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Lymphoma and Pets
How Much Are Worthless Cancer Drugs Worth? You Have No Idea
The research firm IMS Health has issued a list of the top 100 selling drugs in the United States, and Medscape has made the list accessible. IMS Health actually compiles two lists; one goes by total sales, and the other goes by prescription volume.
The first list – total sales – is most relevant to us here since we know how expensive cancer drugs can be. To that end, I counted about one dozen cancer drugs on that list.
Before I get to them, I'd like to point out that on that list, the top-selling drug over the past 12 months is Abilify, with $6,391,050,009 in sales.
Maybe you've seen the commercials for Abilify. This is the drug that you're supposed to add to your current antidepressant medication when that drug "alone is not enough."
Here's one of those commercials:
Despite everything expressed in that video, Otsuka America Pharmaceuticals still enjoyed $6.3 billion in revenue from the drug over the past 12 months. You may not find a more blatant indictment of SSRIs as ineffective placebo pills than Abilify.
Now to some of the cancer drugs.
Neulasta and Neupogen
At number 10 on the list is Neulasta, with more than $3.5 billion in sales. Neulasta is a white blood cell booster given to patients whose chemotherapy has depleted them of white blood cells, largely as a precaution against developing a sometimes fatal condition known as febrile neutropenia. It comes off patent in the U.S. in 2015.
Neupogen, which does the same thing and comes off patent this year, came in at number 45, with about $972 million in sales.
Apparently, few practicing oncologists read the paper by renowned lymphoma expert James Armitage for the New England Journal of Medicine last March, in which he and co-author Charlie Bennett point out that 90 percent of patients who receive these drugs don't really need them.
At number 11 is Rituxan, with almost $3.3 billion in sales. Rituxan is a true game-changer in patients with various subtypes of B-cell non-Hodgkin's lymphoma. It loses patent protection in the U.S. in 2016. In Europe, it loses protection this month.
Rituxan has truly saved many more lives than it has wiped out, and it's hard to rag on it too much, even if it has already generated some $25 billion for Roche.
At number 16 is the anti-angiogenesis drug Avastin, with almost $2.7 billion in sales. It is amazing that the drug is still selling so well when it does so little. I would bet $2.7 billion that Genentech is furious with that sales figure. Despite indications for colorectal cancer, some lung cancers, kidney cancer and glioblastoma, the company was dealt a major setback when regulators in the U.S. and the U.K. pulled its approval for breast cancer.
But with patent protection in the U.S. extending to 2019 and in Europe to 2022, no one at Genentech should be going hungry any time soon.
Like Rituxan – but by a factor of 10 – Gleevec is a game-changer. It is the ultimate cancer wonderdrug. At number 26, with $1.8 billion in sales, this drug is a literal lifesaver. However, as its patent expires stateside, expect profits to continue to fall, and watch as Novartis bad mouths and cannibalizes Gleevec in favor of Tasigna, its me-too drug designed to replace those enormous Gleevec profits. Perhaps never before or since has a drug company made so much money for having done so little.
Better sit down for this one. At number 61 is Xeloda, with more than $747 million in sales. Xeloda is indicated for the treatment of metastatic colorectal cancer and metastatic breast cancer. Its own web site says this:
In medical studies, Xeloda used as a single medicine was no worse than 5-FU and leucovorin taken together. Xeloda did not improve survival compared with these 2 medicines.
"No worse than" and "did not improve survival" should have killed this worthless tablet from the outset. For the record, leucovorin was designed to help 5-FU (5-fluorouracil) work better against metastatic colorectal cancer. These drugs are available as generics and are much, much cheaper.
I called my own pharmacy and asked how much 120 of the 500 mg tablets would cost me (a month's worth, in some cases). The pharmacist said it would have to be special-ordered first, and that one-month supply would eventually cost a little more than $5,100.
Is the convenience of a tablet really worth that much?
At number 67 is Erbitux, with more than $658 million in sales. This is the drug that indirectly put Martha Stewart in prison. Its U.S. patent extends to 2016.
In a study of patients with EGFR-expressing metastatic colorectal cancer, Erbitux added to the combination chemotherapy regimen FOLFIRI amounted to an overall survival rate of 9.5 months, compared to FOLFIRI alone, in which the survival rate was 8.1 months. That was in patients with K-Ras mutation-negative (wild-type) disease. So it granted patients about a month and a half more of misery. If the patient was K-Ras mutation-positive, he or she died sooner on the Erbitux plus FOLFIRI.
Explore the embarrassing data yourself here (opens as PDF), or read Alex Prud'Homme's The Cell Game to learn all about Sam Waksal's otherwise worthless cancer drug.
At number 69, with $622 million in sales, is Velcade, approved in 2006 as a treatment for mantle cell lymphoma (MCL). In the pivotal phase III trial for Velcade, Millenium Pharmaceuticals recruited 155 patients with MCL. The overall response rate – meaning the percentage of patients who appeared to get something from the drug – was 31 percent. Only 8 percent of patients had a complete response. A full 92 percent of patients got either a couple months' reprieve or just a ton of awful side effects.
Other cancer drugs on the list included:
- Herceptin at number 24, with $1.9 billion in sales
- Tarceva at number 68, with $651 million in sales
- Taxotere at number 99, with more than $25 million in sales
Patent information for biologic drugs like Rituxan and Avastin is difficult to assess because pharmaceutical companies are often sneaky, greedy and underhanded. The information here comes from the Generics and Biosimilars Initiative (GaBi).
Number two on the list, right behind Abilify, is Nexium, with more than $6 billion in sales. If you're looking for one thing that best exemplifies how mangled the U.S. health care system is, look no further than this little purple plague.
Nexium is a slightly modified and barely reformulated version of the original purple pill, Prilosec. It offers no therapeutic benefit over Prilosec, but it allows Astrazeneca to maintain patent protection over this successful molecule. You might wonder why you would get a prescription for Nexium when you can get Prilosec over the counter. If you have health insurance, your copay for Nexium is likely cheaper than over-the-counter Prilosec.
But worry not – all the players in this scam are still getting paid, and all the consumers, all the way down the line, are still getting screwed.