MOST HYPED CANCER DRUG

At the end of June, a few weeks after the close of this year's annual meeting of the American Society of Clinical Oncology, a pair of researchers googled a list of 10 superlatives, such as "breakthrough" and "revolutionary," along with the term "cancer drug."

"We sought to determine who uses this inflated language and what classes of drugs were most heralded," write Vinay Prasad, MD, MPH, a medical oncologist at the Knight Cancer Center, Oregon Health and Science University, in Portland, and Matthew V. Abola, BA, a medical student at Case Western Reserve University in Cleveland.

The pair undertook the study because of a concern that media hype can lead to "misunderstandings," especially among the public, including cancer patients. And most new cancer drugs provide "modest benefits," they report in their research letter published online October 29 in JAMA Oncology.

They found no shortage of hype.

Over a 5-day period, the pair hunched over their computers and found, after reading the full text of many online news articles, 94 articles from 66 distinct news outlets that made 97 superlative mentions that fit their criteria in relation to 36 specific drugs.

"We used news.google.com, which searches many news outlets. We wanted a broad sampling of what was out there," Dr Prasad told Medscape Medical News.

The news outlets ranged from global newspapers to industry trade publications, which have audiences that include consumers, investigators, physicians, and cancer researchers.

Were any venerable news organizations guilty of hype? The researchers don't specify. "I don't want to name names," said Dr Prasad.

The most hyped drug was actually the combination of two immunotherapy checkpoint inhibitors — ipilimumab (Yervoy, Bristol-Myers Squibb) and nivolumab (Opdivo, Bristol-Myers Squibb). The combination, which is now approved for advanced melanoma, had 20 mentions (21% of the 97 superlatives). It was described as a breakthrough seven times, a miracle five times, a game changer five times, revolutionary two times, and groundbreaking once.

In second place was pembrolizumab (Keytruda, Merck) — an immunotherapy checkpoint inhibitor approved for the treatment of melanoma and lung cancer and being tested for head and neck cancer, colorectal cancer, and other malignancies — had 12 mentions (12% of the 97 superlatives). Among the superlatives used were miracle, one time, and cure, two times.

Third place belonged to palbociclib (Ibrance, Pfizer), which was approved this year for metastatic breast cancer and had seven mentions.

The other drugs in the top 10, which were described with at least one of the designated superlatives, were the targeted therapies trastuzumab emtansine (Kadcyla Genentech/Roche) and dinutuximab (Unituxin, United Therapeutics), the checkpoint inhibitor MPDL3280A (Genentech/Roche), the targeted therapy olaparib (Lynparza, AstraZeneca), the vaccine talimogene laherparepavec (T-VEC, Amgen), the targeted therapy pertuzumab (Perjeta, Genentech/Roche), and the radiotherapy radium-223 dichloride (Xofigo, Algeta/Bayer).

Superlatives are okay sometimes, Dr Prasad conceded.

He personally describes the ipilimumab–nivolumab combination as "highly promising and very exciting." But both drugs have been demonstrated to improve survival, unlike many cancer drugs, either approved or experimental.

"While some of the use of superlatives seems justified and reflects a real excitement oncologists have about these drugs, many other uses may be questionable," he noted.

It is this questionable use that most concerns Dr Prasad.

The researchers found that 14% of the superlatives used described a drug that has never been tested in people (evidence was based on laboratory, cell culture, mouse, or other animal data).

This is wildly speculative, given the challenges of drug development. "This is like doing a story about someone who is playing the lottery, but has not yet won, and talking about how they will be rich," Dr Prasad explained.

So who is actually articulating these superlatives?

Mostly, it is journalists (55% of all the superlatives used, with no other attribution). Then, in order of frequency, it is physicians (27%), industry experts (9%), patients (8%), and a member of the US Congress (1%).

The use of superlatives reflects the current "hot fields" of cancer research, the researchers report.

Checkpoint inhibitors made up only 14% of the drugs mentioned, but accounted for 38% of all superlatives. Targeted therapies were the most common drugs mentioned, and received the most superlatives.

Dr Prasad and Mr Abola have disclosed no relevant financial relationships.

JAMA Oncol.Published online October 29, 2015. Abstract