Although the newest generation of cancer therapies is holding plenty of promise for the future, they also carry with them a considerable price tag. 

Immunotherapies – treatments that alter the way a cancer patient’s immune system works to ‘re-activate’ its ability to detect and destroy cancer cells – have costs around the $100,000 mark, making them an incredibly difficult treatment option to sustain for patients.

With little competition in the oncology market, pharmaceutical companies have gradually increased their drug prices over the past decade, making leading cancer drugs being some of the most expensive medicines available today.

Pricing tactics of pharmaceutical companies have received plenty of attention during the most recent US Presidential campaign and continue to be a hot topic for new president, Donald Trump. Regardless of the good intentions behind lowering drug prices, can the situation still be considered salvageable? Or will big pharma continue to hold the cards when pricing its treatments?

Academics unite

In response to the issue, researchers from some of the world’s leading cancer research organisations recently called for a revamped drug development process.

Made up of renowned scientists from some of the leading cancer research institutes in the world – including the UK’s Institute of Cancer Research and the University of Texas MD Anderson Cancer Center – the team stated that “there is a clear and urgent necessity to lower cancer drug prices to keep lifesaving drugs available and affordable to patients,” as part of their published paper in research journal Cell.

Specifically, the team want to put an end to cancer drugs costing more than $100,000 (roughly £80,000) a year – a growing concern for both doctors and patients who want to provide and have access to a line of drugs that are causing some of the most exciting improvements cancer care in recent times.

For pharmaceutical companies, cancer immunotherapy is the market to be in with global forecasts of drug sales estimated to be at least $150 billion by 2020.

Speaking to Reuters, Professor Paul Workman of the ICR and lead author of the paper emphasised a need for change: “Charging $100,000 is unsustainable. We need to be thinking about getting prices down toward a half or a third of that, ideally even less.”

Combinatory conundrums

Ramping up the issue of sustainability is the fact that many of the newest treatments are most effective in combination with others. Two of the leading immunotherapies for example, Bristol Myers-Squibb’s Opdivo and Yervoy, cost around $252,000 for a year’s treatment of one patient.

As a result, many health systems – the NHS in particular – is having to devise methods of balancing cost with demand. The controversial Cancer Drugs Fund is a prime example of a health system willing to cooperate, yet having to prioritise some drugs – and therefore patients – over others, thanks to high drug prices.

Realising they are potentially missing out on one of the world’s biggest drugs markets, pharmaceutical companies are cutting deals with cost-effectiveness body NICE and the NHS to make sure their drugs are available to some patients at least. Which begs the question, why weren’t the drugs marketed at that price in the first place?

In the US, drug pricing has received plenty of mainstream coverage thanks to both Hilary Clinton’s ‘war on price gouging’ during her presidential campaign, and Donald Trump making drug prices one of his first priorities as new president.

Their concerns are well-founded. Cancer bills remain the leading cause of personal bankruptcy in the US.

A shifting research landscape

Over the years, one of pharma’s most common justifications behind high drug prices has been research and development costs. With total development times for new drugs from discovery to market being at least 10 years in the majority of cases, pharma companies often ring up costs in the millions before their new drug is exposed to the public.

However, in recent years, the advent of new genetic sequencing techniques means the trial enrolment process is far more specific than ever before. Pfizer’s Xalkori, for instance, was approved for use in advanced lung cancer after a trial that included only 347 patients. As drug testing techniques continue to improve and therapies become ever more targeted, the argument of high development costs is becoming ever more irrelevant.

So what is Workman’s solution to the issue? According to the professor, academic discovery centres need to up their role in the drug development process, building relationships with smaller private companies rather than simply licensing their candidates to big pharma.

“By partnering with generic drug makers or new companies specifically formed to enable this new model, academic drug discovery units and interested drug makers can lead by example and deliver innovative drugs at sustainable prices,” conclude the researchers.

As part of their renewed role in the process, Workman suggests that academics negotiate pricing caps for their candidates once they hit the market.

The concept is commendable and one that could, in theory, develop with time. The most exciting cancer medicines tend to begin life in academic labs already and those academic institutes dedicated to cancer drug discovery are strong in number. In that regard, the infrastructure is already there for Workman’s proposed plan – all that’s needed is a collaborative effort to make a change.

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