
Pharmacyclics' "miracle cure": A cancer drug - signa11
http://www.mercurynews.com/science/ci_29313049/pharmacylics-miracle-cure-cancer-drug
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Udo
Ibrutinib is neither miraculous, nor is it a cure for anything. Like any
cytostatic, it has severe side effects, but it does disrupt a critical
signaling path in certain types of B-cell cancers. It's an expensive drug that
cancer patients can take to prolong their lives for a comparatively short
period. It's not a cure.

Of course, since patients on Ibrutinib require daily doses, Pharmacyclics is
golden for now, but only until better cytostatics become available or the
patent runs out.

Even from a business perspective, this doesn't seem to be a particularly
inspiring story. By rights, this company should have gone under, but then
randomly struck gold. However nice this turn-around may be for the founders,
there is no special insight, scientific or business-related, to be gained
here.

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sjg007
Ummm... This is progress and a big win.

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entee
I've been asked several times before why we don't use more "kill-it-dead-
forever" (another way to look at covalent inhibitors like Ibrutinib)

Covalent inhibitors are quite tricky to work with because every drug, no
matter how specific has some off target effects. If your non-covalent drug
accidentally binds to something it shouldn't, after a little while it'll go on
its merry way (assuming the kinetics aren't awful). This means some side-
effect regarding that protein it bound, but nothing permanent.

On the other hand if a covalent inhibitor hits something it shouldn't, then
that protein it hit is SOL, and gone until a new copy of it can be made. This
could take a very long time in certain cases, causing much longer lasting
effects.

As a result, side-effects with covalent drugs can be both more severe and more
variable. This is one reason that although they are popular in some areas of
lab biochemistry, they haven't made as much of an impact in the broader
clinic.

In this particular case, the specificity of the drug, the importance of the
target to the disease mechanism, and the patient population all combine to
make it viable. However, it doesn't mean the next covalent inhibitor that
comes along will work as well.

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roadnottaken
That's a reasonable description of some common concerns with covalent drugs,
but to say that they haven't had much impact in the clinic is misleading. See,
for example

* Beta lactam antibiotics (e.g. penicillin)

* Aspirin

* Prilosec

And there are plenty of others. Many companies do tend to avoid them, but one
could reasonably argue that their reputation is undeserved.

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Someone1234
I know the mods typically prefer to leave titles the same as the article's
title, but the article's title is misleading.

There's no "cure," miracle or otherwise. The article is pretty interesting,
but the drug doesn't cure or even attempt to cure cancer, it just delays it.

So Pharmacyclics cannot have a miracle cure since they don't attempt to cure.

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cobrabyte
I believe OP was trying imply that the cancer drug was the miracle cure for
the (struggling) company... not cancer itself.

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pmontra
$90 per pill and about $100k per year per patient, life long? I should do some
math to understand how many of those patients a country is able to sustain.
Private insurances or welfare don't make much difference, somebody has to pay
all that money and few people make 100k per year plus what they need to live.

~~~
gwern
The quick estimate is that US per capita GDP is ~$50k and the population is
~320m. So you can immediately upper bound it at half the population or 160m
patients (two people earn <100k, which pays for <1 person's treatment). This
is why health economics tends to use much lower amounts like $50k per QALY. I
don't know if the UK's NHS has approved Ibrutinib, but if they have, they
must've gotten a big price break from Pharmacyclics because $100k is way above
any price they would approve.

~~~
hawkice
The NHS seems to have approved it at ~17% discount (but may be towards a
higher risk group because it is only available as a first-line medication if
you have a chromosomal anomaly -- I am not sure of the relevance of this but
it seems it's not the preferred treatment in other cases):

[http://www.ukmi.nhs.uk/applications/ndo/record_view_open.asp...](http://www.ukmi.nhs.uk/applications/ndo/record_view_open.asp?newDrugID=5810)

That lists the per-pill price as about 51 gbp or 75 usd instead of 90 usd.

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veritas213
The word "miracle cure" really grinds my gears.

I wish they would not use such language. There is no such things as "miracles"

regards,

science

