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Metronomic therapy could cut prohibitive cancer care costs: expert

Senior cancer researcher and scientist Dr Robert Kerbel at the Tata Memorial Hospital on Friday—Photo: Rajneesh Londhe  

The spiralling cost of cancer drugs and their high toxicity has made cancer care financially unsustainable even in high-income countries. The problem worsens in a country like India, Dr Robert Kerbel, a Canada-based senior scientist known as the father of metronomic therapies (drugs administered in low, continuous doses) said

Speaking on Friday to The Hindu on the sidelines of the 5th Biennial International Metronomic and Anti-Angiogenic Meeting being held at the Tata Memorial Centre, Dr Kerbel said, “The cost of almost all new cancer drugs that make it to the market range between $5000 and $10,000 for a month’s dose. We are getting to a point in the US, Canada and countries in Western Europe — the so-called high-income countries — where we can’t afford cancer care. Many oncologists and healthcare economists have said this is unsustainable.”

Dr Kerbel said there has been some amazing development in cancer care in the last four to five years with patients of lung cancer, melanoma, bladder cancer or other incurable cancers getting cured by immunotherapy, in which the body’s immune system is harvested. And while the results have been good, even this therapy has hit the price roadblock. Apart from their high cost, the drugs work only on a minority of patients. “Maybe you can cure 10 to 20 per cent of melanoma cases, and that’s an amazing result. But they cost a fortune,” he said.

His key research subject, anti-angiogenesis (treatments that stop tumours from growing their own blood vessels), has shown benefits, albeit small, but the cost of the drugs is very high. “The drug costs $5,000 a month and the patient lives two months longer. It is important for the patient to live those two additional months, but we have to view it in the context of cost to society,” Dr Kerbel said.

Why metronomic therapy

The solution to high-cost and toxic drugs could well be metronomic chemotherapy, which is a continuous administration of low-dose chemotherapy drugs over time.

“The way this is being done is by way of oral drugs and a lot of oral chemo drugs that are available. These are off-patent drugs and really inexpensive, which is good. But pharmaceutical companies do not want to do clinical trials with off-patent drugs,” Dr Kerbel said.

He added that a lot of pre-clinical work on dogs, mice has been done, and some clinical trial results indicate there may be a benefit in giving lower doses of drugs continuously. Also, in the case of immunotherapy the drugs cost a fortune, but they can be combined with metronomic therapy that may make drugs more effective and improve survival rate, Dr Kerbel said.

He added that in metronomic chemotherapy, the total drug amount administered remains unchanged but the challenge is changing the belief among many oncologists and researchers that higher the drug’s toxicity, the more effective it is.

“One of the best ways of reducing cancer care cost is to use off-patent drugs that cost very little in comparison and have been shown to be effective and safe. The cost of new cancer drugs could become a driving force for a greater proactive consideration for metronomic chemotherapy,” Dr Kerbel said.

One of the best ways of reducing cost is to use off-patent drugs that cost very little

Dr Robert KerbelSenior oncologist

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Printable version | Jun 21, 2021 4:38:45 AM |

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