Colorectal Cancer: New Treatments, Improved Prognosis
New drugs show promise, but more research needs to be done.
Fine-Tuning Chemotherapy for Colorectal Cancer
With more drugs to use for colorectal cancer, doctors are now trying them in
new combinations and sequences.
Experts have developed a number of regimens that combine the benefits of
different drugs. For some time, IFL or the "Saltz Regimen" (Irinotecan,
5-Fluorouracil and Leucovorin) was a primary treatment. But new regimens have
eclipsed it, Hoff tells WebMD.
"IFL has largely been abandoned in the U.S.," says Hoff, "It's
considered a little more toxic and less effective than FOLFOX (Folinic Acid,
Fluorouracil, Leucovorin, and Oxaliplatin) and FOLFIRI (
Folic Acid, Leucovorin, Fluorouracil, and Irinotecan)."
In people with metastatic cancer, these regimens may be combined with
Avastin or Erbitux. Many other combinations, including the use of Avastin and
Erbitux at the same time, are being tested in clinical trials.
Researchers are also studying whether Avastin and Erbitux could be used in
earlier stages of the disease, when the chances of actually curing the cancer
are much higher. However, the results of those trials are a ways off, says
A Dramatic Rise in Costs
The key problem with the new targeted therapies is their price.
"Avastin and Erbitux are outrageously expensive," says Anthony Back,
MD, an oncologist at the Fred Hutchinson Cancer Research Center in Seattle.
The numbers show an explosion in the cost of treating colorectal cancer
because of these drugs. One year's worth of treatment with the combination of
Erbitux and Camptosar for metastatic colon cancer would add up to $161,000,
according to an article published in the New England Journal of
Medicine in 2004. Overall, the article noted that the costs for the first
eight weeks of standard treatment for advanced colorectal cancer have risen 340
times over the past 10 years.
For people with insurance that covers medication, the actual costs may seem
irrelevant. But even the co-payments for these drugs add up.
"Some people have 20% co-pays for these medications," says Back.
"Over the course of therapy for metastatic cancer, that adds up to tens of
thousands of dollars out of their own pockets." The high cost of drugs
could force a person to make the impossible choice between extra months of life
and financial ruin for his or her family.
"The benefits of these drugs are so dramatic that we can't deny people
from getting them," says Damian Augustyn, MD, spokesperson for the American
Gastroenterological Association. "But the costs will put an enormous strain
on the health care system."
Saltz agrees. "It doesn't take an economist to see that these prices are
unsustainable," he tells WebMD.
Although your insurance company may bear the brunt of these costs now,
experts worry that even insured patients may be affected eventually. As the
drugs become more widely used, their price tag could make insurance companies
attempt to limit their use.