Provenge: Pricey prostate cancer breakthrough
- Article by: JOSEPHINE MARCOTTY
- Star Tribune
- October 3, 2010 - 10:28 PM
After years of controversy and debate, a novel -- and enormously expensive -- treatment for advanced prostate cancer has arrived in Minnesota and is being offered to patients who have few other options.
The treatment, called Provenge, triggers the patient's own immune cells into attacking cancer cells. It was approved earlier this year by the Food and Drug Administration after years of delay that prompted an outcry by patient advocates and congressional intervention.
Now the University of Minnesota Medical Center, which participated in the original clinical trials, is giving it to patients for whom chemotherapy is the only other possible treatment. Other clinics are expected to follow. The treatment is in huge demand, and many health plans are paying for it.
But Provenge costs nearly $100,000 and appears to extend life by only an average of four months, which makes it yet another new therapy that is driving the soaring cost of health care for people at the end of life.
"We are all wrestling with this in our lives -- the costs and decisions about cancer," said Dave Durenberger, the former U.S. senator and founder of the National Institute of Health Policy at the University of St. Thomas. "But at some point we as the public are entitled to say that there are some limits to the benefit of invention."
For Sid Thompson, however, the benefit is well worth the price. Thompson, 70, of Minnetonka has had prostate cancer since 2004. Despite years of drug treatment to suppress the testosterone in his body that feeds it, the cancer spread to his bones.
Thompson had chemotherapy on and off for a year, a regimen that left him exhausted and depressed.
"I would rather die than continue with it," he said in an interview.
But last spring he was offered the chance to participate in a clinical trial for Provenge, made by Seattle-based Dendreon Corp.
Today, more than four months since he had the one-time treatment, the pain in his shoulders is gone and he's golfing again. He didn't have to pay the cost of the treatment because he was part of a clinical trial, but said he would be willing to pay for at least some of it if he had to. He also pointed out that the cost of his one-time treatment of Provenge was comparable to the dozens of chemotherapy sessions he had.
Thompson doesn't know if his cancer has spread or how long he'll live. But at least the life he has now is worth living, he said.
"This Provenge is the beginning stage of a new method of treating cancer," he said. "I think it's going to be a huge success."
Dr. Robert Kratzke, a prostate cancer specialist at the university and Thompson's physician, said that with Provenge the cost-benefit analysis is impossible to predict for individuals.
The clinical trials have shown that Provenge patients lived an average of four months longer compared with patients who took a placebo. But variation among individuals was huge. Some have lived for years, he said, and at this point no one knows why.
About 200,000 men are diagnosed with prostate cancer each year. But it's a slow-growing cancer that can also be treated with surgery and hormone-suppressing drugs. About 30,000 men per year die of prostate cancer, and they are the ones who are most likely get chemotherapy and would benefit from Provenge, Kratzke said.
"Chemo clearly results in better survival than not doing chemo," he said. "But Provenge is more tolerable. It's my first choice."
Provenge has been described as a cancer vaccine because it causes the body's immune system to attack malignant cells, but experts say it's impossible to predict if or when the novel technology could be used for other cancers.
In step one of the treatment, white blood cells are withdrawn from a patient's blood and sent to a processing center in New Jersey. The cells are exposed to a synthetic protein similar to that made by prostate cancer cells. When the blood cells are injected back into the patient's body, they are primed to attack the cancer cells.
Kratzke said research is underway to try to understand why the therapy works better in some men than others. But he's ready to offer it to his patients who have insurance that will cover it, or who can pay for it out of pocket.
"Knowing that some patients seem to derive great benefit from it makes it OK in my mind," he said. "But I would bet that a health economist would say no."
Josephine Marcotty • 612-673-7394
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