Assembly Line MedicineOctober 2014
By William Faloon
The Insurance Company’s “Recommended Regimen”
The chemotherapy drugs that insurance companies want oncologists to prescribe represent the most commonly used drugs in the industry and can be viewed as aggressive “cookbook medicine approach” treatments. Some of drugs listed, such as Adriamycin®, are being limited by several oncologists at major medical institutions, such as MD Anderson, for use in adjuvant settings due to excessive toxicity.121-123
Progressive oncologists, with whom Life Extension® is working, are using mitoxantrone instead of Adriamycin® in their elderly patients since it has the same survival rate as Adriamycin®, but is less toxic to the heart.124-126
Oncologists will be paid $350/month per patient by one insurer to prescribe chemo drugs such as Adriamycin®, which was approved by the FDA in 1974. Another insurer is offering higher reimbursement to the oncologist when lower-cost chemo drugs are used.
All these chemo drugs are considered standard of care by the National Comprehensive Cancer Network, which is an alliance of 25 cancer centers in the United States, most of which are designated by the National Cancer Institute as comprehensive cancer centers.
Health insurance companies reward practicing oncologists for following the standard published protocols that minimize creative approaches for cancer treatment.
Perhaps the greatest failing of the chemo drugs that insurers are paying oncologists to prescribe is that they seldom cure advanced-stage cancers. Despite widespread availability of these chemo drugs, metastatic lung cancer kills 98% of patients within five years.127 Metastatic colon cancer kills 94% within five years.128 Those afflicted with metastatic breast cancer fare better, but 78% still die within five years.129
Clinical oncology practice clearly needs more innovation—yet health insurance companies are providing financial incentives for physicians to prescribe chemo drugs that fail to cure advanced-stage patients. This kind of backwards approach to treatment will stifle the discovery of breakthroughs so desperately needed to spare the lives of more than 585,000 Americans who perish from cancer annually.
I’m purposely leaving the names of the insurance companies out of this article because it is likely that other insurers will follow this pattern of scientific regression. What we are witnessing is clinical oncology practice being driven backwards by outlandish drug prices, along with the high cost of increased physician involvement when aggressive therapies are utilized.
Health insurance companies argue their “recommended regimens” will improve patient care. We at Life Extension® disagree and advocate that more (not fewer) individualized, creative, and comprehensive treatment approaches could spare numerous lives.
Most Effective Brain Tumor Drug Not Approved To Treat Any Cancer
Perhaps the most frightening malignancy one can be diagnosed with is a form of brain cancer called glioblastoma. This type of brain cancer has a dismal prognosis, with median overall survival of 12 to 14 months, and a two-year survival rate of 15 to 26%.131
Senator Ted Kennedy was diagnosed with glioblastoma in May 2008. Despite intervention by some of the best brain tumor experts, Kennedy died in August 2009—a mere 15 months later.
A study published in the New England Journal of Medicine on September 5, 2013, may represent the most significant advance yet discovered in treating glioblastoma.131
What follows is an overview of a drug that is not approved to treat any cancer, and thus is likely to be rejected by insurance company mandates:
- Valganciclovir (Valcyte®) is an FDA-approved drug used to treat cytomegalovirus infection.
- Cytomegalovirus has been suspected as facilitating the initiation and promotion of brain cancers.132-135 Some 50 to 80% of adults in the US show exposure to cytomegalovirus, but relatively few harbor active viral infection.135
- Doctors followed 75 glioblastoma patients and found the median overall survival of those with low-grade cytomegalovirus infection was 33 months. In patients with high-grade cytomegalovirus infection, median overall survival was 13 months.131
- All but one of the 75 glio-blastoma patients studied had active cytomegalovirus infection, indicating that this virus may be involved in the development of this lethal malignancy. 131
- In glioblastoma patients with high-grade cytomegalovirus infection, median two-year survival was 17.2%. Patients with low-grade cytomegalovirus infection had median two-year survival rates of 63.6%.131 This suggests that high-grade, active cytomegalovirus infection accelerates tumor progression.
- In a double-blind clinical trial of valganciclovir involving 42 patients with glioblastoma, an exploratory analysis of 22 patients receiving at least six months of antiviral therapy showed 50% overall survival at two years compared with 20.6% of contemporary controls.131 This study showed that valganciclovir-treated patients had a median overall survival of 24.1 months compared to 13.7 months in patients not treated with valganciclovir .
- Owing to the promising results of this pilot study, physicians at the world-famous Karolinska University Hospital administered valganciclovir to glioblastoma patients and results were then compared to a control group. Both groups received standard conventional therapy and both groups had a similar disease stage and surgical-resection grade.
- The researchers retrospectively analyzed the data on 50 of these brain cancer patients and found the two-year rate of survival in the valganciclovir group was 62%, whereas two-year survival was only 18% in the control group.131
- In 40 glioblastoma patients who received valganciclovir for at least six months, the two-year survival rate was 70%, with a median overall survival of 30.1 months.131
- In 25 glioblastoma patients that received continuous valganciclovir treatment after the first six months, the two-year survival rate was 90%, with a median overall survival of 56.4 months (4.7 years)!131
- The current median survival of glioblastoma patients is only 12 to 14 months (1.0 to 1.16 years).131 The efforts made to prolong Senator Kennedy’s life by the experts at Duke University Medical Center was a survival of 15 months (1.25 years)—3.45 years less than the median survival in the 25 glioblastoma patients who received continuous valganciclovir treatment as detailed above.
The implication from these findings is that treating active cytomegalovirus infection may dramatically reduce progression, and significantly increase survival time, in patients suffering from the deadly brain cancer glioblastoma. Most exciting is the intriguing data from this retrospective study showing that in glioblastoma patients with active cytomegalovirus, a treatment protocol employing valganciclovir resulted in a median survival of 4.7 years!
Not only does this retrospective data involving the continuous use of valganciclovir substantially extend survival in glioblastoma patients, but it provides an opportunity to incorporate additional complementary therapies that could improve survival even more!