Pricey precision medicine often financially toxic for cancer patients

A diagnosis of incurable breast cancer prompted Kristen Kilmer of Spearfish, SD, to search for alternative treatments. She opted for precision medicine, which her insurer deemed experimental, covering only a fraction of her care. Kilmer's genomic tests identified a rearrangement in the PALB2 gene.

A diagnosis of incurable breast cancer prompted Kristen Kilmer of Spearfish, SD, to search for alternative treatments. She opted for precision medicine, which her insurer deemed experimental, covering only a fraction of her care. Kilmer's genomic tests identified a rearrangement in the PALB2 gene. Preliminary studies suggest that tumors with this genetic rearrangement could be susceptible to the drug olaparib (Lynparza—AstraZeneca), which the FDA has approved only for breast cancer patients with a mutation called BRCA. Doctors can legally prescribe olaparib "off label" to anyone with cancer, but insurance programs are reluctant to cover off-label treatments unless they are specifically recommended in expert guidelines. Over the past 3 years, drugmakers have been generous, allowing Kilmer to take a rotating mix of experimental drugs at no cost because of her modest income. The drugs cost nearly $17,000 a month. Patients who pay for these new treatments on their own "could be in debt for decades," observes Scott Ramsey, MD, PhD, director of the Hutchinson Institute for Cancer Outcomes Research in Seattle. A recent study in the American Journal of Medicine found that 42% of patients depleted 100% of their assets within 2 years of diagnosis. Medicare announced earlier this year that it will pay for genomic testing for people with advanced cancers, which could add $2.5 billion to federal health care costs, an analysis in Health Affairs concludes.