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12:00 AM
Nov 19, 2012
 |  BioCentury  |  Strategy

Zapping Zaltrap

Why Sanofi price discount may not drive use of Zaltrap in colorectal cancer

Sanofi's decision to offer a 50% discount on Zaltrap ziv-aflibercept would appear to address oncologists' objections to the colorectal cancer drug's cost, but it is not clear whether the move will improve either patient access or physician uptake.

The reason is some doctors simply don't see enough improvement over Avastin bevacizumab to try the new drug even if they cost the same - and the ones who do try it could choose to pocket the discount without passing it on to patients.

Regardless of how the discount plays out for Sanofi, other companies planning to enter established markets with expensive new drugs should consider this another warning that a premium price must be supported by a clinically meaningful improvement over existing drugs as they are used in current practice - which may not be the same as the use recommended on their labels.

Sanofi launched Zaltrap in August at a wholesale acquisition cost (WAC) of about $9,600 per month for a 75 kg patient. The drug, a fusion protein containing the extracellular domains from two VEGF receptors linked to the Fc portion of human IgG, was co-developed with Regeneron Pharmaceuticals Inc. It is approved in combination with FOLFIRI chemotherapy to treat second-line metastatic colorectal cancer (mCRC). The drug's recommended dose is 4 mg/kg.

At the time, Sanofi said the WAC was competitive with Avastin bevacizumab from Roche and its Genentech Inc. unit. Avastin is a humanized mAb against VEGF that was approved for mCRC in 2004. According to Genentech, the monthly WAC for Avastin given to a 75 kg patient at the recommended dose of 10 mg/kg is about $10,000.

However, three oncologists from Memorial Sloan-Kettering Cancer Center said Avastin is routinely given at 5 mg/kg, making the monthly cost about $5,000.

In an op-ed in the Oct. 14 New York Times, the oncologists said the hospital would exclude Zaltrap from its formulary due to its high price.

The authors included Peter Bach, an attending physician in the epidemiology and biostatistics department; Robert Wittes, physician-in-chief; and Leonard Saltz, chief of the gastrointestinal oncology service and head of...

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