Publicly funded trials of lower and less frequent doses of expensive cancer drugs
Many cancer drugs work as well at lower doses or given less often, but companies have no reason to prove it. Public funders should run those trials.
Abiraterone at a quarter dose with food matched full-dose exposure; extended-interval pembrolizumab and nivolumab are supported by pharmacology; several kinase inhibitors are effective at reduced doses with less toxicity. Because no manufacturer will fund trials that cut its own revenue, these questions are answered slowly by academic groups. The proposal is a dedicated public 'value trials' fund (modelled on the Netherlands' ZonMw and the UK NIHR programmes) that prioritises dose and schedule de-escalation of the highest-spend oncology drugs using non-inferiority designs, with payers committing to adopt positive results.
- 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.
- Wrong doses · Most drug doses were chosen as the highest a person can tolerate, which is often more than they need.