Test one-tenth-dose immunotherapy where the full dose is unaffordable
A randomised trial at Tata Memorial found that adding a very low dose of nivolumab to cheap chemotherapy nearly tripled one-year survival in head and neck cancer patients who could not afford standard immunotherapy; larger trials should confirm which cancers this works in.
Overview
Patil et al. (JCO 2023) randomised 151 patients with advanced head and neck cancer to triple metronomic chemotherapy with or without nivolumab 20 mg flat dose every three weeks, about one-twelfth of the standard dose. One-year overall survival was 43.4% versus 16.3%. Checkpoint inhibitors saturate their target at doses far below those approved, which were chosen for development convenience rather than minimum effective exposure. Publicly funded non-inferiority trials of low-dose pembrolizumab and nivolumab in common indications would establish whether the finding generalises.
- Wrong doses · Most drug doses were chosen as the highest a person can tolerate, which is often more than they need.
- Most of the world has almost no cancer care · Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.
- Prices and value · New cancer drugs routinely cost over $150,000 a year, often for months of benefit. Systems cannot afford them and patients go bankrupt.
Pages like this
not linked directly; found by shared links- IdeaRestore weight-based dosing and vial sharing for immunotherapy in the label
Shares Wrong doses, Prices and value, Nivolumab, Pembrolizumab.
- IdeaSubscription pricing for checkpoint inhibitors: fixed national fee, unlimited use
Shares Prices and value, Nivolumab, Most of the world has almost no cancer care, Pembrolizumab.
- IdeaAn advance market commitment for PD-1 biosimilars for lower-income countries
Shares Prices and value, Nivolumab, Most of the world has almost no cancer care, Pembrolizumab.
- IdeaConfirm ultra-low-dose immunotherapy so it can be afforded where most patients live
Shares Tata Memorial Centre, Wrong doses, Prices and value, Nivolumab.
- IdeaPublicly funded dose-reduction trials of expensive approved drugs
Shares Wrong doses, Prices and value, Nivolumab, Pembrolizumab.
- IdeaPublicly funded trials of lower and less frequent doses of expensive cancer drugs
Shares Wrong doses, Prices and value, Nivolumab, Pembrolizumab.
- IdeaGive subcutaneous immunotherapy in community clinics and at home
Shares Prices and value, Nivolumab, Most of the world has almost no cancer care, Pembrolizumab.
- IdeaMake six-weekly immunotherapy the default schedule
Shares Wrong doses, Nivolumab, Pembrolizumab, Immune checkpoint inhibitors.