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Costs keeping 'rescue' drugs from patients

Health: Physicians advise chemotherapy patients to ask about treatments that may reduce suffering from side effects.

By Marilyn Chase- The Wall Street Journal

letter.editor@edit.wsj.com

Many of this country's 11 million cancer survivors have had to deal with the side effects of chemotherapy. Chemotherapy kills cancer cells, but also damages healthy cells in the digestive tract, bone marrow, hair follicles and other organs. Research is homing in on new rescue drugs for these healthy cells all the time. But some health-care plans don't offer the drugs to patients because they are so costly.

"Most patients don't know they exist," says Marti Ann Schwartz, a Portland, Ore.-based consumer advocate who survived Hodgkin's disease after radiation therapy and a four-drug medley called MOPP.

"Ask your oncologist, the nurse who administers chemotherapy, your cancer counselor... everyone and anyone for hints," she says. "Nothing is easy, but there are tips that make it less horrendous."

Only after Schwartz was hospitalized three days for nausea did a counselor suggest the drug ondansetron, or Zofran, which quelled her vomiting. Now that has been joined on the market by a similar drug, granisetron, and more are coming. Lisa DeAngelis of Memorial Sloan-Kettering Cancer Center in New York tells of a California managed-care patient who underwent chemo with-out either ondansetron for nausea, or drugs to help her bone marrow recover from chemo.

The new anti nausea drugs are expensive, topping $100 for an intravenous infusion, or $50 dollars for two pills. But by making tough treatment tolerable, they can enable patients to stay the course and get a shot at a cure. Moreover, compared with total chemo costs or, say, an emergency-room visit for uncontrollable nausea, their cost pales. Patients shouldn't accept misery as unavoidable, health professionals say. They should ask for relief and enlist their doctor in lobbing insurance companies, which vary on coverage.

"People are on firm ground to ask for these drugs before their chemotherapy," says Mark Kris of Memorial Sloan-Kettering. He contends that standard care should seek to prevent chemo's side effects, and he's pressing pharmaceutical and cancer groups for more liberal treatment guidelines "to ensure optimal therapy is given to everybody."

Kris also is testing the next generation of nausea fighters, chemicals that target substance P, a neurochemical involved in digestion and pain perception. At least three drug companies are in hot pursuit of products based on this research. Additional new rescue agents aim to take the sting out of chemotherapy's other tonicities. Memorial's DeAngelis and Brigitte Widemann of the National Cancer Institute are testing an enzyme that limits toxicity of the drug methotrexate. A staple of the chemotherapy armory, methotrexate is used on many cancers, including leukemia, lymphoma, bone cancer and head and neck tumors. Among its side effects is kidney dysfunction, which hampers excretion of the potent drug, raising blood levels and, in turn, raising its potential to damage other organs.

The rescue enzyme, carbodypeptidase-G2, or CPDG2, detoxifies excess methotrexate in the blood, rendering it harmless to other organs. DeAngelis is using CPDG2 in experiments treating patients with brain tumors. At NCI, Wildemann is using CPDG2 and another rescue drug- thymidine- to mute methotrexate toxicity in several cancers. Because they're still classed as investigational drugs, CPDG2 and thymidine are available only to patients under a compassionate-use program. Doctors can obtain the drugs by contacting the NCI's Cancer Therapy Evaluation Program in Bethesda, Md., at (301)496-5725.

To be sure, not all chemo side effects can be counteracted by rescue agents. But many can. Patients can arm themselves with information about their particular tumor types, the recommended drugs and potential toxicity and remedies for it.

"Ask your physician lots of questions and ask what drugs are available to prevent toxic effects," says Robert Witherspoon of the Fred Hutchinson Cancer Research Center in Seattle. Do this before treatment begins, he advises. But remember, he adds, "Oncologists have to walk a tightrope. You want to make sure you don't protect the cancer in trying to protect the patient."

Some rescue strategies that may seem harmless- self-medicating with megadoses of antioxidant vitamins, for example- could undermine treatment, he warns. Ice caps or skull bands to limit hair loss might be OK during treatment of solid tumors far from the head, but not for blood cell malignancies such as leukemia or lymphoma, where stray cells might take refuge under hair-sparing devices.

"Most toxicities are short term and reversible," Memorial's DeAngelis says. "Every now and then, some are not." The essential thing is to understand what potential toxicities are before they even get the drug," she adds. "Ask what the options are, should they develop toxicity."

"Prevention is the goal of therapy," adds Memorial's Kris urging patients to plan their rescue strategies well before toxicity develops. Schwartz concludes, "No one making a decision to withhold drugs has ever gone through chemotherapy." Thanks to treatment- and the drugs that eased it- she's reveling in her renewed ability to "take felling good for granted."

Copyright the Wall Street Journal. Reprinted under the fair use doctrine.

Link to Nahas versus Kassirer: How The Wall Street Journal defrauded the readers of its editorial page. A critique of a column by Gabriel Nahas printed on the editorial page of the WSJ which denied that there is any need for the medical use of marijuana.

Comment by the editor of The Medical Marijuana Magazine: This article does not mention medical marijuana. (Would the Wall Street Journal have published it, if it did?) However, knowing that much of this suffering could be eliminated by a few puffs of marijuana -- costing only a few cents even on the black market -- makes this even more horrendous.

There are two points of relevance to the medical marijuana issue here. First, prohibitionists claim that there are pharmaceuticals that make medical marijuana unnecessary. This article makes clear that this is simply not true. Second, even if it were true, there are large numbers of people in America, and many more in other countries, for whom this is irrelevant because they just cannot afford these very expensive pharmaceuticals. Could this be why so many cancer wards are said to reek of marijuana? Also note the ironic header: "Physicians advise chemotherapy patients to ask about treatments that may reduce suffering from side effects." Consider this in the context of the recent efforts to make it a crime for a doctor even to recommend the medical use of marijuana.

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