Education And Debate

Efficacy, safety, and cost of new anticancer drugs

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7358.269 (Published 03 August 2002) Cite this as: BMJ 2002;325:269
  1. Silvio Garattini, director,
  2. Vittorio Bertele, head, regulatory policy laboratory
  1. Mario Negri Institute for Pharmacological Research, 20157 Milan, Italy
  1. Correspondence to: S Garattini
  • Accepted 31 January 2002

Italian pharmacologists Silvio Garattini and Vittorio Bertele' note that new anticancer drugs reaching the European market in 1995-2000 offered few or no substantial advantages over existing preparations, yet cost several times—in one case 350 times—as much

Though only an imperfect indicator of progress in cancer control,1 age standardised mortality in the European Union, for both sexes combined, had been increasing up to 1988; since then it has decreased from 147 to 136 per 100 000 inhabitants.2 Prevention is probably one of the main reasons for this drop, particularly the decrease in tobacco smoking; another reason is the use of screening for early diagnosis of cancers of the cervix and breast and possibly also of the colon and rectum..

The greatest changes have been 4500 fewer deaths from childhood tumours and 4000 fewer from lymphomas (Hodgkin's disease) each year over the past four decades. Among solid tumours, advances have been made in treating breast cancer, in which tamoxifen increases 10 year survival by 6% for node negative and 11% for node positive tumours,3 and chemotherapy increases survival by 7% and 11%, respectively.4 For most other common solid tumours such as those of lung, oesophagus, stomach, or pancreas, only limited survival gains have been achieved. 256

On the whole, pharmacological treatments are credited with only a very small proportion of cures.7 However, some kind of pharmacological intervention is often considered as a last resort, particularly when cancer has already disseminated. We evaluated the progress made over the past few years in terms of new drugs approved for prescription in order to judge their likely impact on cancer mortality in the near …

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