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Progress at Huge Cost

Posted 10/22/2014

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  We are all acutely aware of the high and rising costs of health care. People with serious illness are especially concerned, worried both that their own bills will become impossible and that various restrictions may be placed on their options. The costs of drugs are a big part of the problem.

  This article from CureToday is a terrific example of this important issue. There is a new pill available to prevent chemotherapy-related nausea and vomiting. In clinical trials, it outperformed the current useful medications in all groups of patients. The cost, however, is $476 per pill. Not to worry, says the drug company, your insurance will cover it. What about co-pays? What about caps? And what about the people whose insurance, for a range of reasons, won't cover it? Again, not to worry says the drug company; we have programs to help. As a longtime oncology social worker, I know abot those drug assistance programs. Yes, indeed, they are very helpful for a very few people with almost zero money. They are zero help to everyone else.

  Here is the start of the article and a link to read more:

Patients Have a New Option When Facing Chemotherapy- Induced Nausea and Vomiting

With 70% to 80% of patients who have cancer experiencing chemotherapy-induced nausea and vomiting (CINV), and reports of up to 40% of patients having anticipatory symptoms, the recent approval of a new anti-emetic called Akynzeo (netupitant/palonosetron) might be a welcome new supportivecare
treatment for some patients.
The new medication could make a big difference in treating CINV, says Deborah L. Selm-Orr, an oncology nurse with Cancer Treatment Centers of America at Eastern Regional Medical Center in Philadelphia.
“Anticipatory CINV is when acute and delayed CINV were not adequately treated, and the patient then demonstrates a conditioned response [prior to additional treatment], much like Pavlov’s dogs,” she says. “So, it is best to treat CINV aggressively,” which could be possible because of the drug’s goal of preventing both acute and delayed CINV.
How Akynzeo Works
Akynzeo combines a standard anti-emetic, Aloxi (palonosetron) with a new drug called netupitant, which has been shown to prevent the side effect both immediately after chemotherapy and up to 3 days later (called the delayed phase of CINV). The combination of the drugs helps prevent the side effect in two different ways.
“Our current understanding of pathways for nausea and vomiting includes at least 26 different chemical transmitters. At this time, we only have two distinct pathways that can be blocked: the NK1 pathway and the 5-HT3 pathway,” says Selm-Orr, who helped develop the CINV patient-care resources
for the Oncology Nursing Society. “The new combination pill is a joining of blocking these two pathways.”
Specifically, Aloxi is a 5-HT3 receptor antagonist, which blocks the receptors in the brain and gut that trigger nausea and vomiting, while netupitant blocks the activation of the NK1 receptors in the central nervous system, preventing another signaling pathway involved in CINV.
Using a combination of anti-emetic drugs to tackle different pathways involved in CINV is a strategy that has been included in treatment guidelines, but Akynzeo is the first drug that combines two different types of therapies.


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