As head of the Prostate Cancer Foundation (PCF), oncologist Jonathan Simons can speak at length about the various challenges and inequities he encounters in his field. There’s suboptimal patient education and a delay in the adoption of precision medicine by many rural cancer centers, to name just a few.
Work clearly still needs to be done, but his overarching message at the 2017 American Society of Clinical Oncologists (ASCO) annual meeting was that of optimism.
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“This has been a new chapter in the history of ending death from prostate cancer,” Simons declared during a Sunday interview with MedCity News. “This is the largest reduction in death in the history of the field, for advanced disease, and it’s a new chapter also because this is a targeted drug in a pill.”
Simons was talking about abiraterone acetate (Zytiga), a drug that his foundation helped bring to life. PCF donated a total of $13 million over the course of 10 years, he said, and the investment is paying off.
Manufactured by Janssen Biotech, an arm of Johnson & Johnson, abiraterone was approved by FDA in 2011 for the treatment of men with metastatic castration-resistant prostate cancer who have received prior chemotherapy containing docetaxel.
New research announced over the weekend shows the drug is also highly effective when administered before the patient has become resistant to androgen deprivation therapy (ADT). Simons believes it could even replace the need for toxic chemotherapies.
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In two global studies, dubbed LATITUDE and STAMPEDE, researchers showed that early combination treatment with abiraterone was superior to placebo or chemotherapy.
In the LATITUDE study, the drug reduced the risk of death by 38 percent. Administered alongside prednisone and ADT, the combination also more than doubled median progression-free survival from 14.8 months (prednisone + ADT + placebo) to 33 months. Overall, it significantly prolonged the lives of many patients with a potentially lethal form of the disease and even sent some into complete remission, Simons said.
Likewise, an abstract on the STAMPEDE trial concluded that “The results show a clinically & statistically significant effect on overall survival & failure-free survival from adding abiraterone at start of ADT with a manageable increase in toxicity.”
The National Cancer Insitute estimates that 161,360 men will be diagnosed with prostate cancer in 2017, accounting for 9.6 percent of all cancer cases in the United States.
According to Simons, incidence rates are steadily increasing worldwide, alongside rising incomes in the developing world and subsequent dietary changes.
“A lot of Chinese researchers call it Kentucky Fried Chicken syndrome,” he said with a straight face. “With the Western diet comes breast cancer, prostate cancer, and colon cancer.”
Fortunately, the disease is extremely well characterized, which Simons said bodes well for tackling the remaining challenges in the field.
But with therapeutic options come debates about pricing and coverage. As Benjamin Davies, a urologic oncologist and associate professor of Urology at the University of Pittsburgh wrote in Forbes:
“This is convincing and practice-changing data. No arguments here–every patient with high-risk metastatic prostate cancer should be at least offered abiraterone. Starting today… The financial outlook to patients and insurers is not as rosy.”
Based on its average wholesale cost, Davies estimates that abiraterone will cost around $115,000 per year. Many patients may take the therapy for multiple years. Given the growing prevalence of prostate cancer, this could become quite a burden for the healthcare system.
Photo: AdrianHillman, Getty Images
