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‘The Same Old Story’: Thoughts On Authorized Doses Of Anticancer Drugs

F. Meriggi, A. Zaniboni
Published 2020 · Medicine

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Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( Introduction Worldwide, tumours are currently one of the main causes of death with approximately 9.6 million deaths a year and an incidence of approximately 18.1 million new cases in 2018.1 Consequently, the prevention, diagnosis and treatment of cancer represent, more than ever before, goals towards which all international administrations are moving; however, the results are not always tangible and comforting. One of the causes of these total or partial failures has been identified as the absence of adequate nationwide awareness programmes regarding the lifestyles most likely to reduce the incidence of cancer, as well as a shortage of funding for research and for the distribution of the most innovative medicinal products to the whole population. On the other hand, cancer is a huge business opportunity for pharmaceutical companies around the world, even more now than in the past. A review by Hong and colleagues2 shows that in the United States between 2011 and 2016, spending on cancer drugs grew by over 50% (from US$26.8 to 42.1 billion). Although the introduction of immune checkpoint inhibitors has dramatically changed the treatment of a number of cancer types, they bring a host of new adverse effects to be managed and a further exponential increase in both direct and indirect costs. Researchers are exploring new strategies making it possible to deal in the years to come with what can be defined as an authentic politico-socio-economic emergency that is now well identified, also regarding the possibly over simplistic terminology such as the ‘financial toxicity’ of cancer treatments. The price, not merely in economic terms, that is likely to have to be paid is dramatic meaning that much of the world population, even in higher income countries, could be excluded from access to the most novel cancer treatments. One well consolidated, albeit far from decisive, pathway undertaken in an attempt to reduce costs is the authorization of biosimilars and generic medicines. Another option to be given careful attention is that of reconsidering (at equal efficacy) the authorized doses of certain medicinal products, especially those with higher costs, particularly when used on a large scale such as those indicated for the treatment of the most frequently terminal cancers.
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