December 17, 2025 • 19 mins
Treating cancer is a massive business. In 2024 alone, cancer treatments generated at least $200 billion in worldwide sales for the pharmaceutical industry, more than the obesity drug rush. But a Bloomberg News analysis showed that fewer than half of treatments reviewed — some of which have painful side effects — have been shown to extend patients’ lives.
On today’s Big Take podcast, Bloomberg senior healthcare reporter Robert Langreth takes host David Gura inside what some doctors call the “cancer-industrial complex” — from the regulatory landscape that ushered in a wave of lucrative new drugs to the damaging financial and health impacts some treatments can have on patients.
Read more:
Cancer Drugs Cost More Than Ever. They Often Don’t Extend Lives.
The Implants Were Supposed to Dissolve. They Didn’t.
Pharma Is Pushing $200,000 Cancer Drugs When Cheaper Doses May Work
Cancer Doctors Are Making a Fortune Off Drug-Trial Participants
One Generic Cancer Drug Costs $35. Or $134. Or $13,000.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
Bloomberg Audio Studios, podcasts, radio news. In the summer of
twenty twenty, Stacy Deuce had seen his mom went to
the emergency room.
Speaker 2 (00:13):
She had been feeling very bad and just wasn't sure
like why, and kept trying to go and see different
doctors to find out what was going on with her.
And by the time they diagnosed it, they diagnosed it
in the emergency department, which is as a health services researcher,
you're like, you know, that's the worst case scenario.
Speaker 1 (00:35):
The diagnosis was advanced stage breast cancer. Stacy remembers it
was overwhelming, but also understood she'd play a big role
in what came next.
Speaker 2 (00:44):
So neither of my parents had a college education, you know,
like my mom cleaned houses and my dad was a welder,
and so you know, it was like an immediate I've
got a takeover. I'm going to help figure out how
to get them through this healthcare system and navigate that
as best as we can.
Speaker 1 (01:04):
Stacy is a cancer policy researcher at Vanderbilt University Medical Center.
She got her PhD in pharmaceutical sciences at UNC Chapel
Hill and still had a network there to draw on.
Speaker 2 (01:14):
My friend who was a head of rest oncology, called
me and is like, hey, you know, like let me
talk to you about what this probably is going to
look like, like what's the most common cancer type, what's
the most common treatment recommendation now? And one of the
really tricky parts is like she recommended or said, you know,
(01:36):
like for the most common cancer, we use these combination
of this low cost hormonal therapy, and that this higher
cost treatment.
Speaker 1 (01:45):
The higher cost treatment was a drug from Pfizer called Ibrants.
Stacy knew it was considered the standard of care as
first line treatment for her mom's type of breast cancer,
but she also knew there could be a problem.
Speaker 2 (01:56):
My entire career leading up to that, studied the Medicare
prescription drug benefit, and I knew, like the very first
time my mom would try to fill that medicine it
would be thirty two hundred dollars out of pocket. And
we're talking about someone living on a very small amount
of retirement and like living fine, but no way, like
(02:21):
in no universe is that amount of money going to
be something that like she and my dad found to
be acceptable. And so like I knew, I was like, oh,
I would just figure out like, should I pay for
it for her? And I would be totally happy to
do that if it was worth doing.
Speaker 1 (02:41):
In twenty twenty, Ibrins was listed for a jaw dropping
one hundred and sixty thousand dollars a year. It's since
risen to more than two hundred and fourteen thousand dollars,
and even though Medicare would have paid for most of it,
Stacy knew the cost was still going to be significant.
Worst of all, even as a cancer policy expert, she
couldn't figure out if the drug would make a difference.
Speaker 2 (03:02):
Even someone as knowledgeable as myself, Like, studying this for years,
I felt like I couldn't get a clear answer. I'm like, Okay,
well this is the recommended treatment, so like that's what
you trust. You're like, okay, the young collogists are all
saying this is what we're doing now. And I couldn't
find anything that made me feel confident that if I said,
(03:26):
all right, like we as a family are going to
start spending fifteen to twenty thousand dollars just on this
one drug, not to mention everything else you have going on,
Like is it going to change anything? Like is it
going to change? How long you live and how good
you feel.
Speaker 1 (03:44):
Stacy's mom didn't end up taking Iburns, further testing indicated
a different medication would likely be more effective. She pursued
treatment until the side effects became intolerable. She died last summer.
Bloomberg Senior healthcare reporter Robert Langreth says a big reason
why it was so difficult for Stacy to figure out
whether ibans would have been worth it is because of
(04:05):
how the cancer treatment industry has changed over the last
few decades.
Speaker 3 (04:09):
Cancer treatments cancer drugs, and this is very interesting. That
has become the biggest selling single disease area in the
world for the pharmaceutical industry. We've found it's not over
two hundred billion dollar market now.
