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Bloomberg Brief | healthcare Finance 12 Q & A Dr. cy stein sees a role for zytiga, Jevtana and enzalutamide in Prostate cancer Q: have you faced any issues with re- enzalutamide in the first-line setting? cy stein, M.D., Ph.D., an oncologist special- imbursement? how has J&J marketed a: It could be better than Casodex but
izing in the biology and treatment of genitouri-
nary cancers, discussed recent developments
a: Some patients are not covered for Zytiga.
in prostate cancer with Elizabeth Krutoholow.
J&J has done a brilliant job marketing the
Q: if enzalutamide proves effective as
The subtle differences between Johnson &
drug. It’s very easy to communicate its ben-
a front-line therapy and has an over-
Johnson’s Zytiga and Medivation’s enzalu-tamide could create a marketing battle.
efits scientifically and they have gone all out. all survival benefit in its label, would this encourage use over Zytiga if it Q: if Medivation’s enzalutamide is only is labeled for a progression-free Q: What is your standard approach for approved, how will it fit into the treat- survival benefit? treating metastatic castrate resistant ment paradigm with Zytiga, Provenge a: The overall survival data for enzalu- prostate cancer? and Jevtana? a: There is no standard approach and a: Enzalutamide is another good drug.
Phase III trial in the front-line setting did
I am waiting for the published data on it.
have two primary endpoints and it only hit
How will it fit with Zytiga? If a patient has
one-progression free survival. Zytiga did
not reach overall survival but this data is
Q: how would you describe your expe-
However, it won’t be a question of either
received afterwards anyway. Also, in the
rience with Provenge?
or with these drugs and patients will be
a: I have used Provenge in the hospital
given what they can tolerate. The fact that
sion free survival since I am just trying to
setting, so I have not had any issues with
Zytiga must be given with steroids while
put off giving taxotere so overall survival
reimbursement and I select patients that
enzalutamide does not is not a major sell-
will not be turned down. There is a fear
ing point for Medivation. Prednisone is not
FDA will approve it for first-line use with-
a rough drug. Jevtana is also a very good
out overall survival remains unclear.
drug and I have seen fantastic results with
it. It tends to be more toxic and Sanofi did
Q: What other experimental therapies
not market it as well as J&J has marketed
are you most interested in?
months in two Phase III trials but it does
Zytiga. Also, many think that Jevtana is
a: aragon Pharmaceuticals’ ARN-509 is
just another taxane but it really is different.
vival and we cannot assess how a patient
me-too drug. takeda’s TAK-700 looks
is doing. If there is new objective disease, I
Q: since Zytiga and enzalutamide have
then treat with ketoconazole which is a ge-
different mechanisms of action, could
Zytiga. There is also galeterone from tokai
neric drug that is similar to Zytiga and very
the two be combined? Pharmaceuticals, which is a small com-
inexpensive. It is more toxic than Zytiga,
a: The combination may be cost-pro-
pany in Cambridge. This is very similar to
but provides about a 50 percent response
hibitive but it would be great to combine
Zytiga but they have had positive Phase I/
II results. None of the drugs we have so far
dose to alleviate some of the toxicity. Also,
are a homerun as they only help about 50
Zytiga is not yet approved for use before
percent of patients and all provide incre-
taxotere. Once patients fail on taxotere,
mental benefits. These are elderly patients
then we look toward new medications.
though so any benefit is a good thing. Still, some patients do really well and having
Q: What is your experience with John- Q: What are your expectations for son & Johnson’s Zytiga? a: Zytiga is a good drug. It is pretty non- toxic with some mineralocorticoid side effects. The response rates with Zytiga Role: Chair of the Department of Medical Oncology & Therapeutics
depend on whether or not a patient has had prior treatment with ketoconazole. Re-
Research, City of Hope comprehensive cancer center, Duarte, CA
sponse rates are lowered in patients who
Awards: Named top physician in his field by New York Times Magazine
have taken it because the drugs have a similar mechanism. I won’t deny a patient
ketoconazole for this reason though since
Summer Plans: Spending time in New York with his first granddaughter
I am trying to stretch a patient for as long
who was born 8 weeks premature and is doing very well
B O L L E T T I N O N° 14 M E S E DI S E T T E M B R E 2O11 -.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.- R T I C O L I C O N T E N U T I : RTO DELL'ORCHESTRA '' CANTARE SUONANDO'' TUTTE LE IMMAGINI PORTANO SCRITTO: PIU' IN LA' '' E. MONTALE: METAMORFORSIZZARE IL SAPERE SI DEVE ''INSEGNA RE A CHI NON VUOLE IMPARARE'' : LETTURE SUL TEMA DELLA SCUOLA -
Adverse effects of medication Eric Taylor, Emeritus Professor Child and Adolescent Psychiatry King’s College London, Institute of Psychiatry, London, UK firstname.lastname@example.org No financial competing interests. The author was a member of a NICE guidelines development group and a European Guidelines Group review of adverse effects and has published books and papers on Abstract Th