Many Cancer Drugs Don’t Extend Life

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1:02Bloomberg Audio Studios. Podcasts. Radio. News. In the summer of 2020, Stacey Deuce had seen his mom went to the emergency room. She had been feeling very bad and just wasn't sure like why and kept trying to go and see different doctors to find out what was going on with her. And by the time they diagnosed it, they diagnosed it in the emergency department, which is as a health services researcher. you're like, you know, that's the worst case scenario. The diagnosis was advanced stage breast cancer. Stacey remembers it was overwhelming, but also understood she'd play a big role in what came next.

1:44So neither of my parents had a college education. You know, like my mom cleaned houses and my dad was a welder. And so, you know, it was like an immediate, I've got to take over. I'm going to help figure out how to get them through this health care system and navigate that as best as we can. Stacey is a cancer policy researcher at Vanderbilt University Medical Center. She got her Ph.D. in pharmaceutical sciences at UNC Chapel Hill and still had a network there to draw on. My friend who was the head of breast oncology called me and was like, hey, you know, like, let me talk to you about what this probably is going to look like.

2:23Like what's the most common cancer type? What's the most common treatment recommendation now? And one of the really tricky parts is like she recommended or said, you know, like for the most common cancer, we use these combination of this low cost hormonal therapy and this higher cost treatment. The higher cost treatment was a drug from Pfizer called Ibrance. Stacey knew it was considered the standard of care as first-line treatment for her mom's type of breast cancer. But she also knew there could be a problem. My entire career leading up to that, I studied the Medicare prescription drug benefit.

3:03And I knew, like, the very first time my mom would try to fill that medicine, it would be$3 ,200 out of pocket. And we're talking about someone living on a very small amount of retirement. And like living fine, but no way, like in no universe is that amount of money going to be something that like she and my dad found to be acceptable. And so like I knew I was like, oh, I would just figure out, like, should I pay for it for her? And I would be totally happy to do that if it was worth doing. In 2020, Ibrance was listed for a jaw dropping$160 ,000 a year. It's since risen to more than$214 ,000. And even though Medicare would have paid for most of it, Stacey knew the cost was still going to be significant.

3:56But worst of all, even as a cancer policy expert, she couldn't figure out if the drug would make a difference. Even someone as knowledgeable as myself, like studying this for years, I felt like I couldn't get a clear answer on like, okay, well, this is the recommended treatment. So like, that's what you trust. You're like, OK, the oncologists are all saying this is what we're doing now. And I couldn't find anything that made me feel confident that if I said, all right, like we as a family are going to start spending$15 ,000 to$20 ,000 just on this one drug, not to mention everything else you have going on.

4:36Like, is it going to change anything? Like, is it going to change how long you live and how good you feel? Stacey's mom didn't end up taking Iberns. Further testing indicated a different medication would likely be more effective. She pursued treatment until the side effects became intolerable. She died last summer. Bloomberg senior health care reporter Robert Langrith says a big reason why it was so difficult for Stacey to figure out whether Ibrant's would have been worth it is because of how the cancer treatment industry has changed over the last few decades. Cancer treatments, cancer drugs, and this is very interesting, has become the biggest selling single disease area in the world for the pharmaceutical industry, we found it's an over$200 billion market now.

5:22The market for cancer treatments keeps getting bigger and bigger. And that$200 billion in drug sales was just in 2024 alone. Now, to put that in context, we hear a lot about obesity drugs. Cancer is still way larger than obesity drugs. They may catch up someday, but they're not close to that. The boom in the market for cancer treatments is due in part to legislation backed by drug drugmakers that allowed the U.S. Food and Drug Administration to speed up approvals. The agency has given the green light to more than 200 cancer drugs over the past three decades. For some patients, having more treatments on the market can be a source of hope.

5:58Some of them are game changers. But many of the drugs are more expensive than ever. And a Bloomberg News investigation showed that fewer than half the treatments approved since 2000 have ever been shown to extend patients' lives. Bob says even fewer have been shown to improve symptoms or quality of life. So how did so many cancer drugs with unclear efficacy end up on the market? And who's benefiting and profiting from them? What we've found is that, you know, there's another side of the story that doesn't get told. And in the meantime, companies make a lot of money. I'm David Gurra, and this is The Big Take from Bloomberg News.

6:35Today on the show, the cancer industrial complex. how three decades of new treatments have brought hope to cancer patients and billions of dollars in profits to pharmaceutical companies, even when those drugs often fail to help patients survive.

6:54I was interested in looking at this because I've, you know, been covering cancer on and off for years, really decades. That's Bloomberg's Robert Langrith. There's a lot of hype in all sorts of medicine, but because of the kind of the high stakes and the high emotions with cancer, There seems to be a particular lot of hype, you know, with cancer and cancer advances and everything is like a miraculous advance. A big part of Bob's job is to separate the signal from the noise. And over the past year, he and a team of reporters, editors and data journalists here at Bloomberg have tried to answer a big question at the heart of cancer treatment.

