RSS feedThe results of the phase 3 study on Immunotherapy for Prostate AdenoCarcinoma Treatment (IMPACT) were presented at the 104th Annual Scientific Meeting of the American Urological Association. This study involved 512 men with minimally or asymptomatic metastatic castrate-resistant prostate cancer. These patients were randomized to receive either immunotherapy with sipuleucel-T or placebo.
The active treatment is a vaccine produced by mixing a synthetic version of prostatic acid phosphatase (PAP) with dendritic cells harvested from the patient. Once the dendritic cells are stimulated and their numbers increased, the preparation is infused back into the patient. The stimulated dendritic cells will then attack the prostate cancer cells that generate PAP. (The vaccine is called Provenge and is developed by Dendreon Corp.)
The median survival of those patients who were treated with the vaccine was 25.8 months versus 21.7 months for those who received the placebo. The 3-year survival for the vaccine treated patients was 31.7% versus 23% for the placebo group. The prostate cancer vaccine has extended median survival by 4.1 months.
Patients with metastatic castrate-resistant prostate cancer have a life expectancy of about 2 years. Thus an extension of 4.1 months to one’s life expectancy is significant. Most if not all patients with this type of prostate cancer will want to receive the vaccine. However, what is not known yet is how much it will cost the patient. It is unlikely to be cheap.
With the ever-increasing number of new molecular targeted agents for treating cancer patients, the question of affordability will constantly rear its ugly head. It is only human to want to live longer but how are you going to pay for these expensive treatments. If you happen to have full health insurance cover and the policy covers this, then great! But if you do not have insurance cover and you do not have the money to pay for it yourself, what then? Should you mortgage your house or borrow from the bank or relatives in order to have this treatment? Should the state pay for everything?
The issue of treatment cost will always vex the state, the patient and his family members. As a doctor, I find it most difficult to advise patients what to do when cost becomes an issue. I fear my job will get even more difficult as more treatment choices become available.
How I wish for a nanny state which would take care of everything!
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