Turning to philanthropy to test halving dose for patients

Newer cancer drugs have come with increasingly higher costs, making it harder for those who need treatment to gain access to them.

"In Asia, cancer diagnosis can be catastrophic for households who are unable to afford it. Though some of these costs are borne by insurance and the Government, there needs to be a way for these costs to be optimised," said Professor Goh Boon Cher, deputy director of research at the National University Cancer Institute, Singapore.

One way is to relook the dose of the drug given, he added.

In a rush for a drug to get registered, the drug is sometimes given at higher doses in the hope that this will lead to a better outcome.

The same result can actually be obtained with a lower dose, but this option is not tested as the trial may not have been as extensive, Prof Goh said.

One example is epidermal growth factor receptor (EGFR) mutant lung cancer, where a mutation in the gene for EGFR can make it grow too much, leading to cancer.

This particular mutation occurs in more than 40 per cent of tumours in Singaporean lung cancer patients.

The drug to treat this cancer costs about $8,500 a month.

After examining the pharmacology of the drug, Prof Goh and his team started a trial to recruit 60 patients to find out if halving the dose would achieve the same clinical benefits.

However, funding is a stumbling block. Conventionally, trials are funded by pharmaceutical companies, but such a trial would hold little incentive for them, given an erosion of profits should the dose be halved.

"We, hence, turn to philanthropy," Prof Goh said.

"Our trial remains underfunded at this stage but such trials are hugely beneficial to patients - they are able to pay less for the same outcome and potentially experience fewer side effects."

Additionally, patients can take part in more than one trial and there should not be a misconception that the elderly cannot participate in trials, Prof Goh added.

Madam Hee Poh Lian, 83, who has nasopharyngeal cancer, is one example.

Her first clinical trial experience was an immunotherapy trial, which she started after completing a round of chemotherapy treatment. Her second clinical trial was an oral chemotherapy type.

"The process has been very smooth and the staff have been very nice. They calmed me down and always made sure to check on me," said Madam Hee, whose condition has improved after both trials.

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A version of this article appeared in the print edition of The Straits Times on May 23, 2022, with the headline Turning to philanthropy to test halving dose for patients. Subscribe