The High Cost of Cancer Drugs [Interview][Transcript]

Dr_Jason_Williams_MD_cancer_immunotherapy_medicationGuest: Dr. Jason R. Williams MD
Presenter: Neal Howard
Guest Bio: Dr. Jason R. Williams is the CEO of Precision StemCell, an outpatient imaging and image guided treatment facility located in Bogota, Colombia. Dr. Jason Williams is a medical doctor and board-certified radiologist and pioneer in minimally invasive, image-guided cancer therapies. He’s been interviewed by numerous media outlets.

Segment overview: In this segment, Dr. Jason R. Williams, M.D., talks about the new cancer immunotherapy medications and how to make them more effective, have fewer side effects and be more affordable.

Transcription

Health Professional Radio

Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, thank you so much for joining us today. As we wind down Breast Cancer Awareness Month October we’ve invited Dr. Jason Williams into studio today with us, a returning guest to talk about his new minimally invasive cancer, breast cancer treatment. He was here before, we talked about some of the options available that are far less invasive than almost as Dr. Williams said a 100 years of mastectomy and lumpectomy. And he’s returned today to talk about this new minimally invasive breast cancer treatment. And also to talk about new cancer immunotherapy medications and how to make them more effective with less side effects and more importantly how to make them affordable for more people. How are you doing today Dr. Williams?

Dr. Jason Williams: I’m doing great Neal. How are you doing?

N: I’m doing well, thank you so much for returning with us. When we were here before, we were talking about this minimally invasive breast cancer treatment that is essentially scarless because it implements needles rather than scalpels in removing or killing cancer cells. It’s called “cryoablation,” you were talking about that and we segwayed into this discussion about immunotherapy drugs and how their price sometimes quite high. As a matter of fact so high that many of us just don’t even view them as an option. You’ve had a lot of experience with these drugs having obtained your Medical Doctorate from Louisiana State University, completed an internship in Internal Medicine, followed thereby a residency in Radiology at the University of South Alabama. You’ve also trained doctors on image guided cancer therapy here in the United States, Mexico and South Africa as well. So you’ve had a well-rounded experience with all sorts of cancer treatments, and they’re all pretty pricey. But when it comes to some of these immunotherapy drugs they’re even more so. Is that a correct assumption?

W: Yes. That’s very correct. And that’s the thing, it’s a few drugs are showing great success, far more successful than the standard chemotherapy agents. There’s been a lot of work actually, a lot of them came out of Harvard where are the drugs essentially were developed. And what they showed was it basically the immune system should have the capability to attack and kill cancer, but what’s happening is the cancer’s telling the immune system that it’s part of your own body, and it’s trying to keep the immune system from attacking it. These new drugs, the first one which is under the name “Ipilimumab” which is a tradename “Yervoy” was FDA approved in 2011 for melanoma. And then last year we’ve got a couple of new drugs that are of a different class but they work in kind of the same way, and what they do is they block these receptors that the cancer is using to trick the immune system, because the immune system can actually or recognize the cancer and attack it. Unfortunately these are some of the most expensive drug in the United States with a price tag of $200-300,000.

(Crosstalk)

N: That’s a quarter of a Million dollars for, are we talking about the entire treatment from beginning to end or just these drugs?

W: We’re talking about just these drugs for maybe a year. But really that’s a little bit of a trick because the yervoy that’s only 4 doses so you get it every 3 week, 4 times and then kind of off for a while. The other drug that’s are known as TV1 inhibitors and there’s two different ones that are available, they’re given every 2 to 3 weeks but they’re still significantly expensive and they’re showing great success in these numerous cancer types, but one of the problems is that if we could all the patients who have advanced cancer on these drugs, it will break the system. One of the doctors from Sloan Kettering was saying in a major cancer meeting that it will cost hundreds of billions of dollars a year just to treat advanced cancer patients in the United States and the system just can’t handle it.

N: Well is the manufacturer of these drugs that intricate? That specialized that they have to be priced so high? I mean we’re basically talking about good old fashioned chemotherapy, right?

W: Well, these drugs are a little more specific. They’re what we call monoclonal antibodies which are biologic agents. They are more expensive to produce and these drugs that are made by some of the major pharmaceutical companies in existence, some of the larger ones. And yeah, obviously I guess they’re trying to retrieve a lot of their investment in this. But they are more expensive to make than standard chemotherapy.

N: Now these drugs can be directly injected into the cancer.

W: Right.

N: And you can use a needle to do that. Now are we talking about killing the cancer so that there’s no more need for lumpectomies or mastectomies?

W: Well, yes we know one thing of course the way that this drug or typically given intravenous and …. large amount so you’re just slowing the whole body really to enact to …. actual size of the tumor location. And so there’s been some animal studies that have come out of the Netherlands where they actually looked at cancer in the animal model and they would inject it with immunotherapy drug.

N: Uh huh.

W: And what they found was that they can get as good or even better response using a fraction of the dose. And so we kind of translated that into human world where we figured based from the animal study, we can use probably 1/8 of the dose that is needed and injected it directly to the tumor. And so that certainly one thing reduce is cost. But another thing it reduces side effect as well. And where you really want to change the immune response at the tumor site, if you can educate the immune system to attack the tumor, which the best place to do that is at the tumor itself, then you can, the immune system can learn. It will have the memory and will know that it needs to attack that tumor. And not only just where you treat it but it can do it throughout the whole body. And so that’s what the future for these drugs is to be able to do that and actually make it a lot more cost effective, it will certainly reduce side effects. And hopefully will increase the availability of these drugs because there are probably at least 20 different cancer types right now that are being heavily studied. They have approval already for melanoma, some of the drugs have approval for… lung cancer but it’s quickly gonna be across the board for many cancer types, and this will we really hope to open things up to where more patients can get the type of treatment they need, it would be more cost effective.

