Bladder cancer: the only treatment to treat this patient is not reimbursed

A single injection of pembrolizumab costs 5000 euros, and therefore remains inaccessible to most patients. In Cagnes-sur-mer, a doctor fights to save one of his patients.

In Cagnes-sur-mer, a doctor fights to save one of his patients with bladder cancer. Only pembrolizumab, an immunotherapy, could overcome it. Problem: a single injection of treatment costs 5000 euros, without being reimbursed by social security.

"Only one patient can burden the budget of the hospital"

"For Mr. Rene Esteve, I have no other possible solutions because it has another pathology also that I can not use chemo otherwise I put him in danger", explains to France Info Dr. Jérôme Barrière, oncologist at the Saint Jean Clinic. "No institution can afford to take a drug that is not reimbursed, because it is expensive, a single patient can burden the budget of the hospital," he laments.
Rene Esteve, 76, has been fighting the disease for three years, and has not received any treatment for two months, for lack of resources. However, the High Authority of Health is favorable to the management of pembrolizumab. "The KEYNOTE-045 pivotal study estimated the average life span at 1.57 years in patients treated with pembrolizumab versus 0.94 years in those treated with chemotherapy, an average gain of approximately + 7.6 months. per patient The average survival benefit adjusted to quality of life was estimated at 4.8 months per patient compared to chemotherapy The 5-year survival rate was estimated at 16% with pembrolizumab and 1.7% with chemotherapy, "she notes in a report.

Administrative problems

The MSD laboratory, which markets pembrolizumab, raises administrative problems: "a price agreement has been signed between MSD and the authorities (...) but for administrative reasons, funding (...) in this indication is still not published ". In France, the incidence of bladder cancer is low. The updated incidence and mortality projections for 2018 estimate 13,338 new cases, including 5,013 deaths.
Urothelial carcinoma is the most common bladder cancer; more than 95% of cases are tobacco related. For the most severe, so-called "infiltrating" forms, cisplatin-based chemotherapy is part of standard management. But this molecule can not be administered to all patients, especially the older ones.

"Patients often have additional problems related to tobacco, cardiovascular or pulmonary, and are therefore weakened," says Olivier Mir, oncologist at the Gustave Roussy Institute in Villejuif. "The administration of cisplatin also requires good renal function, but it declines with age," he adds. In the end, almost half of the patients would be ineligible for cisplatin and therefore potentially benefit from pembrolizumab.

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