Speaker 1 (04:22):
The market for cancer treatments keeps getting bigger and bigger,
and that two hundred billion dollars in drug sales was
just in twenty twenty four alone.
Speaker 3 (04:31):
Now, to put it on context, we hear a lot
about ABC of drugs. Cancer A still way larger than
BC drugs. They may catch up someday, but they're not
close to that.
Speaker 1 (04:39):
The boom in the market for cancer treatments is due
in part to legislation backed by drug makers that allowed
the US Food and Drug Administration to speed up approvals.
The agency has given the green light to more than
two hundred cancer drugs over the past three decades. For
some patients, having more treatments on the market can be
a source of hope. Some of them are game changers,
(05:00):
but many of the drugs are more expensive than ever
and the Bloomberg News investigation showed that fewer than half
the treatments approved since two thousand have ever been shown
to extend patients' lives. Bob says even fewer have been
shown to improve symptoms or quality of life. So how
did so many cancer drugs with unclear efficacy end up
on the market and who's benefiting and profiting from them?
Speaker 3 (05:23):
What we've found is that, you know, there's another side
of the story that doesn't get told, and in the meantime,
companies make a lot of money.
Speaker 1 (05:32):
I'm David Gura, and this is the big take from
Bloomberg News today on the show The Cancer Industrial Complex.
How three decades of new treatments have brought hope to
cancer patients and billions of dollars in profits to pharmaceutical companies,
even when those drugs often fail to help patients survive.
Speaker 3 (05:54):
I was interested in looking at this because I've you know,
been covering cancer on and off for years, early decades.
Speaker 1 (06:01):
That's Bloomberg's Robert Langreth.
Speaker 3 (06:02):
There's a lot of hype and all sorts of medicine,
but because of the kind of the high stakes and
the high emotions with cancer, it seems to be a
particular lot of hype, you know, with cancer and cancer
advances and everything like a miraculous advance.
Speaker 1 (06:14):
A big part of Bob's job is to separate the
signal from the noise, and over the past year, he
and a team of reporters, editors, and data journalists here
at Bloomberg have tried to answer a big question at
the heart of cancer treatment.
Speaker 3 (06:27):
How many of these supposedly miraculous drugs, you know, really
do extend patient survival.
Speaker 1 (06:32):
They looked at one hundred and seventy six drugs that
have entered the cancer treatment market since two thousand and
By analyzing FDA labels, they separated the drugs that had
been proven to extend cancer patients' lives from the ones
that hadn't.
Speaker 3 (06:45):
We only counted it as not having proven a survival
difference if it was never proven to extend survival for any.
Speaker 1 (06:53):
Of its approved uses.
Speaker 3 (06:54):
If it got one out of five uses showed a
survival difference, so we gave it a yes, said that's good,
you know, So we kind of gave the companies the
benefit of the doubt for their drugs.
Speaker 1 (07:03):
But Bob and the rest of the team saw some
striking trends emerge in the data they analyzed.
Speaker 3 (07:08):
The prices for all the drugs increased. The starting prices
increased dramatically. I think the per median monthly cost is
up over twenty five thousand dollars a month for the
most recently approved drugs. But that is an independent of
whether they increased survival or not. In less than half
of the drugs that we've looked at have ever been
shown to increase patient survival.
Speaker 1 (07:29):
So how did we get here where the market for
cancer treatments has gotten so big and there were so
many drugs available but with limited efficacy. Part of the reason,
Bob says, is that US insurers essentially have to cover
cancer treatments.
Speaker 3 (07:43):
Medicare essentially covers all cancer treatment drugs because of the
protected colass under Medicare, and basically that means private insurance
essentially kind of follow along with that, and that means,
you know, ten twenty twenty five years ago, when some
of these new drugs they started coming out, companies found
essentially they could charge almost infant ount for cancer drugs.
Speaker 1 (08:04):
Bob says. Another factor fueling the cancer treatment boom is
regulatory changes.
Speaker 3 (08:09):
Changes at the FDA calling for various sort of fast track,
shortcut expedited approval mechanisms for cancer with very kind of
limited preliminary data.
Speaker 1 (08:20):
Since the early nineteen nineties, the hurdles that companies have
had to clear to bring cancer drugs to market have
gotten lower, but Bob says one of the most critical
shifts happened in the mid two thousands when the FDA
moved away from evaluating actual survival rates and towards a
new criteria.
Speaker 3 (08:36):
It's very hard to demonstrate actual survival that takes a
long time, a lot of patients and a lot of drugs,
you know, just falls short. A lot of drugs have
been approved upon with some a different metric that is
misleadingly called progression free survival.
Speaker 1 (08:50):
Progression free survival is a measure of tumor growth over
a set period of time and it hinges on a
number twenty percent. If a patient's tumors grow more than
twenty percent, and doctors consider the cancer to have progressed.
