ASCO proposes cancer drug scorecard, with some scary examples for Big Pharma


The American Society of Clinical Oncology promised a rating scale for cancer drugs--and now, it has delivered. Let the blowback begin.

The drug scorecard, published in the Journal of Clinical Oncology, is designed to simplify decision-making by boiling down available data--on survival benefits in specific types of cancer, as well as side effects--into one number. It rates treatment regimens on a 0-to-100 scale--0-to-130 in some cases, with bonus points--and the physicians' group hasn't been shy about awarding low scores.

A lung cancer cocktail that includes Eli Lilly & Co.'s ($LLY) Alimta, for instance, got a big fat goose egg. A treatment combo with Roche's ($RHHBY) Avastin won just 16 points in the same disease. A prostate cancer combo that incorporates Sanofi's ($SNY) Jevtana also racked up just 16 points.

The scorecard also tots up the cost of treatment, with the Alimta cocktail at $9,200 and the Avastin combo at $11,900. The Jevtana prostate cancer combo costs $10,700, the report says.

Of course, scores vary by type of cancer, and a low number in one indication doesn't mean similar ratings in other cancers. Avastin was first approved for colorectal cancer, and has better overall survival data in that disease; the scorecard examples the journal article presented didn't go into that field.

ASCO is asking for feedback on the drug-assessment framework, and there's likely to be plenty. Once the scorecard is finalized, the idea is for doctors to review the scorecard with patients when deciding how to approach treatment. Oncologists "must have the knowledge and tools necessary" to compare different therapies "for specific clinical scenarios," the journal article said. Doctors and patients both need to think about costs, too; patients need to understand "the relative financial consequences" of various treatments, while each doctor "also has a responsibility to be a good steward of health care resources," the framework authors state.

The journal article also lines up alternatives in particular cancers; alongside the Jevtana cocktail, the authors crunched the numbers on Johnson & Johnson's ($JNJ) Zytiga in combination with prednisone. Its score was more than double the Jevtana number, at 42 out of 130 possible points. Medivation ($MDVN) and Astellas' newer prostate cancer pill Xtandi, used solo, won 32 overall points. Cost? About $7,500 per month for the Zytiga combo versus $8,500 for Xtandi--both several thousand less than Jevtana.

The authors compared HER2 breast cancer regimens, too, with Herceptin playing a starring role. One combination--which puts the Roche drug with doxorubicin, cyclophosphamide and paclitaxel--won a score of 48 out of 100, with a total treatment cost of $73,165. Another, combining Herceptin with carboplatin and docetaxel, didn't fare as well, with a score of 32 out of 100.

Eventually, ASCO would like to develop a "user-friendly tool" doctors can use with their patients, including a mobile app.

"Value and cost are among the biggest issues in healthcare today, but there are few tools to help doctors and patients objectively assess benefits, side effects and costs," ASCO President Julie Vose said in a statement. "Our goal is to help oncologists and their patients weigh potential treatment options based on high-quality scientific evidence and a thoughtful assessment of each patient's needs and goals."

- check out the ASCO framework

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