Life-extending lung cancer nivolumab drug approved (for NHS patients in England)
Source: BBC
A life-extending lung cancer drug will be made immediately available to NHS patients in England, say advisers.
In new draft guidance, the National Institute for Health and Care Excellence (NICE) has approved nivolumab through the fast-track Cancer Drugs Fund while more evidence is gathered on its cost-effectiveness.
Research has shown that nivolumab increases the number of patients still alive after three years of treatment by two- or three-fold, depending on the type of lung cancer they have.
Patients can have nivolumab into a vein as a drip.
It is used to treat advanced melanoma, blood cancer (Hodgkin lymphoma), kidney cancer and the most common type of lung cancer - non small-cell lung cancer. It is also used in clinical trials for other types of cancer.
Read more: http://www.bbc.com/news/uk-41318417
still_one
(92,454 posts)DFW
(54,448 posts)The cost to a cancer patient will be around zero. In the USA, probably thousands to tens of thousands a year, and the Republicans are probably all too eager to make sure that insurance will not cover it.
a la izquierda
(11,797 posts)I have to move back to Europe. Living here three months, I'm convinced I can do it. Now to find a job (or law school).
The shocked looks I get when I explain what I pay for "insurance" have been pretty instructive.
DFW
(54,448 posts)I get down there regularly, both for work, and to see my daughter, although with her job now, she travels as much as I do. Sometimes, she's there when I am. Sometimes, she's in Zürich, Budapest, Santiago, New York, London or wherever. Crazy kid thinks she's me, or something.
a la izquierda
(11,797 posts)But I have to go back next week since I can't extend my visa. I'll be back next year, hopefully permanently.
DFW
(54,448 posts)But with all the bad parts, I'm still here.
jmowreader
(50,567 posts)And it's not going to get any cheaper because of how it's made.
LeftishBrit
(41,212 posts)DFW
(54,448 posts)(Note: I got all this stuff by reading lots of websites and mashing it all together.)
Lots of drugs on your pharmacist's shelf are called "small molecule" preparations. They're made from chemicals. If you mix hydroquinone, ammonium acetate and acetic acid, cook at 230°C for fifteen hours, and wash out the excess vinegar, you'll get all the Tylenol you could possibly want.
This is a biologic drug that's called a "monoclonal antibody." There are plenty of drugs made through biological processes, like penicillin. The difference is, penicillin mold will, if put on a loaf of bread and left in a humid place long enough, make penicillin all by itself. Same thing with...oh, say insulin. If you get a pancreas, pull the islets of Langerhans out of it and plant them on a piece of culture media, insulin will fairly pour out of them. No organism on the face of this earth is capable of making a protein that will turn off a cell's ability to make one specific enzyme. Which is exactly what Opdivo is made to do. (All the cells in your body generate the enzyme PD-1, which keeps your immune system from eating you. Opdivo tricks cancer cells into not producing it.)
The first thing they had to do is design a protein they believed would shut off PD-1 production only in cancer cells, which are less robust than healthy cells. Once they did that, they designed a gene that would induce hamster ovary cells (yup, that's exactly what they use) to produce this protein and another gene that would tell the cell, "making this enzyme is your primary goal in life from here on in." And then they beheaded some hamsters - using drugs to kill the little beasts would ruin the organs they're trying to collect - removed the ovaries, and used gene-splicing technology to put these genes in the ovarian cells. The modified cells were then thrown in a culture medium to multiply until they had a nice-size colony. After testing the cells to be sure they were producing the enzyme they were trying to make, they split the batch up into vials and store the vials in liquid nitrogen until they want to make some medicine. You can well assume that Bristol-Myers Squibb has sent vials to multiple storage facilities to cover their asses if something should happen to the facility they make this in.
When it's time to mix up the medicine, they brew a nutrient medium and put it in a reactor that stands two stories tall. In goes a vial of starter culture, on goes the stirrer, and scientists carefully observe and test this glop to be sure it's producing the right protein, it's only producing what they want, and it's working as fast as it's supposed to. If it starts going off in left field - maybe the hamster ovaries remember what they are and start producing hamsters instead of cancer drugs - they have materials that can bring the process back under control. This goes on for weeks.
After the process is finished, they use advanced separation techniques to strain the desired product out of the nutrient medium and hamster guts. They wind up with a couple ounces of drug after all they did to get it.
This is why generic versions are unlikely. With small-molecule preparations, the patent tells you how to get to Rock Ridge. With biologics you start from scratch.
DFW
(54,448 posts)Unfortunately, it seems to preclude any kind of cheaper mass production in the future
jmowreader
(50,567 posts)Which would lead to another dilemma: They can make these drugs do extremely specific things, so there is a lot of research into making them. If they built another reactor to make Opdivo, by the time it was done another drug would need it.
And it's not like you can just turn a knob and increase production. Granny Clampett's Hamster Innard Stew is going to produce protein as fast as it feels like.