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Will Growth of Targeted Cancer Drugs Thwart Access to Cheap Cancer Rxs in Poor Nations?

LOS ANGELES – The proliferation of targeted cancer therapies in Western markets may hurt the chances of patients in the developing world of obtaining affordable oncologics, a healthcare ethicist told the annual meeting of the American Association for Cancer Research here last week.
As more targeted drugs, especially for cancer, displace traditional chemotherapeutic agents, it could stifle the so-called trickle-down effect that enables developing countries to obtain less expensive versions of these drugs, said Alexander Capron, a professor of health policy and medical ethics at the University of Southern California, Los Angeles.
“If the cost of development and testing is spread over a smaller patient base, this may well mean fewer blockbuster drugs, those pharmaceutical cash cows, that not only inflate company profits but also underwrite research and development of other drugs,” Capron said during his presentation.
However, Susan Desmond-Hellmann, president of product development at Genentech, said drug makers shouldn’t be criticized for making money from innovative treatments. In fact, she noted that it is Genentech’s philosophy to use a genetic test to target a population whenever possible.
Genetic testing is still a fairly new concept for some entities within the US health care system. As a result, test makers face substantial barriers in garnering reimbursement for their products, a factor which may mean that patients pay a higher cost for diagnostic-based targeted therapies (see related story, this issue.) 
“There should be incentives for innovations,” Desmond-Hellmann said in her presentation at the AACR meeting. “Targeted therapies are an important part of looking at [the cancer drug development] model. Genentech believes that we should always select patients when there is a test to select patients.”
She added that targeted drugs allow clinical trials to be “shorter and smaller” and  enable patients to have a “much higher magnitude of benefit.”
Pros and Cons
However, Eli Lilly would disagree. According to Richard Gaynor, vice president of Lilly Oncology, biomarker-based PGx studies are more expensive and complex than traditional clinical trials [see PGx Reporter 04-18-07]. 
But Gaynor, who spoke with Pharmacogenomics Reporter at the AACR meeting last week, acknowledged that Lilly was still investing in PGx and targeted therapies because, in the end, it would be a win-win for patients, payors, and industry by getting the right drug to the right patients.

“Targeted therapies are an important part of looking at the model. Genentech believes that we should always select patients when there is a test to select patients.”

Other industry observers believe that Capron’s concerns will dissolve as the blockbuster model — and resultant trickle-down effect — sustains itself by treating populations in developing countries that increasingly adopt “Western patterns of bad eating and unhealthy living” [see PGx Reporter 04-04-07].
However, the success of blockbusters in developing countries is dependent upon pricing. HarvardUniversity economics professor David Cutler told Pharmacogenomics Reporter that in poorer nations drug prices are constrained, which may make it difficult for pharma companies to garner the same profits with blockbusters as they do in wealthier Western nations.
In an effort to deflect criticism for the high cost of targeted cancer care, big pharma has begun developing patient-access programs for certain therapies.
Novartis has recently come under criticism in India for fighting to garner patent rights for its targeted chronic myeloid leukemia drug Gleevec, and trying to shut down Indian generic manufacturers from marketing cheaper knockoffs of the drug.
In response to patient advocacy groups that claim that a court decision in favor of Novartis will hamper access to cheap medications for the poor in India, Novartis counters that it gives 99 percent of Gleevec away for free as part of a patient-assistance program.   
Genentech has several patient-access programs in the US to help poor patients gain access to its targeted therapies Avastin and Tarceva.

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