Newly approved anticancer drugs that do not have a specific molecular target on cancer cells are associated with increased toxicity and the accompanying costs of management, according to research published online in the Journal of Clinical Oncology.

Saroj Niraula, M.B.B.S., M.D., from CancerCare Manitoba and the University of Manitoba in Winnipeg, Canada, and colleagues examined the incidence of 12 frequent grade 3 and 4 adverse events associated with new anticancer drugs, and the costs associated with their management. Data were included from 41 studies involving 27,539 patients and assessing 19 experimental drugs.

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The researchers found that the incidence of grade 3 and 4 toxicities was lower for agents directed against a specific molecular target on cancer cells than controls (median risk ratio [RR], 0.67; P = 0.22), while less-specific targeted agents were more toxic (angiogenesis inhibitors: median RR, 3.39; P < 0.001; and chemotherapeutic agents: median RR, 1.73; P < 0.001).The increased risk was observed irrespective of whether the control arm was active treatment (RR, 2.11; P < 0.001) or not (RR, 3.02; P < 0.001).

For experimental drugs, the median incremental drug price was $6,000 per patient per month. Compared with drug costs, the median cost of managing toxicity was low, but for treatment with less-specific targeted agents and chemotherapies, costs for managing toxicities were higher than controls.

“Development of biomarker-driven agents should be encouraged,” the authors write.


  1. Niraula, Saroj, et al. “Risk of Incremental Toxicities and Associated Costs of New Anticancer Drugs: A Meta-Analysis.” Journal of Clinical Oncology. doi: 10.1200/JCO.2014.55.8437. September 29, 2014.