David's New Book

Sunday, May 2, 2010

Treatment of Cancer vs. Antibiotics for Infection

I see that the first therapeutic vaccine for cancer was approved recently (http://www.nytimes.com/2010/04/30/health/30drug.html).  This particular product is a difficult one.  A sample of the patient’s own immune cells are removed, treated with a protein or peptide derived from prostate cancer and then re-injected into the patient over several treatment courses to help fight their own prostate cancer.  The treatment improved survival in end-stage patients from 21.7 to 25.8 months.  After 3 years, 32% of vaccine recipients were still alive compared to 23% of those who did not receive it.  The treatment will cost $93,000 and only 2,000 treatments will be available from the company (Dendreon) initially. 
This represents a major advance in cancer therapy since it is the first example of an efficacious and specific therapeutic vaccine.  Scientists have been working for decades to make this work and it finally has.
Science aside, lets compare this result to the treatment of infections caused by bacteria like pneumonia, serious skin infections, wound infections, and others.  These infections, untreated, kill between say 15 and 80% of their victims.  Antibiotics reduce this mortality to anywhere from 0.3 to 15% or so.  Not bad.  Not only that, but patients treated with antibiotics are cured of their infection – not usually the case for cancer victims.  For this cure, patient take a few days of pills or they may have to spend a week or two getting intravenous therapy at home, in a chronic care facility, in a hospital or some combination of these.  Generic antibiotics in pill form can cost as little as pennies per day.  The most expensive of antibiotics will cost about $1800 for a 10-day course of therapy (cost from the pharmacy).
How lucky can we get?  Of course, this luck won’t last long if we continue to stick our heads in the sand and ignore growing antibiotic-resistance in bacterial pathogens.  And the first step in getting back on track must be the FDA.  The industry, both large and small pharmaceutical companies, and the FDA must find a way to work together to bring needed therapies forward to the marketplace.  In this regard, my own view is that the FDA lost its way more than industry has.  For more details, you can see my previous blogs (http://antibiotics-theperfectstorm.blogspot.com/2010/03/earthquake.html).  But if the FDA cannot find its path forward, and the industry cannot follow, we are doomed to a future with more resistant bacterial pathogens and fewer and fewer antibiotics to fight them.  In a future that I hope will never come, maybe the one or two large pharma companies still left in the antibiotics business will be able to charge $93,000 for a course of life-saving, curative therapy for resistant infections.  Who knows?