Top Selling Cancer Treatments of 2018

I have a Google Alert set for Follicular Lymphoma. Every day, sometime in mid-morning, I get an email from Google with a list of things that were written about Follicular Lymphoma in the last day or two.

(I'd be lying if I told you I didn't get a thrill from having something I wrote appear on the list. Kind of cool.)

A large number of the articles I receive come from financial web sites that giving an evaluation of trends. They are meant for investors who are looking for advice about where they might make money. So the articles will name pharma companies that look like they will have a treatment approved, and thus make a lot of money, for the company itself and for its investors.

I have such mixed feelings about emails like this. On the one hand, they seem kind of predatory -- someone is making money off of me being sick.

On the other hand, they are strangely hopeful -- someone is making money off of me becoming well.

I had those same mixed feelings when I say this piece published today: "Top 10 Best-Selling Cancer Drugs of 2018" from Genetic Engineering and Biotechnology News.

It's a fascinating list, and it includes some familiar names.

#8 is Neulasta. This isn't a treatment for cancer, but rather a treatment for a common side effect of many treatments. It helps the body make white blood cells, a type of immune cell that gets wiped out by many cancer treatments. Last year, it had $4.684 billion in sales (down 0.7% from 2017).

#7 is Ibrutinib (also known as Imbruvica). It's a BTK inhibitor -- it sticks to a protein that cencer cells need to grow and live, and keeps that from happening. It is a major treatment for CLL, another slow-growing blood cancer. It doesn't do too well with Follicular Lymphoma on its own, but there are still some trials out there that combine it with other things. Last year, it had $6.205 billion (up 38.9% from the year before).

#6 is Rituxan (Rituximab or MabThera). My old pal! Being this high on the list makes sense. Rituxan is the bacon of cancer treatments -- it makes everything better. Because it's such an important part of so many treatment combinations, it's no surprise that it had $6.750 billion in sales last year (though that was down 7.5% -- some biosimilars are probably eating into those sales).

And #1 is Revlimid, also known as Lenalidomide, half of the R-Squared duo. It had $9.685 billion in sales last year, up 18.3%, and is an important treatment for a bunch of different blood cancers, and could get an FDA approval for FL later this year as part of R-squared.

Just looking at Rituxan and Revlimid, that's over $16 billion in sales in 2018. Cancer treatments overall cost about $50 billion in the USA in 2018, and another $60 billion in the rest of the world. That's a lot of money.

But (says my conflicted mind), that's also a lot of people who are still alive.

I certainly think the cost of my Rituxan treatments was worth it.

The Genetic Engineering and Biotechnology News piece also quotes from some participants at a recent event that focused on the cost of cancer treatments. They do a good job, but they're too high, and something needs to be done to bring down costs.

One answer might be value-based pricing. With this strategy, the cost is tied to the success of the treatment. Something that cures a cancer will be expensive. Something that gives a long remission will be less expensive. Something that didn't work will not cost much. There's some incentive there to figure out which treatments will work for which patients, rather than guessing and hoping for the best (though I think most health professionals work hard at this already).

I'm still conflicted. I guess I try to focus on the good that a treatment can do, but I can't help think of the cost. For now, I take comfort in knowing that there are a bunch of treatments out there for me when I need one.

I'll figure out how to pay for it when the time comes.