TV Ad for Lung Cancer Drug May Fuel Patient Demand

Nick Mulcahy

November 13, 2015

Immunotherapies for cancer have been one the hottest stories in medical news in the past couple of years, and cancer patients have responded to the buzz by requesting treatment and, in some cases, even offering to pay the full price out of pocket.

Now one group of patients is being targeted specifically through direct-to-consumer advertisements aired on television, which is likely to create even more demand.

The advertisements, appearing on US television on network evening news broadcasts, feature the immunotherapy nivolumab (Opdivo, Bristol-Myers Squibb Company) for the treatment of a type of advanced lung cancer.

Such stimulation of consumer desire has upsides and downsides for clinicians and patients, according to experts.

The purpose of the new ad is to educate patients and families about a new treatment option for an "aggressive" disease that is "highly stigmatized" and for which there have been "limited advancements in treatment over the past decade," said BMS spokesperson Laurel Sacks in an email to Medscape Medical News.

The ad, which is dubbed Longer Life, says that nivolumab gives patients with lung cancer "the chance to live longer."

However, a media critic questions whether the overall impression of the ad is fitting.

"There's a feeling of a substantial advance," Adrienne Faerber, PhD, of the Dartmouth Institute for Health Policy and Clinical Practice, in Lebanon, New Hampshire, told Medscape Medical News. "But the fact is that there is a 3-month survival difference [compared with standard therapy]," she said, referring to data from a phase 3 clinical trial comparing nivolumab to chemotherapy that were the basis of the initial US Food and Drug Administration approval.

 
The fact is that there is a 3-month survival difference. Dr Adrienne Faerber
 

Nivolumab was approved in March for use in patients with advanced/metastatic squamous non–small cell lung cancer (NSCLC) who experienced disease progression while taking or after taking platinum-based chemotherapy. In October, nivolumab received an expanded approval for the treatment of nonsquamous NSCLC, also as a second-line therapy.

The new ad focuses on the first approved use — for advanced squamous NSCLC. It is also a first for BMS. "The Opdivo television ad will be the first time Bristol-Myers Squibb has done an oncology-branded television ad," said Sacks.

The new TV ad, she said, aims to prompt patients "to have an informed discussion with their physician to learn if nivolumab is appropriate for them."

But Dr Faerber says that drug ads in general, and this one in particular, may be misleading and misunderstood by patients.

One of the ad's main messages is that nivolumab "significantly increases the chance of living longer vs chemotherapy," observed Dr Faerber, who studies pharmaceutical advertising. But the ad does not specify what the average length of that survival benefit is. "In general, people overestimate benefits and underestimate risks" when viewing drug ads, she said.

Sigrun Hallmeyer, MD, a medical oncologist at Oncology Specialists SC, Advocate Lutheran General Hospital, in Park Ridge, Illinois, thinks the ad does "a decent job" balancing "an important milestone in outcomes" in lung cancer "without being misleading.

"Given the data, I would say that the survival benefit is truly significant, as nothing has shown to improve survival in lung cancer beyond first line in a very long time. It's all about perspective," said Dr Hallmeyer, who was asked to comment by Medscape Medical News.

 
It's all about perspective. Dr Sigrun Hallmeyer
 

Dr Hallmeyer, who is a BMS advisory board member and acts as a consultant to the company, also noted that the nivolumab ads can have a simple and positive effect on patients. Two of her patients had already been receiving the drug for their lung cancer at the time they first saw the ads. "One said he felt reaffirmed in his decision and felt like he was treated with an impressive drug," she said.

Dr Hallmeyer conceded that a television ad is not the ideal introduction to a treatment. "Of course, the problem with consumer-directed advertising is that there is no time to create perspectives, and much of the true message gets lost in the disclosure of safety and toxicity profile," she said.

But there is time to create mood in the ad, suggested Dr Faerber. There is a "wide optimism" in the Longer Life ad, she said. That feeling reminded her of television ads for omeprazole (multiple brands) for the treatment of heartburn that appeared in the late 1990s, in which patients danced on clocks, she said.

Clinicians may have to deal with those expectations, suggested Dr Faerber. "The benefits of Opdivo are repeated in the commercial and are thus overstated," she said.

The new nivolumab ad can also be viewed in the history of direct-to-consumer drug advertising, said Dr Faerber. The conventional wisdom in pharmaceutical marketing used to be that drugs advertised on television should have few side effects and no serious ones, should be prescribed by general practitioners, and should potentially be taken by millions of patients.

The new nivolumab ad has a relatively narrow patient audience in comparison, according to Dr Faerber. "The medical indication is very specific and not broad," she said. "It's a subset of a subset."

The ad's second main message may serve a wider audience and purpose, she explained. That message is that nivolumab is an immunotherapy and that that is a new treatment type compared with chemotherapy. "Ads are also a way to introduce a lot of people to a new concept," she noted.

The Longer Life ad was aired repeatedly during the evening network news shows on ABC and NBC during September and October, Dr Faerber said, citing results of a search of the Vanderbilt University Television News Archive. During this time, ads for other, more commonly used drugs also aired, according to the archive log.

For example, the nivolumab ad joined ads on those news shows for drug products with much larger markets, such as Advil, Alka Seltzer, and sildenafil (Viagra, Pfizer Inc), and for much less serious diseases.

Cancer drugs are not commonly advertised on television, points out Dr Faerber. However, there is some precedent for the ad. She cited ads for epoetin alfa (Procrit, Janssen Pharmaceuticals, Inc) to treat anemia due to chemotherapy, for raloxifene (Evista, Eli Lilly and Company) to reduce the risk for breast cancer, and for sipuleucel-T (Provenge, Dendreon Corporation) to treat advanced prostate cancer.

Bristol-Myers Squibb says that the nivolumab television ads are part of a broader campaign that includes digital and select print magazine ads and will run through the end of 2015.

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