[ RadSafe ] Xofigo etc.

[Chris Alston]

Radsafers

I got a private email from an acquaintance at a large cancer center,
who said that they do get some use out of these drugs (quantification
not available).  However, that may be a special case, partly because
it is very big, partly because of its geographic locale; i.e., they
may see a lot of pts as first referrals.

I worked at a Comprehensive Cancer Center, for many years (~10).  We
treated with Quadramet or Metastron less than once a year.  We maybe
treated once with Zevalin, in that time, even after people showed that
it, and Bexxar, are effective as first-line tx, as well as salvage tx.

We once hosted a meeting of the local chapter of the Leukemia and
Lymphoma Society, starring our chief hematologist, at which a lay
member of the audience asked (beating me to the punch) why Bexxar and
Zevalin were not used more, since they were clearly such good drugs.
The doc's  answer was that partly it had to do with the fractured
nature of our healthcare system.  Most of the standard chemotherapies
for the diseases in question can be done by a physician, in his or her
office, in the community.  One needs special licensure, and specially
trained staff, to treat with radiopharmaceuticals.  He thought that he
medical oncologists in solo, or small group, practices worried that,
if they were to refer their pts to the relatively very few places
authorized to use radioactive drugs in tx, they would lose the pts to
those facilities permanently.  Personally, I think that is an entirely
reasonable fear.  Of course, this does not entirely explain why *our*
institution used them so little.

Also, I have a msg, from another mailing list, that offers an estimate
for a full course of tx with Xofigo, of US$66,000 (6 fx @ $11,000
each).  I suspect that the docs are going to have to fight very hard
to get insurance to pay for it.

Your thoughts, I solicit

Cheers
cja