If a patient's tumors grow less than twenty percent, doctors
and drug makers can classify that as what's known as
progression free survival.
Speaker 3 (09:11):
It's really not survival, it's really you know, does this
delay your chair of growth by a couple months, two, three, four,
maybe five months? And what research does have found is
that metric it trens out is not actually a reliable
predictor all the time of whether the drug actually increases survival.
So you're going to have a drug that sounds great,
sounds like you're going to live longer, but you don't necessarily.
Speaker 1 (09:33):
A review published in the European Journal of Cancer found
that from nineteen ninety nine to twenty fifteen, two thirds
of drug trials aiming to slow progression of solid tumors
were deemed successful, but in the long term, only thirty
eight percent of those drugs turned out to help patients
live longer. Bob says those kinds of studies take years,
and in the meantime, those information gaps can have big
(09:56):
impacts on the market for those drugs and the outcomes
of the patient's take them. An example of that is
a popular breast cancer medication called Ibrince, the same drug
Stacey dust Zina was looking into for her mother.
Speaker 3 (10:08):
So this was a drug, it's a new class. It
was the first in new class of drugs for the
most common type of breast cancer, advanced breast cancer, hormone
sensitive breast cancer. And it was first approved in twenty fifteen,
you know, based on progression free survival. They did a
study showing it could delay slow the progression the growth
of cancer time it takes you know, your advanced cancer struck,
(10:30):
and it quickly became a multi billion dollar blockbust earlier.
This this early approval is a major Eventrifiser.
Speaker 1 (10:38):
And critically, Robert says ibrants being able to enter the
marketplace after showing it could deliver progression free survival gave
it an advantage over competitors in the same category from
other manufacturers.
Speaker 3 (10:49):
And then only like many years later, the longer term
trials coming in, and then those trials, you know, it
failed to clearly extend patient survival and strangely, some of
the compute eating drugs and their trials they did extend
patient survival and look to this day, researchers of debating
why you know and which drugs are truly better. But
(11:09):
because Piser got that first approval, you know, based only
on the tumor slowing metric, it got you know, billions
upon billions upon billions of sales.
Speaker 1 (11:19):
Ibrints had been on the market for roughly seven years
by the time Pfizer reported the trial results showed an
initial treatment of its drugs produced no survival benefit. What
has Pfizer said about your reporting or what's come to
light here about the degree to which it has not
prolonged patient's lives.
Speaker 3 (11:35):
So Pfizer basically said, it took a lot longer than
plan to show the survival trials because people just lived
longer than anticipated even in the control group, and the
trials were not optimized to detect a difference in actual survival,
And they said it was hard. That can be also
hard to measure because people do different types of treatments.
Speaker 1 (11:56):
At a breast cancer conference last year, Pfizer presented a
real world analysis of nine thousand breast cancer patients that
found no statistical difference between the survival rates of cancer
patients who took Ibrance and those who took competitor drugs.
Bob says doctors are divided over what to make of
the contrasting results. Anfizer stands behind its drug.
Speaker 3 (12:16):
They say it's up standard of care, first line treatment
that gives women with incurable cancer more time with out
the disease worsening.
Speaker 1 (12:25):
Drug Makers have made billions as the cancer drug market grows,
but they aren't the only ones. How other parties are
profiting and what all this means for cancer patients that's
after the break. Cancer treatment has become a big business,
(12:50):
often with mixed results. A Bloomberg analysis has found that
in the past decade alone, drug makers have made more
than fifty billion dollars on cancer drugs that so far
have demons traded no survival benefit. But drug makers aren't
the only ones cashing in on cancer treatment. I'm very
curious for who's profited from the boom that we've been
talking about in cancer treatments and how they've profited.
Speaker 3 (13:11):
Uh yeah, well, I mean, basically the short answer is everyone.
Speaker 1 (13:15):
Bloomberg's Robert Langreth and a team of reporters, editors, and
data journalists have looked into many facets of the cancer
industrial complex. They've dug into issues ranging from hospital markups
on medications that have been around for a while to
the gamification of clinical trials.
Speaker 3 (13:30):
Well, I mean, drug industry clinical trials are lucrative.
Speaker 1 (13:34):
One study published by the American Association for Cancer Research
estimated that drug companies spend eighty billion dollars a year
on clinical trials and oncology, and Bob says that money
has given rise to a sub industry of private clinical
trial operators.
Speaker 3 (13:50):
So it used to be in the past that most
cancer clinical trials responsored by the government, by the National
Cancer Institute, And what's happened is the growth of industry
sponsor trialsmen and so enormous. Now cancer clinical trials are
pretty much dominated by the drug industry and drug industry
sponsor trials. But even at major academic centers medical centers,
(14:10):
you know, having some of these drug industry trials there,
that has a benefit in terms of prestige. And you
give the gold lecture at the big cancer conference in
front of thousands of people if you're in on the
right trial. So there are just many ways that the
system kind of rewards all the participants.
