Drug treatment for melanoma: progress, but who pays?

To the Editor: The recent editorial by Kefford1 fails to mention that (i) the 5-year survival for malignant melanoma is excellent at 89% for males and 91% for females; (ii) treatment with the new melanoma drug ipilimumab for the 1279 people who died from melanoma in 2007 would cost the Australian Government $156 million based on the quoted drug cost of $120 000 for a course of four injections; and (iii) the increase in survival is only minimal with ipilimumab (median survival, 10.1 months v 6.4 months for placebo).2

The enthusiasm about the “practice-changing discovery of drug therapy against brain metastases” ignores the publication from the Sydney Melanoma Unit in 20043 showing that after surgery and postoperative radiotherapy, the median survival was 8.9 months (with a range of up to 17 years) — an option that would cost far less than treatment with ipilimumab.

In 1977, when the specialty of medical oncology was first established in Australia, drug treatment was promoted as being “the cure for cancer”. However, time has shown this belief to be incorrect and has instead confirmed that drug treatment is the most costly and least effective of the cancer treatment modalities.

The Pharmaceutical Benefits Scheme cost of chemotherapy for drugs alone has risen by over 400%, from $302 million for the 2001–02 financial year to $1225 million for 2010–114 — an average annual increase of $92 million.

Clearly, the request by Kefford for funding is not appropriate for what is essentially a minimally effective palliative treatment. If such money were available, it would be far better spent addressing the current lack of palliative care services in Australia, to ensure that those whom we cannot cure, despite new drugs, can die with comfort and dignity.