Cancer Breakthroughs Meet Market Realities
By Virginia Postrel Oct 31, 2012 3:35 PM PT
When analyzed at the molecular level, a cancer that has traditionally been viewed as a single disease commonly fragments into many different subtypes, each possibly requiring a different treatment. There are now tests for about 200 different such abnormalities, which may occur by themselves or in combination.
“We should realize first that every patient is different,” says Tsimberidou. “We cannot treat all patients with, say, colorectal cancer the same or think, for instance, that all metastatic liver disease is the same. In addition to the standard diagnostic procedures, we should perform a more refined tumor molecular analyses to better characterize every patient’s disease, and we have to tailor the treatment to the specific tumor and patient characteristics.”
The molecular understanding of cancer means both good news and bad news for improving treatment.
The good news is that more cures should be possible, with less waste from giving the wrong patients drugs that won’t work in their particular cases. That potentially could save money and significantly reduce suffering.
Since June 2011, she and her team have also doubled the number of patients they’ve tested, finding even more molecular aberrations they might potentially match with new drugs. About 52 percent of patients have shown at least one abnormality, 11 percent have two, and 2.5 percent have three or more. A recent patient even turned up with 10 molecular aberrations. And therein lies the bad news.
The first problem is that not every abnormality has anything to do with the cancer. Some are just, in Tsimberidou’s phrase, “cosmetic” – correlated with a cancer but not causal. That poses a scientific challenge. To develop effective treatments, researchers have to figure out which biomarkers are relevant and should therefore be attacked with drugs.
Then there’s the economic problem.
It costs something like $1 billion to develop a new drug and bring it through testing to market. That cost, plus profit, needs to be spread over a lot of patients.
While the problem of antibiotic-resistant bacteria strains have gotten much, much, more publicity, this is a second problem modern western medicine is facing. “Rare diseases” is a long recognized problem, but were thought to be rare. So the lack of financial incentive to develop treatments for such diseases was thought to impact relatively few people (not that dying of a disease afflicting just a few hundred or thousand people worldwide is somehow less unpleasant than dying of a disease that kills millions). But now understanding “common” diseases is starting to show that some of them have multiple causes. This will put some who were thought to be sufferers of “common” diseases into the “rare” disease category. IF some “common” diseases are split into enough distinct causes evenly enough, modern western medicine may be approaching an economic affordability wall to treatment improvement at a time when expectations were that further understanding would lead to the availability of more effective treatments. A very perverse and sad irony.