Speaker 1 (14:28):
So where does the cancer industrial complex go from here?
Earlier this year, the Trump administration announced it had reached
a deal with Pfizer to sell its drugs at lower
prices to Medicaid patients. The President has also issued an
executive order to support the use of AI in childhood
cancer research. But those moves come amid significant funding cuts
at the US's chief drug regulators and research agencies. Since
(14:50):
Trump took office, the National Institutes of Health has canceled
or frozen more than two billion dollars in research grants.
The administration has also proposed cutting the NIH's budget by
nearly forty percent in twenty twenty six, and Bob says
that comes alongside deep cuts at the Centers for Disease
Control and Prevention and the Food and Drug Administration.
Speaker 3 (15:10):
The short way of putting it is, you know, the
fd and CDC here in turmoil.
Speaker 2 (15:13):
Now.
Speaker 3 (15:13):
It's that period of.
Speaker 1 (15:14):
Like rapid shave.
Speaker 3 (15:16):
Like obviously the FDA director typically changes with the new administration.
That standard, but it's not standards that kind of you know,
the civil servants leading the major centers, they've all been
you know, pretty much replaced or.
Speaker 1 (15:30):
Forced out, even amid a changing regulatory landscape. Bob says,
there have been unquestionable successes. The American Cancer Society says
US cancer death rates have fallen thirty four percent from
their peak in nineteen ninety one thanks to early detection
and a decline in smoking. Immunotherapies have also revolutionized the
treatment of certain cancers like melanoma and improved outcomes in others.
Speaker 3 (15:53):
One of the types of drugs that clearly does improve
patient survival is this type of drug called amminotherapy, and
the most proper an example of that is k true
to from Mirk. It's the biggest selling drug in the world,
and it's is showing to extend patients survival for a
number of cancers. These drugs kind of work a little
bit like an on off mechanism to stimulate the immune system,
and once the immune system is turned on against cancer,
(16:14):
you don't need a lot more of the drug. That's
a very simple way to think of that, and.
Speaker 1 (16:18):
Bob says researchers around the world are now looking into
whether it's possible for those drugs to achieve similar results
with lower doses. The finding that, if true, could have
big ramifications for patients and drug makers.
Speaker 3 (16:30):
I went to India, and there are many centers in
India that are now testing these drugs at a quarter
to one six to the approved doses, and they say
they've gotten very little help from the major drug makers
in the US, and they're finding as best they can tell,
you know, there's little obvious difference in the efficacy. Now,
this is mostly preliminary studies, often you know, very small,
(16:51):
but there's a few larger studies starting to roll in,
so there's evidence emerging, you know that sometimes these drugs
may be effective at much lower doses. But researchers say
that I talked to say that big drug companies have
little incentive to test these drugs at lower doses. All
they're going to do is can reduce their revenue, and
that means that many people in the world, the rest
(17:12):
of the world, you know, may not get these drugs.
Speaker 1 (17:14):
Last year, the FDA issued new guidance recommending more randomized
testing of various doses and cancer drug studies. Still, the
agency relies on the manufacturers to submit their own supporting
data and only has the authority to force labeling changes
for marketed drugs based on new safety information. A spokesperson
told Bloomberg quote the FDA will continue to use golden
(17:36):
standard science in its evaluation of drugs and appropriate dosing.
We'll ask you, Leslie, what you're reporting, What these findings
would mean for somebody who might find himself or herself
facing a cancer diagnosis thinking about treatment. What can we
learn from the reporting about how better to navigate what
for everyone I think is a daunting and complex process.
Speaker 3 (17:57):
First of all, i'd say, you know, search for you know,
drugs and treatments that have approven survival advantage. You know,
and you want the metric called overall survival. If it
doesn't say the words overall survival, that's not survival. You
want that. Don't automatically assume that more is better, which
is kind of an assumption that's kind of baked in.
You know, three drugs helps, maybe four drugs will help
(18:19):
even more. Because cancer drugs have side effects, and the
more treatment you layer on, the more side effects you're
laying on it laying on. At some point those side effects,
you know, could outweigh the benefits of the treatment. And
keep in mind the drug company clinical trials by necessity
are tested on kind of like best case scenarios. These
(18:39):
are patients that are kind of probably have fewer other
comorbid conditions than the average person. You know, they're tend
to be tested on people with advanced cancer and no
other diseases. Often in the real world, you have advanced
cancer and heart disease and alzheim and three other things.
