Of the 92 new drugs analysed in Prescrire's French edition in 2017, 28 are cancer treatments; 20 out of 28 were authorised on the basis of a single clinical trial, often of poor methodological quality because these trials were not comparative, or they had biases due to their non-blinded character, or the drugs were authorised on the basis of laboratory or radiological criteria, and did not necessarily result in the prolongation of life or improved quality of life.

Several reviews published in international journals in 2017 confirmed the extent of this phenomenon in Europe, as already seen in the USA. One study showed that during the period 2009-13, of the 68 cancer indications authorised by the European Medicines Agency (EMA), 44 were approved without evidence of benefit in prolonging life. With hindsight of at least 3.3 years after they were marketed, for 36 authorised indications, there was still no evidence of increased life expectancy or improved quality of life. According to this study, and another covering the period 2009-16, the survival gain, when there was one, was less than 3 months for half of the patients.

Despite little or no progress for patients, pharmaceutical companies are marketing new cancer drugs at increasingly high prices. A study showed that in 2016, in France, the cost per year of life gained was up to 176 000 euros. Exorbitantly priced drugs for minimal, if any, benefits. This development in the medicines market places an unsustainable burden on the financial resources of national health insurance systems, to the detriment of other public expenditure.

©Prescrire 1 May 2018

"New cancer drugs: poorly evaluated, not very effective" Prescrire Int 2018; 27 (193): 115. (Pdf, free)

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