[gdpawel]

I would think that the major obstacle in controlling high cancer drug prices is the widespread inappropriate use of the drugs. As the increasing numbers and types of cancer drugs are developed, oncologists become more and more likely to misuse them in their practice. There is seldom a "standard" therapy which has been proven to be superior to any other therapy. What may work for one, may not work for another.

And the newer "targeted" therapeutics provide mostly small benefit to patients. Each of these new targeted drugs are not for everybody. Even when the disease is the same type, different patients' tumors respond differently to the same agents. These "smart" drugs do not work for everyone.

The needed change in the "war on cancer" will not be on the types of expensive drugs being developed, but on the understanding of all the drugs that are already out there. The system is overloaded with drugs (hundreds of them) and underloaded with the wisdom and expertise for using them.

Cancer chemotherapy could save more lives if pre-testing were incorporated into clinical medicine. The respected cancer journals are publishing articles that identify safer and more effective treatment regimens, yet few oncologists are incorporating these synergistic methods into their clinical practice. Cancer patients often suffer through chemotherapy sessions that do not integrate all possibilities.

It is impossible to design a single chemotherapy protocol that is effective against all types of cancer. The oncologist might need to administer several chemotherapy drugs at varying doses because tumor cells express survival factors with a wide degree of individual cell variability. The objective of pre-testing is to provide the patient with more options to discuss with their oncologist and to bring about multimodality approaches to improve the probability of a successful outcome.

It is highly desirable to know what drugs are effective against your particular cancer cells before these toxic agents are systemically administered into your body. Having a good tumor-drug match not only would improve survival rates, it would be cost-effective, and the high cost of the newer cancer therapies reinforces the necessity of choosing the right therapy the first time around.

Pre-testing on fresh specimens of cancer cells to determine the optimal combination of chemotherapy drugs could be more beneficial for many cancer patients. A failed attempt at chemotherapy is detrimental to the physical and emotional well being of patients, is financially burdensome, and may preclude further effective therapies. Patients, physicians and insurance carriers are all calling for predictive tests that allow for rational and cost-effective use of chemotherapeutic drugs.