Cancer’s Big Infrastructure Problem

Laura Greco thought it was the car accident she had to worry about. An SUV had swiped her while she was driving her six-year-old home from ski lessons on a snowy day. When doctors offered to scan her body for trauma, she says she agreed not only because of the severity of the accident but also because, as a lawyer, she wanted to document her injuries. The doctors didn’t find injuries. They found a 3.75-centimeter mass in her lung.

Greco, 42, had a lobe of one lung removed and endured rounds of chemotherapy and radiation because they offered her a chance at being cured. Her cancer did stay away for fifteen months. In October, she complained of pain in her neck. Her doctor humored her by ordering an MRI, and found new tumors. She chose to go on a new drug, Alecensa, a Roche drug that targets a mutation in her tumor of a gene called ALK. Her tumors shrunk 50% in three weeks, and 75% in six weeks. She’s made partner at her firm, and just attended her 20th college reunion at Georgetown University. “I want nothing more than to show up at my 50th college reunion and say I made it,” she says.

Early this month, I took a long look at another targeted cancer drug, developed by Loxo Oncology, a small biotech. That medicine is targeted against cancers caused by mutations in a particular gene, called TRK, but used in many different types of cancer. “The obvious solution is for patients to have their genes tested routinely, and for clinical trials to be available at far more places,” I wrote. “But that is infrastructure we don’t have.” The way we fund testing gene-targeted drugs now is with high drug prices — Alecensa costs $12,500 a month. But even that is limited. Because only 0.5% of cancers have the TRK mutation Loxo’s drug targets. And the ALK mutation Alecensa targets occurs in only 3% to 5% of non-small cell lung cancer tumors, are ALK+.

But Greco’s story adds a new wrinkle to this problem: that even after you find a drug against a rare mutation, you’re not done. What…