Lower Cancer Drug Dosages Could Save Billions and Expand Patient Access

Studies presented at the American Society of Clinical Oncology (ASCO) annual conference indicate that reducing dosages for anti-cancer medicines, including the top-selling drug Keytruda, could save up to $31.1 billion globally each year. Researchers from the University of Chicago found that 21 of 29 FDA-approved drugs might work effectively with lower doses or less frequent administration.

Why could lower cancer drug doses save billions?

A preliminary study from the University of Chicago suggests that many high-cost immunotherapies stay in the body longer than current dosing schedules assume. Post-doctoral researcher Mohammed Ali stated that this behavior indicates patients could potentially receive treatment less often while maintaining effective drug levels.

The analysis identifies Keytruda, manufactured by Merck & Co., as the largest source of potential savings, totaling more than $14 billion annually. Other significant potential savings include $6.63 billion for Roche/Genentech’s Avastin and Tecentriq, and $2.7 billion for Bristol Myers Squibb’s Opdivo.

According to the study, optimizing these dosages could save individual patients between $40,000 and $240,000 per year. Professor Mark J. Ratain, a coauthor of the study, noted that this research is part of a larger effort to optimize cancer drug dosing funded by Arnold Ventures.

Did You Know? The FDA initially approved Keytruda’s dosage in 2014 based on a patient’s body weight at 2 milligrams per kilogram before Merck later shifted to a fixed dosage.

How do lower dosages impact patient access?

In India, researchers at Tata Memorial Hospital have spent nine years testing low-dose immunotherapies. Oncologist Kumar Prabhash reported that lowering doses can expand patient access by 50% to 60%, compared to only 5% of patients who can afford the standard high dose.

One trial involving 380 patients with advanced non-small-cell lung cancer combined chemotherapy with a low dose of Keytruda. Oncologist Nandini Menon reported that these patients lived longer and experienced slower cancer growth, with side effects remaining similar to those in the chemotherapy-only group.

A separate study of over 400 patients with advanced head and neck cancer compared standard chemotherapy to a combination of a low-cost oral drug and a very low dose of Opdivo. An ASCO abstract found that this regimen helped patients live longer and resulted in fewer serious side effects.

Expert Insight: Samantha Carter notes that the tension here lies between established regulatory approvals and real-world economic necessity. While pharmaceutical companies prioritize the safety of FDA-approved protocols, the data from India suggests that for millions of patients, a slightly less intensive but affordable dose is the only viable path to treatment.

What is the response from pharmaceutical companies and the government?

Merck & Co. disagrees with the findings regarding dose reduction. Julie Cunningham, Merck’s director of global media relations, stated that dosing must be established through well-designed clinical trials to ensure effectiveness and safety in life-threatening diseases.

ASCO 2013: Jane E. Churpek, The University of Chicago, Chicago, Ill.

The U.S. Department of Health and Human Services expressed a different view. Senior press secretary Emily G. Hilliard stated that the National Cancer Institute supports “de-escalating” therapies when evidence shows lower doses are safe, noting this can reduce toxicity and improve quality of life.

Financial pressures remain high for patients. An ICIJ analysis found a 200 mg dose of Keytruda costs $12,000 in the U.S. A Senate report found that the annual cost of Keytruda rose to $210,000—a 6% increase—while Opdivo and Darzalex saw price increases of 4% and 6%, respectively.

What may happen next for cancer treatment costs?

Health authorities in other nations may use these findings to change how they fund care. Lobna Sedky, an oncologist from Egypt, indicated that the ASCO discussions could help persuade the Egyptian Ministry of Health to support more affordable, lower-dose strategies.

The University of Chicago researchers may expand their analysis to dozens more cancer drugs. If further evidence supports dose reduction, the FDA may continue working with developers to determine new, lower dosages that remain safe and effective.

Frequently Asked Questions

Which drug offers the highest potential for global savings?

Keytruda is the largest contributor, with potential global savings of more than $14 billion per year if lower or less frequent doses are used.

What did the Tata Memorial Hospital study find regarding patient access?

Kumar Prabhash stated that lowering the dose could expand access to the drug by 50% to 60%, whereas only 5% of patients can access the drug at the higher dose.

Does the U.S. government support reducing drug dosages?

Yes, Emily G. Hilliard of the Department of Health and Human Services stated that the agency and the National Cancer Institute support scaling back therapies when evidence shows it is safe and effective.

Do you believe healthcare providers should prioritize lower-cost, lower-dose treatments if they show similar efficacy to standard dosages?