7:27How many of these supposedly miraculous drugs, you know, really do extend patient survival? They looked at 176 drugs that have entered the cancer treatment market since 2000. And by analyzing FDA labels, they separated the drugs that had been proven to extend cancer patients' lives from the ones that hadn't. We only counted it as not having proven a survival difference if it was never proven to extend survival for any of its approved uses. If it got one out of five uses, showed a survival difference, we gave it a yes, said, that's good. So we kind of gave the companies the benefit of the doubt for their drugs.

8:03But Bob and the rest of the team saw some striking trends emerge in the data they analyzed. The prices for all the drugs increased. The starting price has increased dramatically. I think the per median monthly cost is up over$25 ,000 a month for the most recently approved drugs. But that is independent of whether they increase survival or not. And less than half of the drugs that we've looked at have ever been shown to increase patient survival. So how did we get here, where the market for cancer treatments has gotten so big, and there are so many drugs available, but with limited efficacy? But part of the reason, Bob says, is that U.S.

8:39insurers essentially have to cover cancer treatments. Medicare essentially covers, you know, all cancer treatment drugs because of the protected class under Medicare. And basically that means private insurers essentially kind of follow along with that. And that means, you know, 10, 20, 25 years ago when some of these new drugs started coming out, drug companies found essentially they could, you know, charge almost infinite amount for cancer drugs. Bob says another factor fueling the cancer treatment boom is regulatory changes. Changes at the FDA calling for various sort of fast-track, shortcut, expedited approval mechanisms for cancer with very kind of limited preliminary data.

9:20Since the early 1990s, the hurdles that companies have had to clear to bring cancer drugs to market have gotten lower. But Bob says one of the most critical shifts happened in the mid-2000s, when the FDA moved away from evaluating actual survival rates and towards a new criteria. It's very hard to demonstrate actual survival. That takes a long time, a lot of patients, and a lot of drugs, you know, just fall short. A lot of drugs have been approved upon with a different metric that is misleadingly called progression-free survival. Progression-free survival is a measure of tumor growth over a set period of time, and it hinges on a number, 20%.

9:57If a patient's tumors grow more than 20%, doctors consider the cancer to have progressed. If a patient's tumors grow less than 20%, doctors and drug makers can classify that as what's known as progression-free survival. It's really not survival. It really does this delay your tumor growth by a couple of months, two, three, four, maybe five months. And what researchers have found is that metric, It turns out it's not actually a reliable predictor all the time of whether the drug actually increases survival. So you can have a drug that sounds great, sounds like you're going to live longer, but you don't necessarily.

10:33A review published in the European Journal of Cancer found that from 1999 to 2015, two-thirds of drug trials aiming to slow progression of solid tumors were deemed successful. But in the long term, only 38 % of those drugs turned out to help patients live longer. Bob says those kinds of studies take years. And in the meantime, those information gaps can have big impacts on the market for those drugs and the outcomes of the patients who take them. An example of that is a popular breast cancer medication called Ibrance, the same drug Stacey Dusitzina was looking into for her mother. So this was a drug.

11:09It's a new class. It was the first in a new class of drugs for the most common type of breast cancer, advanced breast cancer, hormone-sensitive breast cancer. And it was first approved in 2015, you know, based on progression-free survival. They did a study showing it could delay, slow the progression, the growth of cancer, the time it takes, you know, your advanced cancer to start. And it quickly became a multibillion-dollar blockbuster. This early approval was a major event for Pfizer. And critically, Robert says, Ibrant's being able to enter the marketplace after showing it could deliver progression-free survival gave it an advantage over competitors in the same category from other manufacturers.

11:49And then only like many years later, the longer term trials coming in, and then those trials, you know, it failed to clearly extend patient survival. And strangely, some of the competing drugs in their trials, they did extend patient survival. And to this day, researchers are debating why, you know, and which drugs are truly better. But because Pfizer got that first approval, you know, based only on the tumor slowing metric, it got, you know, billions upon billions upon billions of sales. Ibrins had been on the market for roughly seven years. By the time Pfizer reported, the trial results showed an initial treatment of its drugs produced no survival benefit.

12:28What has Pfizer said about your reporting or what's come to light here about the degree to which it has not prolonged patients' lives? So Pfizer basically said it took a lot longer than planned to show the survival trials because people just live longer than anticipated, even in the control group. And the trials were not optimized to detect a difference in actual survival. And they said that can be also hard to measure because people do different types of treatments. At a breast cancer conference last year, Pfizer presented a real-world analysis of 9 ,000 breast cancer patients that found no statistical difference between the survival rates of cancer patients who took Iberance and those who took competitor drugs.

13:10Bob says doctors are divided over what to make of the contrasting results, and Pfizer stands behind its drug. They say it's a standard of care, first-line treatment that gives women with incurable cancer more time without their disease worsening. Drug makers have made billions as the cancer drug market grows, but they aren't the only ones. How other parties are profiting and what all this means for cancer patients, that's after the break.

