The FDA just approved a new revolutionary drug for the treatment of cancer. The medication, Vitrakvi (
The mutation that causes cells to become cancerous is found in many different types of cancers. So, this new treatment is not just for one cancer but may treat many different types of cancer. This is avant-garde thinking.
Vitrakvi (larotrectinib) is manufactured by Bayer and is available in pill and liquid forms. It can treat cancers in children and adults, but it isn’t cheap. For adults, the medicine is just under $400,000 per year. In children, the cost is about $135,000 per year.
How does Vitrakvi (larotrectinib) work?
This drug works by blocking a specific mutated enzyme (tyrosine kinase) in cancer cells. When present, this defective enzyme causes cancerous growth in many different types of cancer.
Why is it revolutionary?
Vitrakvi (larotrectinib)is one of the first drugs of its kind that focuses on treating the genetic basis of cancer, not just the type of cancer. That is, it goes after the switch that turns a normal cell into a cancerous cell.
By analogy, there are many types of car manufacturers. Instead of trying to treat a single entity, like a Chevy or a Ford or Honda, this medicine focuses on treating the force that makes the cars go — the engine!
As a result, this radical approach has the potential of treating many kinds of cancers (all cars have engines) rather than a specific type of cancer (Chevy, Ford or Honda). This groundbreaking approach has a much broader potential in the war against cancer. By developing the ability to stop the engine of any car, there is the potential of stopping many different types of cars from running, which supports the analogy of fighting many kinds of cancer.
Since it is FDA-approved, will insurance cover it?
Yes and no. The drug has a broad appeal and the benefit of treating both children and adults. Unfortunately, the price tag is astronomical.
Medicare and Medicaid are not covering the medication yet, but it is hopeful that they will. If they do, third-party payers usually follow suit, but once again, due to cost, any and all insurances may have restrictions, limitations, and only partial coverage. Insurance coverage, of course, will improve as the price comes down.
If someone has cancer, how do they discover if this medicine will work for them?
The appeal of this medication is that it works in many different cancers both in children and adults. This fact, by itself, is remarkable and substantial.
Unfortunately, the type of genetic mutation that drives these cancers represents only a small percentage of overall cancers, probably less than five percent. So, it certainly won’t work in all cancers. But when it does work — and it has already helped many patients in the tests and trials — some patients have experienced remarkable results.
We currently don’t know which cancers will respond. Fortunately, tests will be available to see if a person’s cancer is responsive to this new treatment. A person’s cancer will be mapped for mutations. Once the mutations are discovered, any available medications that attack that mutation can be employed.
Hopefully, over time, we will build a bigger and bigger army of medicines that attack a wide variety of genetic mutations that cause a wide range of cancers located anywhere in the body. Unfortunately, these tests are new, expensive and challenging. They will very likely get better and less costly on a rapid and regular basis. Regardless, people should get tested, because we now have a revolutionary and effective treatment for select cancer patients.
The future of cancer treatment
Vitrakvi (larotrectinib) is the first medication designed specifically to attack cancers based on the gene mutations that make them malignant and not where they occur in the body or the type of tissue the cancer comes from. We will no longer treat the tissue where cancer comes from; we will address the DNA mutation that causes a cancer in the first place.
Calling a cancer by the mutation that causes it and not the tissue or organ it comes from, such as breast or prostate cancer, is a trail-blazing approach in the treatment of cancer. It now shifts our thinking and focus when it comes to treating and curing cancer. This new view is the future of cancer treatment.
We no longer need to consider or call cancer the name based on its tissue type. We will now look at cancers based on the gene mutations that drive them. These very mutations can then be detected, and drugs can be designed and selected to attack the mutations.
Attacking the genetic cause of malignancy has been the Holy Grail for cancer treatment, and we are now about to sip from the cup. The future has never been brighter for the war on cancer.
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Charles E. Crutchfield III, MD is a board-certified dermatologist and clinical professor of dermatology at the University of Minnesota Medical School and a Benedict Distinguished Visiting Professor of biology at Carleton College. He also has a private practice, Crutchfield Dermatology in Eagan, MN.
He received his MD and Master’s Degree in molecular biology and
genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Minnesota Medicine recognized Dr. Crutchfield as one of the 100 Most Influential Healthcare Leaders in Minnesota. Dr. Crutchfield specializes in
skin-of-color and has been selected by physicians and nurses as one of the leading dermatologists in Minnesota for the past 18 years.
He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations and president of the Minnesota Association of Black Physicians. He can be reached at CrutchfieldDermatology.com or by calling 651-209-3600.