[breck]

> After five years, 88% of patients who took the daily pill after the removal of their tumour were still alive, compared with 78% of patients treated with a placebo.

My chance of living 5 years goes from 78% to 88% by taking an expensive pill everyday with side effects? That's not an amazing thing. If it was 78% to 95% with one or two pills, or a positive healthy lifestyle change, then that's something.

I'm going to push back and say this is garbage. The fact that this is being billed as "thrilling" and "incredibly positive" makes me want to puke. This is par for the course in the cancer industry.

I'm going to call this what it is: an advertisement for two crappy new lines of business. First, we have a new genetic testing business: "Not everyone diagnosed with lung cancer is tested for the EGFR mutation, which needs to change, Herbst said, given the study’s findings." Cha-ching!

Then, we have the actual new business of the pill. What are they going to charge, $50,000 a year?

Imagine if you could choose 2 options:

1. Take a pill everyday. Have side effects. Pay $250,000 2. Don't take a pill. No side effects. Keep the $250,000

If that was the choice I'd bet people in group #2 live longer.

This isn't science or medicine, this is advertising.

Pardon my bluntness, but sometimes anger is necessary to get people to wake up.

[qwytw]

> My chance of living 5 years goes from 78% to 88% by taking an expensive pill everyday with side effects?

Reducing the likelihood of death by a half is still something... Of course yeah, the price is pretty insane but besides that it's still a great achievement and a significant step in the right direction.

[dennis_jeeves1]

Pity you have been down voted by people who have not understood one of the common patterns that big pharma utilizes to rake in profits.

[ProjectArcturis]

Far too cynical. You are incredibly uninformed about the significance of this drug.

[breck]

I could be wrong. Absolutely. I am always open to more information.

However, I'm usually not wrong about these things. This pattern is so common in big pharma it's an easy bet right now.

Based upon the limited information released I would bet:

1) it has high odds of being very lucrative for a small number of people

2) it will be a net negative for patients^

^ Patients would be better off with more money and using an alternative treatment strategy. This drug is priced at $12,750 per month, according to Wikipedia.

[dennis_jeeves1]

>I could be wrong. Absolutely. I am always open to more information.

You really need not be apologetic, being too 'open' to repeated nonsense from the same entities (big pharma in this case) is not a good thing either.

[haldujai]

> I could be wrong. Absolutely. I am always open to more information.

You're still a bit too cynical but there are some nuggets of truth in what you're saying.

With regards to mutation testing: I'm not sure where this Hopkins guy is getting his data from but mutation testing for lung cancer is already standard of care, it's been part of the NCCN guidelines for > 5 years at least.

EGFR is not the only driver mutation and osimertinib is not the only drug that can be used, even for EGFR.

Molecular marker and genetic testing of cancer is unequivocally to the benefit of patients and is not a BigPharma scam, it also has little to do with this specific drug other than that this is one of many gene-directed cancer therapies.

> 2) it will be a net negative for patients^ > ^ Patients would be better off with more money and using an alternative treatment strategy. This drug is priced at $12,750 per month, according to Wikipedia.

Be careful with generalizations like this. This drug is very signficant, you just have to select patients appropriately.

There is no doubt osimertinib works well, if you have unresectable/non-curable lung cancer it can potentially buy the patient an extra couple of years (median ~8 months) over previous generation TKIs and even longer versus conventional chemo. These patients used to just die within a few months 5-10 years ago.

This article, and the trial it talks about, is about adjuvant therapy (i.e. after the surgery) in patients with locally-advanced but curative intent disease that at baseline have pretty good good survival so in this specific use-case your criticism of cost-effectiveness is a reasonable one.

Consider a 45 year old with an EGFR mutation and stage IV lung cancer (unfortunately common these days), an extra 8 months-3 years is immensely significant for them and their families and this is a miracle drug.

On the other side of the spectrum, for a 75 y/o with stage II cancer who underwent curative-intent treatment (i.e. this study population), the argument is much weaker given the costs vs low absolute risk reduction over a long time period. I broke down the financials in another comment.

You're probably right that the numbers won't add up in this trial for this specific patient population, the article + PR releases so far do smell a bit like AstraZeneca buffing somewhat underwhelming results (expectation was that overall survival would look better than 10%) to sell more of an expensive drug, but you're overgeneralizing and it is a very good treatment option in well selected patients. It will also be a great adjuvant treatment option whenever this becomes cheaper like 1st-gen TKIs are now.

[breck]

Solid response. Thank you for taking the time and providing the additional information.