We Have a New Treatment, But You Can't Afford It

Case PresentationI got a call 2 weeks ago from a former patient asking for help. For the past 5 years, I've provided care for this gentleman, who is now in his late 70s, with slowly growing metastatic renal cell carcinoma. To make a long story short, over these years he's undergone resection and radiation of brain metastases, at least 2 surgeries to remove local nodal deposits, and various chemotherapy trials with minor responses, and experienced a pulmonary embolus. Nevertheless, he lives a normal life. The goal he set from the very first visit was to live longer than his wife, who is chronically ill and requires his devoted attention.His disease has progressed again. My partner recommended sunitinib— a reasonable choice given the favorable data in recent reports.1 However, my former patient called me for advice when he found out it would cost approximately $4000 a month.2 He wanted to know if I had any contacts or knew of clinical trials that would reduce the burden on his family.I've tried. A search of the National Cancer Institute (NCI) web site revealed no sunitinib trials on kidney cancer outside of Japan. What about his insurance? Although he signed up for Part D of Medicare, the rules state that Medicare drug benefits do not include “off label” medication.3 Sunitinib was added to the NCCN Kidney Cancer Clinical Practice Guidelines in Oncology soon after the recent American Society of Clinical Oncology (ASCO) meeting, but the mandated reference compendia have yet to...

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Christopher E. Desch, MD, is the National Medical Director of the NCCN and Co-Editor-in-Chief of JNCCN. As National Medical Director, Dr. Desch serves as the clinical leader for the broad spectrum of NCCN programs, including the NCCN Clinical Practice Guidelines in Oncology™. Dr. Desch previously served as hematologist/oncologist and Research Director for Virginia Cancer Institute. He is Chair of the Health Services Committee at the American Society of Clinical Oncology and has been a member of the American College of Physicians, the American Society of Hematology, and the Virginia Society of Hematology/Oncology.

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    American Cancer Society. Medicare Part D: what you need to know about the new drug benefit. Available at: http://www.cancer.org/docroot/MIT/MIT_3_1_Medicare_Part_D.asp. Accessed June 26, 2006.

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