So and you're more likely to get those side effects
that they say, oh rare. So, you know, so keep
in mind that the drug industry Trials TEPICO represents the
(19:01):
best case scenario for drag outcome and minimizing side effects.
Speaker 1 (19:13):
This is the Big Take from Bloomberg News. I'm David Gurat.
To get more from The Big Take and unlimited access
to all of Bloomberg dot com, subscribe today at Bloomberg
dot com slash podcast offer. If you like this episode,
make sure to follow and review The Big Take wherever
you listen to podcasts. It helps people find the show.
Thanks for listening. We'll be back tomorrow.
Bloomberg Audio Studios, podcasts, radio news. In the summer of
twenty twenty, Stacy Deuce had seen his mom went to
the emergency room.
Speaker 2 (00:13):
She had been feeling very bad and just wasn't sure
like why, and kept trying to go and see different
doctors to find out what was going on with her.
And by the time they diagnosed it, they diagnosed it
in the emergency department, which is as a health services researcher,
you're like, you know, that's the worst case scenario.
Speaker 1 (00:35):
The diagnosis was advanced stage breast cancer. Stacy remembers it
was overwhelming, but also understood she'd play a big role
in what came next.
Speaker 2 (00:44):
So neither of my parents had a college education, you know,
like my mom cleaned houses and my dad was a welder,
and so you know, it was like an immediate I've
got a takeover. I'm going to help figure out how
to get them through this healthcare system and navigate that
as best as we can.
Speaker 1 (01:04):
Stacy is a cancer policy researcher at Vanderbilt University Medical Center.
She got her PhD in pharmaceutical sciences at UNC Chapel
Hill and still had a network there to draw on.
Speaker 2 (01:14):
My friend who was a head of rest oncology, called
me and is like, hey, you know, like let me
talk to you about what this probably is going to
look like, like what's the most common cancer type, what's
the most common treatment recommendation now? And one of the
really tricky parts is like she recommended or said, you know,
(01:36):
like for the most common cancer, we use these combination
of this low cost hormonal therapy, and that this higher
cost treatment.
Speaker 1 (01:45):
The higher cost treatment was a drug from Pfizer called Ibrants.
Stacy knew it was considered the standard of care as
first line treatment for her mom's type of breast cancer,
but she also knew there could be a problem.
Speaker 2 (01:56):
My entire career leading up to that, studied the Medicare
prescription drug benefit, and I knew, like the very first
time my mom would try to fill that medicine it
would be thirty two hundred dollars out of pocket. And
we're talking about someone living on a very small amount
of retirement and like living fine, but no way, like
(02:21):
in no universe is that amount of money going to
be something that like she and my dad found to
be acceptable. And so like I knew, I was like, oh,
I would just figure out like, should I pay for
it for her? And I would be totally happy to
do that if it was worth doing.
Speaker 1 (02:41):
In twenty twenty, Ibrins was listed for a jaw dropping
one hundred and sixty thousand dollars a year. It's since
risen to more than two hundred and fourteen thousand dollars,
and even though Medicare would have paid for most of it,
Stacy knew the cost was still going to be significant.
Worst of all, even as a cancer policy expert, she
couldn't figure out if the drug would make a difference.
Speaker 2 (03:02):
Even someone as knowledgeable as myself, Like, studying this for years,
I felt like I couldn't get a clear answer. I'm like, Okay,
well this is the recommended treatment, so like that's what
you trust. You're like, okay, the young collogists are all
saying this is what we're doing now. And I couldn't
find anything that made me feel confident that if I said,
(03:26):
all right, like we as a family are going to
start spending fifteen to twenty thousand dollars just on this
one drug, not to mention everything else you have going on,
Like is it going to change anything? Like is it
going to change? How long you live and how good
you feel.
Speaker 1 (03:44):
Stacy's mom didn't end up taking Iburns, further testing indicated
a different medication would likely be more effective. She pursued
treatment until the side effects became intolerable. She died last summer.
Bloomberg Senior healthcare reporter Robert Langreth says a big reason
why it was so difficult for Stacy to figure out
whether ibans would have been worth it is because of
(04:05):
how the cancer treatment industry has changed over the last
few decades.
Speaker 3 (04:09):
Cancer treatments cancer drugs, and this is very interesting. That
has become the biggest selling single disease area in the
world for the pharmaceutical industry. We've found it's not over
two hundred billion dollar market now.
Speaker 1 (04:22):
The market for cancer treatments keeps getting bigger and bigger,
and that two hundred billion dollars in drug sales was
just in twenty twenty four alone.
Speaker 3 (04:31):
Now, to put it on context, we hear a lot
about ABC of drugs. Cancer A still way larger than
BC drugs. They may catch up someday, but they're not
close to that.
Speaker 1 (04:39):
The boom in the market for cancer treatments is due
in part to legislation backed by drug makers that allowed
the US Food and Drug Administration to speed up approvals.
