New therapies with a very new price tag What to do?

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Screen Shot 2014-05-19 at 1.38.42 PMHats off to Paul Howard at the Manhattan Institute for a fascinating and very timely commentary entitled Sure, We'll (Eventually) Beat Cancer. But Can We Afford To?

Howard s piece is about the disconnect between emerging scientific advances to fight cancer and our ability as a society to pay for them.

This is an especially newsworthy topic right now, since Gilead has taken much heat over the past few weeks over their pricing of Solvaldi a revolutionary new drug for treating (and curing) hepatitis C. ACSH s Dr. Josh Bloom wrote about this last week, saying that despite Solvaldi costing $1,000 per pill ($84,000 per course), it is actually a bargain when compared to prior therapy options.

Well, if $84,000 per treatment sounds bad, you should be sitting down before you read Howard s article.

Although upon first glance, this piece is about the high price of cancer drugs, it is really about the advent of personalized medicine for cancer the most scientifically sophisticated (and probably most effective) way to combat individual cancers.

Howard points out that targeted cancer drugs those that disrupt a particular pathway in the cell growth cycle despite some notable advances, e.g. Gleevec for chronic myelogenous leukemia (CML), have been far from spectacular. Most new cancer drugs in this class cost more than $100,000, and often provide only a few extra months of life. This has created an uproar in the oncology field, with doctors from prestigious cancer centers like M.D. Anderson and Sloan-Kettering, the American Society of Clinical Oncology, and even longstanding critics of pharmaceutical pricing joining forces to call for changes in the pricing of cancer drugs, if not outright price controls.

But the cost of personalized treatment for cancer could dwarf this. This is because it involves determining the genome of the tumor cells in question, and selecting the precise immunotherapy agents best suited to keep the particular cancer in check. This would have to be done on a patient by patient basis.

Howard writes, Payers are already struggling to fund impressive advances against Hepatitis C, multiple sclerosis, and rheumatoid arthritis, to name just a few other expensive specialty drug indications. In at least the short term, can society afford to win the war on cancer?

It is also possible that not all groundbreaking therapies will be extremely costly.

Howard gives us a peek at what the future of cancer care might look like when he discusses the case of Stacy Erholtz, a 50 year old mother with myeloma who had failed all therapies conventional and otherwise. As a last chance, Erholtz became a participant in a clinical trial at the Mayo Clinic, where she underwent virotherapy treated with a dose of measles vaccine large enough to inoculate ten million people.

He says, Within minutes of her inoculation, her temperature spiked, and she started shaking and vomiting but within 36 hours her tumors started shrinking, and today she is in complete remission ¦

[This is] an astonishing accomplishment that has the potential to save lives even as it reduces the use of other expensive treatments with severe side effects", says Howard. " That s the future of medicine. Let s figure out how to get there faster.