Taking Tykerb? Lower Costs May Be On the Way

Patient Expert

Those of us in business know that time is money. Increased efficiency, spending less time on any one project, yields a greater ROI: return on investment. And what does this have to do with breast cancer? As it turns out, plenty-potentially.

Scientists at Dartmouth Medical School in Hanover, New Hampshire discovered this year that the breast cancer drug lapatinib (a.k.a. Tykerb, drug company GlaxoSmithKline's rival to Genentech's Herceptin) can be made vastly more efficient when it's taken with food, rather than on an empty stomach. A report by the University of Chicago Medical Center detailing their study, delivered to the American Society for Clinical Oncology in June, was the basis for a commentary in the July 16, 2007, issue of the Journal of Clinical Oncology. And that commentary has been a wakeup call for anyone tracking the rising cost of prescription drugs, particularly cancer drugs.

Women with HER-2 receptive breast cancer, who represent fully one-third of all women with invasive breast cancer, can spend up to $2900 a month taking Tykerb, which is in the process of supplanting Herceptin as the HER-2 receptive drug of choice. Tykerb, which received FDA approval in April, is more effective than Herceptin and easier to administer; it's taken in pill form, rather than by injection. In clinical trials, women taking Tykerb were surviving significantly longer than women on Herceptin, so much so that researchers put a quick end to the trials, advising women to switch to Tykerb immediately.

However, one aspect of both Tykerb and Herceptin is fairly equal: their cost, which runs about $2,900 a month. Those on health insurance thankfully pay only part of that, though the expense of the drug doubtless drives up premiums for everyone. Those without health insurance? Well, how much is your life worth? Losing a roof over your head? Telling your daughter she can't go to college? None of us should have to make those kinds of decisions, but with the state of America's health care system, we do-every day. Drug costs are definitely an issue.

Women on Tykerb typically take five pills (1250mg) a day, either an hour before or after eating-in other words, on an empty stomach. Researchers have discovered that just two pills (500mg), when taken with food (specifically, high-fat food), are every bit as effective as five pills. And, when taken with food and grapefruit juice both, a single pill may deliver as much medication to the bloodstream as those original five pills. In addition, fewer pills seems to result in fewer side effects, most notably diarrhea.

What does this mean in dollars? If further trials prove the Dartmouth researchers' initial findings, HER-2 receptive women may be able to save 60 percent-$1,740 per month, nearly $21,000 a year-on their primary cancer drug. Bottom line for patients: positive.

Note: Women should not start or stop taking prescription medications or alter prescribed dosages without discussing the matter with their physician.

But bottom line for pharmaceutical giant GlaxoSmithKline? Do the math. Established drug Herceptin currently accounts for $3 billion/year in sales for Genentech and parent company Roche Holding AG. Newcomer Tykerb is expected to generate $1 billion in sales by 2010 for GlaxoSmithKline-if prescribed at its current dosage. Lower that figure by $600 million if its price remains the same, but the dosage is reduced. In most businesses, efficiency means an improved bottom line. But in the case of Tykerb, GlaxoSmithKline may be wishing those Dartmouth researchers hadn't been quite so thorough in proving Tykerb's capacity for efficiency.