The agency has given the green light to more than
two hundred cancer drugs over the past three decades. For
some patients, having more treatments on the market can be
a source of hope. Some of them are game changers,
(05:00):
but many of the drugs are more expensive than ever
and the Bloomberg News investigation showed that fewer than half
the treatments approved since two thousand have ever been shown
to extend patients' lives. Bob says even fewer have been
shown to improve symptoms or quality of life. So how
did so many cancer drugs with unclear efficacy end up
on the market and who's benefiting and profiting from them?
Speaker 3 (05:23):
What we've found is that, you know, there's another side
of the story that doesn't get told, and in the meantime,
companies make a lot of money.
Speaker 1 (05:32):
I'm David Gura, and this is the big take from
Bloomberg News today on the show The Cancer Industrial Complex.
How three decades of new treatments have brought hope to
cancer patients and billions of dollars in profits to pharmaceutical companies,
even when those drugs often fail to help patients survive.
Speaker 3 (05:54):
I was interested in looking at this because I've you know,
been covering cancer on and off for years, early decades.
Speaker 1 (06:01):
That's Bloomberg's Robert Langreth.
Speaker 3 (06:02):
There's a lot of hype and all sorts of medicine,
but because of the kind of the high stakes and
the high emotions with cancer, it seems to be a
particular lot of hype, you know, with cancer and cancer
advances and everything like a miraculous advance.
Speaker 1 (06:14):
A big part of Bob's job is to separate the
signal from the noise, and over the past year, he
and a team of reporters, editors, and data journalists here
at Bloomberg have tried to answer a big question at
the heart of cancer treatment.
Speaker 3 (06:27):
How many of these supposedly miraculous drugs, you know, really
do extend patient survival.
Speaker 1 (06:32):
They looked at one hundred and seventy six drugs that
have entered the cancer treatment market since two thousand and
By analyzing FDA labels, they separated the drugs that had
been proven to extend cancer patients' lives from the ones
that hadn't.
Speaker 3 (06:45):
We only counted it as not having proven a survival
difference if it was never proven to extend survival for any.
Speaker 1 (06:53):
Of its approved uses.
Speaker 3 (06:54):
If it got one out of five uses showed a
survival difference, so we gave it a yes, said that's good,
you know, So we kind of gave the companies the
benefit of the doubt for their drugs.
Speaker 1 (07:03):
But Bob and the rest of the team saw some
striking trends emerge in the data they analyzed.
Speaker 3 (07:08):
The prices for all the drugs increased. The starting prices
increased dramatically. I think the per median monthly cost is
up over twenty five thousand dollars a month for the
most recently approved drugs. But that is an independent of
whether they increased survival or not. In less than half
of the drugs that we've looked at have ever been
shown to increase patient survival.
Speaker 1 (07:29):
So how did we get here where the market for
cancer treatments has gotten so big and there were so
many drugs available but with limited efficacy. Part of the reason,
Bob says, is that US insurers essentially have to cover
cancer treatments.
Speaker 3 (07:43):
Medicare essentially covers all cancer treatment drugs because of the
protected colass under Medicare, and basically that means private insurance
essentially kind of follow along with that, and that means,
you know, ten twenty twenty five years ago, when some
of these new drugs they started coming out, companies found
essentially they could charge almost infant ount for cancer drugs.
Speaker 1 (08:04):
Bob says. Another factor fueling the cancer treatment boom is
regulatory changes.
Speaker 3 (08:09):
Changes at the FDA calling for various sort of fast track,
shortcut expedited approval mechanisms for cancer with very kind of
limited preliminary data.
Speaker 1 (08:20):
Since the early nineteen nineties, the hurdles that companies have
had to clear to bring cancer drugs to market have
gotten lower, but Bob says one of the most critical
shifts happened in the mid two thousands when the FDA
moved away from evaluating actual survival rates and towards a
new criteria.
Speaker 3 (08:36):
It's very hard to demonstrate actual survival that takes a
long time, a lot of patients and a lot of drugs,
you know, just falls short. A lot of drugs have
been approved upon with some a different metric that is
misleadingly called progression free survival.
Speaker 1 (08:50):
Progression free survival is a measure of tumor growth over
a set period of time and it hinges on a
number twenty percent. If a patient's tumors grow more than
twenty percent, and doctors consider the cancer to have progressed.
If a patient's tumors grow less than twenty percent, doctors
and drug makers can classify that as what's known as
progression free survival.
Speaker 3 (09:11):
It's really not survival, it's really you know, does this
delay your chair of growth by a couple months, two, three, four,
maybe five months? And what research does have found is
that metric it trens out is not actually a reliable
predictor all the time of whether the drug actually increases survival.
