Cost-consciousness and excellent medical care can go hand in hand — for instance, a recent discovery in genetic medicine lets doctors customize chemotherapy not only to increase the likelihood it will work, but also to dramatically cut overall costs. Specifically, scientists have found that people with a certain gene mutation do not respond to cetuximab (Erbitux), a powerful chemotherapy drug for treatment of advanced colorectal cancer.
Make colon cancer less scary
Testing for this mutation before initiating treatment spares patients from ineffective and potentially toxic therapy so they can try other therapies more likely to work, explains study author Veena Shankaran, MD, of the Northwestern University Feinberg School of Medicine in Chicago.
Sparing Patients and Saving Health Dollars
Cetuximab and similar drugs such as panitumumab (Vectibix) work by blocking epidermal growth factor receptor (EGFR), a substance that makes tumors grow. But when there is a mutation in a specific gene called the Kras gene, this therapy doesn’t work. Dr. Shankaran said that testing for it can therefore help patients have faster access to chemotherapy that may work better.
The cost savings are quite significant, too. In her study, Dr. Shankaran made calculations based on a theoretical population of patients to forecast how much would be saved by testing all advanced colorectal cancer patients for Kras mutations before administering cetuximab chemotherapy, as follows:
- Estimated number of patients annually with metastatic colorectal cancer: 28,274 (American Cancer Society statistics).
- Approximate percentage of patients with Kras mutations: 35.6% (based on estimates from a recent study by Van Cutsem et al).
- Average cost of a Kras test: $452.
- Average cost of cetuximab treatment for starting dose is $3,986; and a weekly dose is $2,491 ( assuming $61,279 per patient).
Using these figures, the annual cost of testing patients for Kras mutations is $13 million, compared with the cost of treating the 10,066 patients with Kras mutations (in whom treatment is ineffective), which is $617 million. Thus testing patients for Kras mutations before treating them would save $604 million. Dr. Shankaran presented these results at the January 2009 Gastrointestinal Cancers Symposium.
Dr. Shankaran recommends that all patients with advanced (or metastasized) colorectal cancer be tested for Kras mutations before cetuximab chemotherapy. In the future, identifying more Kras-like markers is likely to result in more targeted therapies — treatments that are both more beneficial for patients and more cost-effective for our health care system as a whole.
Source(s):
Veena Shankaran, MD, Northwestern University Feinberg School of Medicine, Chicago.
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