NYTimes Op-Ed: Opdivo doesn't work for most people

NYTimes Op-Ed: Opdivo doesn't work for most people, why are they allowed to advertise it?

What's really remarkable is who wrote it:

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Matt Jablow is the public relations director for Evergreen Health, an insurance company .

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Although I suppose perhaps he's doing the insurance company a favor, by telling people not to bother taking a really expensive drug.

http://www.nytimes.com/2016/08/09/opinion/can...8&_r=0

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TOWSON, Md. — Two days into a long-dreamed-of family vacation to Italy in August 2013, my wife, Ronna, became nauseated, unusually tired and short of breath. One of the great non-complainers in American history, she insisted that it was no big deal and valiantly tried to join in on various outings in the Italian countryside. But, after a few increasingly difficult days, even Ronna knew that it was time to go to the emergency room.

In a small hospital in Tuscany, doctors identified the apparent source of the problem: a pericardial effusion, or a buildup of fluid around the heart. Ronna was transferred to a larger medical center in Arezzo, where a pericardial tap was performed. Immediately afterward, in a scene that still plays on a loop in my mind’s eye, the hospital’s chief of cardiology informed me that, while the fluid was gone, he was quite sure that Ronna had lung cancer.

A few weeks later, when we were back home in Maryland, doctors at Johns Hopkins Hospital confirmed his suspicion: My healthy, active, 48-year-old, never-smoker wife had Stage 4 non-small cell lung cancer.
Over the next two years, Ronna underwent several rounds of grueling chemotherapy and, when the cancer spread to her brain, several rounds of radiation treatment. She also took part in a clinical trial at Johns Hopkins for Opdivo, an immunotherapy drug made by the pharmaceutical company Bristol-Myers Squibb. Briefly stated, immunotherapy is a recently developed, highly promising treatment that helps a person’s immune system identify and attack cancer cells. But it did not work for Ronna, and last Sept. 25 she died as her parents and I held her hands and whispered in her ear.

Needless to say, it has been a difficult year for my two children and me. But, knowing that Ronna couldn’t abide self-pity, we have been slowly moving forward by doing our best to cope and trying to honor, whenever possible, her remarkable memory and legacy.
A few weeks ago, though, I saw a television commercial that dealt that process a setback. It was a 90-second ad for Opdivo that began with soaring music and shots of older people in warm sunlight, gazing upward at a building on which the words “A chance to live longer” were superimposed. The voice-over said, “Opdivo significantly increased the chance of living longer versus chemotherapy.” The wording may be a little clumsy, but the velvet-voiced narrator made his point, bolstered by actors portraying lung cancer patients playing with babies and watching Little League games.

It would be incredibly uplifting if it weren’t so utterly misleading and exploitive. To date, only about one in five patients with Stage 4 non-small cell lung cancer has seen any measurable response to Opdivo; and, in those patients who do respond, the median increase in life expectancy is only about three months compared with standard chemotherapy.
The overall five-year survival rate for people with Stage 4 lung cancer is between 1 and 5 percent. Instead of a “chance of living longer,” a more truthful narrator would have said, “Opdivo provides an outside chance for people with advanced lung cancer to live just a few months longer.”

Last Friday, Bristol-Myers Squibb announced that Opdivo didn’t pass its most crucial test to date: During a clinical trial, the drug failed to slow the progress of advanced lung cancer (compared with chemotherapy) when used as the front-line drug. Opdivo is still approved to treat lung cancer after a patient has gone through chemotherapy — but, dashing huge expectations and the highest of hopes, the drug didn’t work as a first treatment for patients.

Immunotherapy is an exciting development with the potential to significantly extend the lives of thousands, perhaps millions, of patients. But right now, the hype far exceeds the reality. The drugs are expensive and their efficacy, as shown by the Opdivo trial, is far from guaranteed.
Given the uncertainty, it is shameful for Bristol-Myers Squibb to prey upon the fears and waning hopes of terminal cancer patients, and irresponsible of the Food and Drug Administration to let it. The United States and New Zealand are the only two countries in the world that permit direct-to-consumer pharmaceutical ads. Whether or not they should be banned, as the American Medical Association has argued, a good first step would be to insist that advertisements promoting drugs for life-threatening conditions be entirely forthright about outcomes.

The Opdivo commercial closes with the narrator thanking “the patients and physicians who participated in the Opdivo clinical trial.” Patients like my incredible wife. If you really want to thank them, pull those ads off the air.

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