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Melanoma news seems bright, but drug’s real world future is cloudy

Whenever there’s an advance in the fight against cancer, there’s going to be some real excitement. And, if history is a judge, there’s going to be some disappointment, too. Treatments that look promising in the lab can fizzle in human trials. And even drugs that seem to work well in human studies may not end up helping many patients in the real world.

A new study showing that the chemotherapy drug vemurafenib can prolong the lives of people with malignant melanoma — the especially aggressive and dangerous form of skin cancer that kills about 8,700 Americans each year — has rightfully lifted the spirits of doctors and patients alike.

But a close look at the numbers raises questions about the drug’s real-world impact. The study suggests that only one out of four patients with malignant melanoma will respond to the drug. For those who do respond, the benefits are uncertain, says Tim Turnham, executive director of the Melanoma Research Foundation.

The study found that vemurafenib reduced the risk of death by 63% over six months compared with a standard treatment. That sounds impressive, but it’s impossible to predict how much time patients really bought themselves, Turnham says. A few patients may enjoy a few extra years of life thanks to the drug, but they will likely be the exception, not the rule. “This is not the breakthrough that we really need for this population,” he says. “There’s been a lot of hype in the news, but this is not a home run. It’s a really solid single.”

An expensive single, at that. Vemurafenib will likely cost tens of thousands of dollars per year. (Turnham’s off-the-cuff guess is $50,000.)

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Earlier this year, the Food and Drug Administration approved Yervoy (ipilmumab), the first new melanoma drug in 13 years. A biologically engineered drug designed to help the immune system attack cancer cells, Yervoy has been shown to add a couple of months to the typical patient’s life. The price for that extra time: About $120,000 for a treatment.

Turnham says that such price tags are a huge problem in cancer treatment, as this Reuters article explains, and indeed in medicine in general. As doctors understand more about melanoma, they may find that certain patients need both vemurafenib and Yervoy or some other pricey combo. He expects vemurfamenib will be covered by insurance, but of course not everyone has such a luxury. “For many, a cancer diagnosis is a gateway to bankruptcy or poverty,” he says.


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