13:47Cancer treatment has become a big business, often with mixed results. A Bloomberg analysis has found that in the past decade alone, drug makers have made more than$50 billion on cancer drugs that, so far, have demonstrated no survival benefit. But drug makers aren't the only ones cashing in on cancer treatment. I'm very curious of who's profited from the boom that we've been talking about in cancer treatments and how they've profited. Yeah, well, I mean, basically, the short answer is everyone. Bloomberg's Robert Langrith and a team of reporters, editors, and data journalists have looked into many facets of the cancer industrial complex.

14:23They've dug into issues ranging from hospital markups on medications that have been around for a while to the gamification of clinical trials. Well, I mean, drug industry clinical trials are lucrative. One study, published by the American Association for Cancer Research, estimated that drug companies spend$80 billion a year on clinical trials in oncology. And Bob says that money has given rise to a sub-industry of private clinical trial operators. So it used to be in the past that most cancer clinical trials were sponsored by the government, by the National Cancer Institute, and what's happened is the growth of industry-sponsored trials has been so enormous that now cancer clinical trials are pretty much dominated by the drug industry and drug industry-sponsored trials.

15:06But even major academic centers, medical centers, having some of these drug industry trials there, that has a benefit in terms of prestige, and you give the gold lecture at the big cancer conference in front of thousands of people if you're in on the right trial. So there are just many ways that the system kind of rewards all the participants. So where does the cancer industrial complex go from here? Earlier this year, the Trump administration announced it had reached a deal with Pfizer to sell its drugs at lower prices to Medicaid patients. And the president has also issued an executive order to support the use of AI in childhood cancer research.

15:45But those moves come amid significant funding cuts at the U.S.'s chief drug regulators and research agencies. Since Trump took office, the National Institutes of Health has canceled or frozen more than$2 billion in research grants. The administration has also proposed cutting the NIH's budget by nearly 40 percent in 2026. And Bob says that comes alongside deep cuts at the Centers for Disease Control and Prevention and the Food and Drug Administration. The short way of putting it is, you know, the FDA and CDC are in turmoil now. Now it's a period of rapid change. Great upheaval, yeah. Like, obviously, the FDA director typically changes with the new administration.

16:20That's standard. What's not standard is that kind of, you know, the civil servants leading the major centers, they've all been, you know, pretty much replaced or forced out. Even amid a changing regulatory landscape, Bob says there have been unquestionable successes. The American Cancer Society says U.S. cancer death rates have fallen 34 percent from their peak in 1991. thanks to early detection and a decline in smoking. Immunotherapies have also revolutionized the treatment of certain cancers like melanoma and improved outcomes in others. One of the types of drugs that clearly does improve patient survival is this type of drug called immunotherapy.

16:59And the most prominent example of that is Kate Trudor from Merck. It's the biggest selling drug in the world. And it is shown to extend patient survival for a number of cancers. These drugs kind of work a little bit like an on-off mechanism to stimulate the immune system. And once the immune system is turned on against cancer, you don't need a lot more of the drug. That's a very simple way to think of that. And Bob says researchers around the world are now looking into whether it's possible for those drugs to achieve similar results with lower doses. The finding that, if true, could have big ramifications for patients and drug makers.

17:30I went to India, and there are many centers in India that are now testing these drugs at a quarter to one-sixth of the approved doses. And they say they've gotten very little help from the major drug makers in the U.S. and they're finding, as best they can tell, you know, there's little obvious difference in the efficacy. Now, this is mostly preliminary studies, often, you know, very small, but there's a few larger studies starting to roll in. So there's evidence emerging, you know, that sometimes these drugs may be effective at much lower doses. But researchers say that I talk to say that big drug companies have little incentive to test these drugs at lower doses.

18:07All they're going to do is reduce their revenue. And that means that many people in the world, rest of the world, you know, may not get these drugs. Last year, the FDA issued new guidance recommending more randomized testing of various doses in cancer drug studies. Still, the agency relies on the manufacturers to submit their own supporting data and only has the authority to force labeling changes for marketed drugs based on new safety information. A spokesperson told Bloomberg, quote, the FDA will continue to use golden standard science in its evaluation of drugs and appropriate dosing. I want to ask you, Leslie, what you're reporting, what these findings would mean for somebody who might find himself or herself facing a cancer diagnosis, thinking about treatment.

18:50What can we learn from the reporting about how better to navigate what, for everyone, I think, is a daunting and complex process? First of all, I'd say, you know, search for, you know, drugs and treatments that have a proven survival advantage, you know. You want the metric called overall survival. If it doesn't say the words overall survival, that's not survival. If you want that, don't automatically assume that more is better, which is kind of an assumption that's kind of baked in. If three drugs helps, maybe four drugs will help even more because cancer drugs have side effects, and the more treatment you lay on, the more side effects you're laying on.

19:26At some point, those side effects could outweigh the benefits of the treatment. And keep in mind that drug company clinical trials, by necessity, are tested on kind of like best case scenarios. These are patients that probably have fewer other comorbid conditions than the average person. They tend to be tested on people with advanced cancer and no other diseases. Often in the real world, you have advanced cancer and heart disease and Alzheimer's and three other things. And you're more likely to get those side effects that they say are rare. So keep in mind that the drug industry trials typically represents the best case scenario for drug outcome and minimizing side effects.

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