N: So when we were talking about the billions of dollars that it will take to treat just people who have advanced stage cancer. When we’re talking about breast cancer, being Breast Cancer Awareness Month, what are the numbers as far as breast cancer? We see the pink ribbons everywhere in October and throughout the year actually because all of us have been touched by breast cancer in one way or another. I just can’t see anybody whose, doesn’t know someone whose been touched by it.

W: Sure.

N: When we’re talking about the numbers, what are we talking about here?

W: Sure. So in the United States there is 231,000 new cases of invasive breast cancer every year. In addition to that, there is actually there’s what they call “carcinoma in situ” which can be considered either an extreme early form of cancer, some people consider it more of a pre-cancer. There’s about 62,000 cases a day. And in out of all these you see about 40,000 deaths per year of breast cancer. So even with the treatment options of mastectomy, lumpectomy, radiation, chemo there is still a fair of number people dying from breast cancer. And looking at the numbers…somebody that’s affected by it. I know it from me personally my grandmother died of breast cancer which is one of the reasons why I’m very interested in this work.

N: Now when were talking about this pre-cancer or this early form of cancer, is this just something that indicates the possibility of cancer developing? Or is it actual cancer that can be treated now with this invasive method in early stage detection and make it even more cost effective, is that an option?

W: Yes, and it is. In breast cancer … they call “ductal carcinoma in situ” it’s very controversial for many many years the patients were treated very aggressive, just like if they have an invasive cancer. So they were even actually some of them are treated more aggressive because most of them were doing lumpectomy, they were getting radiation, they were given chemotherapy. And these therapies are not benign. And when you look at it, the patients …. the carcinoma they’re risk of actually developing an invasive breast cancer is only about 20%. A large number of patients who essentially being terribly treated for this and most patients were unaware. I mean I think plenty patients who have this type of pre-cancer and from what they knew there’s no any difference in person who have invasive cancer. They didn’t realize their cancer or their situation may not even become cancer. And obviously it does help had the statistics a lot because it increases your treatment … where all this people into breast cancer category, to 20% for the majority. I do think that for cryoablation for the future for these patients, this could be something that could be a great option because it freezes the area that’s potentially a pre-cancerous area and get rid of it before it becomes cancer. Certainly some of them may have a large area and may not be amenable to that. But it’s very much like the idea of women with cervical cancer obviously with … pap smears and they can detect pre-cancers that lesions there that may have a chance to become cancer, and they go and they burn off part of the cervix and freeze part of the cervix and I think that in future for the breast, we can see the same type of treatment.

N: I’d like to ask you about some of the new guidelines for breast cancer screening that the American Cancer Society has just to come out with. And in your opinion and in your experience, what is the best type of screening to detect this early form cancer, even before it becomes cancer as you said.

W: Sure. So certainly in a mammography has really led to the increased protection. Before mammography just the patients who have these types of pre-cancerous conditions, they were undetected and obviously they weren’t found unless they actually became cancer. Now the American Cancer Society has kind of changed some of the guidelines. Before it’s really 40 and elderly …. mammogram, even years back sometimes it had patients … 35. Now the new guideline they’re really starting more at 45 and the patients from age 45 to 55 … they’re recommended a yearly mammogram, patients older than that will get one every two years. And the problem is because there is a fair number of patients who are under the age of 45 who get breast cancer and it’s kind of a pretty aggressive breast cancer and we may start… some of those people by these new guidelines. But one of the problems was that that patients with all the screening they’re getting a lot of these biopsies. Younger women tend to have a lot of different benign non-cancerous condition that were heavily worked up. I mean I think you’d find it very hard to talk to women and not find a large number who have at least had a biopsy before. And so these guidelines a little bit controversial, certainly women with family history they need to consider getting mammogram in an earlier age. We always recommend 10 years prior to whatever…. age they had breast cancer. So if they had a mother that has breast cancer aged 45 then they should start their annual screening at least 35. So the other thing is about for many, many years now we had just the standard mammography and use of film just like cameras. And then in the early 2000 they came out a digital mammography and everybody really made a big deal about it, that didn’t really show much increased detection but the images were certainly better quality and I think that radiologists was would argue and say that it did increase detection. But now we have new technique known as 3D mammogram also called “breast tomosynthesis” and this technique is really different. In the fact that it look kind of like a mammogram but you’re taking slices thru the breast, so that the overlapping tissues is not as much of a problem. And there’s been several major studies comparing that to standard digital mammography showing a 40-50% increase detection in breast cancer. So for my opinion if women have the option to be able to get 3D mammography, the type should really be choosing for credible enhanced detection, I think.

N: Great advice. You’ve been listening to Health Professional Radio, I’m your host Neal Howard. We’ve been in studio this afternoon talking with Dr. Jason Williams, a board Certified Radiologist and pioneer in minimally invasive image guided cancer therapies. And we’ve been here talking about new highly effective immunotherapy drugs that have prohibitive cost up to quarter of a million dollars in most cases for just 4 doses. But Dr. Williams has been researching and implementing a very unique technique with equal or better results, a fewer side effects substantially lowering the cost and hopefully bringing, well hopefully bringing hope to many who would otherwise not be able to afford these new highly effective drugs. It’s been great talking with you today Dr. Williams.

J: Thank you Neal. I appreciate to talk with you as well.

N: Thank you. Transcript and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to our podcast on iTunes.