Cancer patients desperate to buy themselves more time are spending thousands of dollars to self-fund immunotherapy treatment even though there is little evidence to show it is likely to have a major benefit.
A retrospective review describing outcomes and toxicity of self-funded pembrolizumab in patients with non-melanoma solid cancers at Chris O’Brien Lifehouse has followed the journeys of 21 patients who planned to receive the treatment over an eight-month period in 2015.
The results have been published in the Internal Medicine Journal and showed that while pembrolizumab was well tolerated, “meaningful responses” were observed in only 17% (three) of the 18 patients who received at least one dose.
This response continued after 5-6.5 months follow-up in two patients and more than eight months of follow-up for the other responding patient.
However there was a cost to the other patients that was highlighted by the authors.
“Financial impact to the patient can be substantial,” they wrote.
“Outcomes for 33% were poor with three patients dying prior to receiving therapy and four dying within weeks of receiving one dose.
“This highlights issues regarding the careful selection of patients, futility of anti-cancer therapy at the end of life and patient’s perceived benefit of receiving this therapy.”
The researchers said it was interesting to note that the 14 (67%) patients who requested pembrolizumab had worse outcomes than the seven (33%) of patients who were offered pembrolizumab by the clinician.
They conceded that in an era of rapid dissemination of information regarding advances in cancer care, desperate patients were “increasingly seeking to access drugs on the basis of early data.”
“They are ill equipped to critique or contextualise the evidence of benefit of these therapies,” they wrote.
“The desire to access such high cost therapy is exacerbated by the understandable enthusiasm of the medical, pharmaceutical and general community for these therapies in the media.”
Out of the 21 patients that sought to self-fund pembrolizumab, three (14%) patients died before the approved drug could be supplied and four (19%) died within 13-43 days of receiving a single dose of pembrolizumab.
“This outcome highlights several issues regarding the careful selection of patients, futility of anti-cancer therapy at the end of life and patient’s perceived benefit of receiving this therapy,” the authors wrote.