A new drug helps men with advanced prostate cancer live longer, even after they have not been helped by other treatments, researchers reported Wednesday. The drug, called enzalutamide, is a pill that tackles prostate tumors from several different directions, interfering with molecular pathways that help them grow. It does not cause the nausea, hair loss and other side effects often associated with chemotherapy.
“This is extraordinarily significant,” says Dr. Howard Scher of Memorial Sloan Kettering Cancer Center in New York, who led the study.
The results out Wednesday in the New England Journal of Medicine describe a study carried out on almost 1,200 patients in 15 countries. All had stopped responding to previous treatments, first with drugs that block the hormone testosterone, which can fuel prostate cancer, and then with more traditional cell-killing chemotherapy.
The study found that men taking enzalutamide lived 37 percent longer on average. That is the good news.
The qualifications? The 37 percent comes from comparing men who lived on average 18.4 months on the drug to those who lived on average 13.6 months on placebo. The drug, made by a biotechnology company called Medivation is likely to be approved by the Food and Drug Administration within a few months and will cost about $6,000 a month.
Is the $6,000 monthly cost worth it for a survival benefit of slightly less than six months?
“If it is you, it certainly is,” Scher says. He points out that, as in most cancer studies, the average survival rate can be deceiving. Some patients get no benefit at all, while others have lived for years on the drug.
This has become a familiar story in cancer research. New directed therapies that are hugely expensive prolong life by an average of a few months. Almost everyone in the field says our medical system cannot afford to pay to treat people with all these new discoveries.
But with this drug, as with many others, there is hope that it could be even more effective if it’s just used in a smarter way.
Experiments already are under way to test the drug, in combination with another, earlier in the disease. In those tests, doctors are trying it in men soon after the cancer spreads out of the prostate to the lymph nodes and toward the bones where it becomes life-threatening. The hope is such treatment could bring a far more profound extension of survival. That will not reduce costs, but it would be even more exciting.
But for now this latest development, despite the caveats, represents a huge advance against the second biggest cancer killer of men.
Prostate cancer kills kills more than 28,000 U.S. men a year. Many cases are treated with radiation or surgery before the cancer starts to spread.
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