So you're going to have a drug that sounds great,
sounds like you're going to live longer, but you don't necessarily.
Speaker 1 (09:33):
A review published in the European Journal of Cancer found
that from nineteen ninety nine to twenty fifteen, two thirds
of drug trials aiming to slow progression of solid tumors
were deemed successful, but in the long term, only thirty
eight percent of those drugs turned out to help patients
live longer. Bob says those kinds of studies take years,
and in the meantime, those information gaps can have big
(09:56):
impacts on the market for those drugs and the outcomes
of the patient's take them. An example of that is
a popular breast cancer medication called Ibrince, the same drug
Stacey dust Zina was looking into for her mother.
Speaker 3 (10:08):
So this was a drug, it's a new class. It
was the first in new class of drugs for the
most common type of breast cancer, advanced breast cancer, hormone
sensitive breast cancer. And it was first approved in twenty fifteen,
you know, based on progression free survival. They did a
study showing it could delay slow the progression the growth
of cancer time it takes you know, your advanced cancer struck,
(10:30):
and it quickly became a multi billion dollar blockbust earlier.
This this early approval is a major Eventrifiser.
Speaker 1 (10:38):
And critically, Robert says ibrants being able to enter the
marketplace after showing it could deliver progression free survival gave
it an advantage over competitors in the same category from
other manufacturers.
Speaker 3 (10:49):
And then only like many years later, the longer term
trials coming in, and then those trials, you know, it
failed to clearly extend patient survival and strangely, some of
the compute eating drugs and their trials they did extend
patient survival and look to this day, researchers of debating
why you know and which drugs are truly better. But
(11:09):
because Piser got that first approval, you know, based only
on the tumor slowing metric, it got you know, billions
upon billions upon billions of sales.
Speaker 1 (11:19):
Ibrints had been on the market for roughly seven years
by the time Pfizer reported the trial results showed an
initial treatment of its drugs produced no survival benefit. What
has Pfizer said about your reporting or what's come to
light here about the degree to which it has not
prolonged patient's lives.
Speaker 3 (11:35):
So Pfizer basically said, it took a lot longer than
plan to show the survival trials because people just lived
longer than anticipated even in the control group, and the
trials were not optimized to detect a difference in actual survival,
And they said it was hard. That can be also
hard to measure because people do different types of treatments.
Speaker 1 (11:56):
At a breast cancer conference last year, Pfizer presented a
real world analysis of nine thousand breast cancer patients that
found no statistical difference between the survival rates of cancer
patients who took Ibrance and those who took competitor drugs.
Bob says doctors are divided over what to make of
the contrasting results. Anfizer stands behind its drug.
Speaker 3 (12:16):
They say it's up standard of care, first line treatment
that gives women with incurable cancer more time with out
the disease worsening.
Speaker 1 (12:25):
Drug Makers have made billions as the cancer drug market grows,
but they aren't the only ones. How other parties are
profiting and what all this means for cancer patients that's
after the break. Cancer treatment has become a big business,
(12:50):
often with mixed results. A Bloomberg analysis has found that
in the past decade alone, drug makers have made more
than fifty billion dollars on cancer drugs that so far
have demons traded no survival benefit. But drug makers aren't
the only ones cashing in on cancer treatment. I'm very
curious for who's profited from the boom that we've been
talking about in cancer treatments and how they've profited.
Speaker 3 (13:11):
Uh yeah, well, I mean, basically the short answer is everyone.
Speaker 1 (13:15):
Bloomberg's Robert Langreth and a team of reporters, editors, and
data journalists have looked into many facets of the cancer
industrial complex. They've dug into issues ranging from hospital markups
on medications that have been around for a while to
the gamification of clinical trials.
Speaker 3 (13:30):
Well, I mean, drug industry clinical trials are lucrative.
Speaker 1 (13:34):
One study published by the American Association for Cancer Research
estimated that drug companies spend eighty billion dollars a year
on clinical trials and oncology, and Bob says that money
has given rise to a sub industry of private clinical
trial operators.
Speaker 3 (13:50):
So it used to be in the past that most
cancer clinical trials responsored by the government, by the National
Cancer Institute, And what's happened is the growth of industry
sponsor trialsmen and so enormous. Now cancer clinical trials are
pretty much dominated by the drug industry and drug industry
sponsor trials. But even at major academic centers medical centers,
(14:10):
you know, having some of these drug industry trials there,
that has a benefit in terms of prestige. And you
give the gold lecture at the big cancer conference in
front of thousands of people if you're in on the
right trial. So there are just many ways that the
system kind of rewards all the participants.
Speaker 1 (14:28):
So where does the cancer industrial complex go from here?
