In mapping the melanoma genome, scientists have determined that it’s choked with more than 33,000 mutations. My mets undoubtedly contain many of them, but happen to be missing the single mutation that’s most common—as I wrote about in an earlier post. That means vemurafenib, the new melanoma drug approved this week for clinical use, is definitely not in my future. There’s a host of mutation-specific drugs being tested for melanoma, so it’s possible that something else down the line may prove useful to me.
Where all this targeted, so-called “personalized” therapy is leading us is unclear, but I’m convinced its costs are unsustainable. Cancer patients are in the ultimate double-bind in that they want to live and thus often need expensive drug therapies, yet many can’t afford even their insurance co-payments. Vemurafenib has been hailed a "game changer" for patients with advanced melanoma for whom first-line therapy has failed, but that's typical cancer-treatment hyperbole. It will cost about $56,000 for a six-month treatment regimen. That’s more than the annual income of the typical American household. And, if the drug works at all, the melanoma will eventually recur, sometimes ferociously.
Sympathy for metastatic melanoma patients will soon wear thin as treatment options multiply and costs escalate. If it were possible to develop a drug that exclusively targets the mutations of my melanoma and that would extend my life by, say, one year, but cost $1 million, would the FDA approve it? If it’s clinically effective, the feds aren’t supposed to consider cost in their decision-making about a new drug. But if not the FDA, someone surely should. Our medical science is exceeding our capacity to pay for it.
It may yet become possible to treat and sometimes cure melanoma at lower cost than what’s spent today, but I contend we should first do everything we can to prevent skin cancer in the first place. It's reprehensible to pour money the way we do into the medical-industrial complex to create obscenely expensive drugs that do not cure but that surely can bankrupt.