Summary by Dr. Leonard Minuk
Multiple myeloma is an incurable plasma cell neoplasm that is characterized by multiple relapses requiring many lines of therapy to maintain disease control. Therapy has dramatically changed over the last 10 years to include multiple novel agents (such as thalidomide, lenalidomide, and bortezomib) as well as autologous stem cell transplantation, improving outcomes but also increasing the cost and complexity of treatment …
Current standard treatment is divided mainly according to age. Patients who are 65 are treated with standard melphalan and prednisone with the addition of either thalidomide (MPT regimen) or bortezomib (VMP regimen). Relapsed disease is managed with thalidomide, bortezomib, lenalidomide, or alkylating agents, often in combination with steroids. There is much debate and ongoing research into the appropriate sequencing and combination of these various drugs.
The newer agents are quite expensive and availability varies according to provincial funding or private insurance coverage. As an example thalidomide (Thalomid, Celgene Corporation) costs ~$4,000/cycle, lenalidomide (Revlimid, Celgene Corporation) ~$10,000/cycle, and bortezomib (Velcade, Janssen) ~$7,000/cycle. It is important to note that these therapies are used for many cycles so costs add up significantly.
Our study illustrates the difficulties patients experience trying to access thalidomide, and serves as one example of the larger Canadian cancer drug access issue. At the time of the study, thalidomide was not approved by Health Canada though 90% of surveyed physicians were prescribing the drug. The study indicated that lack of funding led many patients to import the drug illegally from much cheaper generic sources in Mexico and the United Kingdom if the US manufacturer declined compassionate funding. The article explores the ethical implications for physicians put in the difficult position of assisting and/or treating patients taking a non-Health Canada approved sources of drug.