Earlier this year, the Trump administration announced it had reached
a deal with Pfizer to sell its drugs at lower
prices to Medicaid patients. The President has also issued an
executive order to support the use of AI in childhood
cancer research. But those moves come amid significant funding cuts
at the US's chief drug regulators and research agencies. Since
(14:50):
Trump took office, the National Institutes of Health has canceled
or frozen more than two billion dollars in research grants.
The administration has also proposed cutting the NIH's budget by
nearly forty percent in twenty twenty six, and Bob says
that comes alongside deep cuts at the Centers for Disease
Control and Prevention and the Food and Drug Administration.
Speaker 3 (15:10):
The short way of putting it is, you know, the
fd and CDC here in turmoil.
Speaker 2 (15:13):
Now.
Speaker 3 (15:13):
It's that period of.
Speaker 1 (15:14):
Like rapid shave.
Speaker 3 (15:16):
Like obviously the FDA director typically changes with the new administration.
That standard, but it's not standards that kind of you know,
the civil servants leading the major centers, they've all been
you know, pretty much replaced or.
Speaker 1 (15:30):
Forced out, even amid a changing regulatory landscape. Bob says,
there have been unquestionable successes. The American Cancer Society says
US cancer death rates have fallen thirty four percent from
their peak in nineteen ninety one thanks to early detection
and a decline in smoking. Immunotherapies have also revolutionized the
treatment of certain cancers like melanoma and improved outcomes in others.
Speaker 3 (15:53):
One of the types of drugs that clearly does improve
patient survival is this type of drug called amminotherapy, and
the most proper an example of that is k true
to from Mirk. It's the biggest selling drug in the world,
and it's is showing to extend patients survival for a
number of cancers. These drugs kind of work a little
bit like an on off mechanism to stimulate the immune system,
and once the immune system is turned on against cancer,
(16:14):
you don't need a lot more of the drug. That's
a very simple way to think of that, and.
Speaker 1 (16:18):
Bob says researchers around the world are now looking into
whether it's possible for those drugs to achieve similar results
with lower doses. The finding that, if true, could have
big ramifications for patients and drug makers.
Speaker 3 (16:30):
I went to India, and there are many centers in
India that are now testing these drugs at a quarter
to one six to the approved doses, and they say
they've gotten very little help from the major drug makers
in the US, and they're finding as best they can tell,
you know, there's little obvious difference in the efficacy. Now,
this is mostly preliminary studies, often you know, very small,
(16:51):
but there's a few larger studies starting to roll in,
so there's evidence emerging, you know that sometimes these drugs
may be effective at much lower doses. But researchers say
that I talked to say that big drug companies have
little incentive to test these drugs at lower doses. All
they're going to do is can reduce their revenue, and
that means that many people in the world, the rest
(17:12):
of the world, you know, may not get these drugs.
Speaker 1 (17:14):
Last year, the FDA issued new guidance recommending more randomized
testing of various doses and cancer drug studies. Still, the
agency relies on the manufacturers to submit their own supporting
data and only has the authority to force labeling changes
for marketed drugs based on new safety information. A spokesperson
told Bloomberg quote the FDA will continue to use golden
(17:36):
standard science in its evaluation of drugs and appropriate dosing.
We'll ask you, Leslie, what you're reporting, What these findings
would mean for somebody who might find himself or herself
facing a cancer diagnosis thinking about treatment. What can we
learn from the reporting about how better to navigate what
for everyone I think is a daunting and complex process.
Speaker 3 (17:57):
First of all, i'd say, you know, search for you know,
drugs and treatments that have approven survival advantage. You know,
and you want the metric called overall survival. If it
doesn't say the words overall survival, that's not survival. You
want that. Don't automatically assume that more is better, which
is kind of an assumption that's kind of baked in.
You know, three drugs helps, maybe four drugs will help
(18:19):
even more. Because cancer drugs have side effects, and the
more treatment you layer on, the more side effects you're
laying on it laying on. At some point those side effects,
you know, could outweigh the benefits of the treatment. And
keep in mind the drug company clinical trials by necessity
are tested on kind of like best case scenarios. These
(18:39):
are patients that are kind of probably have fewer other
comorbid conditions than the average person. You know, they're tend
to be tested on people with advanced cancer and no
other diseases. Often in the real world, you have advanced
cancer and heart disease and alzheim and three other things.
So and you're more likely to get those side effects
that they say, oh rare. So, you know, so keep
in mind that the drug industry Trials TEPICO represents the
(19:01):
best case scenario for drag outcome and minimizing side effects.
Speaker 1 (19:13):
This is the Big Take from Bloomberg News. I'm David Gurat.
To get more from The Big Take and unlimited access
to all of Bloomberg dot com, subscribe today at Bloomberg
dot com slash podcast offer. If you like this episode,
make sure to follow and review The Big Take wherever
you listen to podcasts. It helps people find the show.
Thanks for listening. We'll be back tomorrow.
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