Improving survival in Liver Cancer - at what cost?

No effective therapy is available for advanced hepatocellular carcinoma (liver cancer), it's a terminal condition. Over 18,000 people typically die from it in the USA each year. It is much more common in Africa and East Asia where the risk of infection from Hepatitis B and C is much higher, which are associated with increased risk factors for the disease.

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In this month's New England Journal of Medicine, a randomised trial involving 602 patients with advanced hepatocellular carcinoma was reported. Sorafenib, a multikinase inhibitor of Raf, vascular endothelial growth factor receptor, and platelet-derived growth factor receptor, improved median survival by 3 months compared to placebo (10.7 vs. 7.9 months, P<0.001). Adverse events, including diarrhea and weight loss, were more frequent in patients receiving sorafenib.

Three months doesn't sound a lot, but improvements in cancer survival nearly always occur in small increments. The other side of the coin is at what cost?

An editorial by Dr Lewis Roberts in the same journal noted the following:

“The pharmacy price of sorafenib is approximately $5,400 per month in the United States, {euro}3,562 per month in France, $1,400 per month in Korea, and $7,300 per month in China. Even in industrial nations, the high cost of new drugs produces significant stresses on health system budgets. There are substantial ethical implications in having effective therapies available for life threatening diseases that are priced beyond the reach of the populations most in need of therapy.”

Would you pay $15,000 for an extra three months of life?

15 minutes of fame in oncology

Wow, my blog on abiraterone in advanced prostate cancer got picked up last night by TopUSAsites for prostate cancer.

It looks like the drug is going to be a hot topic for a while, but caution against the hype is advised until we see whether reduction in PSA and tumour shrinkage actually translates to what really matters to patients - improved survival and better quality of life.

What say you?

A cancer patient's inspiring story

A lady who was diagnosed with non-Hodgkin's lymphoma (NHL) and relapsed on chemotherapy, tells her story about how she overcame the odds with a promising new approach called radioimmunotherapy:

VIDEO

There is always hope around the corner with new treatments coming on the market.

Cediranib (AZD2171) in Glioblastoma and brain cancer

The investigational drug AZD2171 (cediranib) from Astra-Zeneca may help shrink tumours and prolong survival of patients with a relatively common, aggressive type of brain cancer. In a phase II study of 31 patients with recurrent glioblastoma, researchers observed that daily treatment with cediranib decreased tumour volume by more than half in 56 percent of patients. These results were reported at the recent AACR meeting.

Nearly 26 percent of patients were alive and their cancer had not progressed six months into treatment. On average, patients experienced a progression-free survival of 117 days and overall survival of 221 days. Cediranib was also found to alleviate brain swelling, a major cause of morbidity among these patients.

Cediranib is a selective signaling inhibitor for vascular endothelial growth factor (VEGF), which promotes formation of new blood vessels that tumours need for nourishment and growth. The drug targets all three receptors for VEGF, one of which is expressed on the endothelial cells in glioblastoma.

Two of the 31 patients were removed from the current study because of toxicity (fatigue). Dose reductions, ie short breaks from the drug, were required for most patients, usually due to hypertension, diarrhea and fatigue.

By analyzing blood samples from patients, the researchers found that the biomarkers FGF (fibroblast growth factor) and Tie-2 were associated with tumour progression and could be used to predict treatment failure in this study population. FGF is a protein tied to new blood vessel growth; Tie-2 is a receptor that binds to and is activated by the angiopoietins - protein growth factors required for the formation of blood vessels.

New treatment option for patients with liver cancer

Treatment with sunitinib (Sutent) slows tumour growth and reduces the risk of metastasis in patients with hepatocellular carcinoma, an aggressive cancer of the liver.

Hepatocellular carcinoma is a cancer that relies heavily on blood vessels for growth; sunitinib controls the growth of blood vessels and could therefore potentially play an important role for treatment.

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Patients with this type of liver cancer have a very poor prognosis and the only currently available therapy is sorafenib. This study shows that it may be possible to effectively use sunitinib with manageable side effects, thereby providing patients with an alternative treatment option. Sunitinib (Sutent) is a small molecule tyrosine kinase inhibitor that targets multiple receptors, including VEGFR2, c-Kit and FLT3. These receptors may be present in cancer cells as well as in endothelial and immune cells.

Researchers enrolled 34 patients with advanced liver cancer and gave them 37.5 mg sunitinib daily on a standard four weeks on, two weeks off regimen. By 12 weeks, one patient had a partial response and 17 patients had stable disease. The median progression-free survival was four months and the median overall survival was 10 months.

Source:

AACR