| HN Mirror

> 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.