IMiDs? What Da Heck Is an IMiD?
“Shares of the Celgene Corporation rose 5.9 percent yesterday after regulators approved the company’s Revlimid capsule for a rare blood cancer, a treatment that will cost pharmacies $215 to $225 a pill.”
You have got to be kidding me - $215 a pill? For the pharmacy? How much will the consumer have to pay for this? Actually I support the right of companies to charge whatever they want for a product. It’s just that (as we all know) since health care in this country is subsidized by third-party payers, consumers are not subject to typical market forces. Thus when an expensive new treatment gets approved we get the “all-or-nothing” phenomenon: either patients pay little or nothing for their pill and could care less about the cost, or they don’t get the benefit of the new drug unless, as a hardship case, they beg the company to give it to them for free.
What drives oncologists batty is when news articles don’t report the complete facts regarding a new treatment. For example, if one reads this report about the approval of Revlimid one would realize that only a small subset of the 10,000 to 20,000 patients per year who develop myelodysplastic syndrome (MDS) are eligible for this new pill, which is a member of the new class of biologicals called immunomodulatory agents, or IMiDs. According to this more detailed report, in order to qualify for treatment patients must have the following:
1. Transfusion-dependent anemia
2. Low or intermediate-1 risk catagory MDS (not intermediate-2 or high risk catagory)
3. A cytogenetic abnormality of the short arm of chromosome 5, called “5q-”
Only 20-30% of MDS patients have a deletion of chromosome 5, which means that at the most only 4,000 to 9,000 American patients per year will be eligible to take Revlimid - at a cost of over $50,000 per year - and one can bet that not all of them will be able to take the drug.
So are oncologists still excited about this agent? My answer is yes, not just because Revlimid represents another breakthrough in the search for biological agents against cancer, but also because of this announcement:
“Celgene will apply to the F.D.A. this week for approval for Revlimid for multiple myeloma.”
This is good news, as another 14,000 people a year develop myeloma and they almost all get treatment. Revlimid will likely be a major advance in the fight against myeloma - and will hopefully replace the older drug thalidomide, which is loaded with side effects.
One scientist at a time…one experiment at a time…one step at a time, we are going to defeat cancer well before this obscure planet floating in the unknown outer spirals of one of billions of galaxies darkens forever.
