Medicare committee recommends expensive drug for some prostate-cancer patients

"A new treatment for prostate cancer called Provenge won a vote of confidence from a Medicare coverage advisory committee Wednesday, suggesting the federal program is likely to pay for the $93,000-per-patient medicine," The Wall Street Journal reports. The committee's health industry experts, doctors and researchers "found enough evidence to support the use of the medicine for late-stage prostate-cancer patients whose disease has metastasized, but not for those whose cancer hasn't progressed." Its maker, Dendreon, says 100,000 Americans have advanced prostate cancer, the condition for which the FDA approved the treatment in April 2010. Medicare usually covers FDA-approved drugs like Provenge, but "the federal Centers for Medicare and Medicaid Services sparked a new controversy in June when it decided to put Provenge through a national coverage review." The review raised concerns that Medicare, "which isn't supposed to consider price when making coverage decisions," was trying "to ration treatments to save money" (Mundy, 11/18).

CBS: "The makers of Provenge call the drug a value at $93,000. They argue it can be less expensive than chemotherapy, with none of the horrible side effects." Medicare's ruling on whether to cover Provenge, and under which medical conditions, is "a crucial decision because typically most private insurance companies follow Medicare's lead" (Andrews, 11/17).

HealthDay/Bloomberg Businessweek: A study published in the New England Journal of Medicine in July showed that the Provenge vaccine "extends survival by about four months on average," according to clinical trials. The therapeutic vaccine, which is developed by treating a patient's extracted white blood cells with Provenge, was also less toxic than chemotherapy. Once placed back inside the patient, the treated white blood cells "trigger an immune response that in turn kills cancer cells, leaving normal cells unharmed" (Reinberg, 11/17).

The Associated Press: "Most analysts expect Medicare to pay for the drug, giving drugmaker Dendreon Corp. a blockbuster product worth up to $2 billion in sales per year. The agency already pays for other innovative cancer drugs from companies such as Genentech and Eli Lilly that have similar price tags and survival benefits." The leader of a health consulting firm said that "Medicare's review of Provenge is primarily a signal to drugmakers that the agency will not automatically pay for drugs just because they have been cleared by the FDA." A Medicare representative defended the federal programs against accusations that the Provenge review was tied to the high cost of the drug, and said the review was instead "aimed at clearing up bureaucratic confusion among Medicare carriers across the country, some of whom already pay for Provenge, while others do not" (Perrone, 11/17).

The New York Times reports on another prostate cancer drug under development. Early testing revealed that the experimental drug XL184, "is showing what some experts say is intriguing effectiveness in treating a major cause of death and disability for men with prostate cancer — tumors that have spread to the bone." XL184, developed by the biotechnology company Exelixis, "is believed to block the formation of blood vessels that feed tumors and also inhibits a protein called MET that helps spur tumor growth," while Provenge "trains the patient's immune system to attack the tumor." Testing on XL184 revealed that "19 of 20 patients showed an improvement in the scans used to determine whether cancer has spread to the bone," but the tests had a small sample size, did not include a control group and did not follow patients over time (Pollack, 11/18).

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This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.