effort is also an acknowledgment that, despite President Trump's grousing about high drug prices earlier this year, they're unlikely to change soon.

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