Price of 'Phenomenally Expensive' Cancer Drug Slashed

Nick Mulcahy

November 09, 2012

Sanofi has drastically cut the cost of its new colon cancer drug, aflibercept (Zaltrap), according to news reports.

The drug maker said the official price of aflibercept (about $11,000 per month) will remain the same, but they will now offer discounts of about 50%, according to reports in The New York Times (NYT) and the Cancer Letter.

Aflibercept, which is administered intravenously, was approved by the US Food and Drug Administration in August for the second-line treatment of metastatic disease. Medicare and private insurers reimburse the cost of the drug after it is sold to doctors or hospitals.

The price slashing comes after stinging criticisms of the drug by influential forces in the world of oncology.

First, in October, the Memorial Sloan-Kettering Cancer Center announced that it would not use the drug. In an op-ed piece in the NYT, 3 staff members called aflibercept "phenomenally expensive" and said it was "no better" than bevacizumab (Avastin, Genentech) in this setting. Both drugs improve the median survival of patients with metastatic colon cancer by 1.4 months, compared with standard chemotherapy, but bevacizumab costs about $5000 per month, which is less than half the official cost of aflibercept.

A few days later, in a letter published in the NYT, Sandra Swain, MD, president of the American Society of Clinical Oncology endorsed the move by Sloan-Kettering, saying that cancer care has "unsustainable costs" and that the "best medical care is not always the most expensive."

This is an unprecedented reversal. Dr. Alok Khorana

The price cut is unheard of, according to Alok A. Khorana, MD, from the James P. Wilmot Cancer Center at the University of Rochester in New York. "This is an unprecedented reversal," he wrote yesterday in his OncNotes blog.

Leonard B. Saltz, MD, chief of gastrointestinal oncology at Sloan-Kettering and one of the authors of the op-ed, serves or has served as a consultant to numerous drug companies, including Genentech, which makes bevacizumab. Nevertheless, he is a long-time outspoken critic of cancer drug prices, including that of bevacizumab.

"I'm shocked at the cost" of bevacizumab and other new agents for colorectal cancer, he told Medscape Medical News in 2009.

The discount by Sanofi, said Dr. Saltz, "doesn't really address the problem," because Medicare reimbursement and patient copayments will still be based on the higher list price. In other words, hospital and cancer practices would pay less for the drug because of the 50% discount, but the reimbursement would stay the same. This might give doctors and hospitals a financial incentive to use aflibercept, he explained.

Christopher A. Viehbacher, chief executive officer of Sanofi, has reportedly said that the company did not intend to charge a "premium" for aflibercept and that Sloan-Kettering and Sanofi had used different doses of bevacizumab in their price comparisons.