TV Ads for Lung Cancer Drug Are Needed, Says BMS

Nick Mulcahy

February 02, 2016

Direct-to-consumer (DTC) advertisements for nivolumab (Opdivo, Bristol-Myers Squibb) as a lung cancer treatment, currently airing on American television and appearing in print and online, have been criticized for having an efficacy claim that is vague and possibly misleading.

But a new knock against the DTC ad campaign, which has reportedly cost $42 million to date, surfaced last week from an unusual source, a financial analyst, who asked: Are the ads even necessary?

The suggestion is that doctors would willingly prescribe the immunotherapy, and need no prompting from patients.

But Giovanni Caforio, MD, CEO of Bristol-Myers Squibb, responded to the question by saying that lung cancer treatment has sometimes been lax.

"A number of patients, particularly in the second-line setting, are not being treated as aggressively as they should be," he said during a financial results conference call on January 28.

"We felt it was important to invest in a campaign and in many ways to mobilize patients to seek treatment," he added.

Furthermore, there is a "long history" of lung cancer treatments that have not offered "significant value" to patients and, as a result, there is a "pessimism" that the DTC campaign seeks to address, Dr Caforio explained.

The nivolumab DTC campaign, which addresses only patients with advanced squamous non-small-cell lung cancers (NSCLC), might be helping sales.

Last week, the company reported that, in the United States, nivolumab garnered $410 million in sales for the fourth quarter of 2015, about two-thirds of which were for lung cancer (the drug is also approved for melanoma and renal cell carcinoma). This was more than a 50% increase in sales over the $268 million earned in the third quarter, according to the Medical Marketing and Media website.

The Longer Life television ad and DTC campaign started during the last month of the 2015 third quarter and continued throughout the entire fourth quarter.

The ad has aired during evening network news shows on ABC and NBC, as well as other programs, according to a search of the Vanderbilt University Television News Archive.

During the investment teleconference, BMS reported that 60% to 70% of lung cancer patients treated in the second-line setting are now taking nivolumab (for squamous and nonsquamous NSCLC cancers; the drug is approved for both types).

At the end of last year, a media expert who studies pharmaceutical advertising criticized the Longer Life ads.

"There's a feeling of a substantial advance," Adrienne Faerber, PhD, from 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 with chemotherapy that were the basis of the initial US Food and Drug Administration approval.

One of the ad's main messages is that nivolumab "significantly increases the chance of living longer," Dr Faerber observed. 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 reported.

There is a "wide optimism" in the Longer Life ad, she said. Clinicians may have to deal with those expectations, Dr Faerber explained. "The benefits of [nivolumab] are repeated in the commercial and are thus overstated," she said.

A clinician disagreed at that time.

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

"Given the data, I would say that the survival benefit is truly significant, as nothing has been shown to improve survival in lung cancer beyond first-line in a very long time. It's all about perspective," said Dr Hallmeyer, who has acted as a consultant to BMS.

When an article on the ads appeared on Medscape last year, one reader commented: "The [nivolumab] ad sounds like rainbows and unicorns." The same reader, who is an oncologist, reported seeing response rates of 20% to 25% in practice.

In 2015, the American Medical Association called for a ban on DTC advertising of prescription drugs and medical devices.

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