Everolimus helps to control disease and prolong life, but it's expensive

SINGAPORE - As recently as four months ago, patients with advanced kidney cancer basically ran out of scientifically-proven options to control their disease if they had stopped responding to the main treatment drugs, sorafenib (Nexavar) and sunitinib (Sutent).

But since January, when a new drug was approved for use here, they have had one more option in the drug everolimus (Afinitor). It got the green light in the United States in March last year, and is now allowed in Europe and Japan.

Patients for whom sorafenib or sunitinib have stopped working take everolimus tablets daily to block the production of the protein that results in tumour growth.

Those who take sunitinib are, on average, able to control the disease for about nine months.

Dr Wong Seng Weng, a consultant medical oncologist and physician at The Cancer Centre, said that with everolimus "about two out of three patients will have growth of the cancer arrested".

An international clinical trial conducted from December 2006 to November 2007 found that everolimus stopped tumour growth for four to five months and stabilised the disease.

Those taking a placebo have progression-free survival of about two months.

Even at 10 months, about 25 per cent of patients on evero-limus saw their disease controlled, said oncologist Tay Miah Hiang from OncoCare Cancer Centre.

"So there is more opportunity to control the disease, and (the drug) can prolong a patient's life for about an average of nearly 15 months."

Common side effects include mouth ulcers, rash and fatigue.

According to the National Cancer Centre Singapore (NCCS), there are about 120 cases of kidney cancer in Singapore annually, and some 70 per cent of them are advanced cases.

A patient diagnosed with advanced kidney cancer has on average six months to three years to live, said Dr Tay who has five patients on everolimus.

But only one has shown "good results" with the tumour shrinking by 30 to 50 per cent after six weeks on it.

Everolimus did not work on his other patients as their disease was "far too advanced" and because they had received multiple treatments before.

Not many people use the drug because it is expensive, said NCCS senior consultant at the department of medical oncology, Dr Toh Chee Keong. He sees about 10 cases of advanced kidney cancer a month, and eight of his patients are on the drug.

Everolimus could cost about $8,500 to $10,000 a month, said Dr Tay. He is taking part in an international clinical trial to see if everolimus, together with another drug, can be used as a first-line treatment.

This would allow it to be given once advanced kidney cancer is diagnosed, rather than after other drugs have failed.

The trial, which is still recruiting patients, started last February and is expected to end next month.