Development and economic trends in cancer therapeutic drugs: a 5-year update 2010–2014

Over the past 20 years, the systemic treatment of malignancies has altered from being based almost entirely on the use of classical DNA-damaging cytotoxic chemotherapy drugs to a situation where currently the large majority of new cancer treatment drugs have completely different mechanisms of action (Patel et al, 2014). The arrival of these new therapeutic drugs has led to important improvements in patient care with increasing response rates, longer durations of benefit and enhanced overall survival, all generally achieved with favourable side-effect profiles (Coiffier et al, 2002; Richardson et al, 2005; Motzer et al, 2009). Alongside these important developments in clinical care, there has also been an increasing debate regarding the rising costs of the new cancer treatments and how they can be met. This debate on the delivery and funding of optimal modern care to patients in both insurance-based systems and state-funded models is ongoing and featuring more in the political and clinical arenas (Meropol et al, 2009, Sullivan et al, 2011; Experts in Chronic Myeloid Leukemia, 2013; de Souza et al, 2014; Khera 2014). At present, there is relatively little structured information on how the nature of new cancer treatment has changed, the increasing overall benefits from new treatments and the detailed economic issues relating to provision of care. Previously, in 2010, we published a paper that examined all of the drugs available for the treatment of solid tumours in UK practice from 1955 to 2009, looking at the years of introduction and the relative costs of a standard course of therapy (Savage, 2012). The study documented the rising numbers of new drugs, the changes in the types of drugs arriving and demonstrated the rising costs of treatment. Other additional studies have also looked at the similar costs in other countries with similar findings (Kantarjian et al, 2013; Light and Kantarjian, 2013). In the 5 years since 2009, there have now been a total of 33 further new cancer therapy drugs introduced and as a result the management of many malignancies has significantly changed and outcomes improved. Alongside this progress, there has also been an increasing debate within the clinical world and government on how these increasing costs of modern cancer care are to be addressed (Sullivan et al, 2011, Fojo et al, 2014). In this 5-year update paper, we have aimed to provide extended information on the numbers of new drugs introduced, their therapeutic classes, the first licenced indication, the median duration of treatment and the relative costs of treatment measured against the contemporary UK GDP per capita at the time of introduction. The data on the timing of a drugs initial sale and the exact costs are taken from the UK market, where the timing of first drug sales and economic data is readily available. However, it is likely that the overall results regarding the drugs characteristics and the economic costs will be similar across most of the major developed countries. The information in this update may be helpful in reviewing the historical trends in cancer therapeutic developments and comparing changing economic issues in cancer care delivery over time.