January 15, 2013 | By Márcio Barra
Provenge, from Dendreon Corp., is a therapeutic cancer vaccine for prostate cancer, and an unfortunate case of a good idea panned by some bad decisions and bad timing.
This drug is the first therapeutic cellular immunotherapy that showed positive results in clinical trials, when compared to placebo, and the first ever of its kind approved by the FDA back in 2010. It’s a vaccine for late stage hormone-refractory prostate cancer ,and the basic idea behind this vaccine is to recruit the patient’s own immune system to fight off the cancer, first by extracting the patient own white blood cells, incubating them with a specific protein and injecting them back into the patient. It’s a novel idea in the field of cancer therapy, an example of the growing personalized therapy market, and has a much easier side effect profile for the patient than typical chemotherapy. It could have been a blockbuster except for one thing: its cost-benefit correlation.
The drug extends the survival rate by a median of 4.1 months, according to clinical trials. This number, when compared with other existing therapies for terminal prostate cancer, is on the higher end, but is not a significant improvement on other existing therapies. The light side effect profile, from its novel method of action, is the main selling point, alongside the method of administration (three infusions over 4-6 weeks, instead of typical chemotherapy therapy sessions that go on for months). But for many patients and physicians, shelling out $93,000 for a marginal improvement is a steep cost. With a high price reimbursement questions appear, lingering on the minds of physicians in clinics and hospitals, who would have to keep enormous lines of credit for treating a patient with Provenge. From what I talked with a few physicians, they would not prescribe it to a patient for cost reasons. $93,000, it seems, is too much to ask for four more months of life.
The upfront price has been the main reason for a lack of demand of Provenge since its launch in 2011.But now reports are coming in that maybe Provenge may be starting to get a hold of the 30.000 patients market (estimated at a $2.8 billion in annual sales potential). Analyst Geoffrey Porges reports that urologists expect to increase their use of Provenge up to 20% this year. Shortly after, Dendreon Corp. inc stock grew 21%, its biggest increase since January 2012. The drug sale forecast also increased from $580 million in 2017 to $799 million. This might sign the beginning of an increase of demand for the drug in 2013, if the drug can compete with the new drug Xtandi, from Medivation, which has been getting a lot of press. Provenge-ance perhaps? (ouch) Dendreon Corp. sure needs it.